10 ms·

Good riddance. Psychiatry by and large is a sham field. Physicians who practice it love seeing themselves as artists who are experts in identifying the subtleti

by kyro 13y ago

Good riddance. Psychiatry by and large is a sham field. Physicians who practice it love seeing themselves as artists who are experts in identifying the subtleties of human behavior. That's their way of saying there's very little underlying science guiding their practice. Many of the diagnoses given are pulled out of thin air and made to justify a patient's admission, or to appease a patient's desire to feel as if they have a treatable illness. I would ask psychiatrists I trained with to explain why a drug worked or why a disease developed. They would do nothing more than give me the same surface-level information we all know: SSRIs block serotonin reuptake, leading to more serotonin in the synaptic cleft that would then cause increased stimulation, and voila, you're not depressed. This is information anyone can attain with a google search. The majority of their knowledge dealt with pharmacological dynamics. I sat in on a psychiatry conference one afternoon where the docs discussed the treatment of several patients. Never was a scientific article or concept uttered. It was all "well, let's try him on seroquel and olanzapine, let's also throw Paxil in there." It was evident that their treatment protocol was largely one of extremely unsupported trial-and-error based on very, very unique experiences, anecdotes, and preferences each psychiatrist had. Now, I don't want to discredit the entire field. I do know friends and family who have benefited from psychiatric medications, although that could entirely be due to placebo effect. What needs to happen first is that we need to attain a much deeper understanding of how the brain works on the low and high levels, mechanically and abstractly. Mechanically so that we may develop effective meds, abstractly so that we may learn how to manipulate cognitive processes, like with what we see with CBT, which has worked wonders for many with depression -- no medication involved. tl;dr: Psychiatry is a very, very loose and abstract field. You can't run any diagnostic tests on patients. It's mostly a field of educated guessing and confirmation bias. We need better mechanical and abstract understanding of the mind before we douse it in chemicals.

