3 ms·

> 1. You have ADHD and are prone to clinical depression. Both are treatable. Actually, according to recent findings, neither of those can either be reliably di

by lutusp 13y ago

> 1. You have ADHD and are prone to clinical depression. Both are treatable. Actually, according to recent findings, neither of those can either be reliably diagnosed or treated. Recent meta-analyses reveal that anti-depression treatments (both therapy and drugs) are in the majority of cases indistinguishable from the placebo effect. As to ADHD, diagnosis remains a very serious problem -- it's a throwaway diagnosis that anyone can either get or avoid, depending on their tastes. And, like depression, there's no meaningful treatment.

jacques_chester 13y ago
It was very difficult to draft this reply without becoming unproductive and I hope you take it as constructive feedback. The contrarian articles you see linked here on HN or published in the NYT are not a substitute for professional psychological and psychiatric advice. They are published because they are contrarian. "Scientists still agree" is not a story. Obtaining a diagnosis for ADHD is not "a throwaway" in most countries because the first line of pharmaceutical treatment is stimulants with addictive potential. These drugs are tightly regulated and the legal diagnostic bias is against their being prescribed. That the mechanisms are not completely understood and that some studies show a strong placebo effect does not mean that ADHD and depression can't be diagnosed or treated. The preponderance of evidence is that for most cases a judicious combination of pharmaceutical and therapeutic interventions can lead to long term improvements in quality of life for both conditions. Neither diagnosis or treatment is exact, but to throw them away for imperfection is an example of the nirvana fallacy that leads to preventable harm. I encourage you to consider the possibility that you are deterring others from seeking help that could save their lives or significantly improve their quality of life. In future you might consider refraining from doing so and encourage others you see struggling with mental health issues to seek out attention from a psychologist or a psychiatrist, either of whom is better versed with the current research than you or I.
- lutusp 13y ago
  > The contrarian articles you see linked here on HN or published in the NYT are not a substitute for professional psychological and psychiatric advice. Say what? Would that be why the director of the NIMH has recently decided to phase out the DSM as scientifically worthless, saying "Patients with mental disorders deserve better"?: http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml http://www.nimh.nih.gov/about/director/2013/transforming-dia... > That the mechanisms are not completely understood and that some studies show a strong placebo effect does not mean that ADHD and depression can't be diagnosed or treated. No, it only means that diagnosis and treatment claims are anecdotal, neither scientific no reliable. Surely you are aware that health service providers are rapidly moving toward an evidence-based practice model, which when fully enacted would eliminate the majority of psychological treatments across the board, both drugs and therapy? > The preponderance of evidence is that for most cases a judicious combination of pharmaceutical and therapeutic interventions can lead to long term improvements in quality of life for both conditions. Unless you choose to count the placebo effect as a treatment success, that is absolutely false. The current literature shows that neither diagnosis nor treatment is efficacious in any scientific sense. As to cognitive-behavioral therapy, it has recently been shown to be indistinguishable from the placebo effect: http://www.ncbi.nlm.nih.gov/pubmed/23416876 http://www.ncbi.nlm.nih.gov/pubmed/23416876 Quote: "These analyses, in combination with previous meta-analytic findings, fail to provide corroborative evidence for the conjecture that CBT is superior to bona fide non-CBT treatments." Meaning: CBT, indistinguishable from any other therapy, is also ipso facto indistinguishable from the placebo effect. As to antidepression drugs, a recent meta-analysis that includes studies the drug industry chose not to publish, shows them to be clinically indistinguishable from placebo in most cases: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0050045 http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fj... Quote: "Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance." > I encourage you to consider the possibility that you are deterring others from seeking help that could save their lives or significantly improve their quality of life. I encourage you to learn science, and bring yourself up to date on the present self-inflicted plight of psychiatry and psychology. You clearly are living in denial, ironic given the fact that you may be a mental health professional.
  - jacques_chester 13y ago