pyre 13y ago
> although that could entirely be due to placebo effect If the drugs had no effect, then why are people (ab)using drugs like Adderall to improve cognition, etc? A big problem with trying to make a science out of the brain, is that it can be very unique to the person. For example, in people that are blind since birth, the pathways in the brain that are normally used for visual processing can get re-purposed over a lifetime to be used for other things. I'd almost say that the brain is sort of like an evolutionary algorithm. Given similar parameters, the results largely resemble each other, but alter things enough and the results can be way off.
- freyr 13y ago
  >If the drugs had no effect, then why are people (ab)using drugs like Adderall to improve cognition, etc? Placebo effect is certainly an effect. But the claim is not that the drugs don't have an effect (though it's true, some work no more effective than a placebo), but that we have no sound explanation for their effects.
  - pyre 13y ago
    > though it's true, some work no more effective than a placebo Do you have a citation for this? What drugs on the market today are "no more effective than placebo?"
    - freyr 13y ago
      There are many studies. Here's one: http://jama.jamanetwork.com/article.aspx?articleid=185157 http://jama.jamanetwork.com/article.aspx?articleid=185157 This study found that SSRIs provided little to no benefit over placebo for patients suffering from mild to moderate depression. SSRIs did provide a benefit to patients suffering from severe depression. This raises the question, how many of the 30+ million Americans currently prescribed anti-depressants actually suffer from severe depression and benefit from the drugs? How many are taking it unnecessarily, subjecting themselves to unintended side effects and eventual withdrawal symptoms.
      - phren0logy 13y ago
        You ignore people who take it for anxiety, where SSRI are uncontrovertibly effective.
- WildUtah 13y ago
  Amphetamine is certainly effective and fairly well understood in its clinical effects. There is no doubt about its effectiveness and principal uses and side effects. (Adderall(^tm) is a brand name for amphetamine.) Serotonin reuptake inhibitors used for mood management are just a matter of trying them and seeing if you like the way they feel. It's exactly as scientific as drinking liquor or smoking marijuana to see if it makes you more mellow. But doctors are going around collecting rent on their prescription pads by writing scrips for Paxil and Prozac and the like as if they were technical and carefully calibrated professional tools that required twelve years of college and med school and internships and apprenticeships to master and administer. They're doing all that training and then providing the same service as witch doctors -- but for a lot more money.
mathattack 13y ago
Let's play the devil's advocate here... I've known people who have lost their marbles once they stopped taking their meds. Are we rally saying that their grip on sanity was a placebo effect? Or are we saying that we're just treating the symptom? If it's just the symptom, who cares, as long as the drugs help people? For context, I'm not on any psychiatric drugs, have never been on any, and think they're largely being abused by American society. But the extreme cases suggest to me that they have a use.
- joe_the_user 13y ago
  Let's play the devil's advocate here... I've known people who have lost their marbles once they stopped taking their meds. Are we rally saying that their grip on sanity was a placebo effect? Well, the withdrawal effects for quite a few of these drugs includes various acute psychiatric symptoms, include suicide and homicide. I lost one of my bests friends a number of years ago to this. Also found: http://ssristories.com/ http://ssristories.com/
- kyro 13y ago
  > If it's just the symptom, who cares, as long as the drugs help people? Because for many, these symptoms are not adequately addressed through more conservative means. There are numerous ways to attack an unusual disposition that do not involve medication -- exercising, weight loss, meditation, psychotherapy, cognitive behavioral therapy, rectifying family issues, finding a job. Many of these options are not adequately pursued. I have never seen a psychiatrist refer a patient to see a psychologist or a cognitive behavioral therapist, and they have no incentive to really.
  - randomknowledge 13y ago
    > I have never seen a psychiatrist refer a patient to see a psychologist or a cognitive behavioral therapist, and they have no incentive to really. Plenty do, and there are questions about the efficacy of those techniques as well.
  - derefr 13y ago
    On the other hand, where I live (a non-US country with public healthcare), you don't get in contact with a psychiatrist directly; you get referred to one from a therapist. The therapist decides which kind of treatment of your symptoms is best, where one of their options is to pass you off to a psychiatrist (who the therapist thinks of as "the guy who will mostly think of this in terms of prescribing medications.") Even when the therapist thinks medication is a good treatment regimen, they usually suggest combining it various forms of talk-therapy (in other words, to keep seeing them, as well as seeing the psychiatrist.) Those are some much more neatly-aligned incentives, I think. --- I have to say, though, as a separate issue: neuroaffective medications of all kinds (whether for chemical imbalances, or hormonal imbalances, or pain-management, etc.) are basically like crutches. Your problem might not be "just" a chemical imbalance, just like your problem might not be "just" pain. But even if the cause is external, and the "true solution" is external, the symptoms the external problem is causing in you might be too debilitating for you to pursue the external solution on your own, while you're still afflicted. That's when you need a crutch. If you break your leg, walking on it enough to get it to heal is usually far too painful to do all on your own. So, you get crutches. Now you can get some support to lessen the pain, while still walking on it to help it heal. If you lost your job while you were in the hospital for the leg-break, the crutch can let you go back to work before you otherwise would, which can give you the motivation to keep pushing yourself to heal, rather than just sitting around. Once your leg has healed, you don't need the crutch. If you're clinically depressed, going out and doing things you'd otherwise enjoy is hard. SSRIs and the like are a crutch that let you feel less pessimistic about your situation, so you can pursue real sources of happiness (getting a better job, finding a relationship, etc.) Once you've done those things, you might not need the crutch. Sometimes, though, we need crutches for life. Once you're old enough to need a cane or a walker, you're never going to not need a cane or a walker. Some people are born with conditions that put them in a wheelchair for their entire lives. If your problem is inherent to your physiology, there's no external problem to solve--so you'll always need the crutch. --- Here's the odd thing about neurotransmitter imbalances, though. I asked a psychiatrist friend of mine about whether, generally, his patients have obvious problems in their lives that could be possible causes of their symptoms, or whether they more often say things like "everything's great so I don't see why I'm so--". He said it was overwhelmingly the latter. My pure guess to explain this data, is that something happened to our brain chemistry that paralleled the rise of near-/farsightedness as a genetic trait. After the rise of agriculture, sharp near/far vision stopped being something we had natural selection pressuring us to keep--and, unlike traits like height, it's hard to tell how well your partner can see, so it wasn't sexually selected, either. So the likelihood of your vision staying perfectly "in tune" with the reference point became pretty much random chance, with near-/far-sighted people mating with other near-/far-sighted people with no concern for the consequences. So, just as our eyes have to be tuned to a certain reference point to work optimally, so do our neurotransmitter levels. And just like people don't much care if their partner can see well, people don't much care if their partner has strange moods sometimes (--in fact, some might prefer partners with a certain demeanor.) So we've let genetic drift and random crossovers take the place of selective pressure in determining our brain chemistry. A lot more people are born needing figurative wheelchairs than find themselves needing figurative crutches. But a wheelchair is a bad metaphor, here, isn't it? A wheelchair is for someone who can't walk at all without it. Whereas, being slightly off your reference point, and using something to bring you back in line? Why, that's a lot more like wearing glasses!
OldSchool 13y ago
As a young engineer-type with no exposure to the psych field, I had about the same opinion when I was in my early 20's. However, a few decades of real life later I've seen first-hand, successes and turnarounds for people who either found themselves in bad situations or were just plain genetically vulnerable. In fact, I'll go as far as saying that counseling or therapy are nothing compared to the difference that the right medication(s) can make in a life. Finding it is hit-or-miss, and there are still people who ultimately can't be helped but there are countless success stories - they just aren't worth reporting, like every time antibiotics work as expected.
- kyro 13y ago
  I agree with you for the most part. There are people with severe, debilitating conditions that may require medical intervention. There are many, many more that have been labeled due to loose diagnosing guidelines to have a psychiatric disorder. A psychiatrist might just notice that your affect is slightly off, and label you with schizoaffective disorder, which is pretty well known as the diagnosis you give when you can't really put your finger on what's wrong, and yet they still treat medically. How many people diagnosed with MDD or hypomania, do you think, genuinely deserve treatment with muddy medications? How many of them do you think may have other rectifiable issues that are leading to their disposition? Psychiatrists tend to overlook identifying those issues, and jump to asking the questions needed to diagnose a disease as per the DSM-IV.
- neurotech1 13y ago
  As a programmer and former EEG tech, all I can do is nod quietly. They could be way more scientific about their medication selection if they wanted to be [1][2] but most psychiatrists are overconfident in their own judgement. [1] http://www.ncneurocenter.com/eeg/eeg_reference.html http://www.ncneurocenter.com/eeg/eeg_reference.html [2] http://en.wikipedia.org/wiki/Quantitative_electroencephalography http://en.wikipedia.org/wiki/Quantitative_electroencephalogr...
  - vacri 13y ago
    There's a difference between "how about we approach it more appropriately" and kyro's "we shouldn't use this at all until we have a near-complete understanding".
sliverstorm 13y ago
What needs to happen first is that we need to attain a much deeper understanding of how the brain works on the low and high levels, mechanically and abstractly. I like this idea. I have one question; in the meantime, while we spend the next five hundred years figuring out the brain (because as we already know, it is wildly complex and we know almost nothing about it), what do we do with the people who really need psychiatric help? Can we hang them out to dry, or would that be too cold?
- kyro 13y ago
  Look, if you have debilitating schizophrenia refractory to any therapy because the demons in your ears tell you the FBI is after you, then the benefits of symptomatic treatment may outweigh whatever unknown side-effects there are. For the millions of those with 'psychiatric' disorders that are diagnosed using incredibly vague guidelines [0] -- do you ever feel tired? do you ever lose attention? do you ever feel really confident? -- using medications that do not have any observable and immediate symptomatic relief is not worth it. Many of these people have dysfunctions of cognitive processes or issues of their childhood that can be attacked in more conservative ways. [0] http://www.mayoclinic.com/health/depression/DS00175/DSECTION=tests-and-diagnosis http://www.mayoclinic.com/health/depression/DS00175/DSECTION...
  - marvin 13y ago