    > Would that be why the director of the NIMH has recently decided to phase out the DSM as scientifically worthless, saying "Patients with mental disorders deserve better"?: An alternative reading is that he correctly identifies that the DSM is based on consensus and that where possible he would like to replace consensus with classifications built on additional modes of observations that have only recently become available. I see that as a positive development. > Meaning: CBT, indistinguishable from any other therapy, is also ipso facto indistinguishable from the placebo effect. For someone who believes in the immaculacy of science, you enjoy leaping to conclusions. > I encourage you to learn science, and bring yourself up to date on the present self-inflicted plight of psychiatry and psychology. Your rhetoric reminds me of some of the other anti-psychology literature I've seen circulated by various organisations holding other beliefs that might be charitably considered as "exotic". > You clearly are living in denial, ironic given the fact that you may be a mental health professional. I'm not, but good luck with your Skinner Box vision of psychology. In me you seem to see the fruits of a vast conspiracy against science and the public. In you I see a person whose determination to XKCD386 is going to cause active harm to others by spreading the idea that depression or ADHD should simply be accepted and not treated. This one can't be settled satisfactorily. Let's stop talking.
    - lutusp 13y ago
      > An alternative reading is that he correctly identifies that the DSM is based on consensus and that where possible he would like to replace consensus with classifications built on additional modes of observations that have only recently become available. An alternative to your comments would be for someone to read the original and discover that the problem is that, in psychiatry and psychology, these conditions are only described, not explained, and any meaningful treatment requires an explanation, an identified cause. Like in science. > ... additional modes of observations ... The issue is not "modes of observations", the issue is a widespread move toward using the methods of neuroscience to identify the causes of these conditions, and treating causes rather than symptoms. > Your rhetoric reminds me of some of the other anti-psychology literature I've seen circulated by various organisations holding other beliefs that might be charitably considered as "exotic". You aren't arguing against my views. You're arguing against the views of the director of the NIMH and dozens of other qualified critics including the editor of DSM-IV, all of whom hold the same general views I do. You're arguing against a historic move toward science. > I'm not, but good luck with your Skinner Box vision of psychology. It's instructive that you've posted no evidence for your position. As to a Skinner-box view of mental health treatment, I direct your attention to this account of deep brain stimulation, a procedure in which a neurosurgeon was able to erase all symptoms of depression in a severely depressed person by throwing a switch: http://www.nytimes.com/2006/04/02/magazine/02depression.html?pagewanted=all http://www.nytimes.com/2006/04/02/magazine/02depression.html... Quote: "Deanna later described it in similar terms. "It was literally like a switch being turned on that had been held down for years," she said. "All of a sudden they hit the spot, and I feel so calm and so peaceful. It was overwhelming to be able to process emotion on somebody's face. I'd been numb to that for so long." "As it turned out, 8 of the 12 patients he operated on, including Deanna, felt their depressions lift while suffering minimal side effects — an incredible rate of effectiveness in patients so immovably depressed. Nor did they just vaguely recover. Their scores on the Hamilton depression scale, a standard used to measure the severity of depression, fell from the soul-deadening high 20's to the single digits — essentially normal." End quote. I emphasize this is a preliminary result, and at the moment it's expensive and risky invasive surgery, unsuitable for any but the severely depressed. My point is that I doubt the severely depressed clients who received this treatment will object that they're being turned into updated versions of B. F. Skinner's lab rats. > In me you seem to see the fruits of a vast conspiracy against science and the public. Locate that part of my posts in which this paranoid delusion finds support. There is no vast conspiracy, there is just mediocrity, denial and shortsightedness. > ... by spreading the idea that depression or ADHD should simply be accepted and not treated. Another example in which, with no evidence, you invent a position for someone else. The issue before psychiatry and psychology is not whether to treat or not to treat, the issue is that there is no reliable evidence that present treatments work. This is why alternatives are being explored, and why the DSM is finally being put aside. > This one can't be settled satisfactorily. Of course it can. Ask the director of the NIMH. Ask those who have received meaningful scientific treatments for depression. Ask the victims of recovered memory therapy whether they think that treatment merited the public support it received. This issue certainly can be resolved satisfactorily, and the first step has been taken -- the DSM, the "bible" of psychiatry and psychology, has been set aside as having no scientific value.