    The problem you are pointing out is related to doctors' excessive eagerness to prescribe medicines, not any inherent flaw in the field of psychiatry. This is a problem with the culture among MDs in the US, it is not a global problem of psychiatry. I've been in first-hand contact with a fair number of doctors, psychiatrists, psychologists and their patients in Scandinavia, and I haven't seen the rampant prescription of drugs to treat vague diagnoses that you describe. If you're in psychotic and in a mental hospital, they'll prescribe drugs, ditto if you have a mood disorder that is severely affecting your functioning. If you have something that reminds of ME or a similar poorly-understood conditions, the meds usually remain off the table and other forms of therapy attempted. Regardless of the situation, if meds are attempted, it's an ongoing experiment to figure out if something works. Psychiatry would benefit tremendously from a better understanding of brain chemistry. But you're suggeating that we shut down our interim attempts at improving the lives of patients who are suffering greatly today. Psychiatry uses our best guesses yet, and is the best option we have. Its similarities to quack medicine are superficial and incidental.
puma1 13y ago
Just.. wow. You must be a very smart person.
vacri 13y ago
I sat in on a psychiatry conference one afternoon where the docs discussed the treatment of several patients. Never was a scientific article or concept uttered. It was all "well, let's try him on seroquel and olanzapine, let's also throw Paxil in there." One data point? You're talking about the 'how are we going to treat our current patients' conferences? I've been in a couple of those myself, and you're expecting something weird from them. It'd be like spending the afternoon with engineers and saying "I didn't hear any of them mention any of the laws of thermodynamics!". I've worked with engineers building hardware, both medical and agricultural, and much of their day-to-day work is based on their innate understanding of the tasks at hand. At critical points in the design process, they will break out their formulas, but when they're discussing the generalities of what to do with their colleagues, they're not citing canonical resources. What you're desiring is a fantasy world. You can't run any diagnostic tests on patients. As someone who spent several years as a neuro tech, this isn't true. Some things have some tests. It is a very difficult field of study - possibly the most difficult in all of human experience - and it's true that there isn't a great amount of test coverage over the whole field. But you're mischaracterising it to say there are no tests. We need better mechanical and abstract understanding of the mind before we douse it in chemicals. That's a nice throwaway line. You make it sound like the mind is an easy thing to understand, and that it won't take long. And apparently, until we have this complete understanding, we should just say 'fuck you' to the people who are currently in need of help? Overuse of pharmaceuticals is a problem, but the answer isn't to run screaming into the absolutist opposite direction.
- kyro 13y ago
  1. I've sat in on multiple psych conferences. If you compare them with conferences in other specialties, you'll soon realize that there is a severe lack of scientific discourse happening. As I said, there is a belief that the field is an art and that the practitioners within are artists who rely heavily on their experience and preferences. Literature is hardly discussed. The DSM is the bible. 2. Yes, the best and most practical test we have is an EEG that, at best, tells you that something wonky is going on in this vague region of the brain. Good for seizure disorders, little else. The other tests we can run are to detect physiological causes of psychiatric symptoms external to the brain, like thyroid disorder, uremia, overdose, etc. Nobody sends a patient down for a routine fMRI. What tests are you referring to? 3. I'm not advocating to wait until we've achieved a complete understanding of the brain, but rather we explore more conservative managements while we get a better understanding of the mechanical workings on the brain. CBT, DBT, psychotherapy, etc, should be actively encouraged by psychiatrists as first-line options for many of these conditions. They simply aren't.
joyeuse6701 13y ago
>"We need better mechanical and abstract understanding of the mind before we douse it in chemicals" That's what research is for and is doing, but in the meantime what you're suggesting is that we sit on the sidelines and watch those that need help suffer because what we know isn't up to your standard? So we're going to take your anecdotal experiences in the psychiatric community about how psychiatry is anecdotal and is thus largely discredited? Would you really be willing to let millions of people suffer because of that hypocrisy? Very frightening.
skunkworks 13y ago
No, psychiatry is not a very, very loose and abstract field as much as it's an attempt to wrangle and understand a very, very loose and abstract subject, which is the essential nature of our thoughts and how we actionize them into behavior. Criticism of its lack of rigor may be fair in many cases, but for you to call it a "sham field" is reactionary and completely inflammatory. Don't backpedal with "I don't want to discredit the entire field" when you're going to lead your comment with, "Good riddance."
- kyro 13y ago
  Fair comment. My initial comment was too reactionary.
alexhomer1 13y ago
"I do know friends and family who have benefited from psychiatric medications, although that could entirely be due to placebo effect." It isn't just you. EVERYONE knows people that have benefited from medication. I've seen people go from horrible, twisted states of mind turn into happy, functional people within months by taking medication. The idea that this is just a placebo effect is completely counter-intuitive, for too many reasons to list. Don't believe for a second the idea that studies or science have anything to do with the author's opinion. People have been saying the same things ever since these medications were first released, without any facts or reasoning to back up their claims. It isn't a surprise that after 30 years they've been able to come up with a couple of studies to back up what they're saying. What is surprising is that they'd be willing to ignore the tens of thousands of doctors all over the country that have seen these medications work, and the millions of people that have benefited from them. Studies have shown that about 75% of patients treated with antidepressants make a recovery. This is a miracle of modern medicine. The idea that treating depression is a "loose and abstract field" is absurd. Millions of patients suffer from a range of similar systems. They get treatment, those symptoms are gone. There is nothing abstract about it. Yes, patients react differently to different medications, which is true for thousands of non-psychiatric conditions as well. In these cases, doctors also use trial and error. Public figures against antidepressants are no better than Christian scientists who encourage patients not to seek treatment for cancer. They're also much more influential: they've persuaded hundred of thousands of people suffering from depression not to seek treatment.
deleted 13y ago
[deleted]
ZirconCode 13y ago
I strongly disagree. It's an extremely young field, and like Artificial Intelligence, is rapidly growing and seeking to understand the brain (a very, very difficult thing to understand after all). As evidence of that growth, NIMH just recently abandoned their vast use of an older method to diagnose patients. Until now that was the best thing they had. Fortunately, new technology opens new doors, and they are willing to walk through them. [1] Psychiatry is a very young field, but it is very necessary. Positive psychology is also a relatively new field which focuses on making patients happy, rather than diagnosing their problems, which seems to be major nitpick you have with psychiatry. Of course in some cases medicine is required simply due to physical malfunction. [1] http://www.huffingtonpost.com/dr-harold-koplewicz/dsm-mental-health-research_b_3247960.html http://www.huffingtonpost.com/dr-harold-koplewicz/dsm-mental...
DannyBee 13y ago
I used to think much the same thing. I have, however, had the wonderful experience of being treated (for ADHD) by two very science oriented psychiatrists. They know the research articles cold, suggest approaches based on actual research, can explain the best scientific understanding of why something should work, and when it doesn't, why that theory may be wrong, etc. Now, as for " What needs to happen first is that we need to attain a much deeper understanding of how the brain works on the low and high levels, mechanically and abstractly." I couldn't more strongly disagree. What you say could be applied to every area of medicine. We have been very wrong in very many fields about very many causes of very many diseases. We only gain understand through trying and failing, and trying and succeeding. Sitting around waiting for scientific knowledge to magically increase through some unspecified process will do nothing. If you want to argue psychiatrists are overconfident and usually wrong, that's one thing. If you want to argue that the diagnosis criteria are essentially vague bullshit that reads like the stuff they used to use to convict people of being witches, i'm right there with you. But you seem to be arguing we should stop trying with medications until we understand things better. If we did that, we should stop roughly all modern medication, because in large part, we only know it works, not why or how, at any real level. We irradiate cells to try to solve cancer. This is basically at the level of using leeches. We have theories. People are trying these theories out on real live people through making test medications, performing trials and treatments. Sometimes they pan out, sometimes they don't. Sitting around doing MRI imaging studies (and any other kind of study you can think of) of the brains of various mentally ill people has been done, and the results analyzed. It has not helped. So let's start simple: What exact process would you use to increase knowledge to the point you suggest? Past that, if your real argument is that more conservative approaches should be favored over medication first, well, the problem there is simple at it's core: Nobody is willing to pay for it. Insurance companies are happy to cover a pill at 10 bucks a month for months. Most people can't get outpatient CBT/DBT except at significant out of pocket cost. So the fact that you have plenty of psychiatrists willing to sit around and prescribe med after med is partially an artifact of "that is what they can do for their patients".
- marvin 13y ago
  Nice to see someone who has noticed that a good doctor actually bases his opinions of science. You could be fooled by the massive disdain for medicine in this thread, or at the very least be led to believe that no one here has ever talked to a doctor.
phren0logy 13y ago
I'm a psychiatrist, and I disagree with much of your post. I see below you mentioned going to a psychiatry conference many times, but if it was with the same docs why did you expect a higher level of scientific discourse? It's true that there are crummy psychiatrists, but please don't throw the rest of us under a bus. At our patient conferences, not being to cite articles to back up your treatment plan would be considered an embarrassment. I think this article puts psychiatry's dilemma into some good perspective: http://www.sciencebasedmedicine.org/dsm-5-and-the-fight-for-the-heart-of-psychiatry/ http://www.sciencebasedmedicine.org/dsm-5-and-the-fight-for-... I do think that it's interesting how people conceive of psychiatry. We cannot really objectively measure or test pain. There's no blood test or scan that confirms it. But as everyone has experienced it, nobody doubts it exists. There's migraine headaches, which are, like psychiatric illness, diagnosed based on history and symptoms. It's pretty uncontroversial. Yet, as everyone believes themselves to be an expert in behavior, if they have not experienced or known someone with mental illness, it's suddenly all invented.
- saber_taylor 13y ago
  > We cannot really objectively measure or test pain. http://en.wikipedia.org/wiki/Dolorimeter http://en.wikipedia.org/wiki/Dolorimeter Perhaps you meant in the brain.
  - phren0logy 13y ago
    This is a systematized way to elicit a subjective report. My original point stands; we cannot measure it objectively (if, indeed, there is even merit to such a concept).
  - ubercore 13y ago
    I think the point stands, since that test is reliant on a patient reporting a sensation of pain. In the same way, psychiatrists must rely on patients expression the emotional problem they're feeling. Reading that wiki entry, it looks like any objective measurements that arose from dolorimeters are not in active use, because they weren't helpful.
- 13y ago
DenisM 13y ago
>Psychiatry by and large is a sham field >Now, I don't want to discredit the entire field. Looks like that's exactly what you want to do. Luckily, you're not doing a good job of it. >What needs to happen first is that we need to attain a much deeper understanding of how the brain works Yes, and until then what? Do nothing and let the suffers suffer? Per your own admission many people are helped. Perhaps that should be your clue to lay off the righteous indignation at lack of precision. Yes, we all want something that works in all cases, but in the mean time we should use something that works occasionally.