by lutusp 13y ago

jacques_chester 13y ago

It was very difficult to draft this reply without becoming unproductive and I hope you take it as constructive feedback. The contrarian articles you see linked here on HN or published in the NYT are not a substitute for professional psychological and psychiatric advice. They are published because they are contrarian. "Scientists still agree" is not a story. Obtaining a diagnosis for ADHD is not "a throwaway" in most countries because the first line of pharmaceutical treatment is stimulants with addictive potential. These drugs are tightly regulated and the legal diagnostic bias is against their being prescribed. That the mechanisms are not completely understood and that some studies show a strong placebo effect does not mean that ADHD and depression can't be diagnosed or treated. The preponderance of evidence is that for most cases a judicious combination of pharmaceutical and therapeutic interventions can lead to long term improvements in quality of life for both conditions. Neither diagnosis or treatment is exact, but to throw them away for imperfection is an example of the nirvana fallacy that leads to preventable harm. I encourage you to consider the possibility that you are deterring others from seeking help that could save their lives or significantly improve their quality of life. In future you might consider refraining from doing so and encourage others you see struggling with mental health issues to seek out attention from a psychologist or a psychiatrist, either of whom is better versed with the current research than you or I.

lutusp 13y ago
> The contrarian articles you see linked here on HN or published in the NYT are not a substitute for professional psychological and psychiatric advice. Say what? Would that be why the director of the NIMH has recently decided to phase out the DSM as scientifically worthless, saying "Patients with mental disorders deserve better"?: http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml http://www.nimh.nih.gov/about/director/2013/transforming-dia... > That the mechanisms are not completely understood and that some studies show a strong placebo effect does not mean that ADHD and depression can't be diagnosed or treated. No, it only means that diagnosis and treatment claims are anecdotal, neither scientific no reliable. Surely you are aware that health service providers are rapidly moving toward an evidence-based practice model, which when fully enacted would eliminate the majority of psychological treatments across the board, both drugs and therapy? > The preponderance of evidence is that for most cases a judicious combination of pharmaceutical and therapeutic interventions can lead to long term improvements in quality of life for both conditions. Unless you choose to count the placebo effect as a treatment success, that is absolutely false. The current literature shows that neither diagnosis nor treatment is efficacious in any scientific sense. As to cognitive-behavioral therapy, it has recently been shown to be indistinguishable from the placebo effect: http://www.ncbi.nlm.nih.gov/pubmed/23416876 http://www.ncbi.nlm.nih.gov/pubmed/23416876 Quote: "These analyses, in combination with previous meta-analytic findings, fail to provide corroborative evidence for the conjecture that CBT is superior to bona fide non-CBT treatments." Meaning: CBT, indistinguishable from any other therapy, is also ipso facto indistinguishable from the placebo effect. As to antidepression drugs, a recent meta-analysis that includes studies the drug industry chose not to publish, shows them to be clinically indistinguishable from placebo in most cases: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0050045 http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fj... Quote: "Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance." > I encourage you to consider the possibility that you are deterring others from seeking help that could save their lives or significantly improve their quality of life. I encourage you to learn science, and bring yourself up to date on the present self-inflicted plight of psychiatry and psychology. You clearly are living in denial, ironic given the fact that you may be a mental health professional.
- jacques_chester 13y ago