by kyro 13y ago

pyre 13y ago

> although that could entirely be due to placebo effect If the drugs had no effect, then why are people (ab)using drugs like Adderall to improve cognition, etc? A big problem with trying to make a science out of the brain, is that it can be very unique to the person. For example, in people that are blind since birth, the pathways in the brain that are normally used for visual processing can get re-purposed over a lifetime to be used for other things. I'd almost say that the brain is sort of like an evolutionary algorithm. Given similar parameters, the results largely resemble each other, but alter things enough and the results can be way off.

freyr 13y ago
>If the drugs had no effect, then why are people (ab)using drugs like Adderall to improve cognition, etc? Placebo effect is certainly an effect. But the claim is not that the drugs don't have an effect (though it's true, some work no more effective than a placebo), but that we have no sound explanation for their effects.
- pyre 13y ago
  > though it's true, some work no more effective than a placebo Do you have a citation for this? What drugs on the market today are "no more effective than placebo?"
  - freyr 13y ago
    There are many studies. Here's one: http://jama.jamanetwork.com/article.aspx?articleid=185157 http://jama.jamanetwork.com/article.aspx?articleid=185157 This study found that SSRIs provided little to no benefit over placebo for patients suffering from mild to moderate depression. SSRIs did provide a benefit to patients suffering from severe depression. This raises the question, how many of the 30+ million Americans currently prescribed anti-depressants actually suffer from severe depression and benefit from the drugs? How many are taking it unnecessarily, subjecting themselves to unintended side effects and eventual withdrawal symptoms.
    - phren0logy 13y ago
      You ignore people who take it for anxiety, where SSRI are uncontrovertibly effective.
WildUtah 13y ago
Amphetamine is certainly effective and fairly well understood in its clinical effects. There is no doubt about its effectiveness and principal uses and side effects. (Adderall(^tm) is a brand name for amphetamine.) Serotonin reuptake inhibitors used for mood management are just a matter of trying them and seeing if you like the way they feel. It's exactly as scientific as drinking liquor or smoking marijuana to see if it makes you more mellow. But doctors are going around collecting rent on their prescription pads by writing scrips for Paxil and Prozac and the like as if they were technical and carefully calibrated professional tools that required twelve years of college and med school and internships and apprenticeships to master and administer. They're doing all that training and then providing the same service as witch doctors -- but for a lot more money.

mathattack 13y ago

Let's play the devil's advocate here... I've known people who have lost their marbles once they stopped taking their meds. Are we rally saying that their grip on sanity was a placebo effect? Or are we saying that we're just treating the symptom? If it's just the symptom, who cares, as long as the drugs help people? For context, I'm not on any psychiatric drugs, have never been on any, and think they're largely being abused by American society. But the extreme cases suggest to me that they have a use.

joe_the_user 13y ago
Let's play the devil's advocate here... I've known people who have lost their marbles once they stopped taking their meds. Are we rally saying that their grip on sanity was a placebo effect? Well, the withdrawal effects for quite a few of these drugs includes various acute psychiatric symptoms, include suicide and homicide. I lost one of my bests friends a number of years ago to this. Also found: http://ssristories.com/ http://ssristories.com/
kyro 13y ago
> If it's just the symptom, who cares, as long as the drugs help people? Because for many, these symptoms are not adequately addressed through more conservative means. There are numerous ways to attack an unusual disposition that do not involve medication -- exercising, weight loss, meditation, psychotherapy, cognitive behavioral therapy, rectifying family issues, finding a job. Many of these options are not adequately pursued. I have never seen a psychiatrist refer a patient to see a psychologist or a cognitive behavioral therapist, and they have no incentive to really.
- randomknowledge 13y ago
  > I have never seen a psychiatrist refer a patient to see a psychologist or a cognitive behavioral therapist, and they have no incentive to really. Plenty do, and there are questions about the efficacy of those techniques as well.
- derefr 13y ago
  On the other hand, where I live (a non-US country with public healthcare), you don't get in contact with a psychiatrist directly; you get referred to one from a therapist. The therapist decides which kind of treatment of your symptoms is best, where one of their options is to pass you off to a psychiatrist (who the therapist thinks of as "the guy who will mostly think of this in terms of prescribing medications.") Even when the therapist thinks medication is a good treatment regimen, they usually suggest combining it various forms of talk-therapy (in other words, to keep seeing them, as well as seeing the psychiatrist.) Those are some much more neatly-aligned incentives, I think. --- I have to say, though, as a separate issue: neuroaffective medications of all kinds (whether for chemical imbalances, or hormonal imbalances, or pain-management, etc.) are basically like crutches. Your problem might not be "just" a chemical imbalance, just like your problem might not be "just" pain. But even if the cause is external, and the "true solution" is external, the symptoms the external problem is causing in you might be too debilitating for you to pursue the external solution on your own, while you're still afflicted. That's when you need a crutch. If you break your leg, walking on it enough to get it to heal is usually far too painful to do all on your own. So, you get crutches. Now you can get some support to lessen the pain, while still walking on it to help it heal. If you lost your job while you were in the hospital for the leg-break, the crutch can let you go back to work before you otherwise would, which can give you the motivation to keep pushing yourself to heal, rather than just sitting around. Once your leg has healed, you don't need the crutch. If you're clinically depressed, going out and doing things you'd otherwise enjoy is hard. SSRIs and the like are a crutch that let you feel less pessimistic about your situation, so you can pursue real sources of happiness (getting a better job, finding a relationship, etc.) Once you've done those things, you might not need the crutch. Sometimes, though, we need crutches for life. Once you're old enough to need a cane or a walker, you're never going to not need a cane or a walker. Some people are born with conditions that put them in a wheelchair for their entire lives. If your problem is inherent to your physiology, there's no external problem to solve--so you'll always need the crutch. --- Here's the odd thing about neurotransmitter imbalances, though. I asked a psychiatrist friend of mine about whether, generally, his patients have obvious problems in their lives that could be possible causes of their symptoms, or whether they more often say things like "everything's great so I don't see why I'm so--". He said it was overwhelmingly the latter. My pure guess to explain this data, is that something happened to our brain chemistry that paralleled the rise of near-/farsightedness as a genetic trait. After the rise of agriculture, sharp near/far vision stopped being something we had natural selection pressuring us to keep--and, unlike traits like height, it's hard to tell how well your partner can see, so it wasn't sexually selected, either. So the likelihood of your vision staying perfectly "in tune" with the reference point became pretty much random chance, with near-/far-sighted people mating with other near-/far-sighted people with no concern for the consequences. So, just as our eyes have to be tuned to a certain reference point to work optimally, so do our neurotransmitter levels. And just like people don't much care if their partner can see well, people don't much care if their partner has strange moods sometimes (--in fact, some might prefer partners with a certain demeanor.) So we've let genetic drift and random crossovers take the place of selective pressure in determining our brain chemistry. A lot more people are born needing figurative wheelchairs than find themselves needing figurative crutches. But a wheelchair is a bad metaphor, here, isn't it? A wheelchair is for someone who can't walk at all without it. Whereas, being slightly off your reference point, and using something to bring you back in line? Why, that's a lot more like wearing glasses!

OldSchool 13y ago

As a young engineer-type with no exposure to the psych field, I had about the same opinion when I was in my early 20's. However, a few decades of real life later I've seen first-hand, successes and turnarounds for people who either found themselves in bad situations or were just plain genetically vulnerable. In fact, I'll go as far as saying that counseling or therapy are nothing compared to the difference that the right medication(s) can make in a life. Finding it is hit-or-miss, and there are still people who ultimately can't be helped but there are countless success stories - they just aren't worth reporting, like every time antibiotics work as expected.

kyro 13y ago
I agree with you for the most part. There are people with severe, debilitating conditions that may require medical intervention. There are many, many more that have been labeled due to loose diagnosing guidelines to have a psychiatric disorder. A psychiatrist might just notice that your affect is slightly off, and label you with schizoaffective disorder, which is pretty well known as the diagnosis you give when you can't really put your finger on what's wrong, and yet they still treat medically. How many people diagnosed with MDD or hypomania, do you think, genuinely deserve treatment with muddy medications? How many of them do you think may have other rectifiable issues that are leading to their disposition? Psychiatrists tend to overlook identifying those issues, and jump to asking the questions needed to diagnose a disease as per the DSM-IV.
neurotech1 13y ago
As a programmer and former EEG tech, all I can do is nod quietly. They could be way more scientific about their medication selection if they wanted to be [1][2] but most psychiatrists are overconfident in their own judgement. [1] http://www.ncneurocenter.com/eeg/eeg_reference.html http://www.ncneurocenter.com/eeg/eeg_reference.html [2] http://en.wikipedia.org/wiki/Quantitative_electroencephalography http://en.wikipedia.org/wiki/Quantitative_electroencephalogr...
- vacri 13y ago
  There's a difference between "how about we approach it more appropriately" and kyro's "we shouldn't use this at all until we have a near-complete understanding".