  > Would that be why the director of the NIMH has recently decided to phase out the DSM as scientifically worthless, saying "Patients with mental disorders deserve better"?: An alternative reading is that he correctly identifies that the DSM is based on consensus and that where possible he would like to replace consensus with classifications built on additional modes of observations that have only recently become available. I see that as a positive development. > Meaning: CBT, indistinguishable from any other therapy, is also ipso facto indistinguishable from the placebo effect. For someone who believes in the immaculacy of science, you enjoy leaping to conclusions. > I encourage you to learn science, and bring yourself up to date on the present self-inflicted plight of psychiatry and psychology. Your rhetoric reminds me of some of the other anti-psychology literature I've seen circulated by various organisations holding other beliefs that might be charitably considered as "exotic". > You clearly are living in denial, ironic given the fact that you may be a mental health professional. I'm not, but good luck with your Skinner Box vision of psychology. In me you seem to see the fruits of a vast conspiracy against science and the public. In you I see a person whose determination to XKCD386 is going to cause active harm to others by spreading the idea that depression or ADHD should simply be accepted and not treated. This one can't be settled satisfactorily. Let's stop talking.
  - lutusp 13y ago
    > An alternative reading is that he correctly identifies that the DSM is based on consensus and that where possible he would like to replace consensus with classifications built on additional modes of observations that have only recently become available. An alternative to your comments would be for someone to read the original and discover that the problem is that, in psychiatry and psychology, these conditions are only described, not explained, and any meaningful treatment requires an explanation, an identified cause. Like in science. > ... additional modes of observations ... The issue is not "modes of observations", the issue is a widespread move toward using the methods of neuroscience to identify the causes of these conditions, and treating causes rather than symptoms. > Your rhetoric reminds me of some of the other anti-psychology literature I've seen circulated by various organisations holding other beliefs that might be charitably considered as "exotic". You aren't arguing against my views. You're arguing against the views of the director of the NIMH and dozens of other qualified critics including the editor of DSM-IV, all of whom hold the same general views I do. You're arguing against a historic move toward science. > I'm not, but good luck with your Skinner Box vision of psychology. It's instructive that you've posted no evidence for your position. As to a Skinner-box view of mental health treatment, I direct your attention to this account of deep brain stimulation, a procedure in which a neurosurgeon was able to erase all symptoms of depression in a severely depressed person by throwing a switch: http://www.nytimes.com/2006/04/02/magazine/02depression.html?pagewanted=all http://www.nytimes.com/2006/04/02/magazine/02depression.html... Quote: "Deanna later described it in similar terms. "It was literally like a switch being turned on that had been held down for years," she said. "All of a sudden they hit the spot, and I feel so calm and so peaceful. It was overwhelming to be able to process emotion on somebody's face. I'd been numb to that for so long." "As it turned out, 8 of the 12 patients he operated on, including Deanna, felt their depressions lift while suffering minimal side effects — an incredible rate of effectiveness in patients so immovably depressed. Nor did they just vaguely recover. Their scores on the Hamilton depression scale, a standard used to measure the severity of depression, fell from the soul-deadening high 20's to the single digits — essentially normal." End quote. I emphasize this is a preliminary result, and at the moment it's expensive and risky invasive surgery, unsuitable for any but the severely depressed. My point is that I doubt the severely depressed clients who received this treatment will object that they're being turned into updated versions of B. F. Skinner's lab rats. > In me you seem to see the fruits of a vast conspiracy against science and the public. Locate that part of my posts in which this paranoid delusion finds support. There is no vast conspiracy, there is just mediocrity, denial and shortsightedness. > ... by spreading the idea that depression or ADHD should simply be accepted and not treated. Another example in which, with no evidence, you invent a position for someone else. The issue before psychiatry and psychology is not whether to treat or not to treat, the issue is that there is no reliable evidence that present treatments work. This is why alternatives are being explored, and why the DSM is finally being put aside. > This one can't be settled satisfactorily. Of course it can. Ask the director of the NIMH. Ask those who have received meaningful scientific treatments for depression. Ask the victims of recovered memory therapy whether they think that treatment merited the public support it received. This issue certainly can be resolved satisfactorily, and the first step has been taken -- the DSM, the "bible" of psychiatry and psychology, has been set aside as having no scientific value.