sliverstorm 13y ago

What needs to happen first is that we need to attain a much deeper understanding of how the brain works on the low and high levels, mechanically and abstractly. I like this idea. I have one question; in the meantime, while we spend the next five hundred years figuring out the brain (because as we already know, it is wildly complex and we know almost nothing about it), what do we do with the people who really need psychiatric help? Can we hang them out to dry, or would that be too cold?

kyro 13y ago
Look, if you have debilitating schizophrenia refractory to any therapy because the demons in your ears tell you the FBI is after you, then the benefits of symptomatic treatment may outweigh whatever unknown side-effects there are. For the millions of those with 'psychiatric' disorders that are diagnosed using incredibly vague guidelines [0] -- do you ever feel tired? do you ever lose attention? do you ever feel really confident? -- using medications that do not have any observable and immediate symptomatic relief is not worth it. Many of these people have dysfunctions of cognitive processes or issues of their childhood that can be attacked in more conservative ways. [0] http://www.mayoclinic.com/health/depression/DS00175/DSECTION=tests-and-diagnosis http://www.mayoclinic.com/health/depression/DS00175/DSECTION...
- marvin 13y ago
  The problem you are pointing out is related to doctors' excessive eagerness to prescribe medicines, not any inherent flaw in the field of psychiatry. This is a problem with the culture among MDs in the US, it is not a global problem of psychiatry. I've been in first-hand contact with a fair number of doctors, psychiatrists, psychologists and their patients in Scandinavia, and I haven't seen the rampant prescription of drugs to treat vague diagnoses that you describe. If you're in psychotic and in a mental hospital, they'll prescribe drugs, ditto if you have a mood disorder that is severely affecting your functioning. If you have something that reminds of ME or a similar poorly-understood conditions, the meds usually remain off the table and other forms of therapy attempted. Regardless of the situation, if meds are attempted, it's an ongoing experiment to figure out if something works. Psychiatry would benefit tremendously from a better understanding of brain chemistry. But you're suggeating that we shut down our interim attempts at improving the lives of patients who are suffering greatly today. Psychiatry uses our best guesses yet, and is the best option we have. Its similarities to quack medicine are superficial and incidental.

puma1 13y ago

Just.. wow. You must be a very smart person.

vacri 13y ago

I sat in on a psychiatry conference one afternoon where the docs discussed the treatment of several patients. Never was a scientific article or concept uttered. It was all "well, let's try him on seroquel and olanzapine, let's also throw Paxil in there." One data point? You're talking about the 'how are we going to treat our current patients' conferences? I've been in a couple of those myself, and you're expecting something weird from them. It'd be like spending the afternoon with engineers and saying "I didn't hear any of them mention any of the laws of thermodynamics!". I've worked with engineers building hardware, both medical and agricultural, and much of their day-to-day work is based on their innate understanding of the tasks at hand. At critical points in the design process, they will break out their formulas, but when they're discussing the generalities of what to do with their colleagues, they're not citing canonical resources. What you're desiring is a fantasy world. You can't run any diagnostic tests on patients. As someone who spent several years as a neuro tech, this isn't true. Some things have some tests. It is a very difficult field of study - possibly the most difficult in all of human experience - and it's true that there isn't a great amount of test coverage over the whole field. But you're mischaracterising it to say there are no tests. We need better mechanical and abstract understanding of the mind before we douse it in chemicals. That's a nice throwaway line. You make it sound like the mind is an easy thing to understand, and that it won't take long. And apparently, until we have this complete understanding, we should just say 'fuck you' to the people who are currently in need of help? Overuse of pharmaceuticals is a problem, but the answer isn't to run screaming into the absolutist opposite direction.

kyro 13y ago
1. I've sat in on multiple psych conferences. If you compare them with conferences in other specialties, you'll soon realize that there is a severe lack of scientific discourse happening. As I said, there is a belief that the field is an art and that the practitioners within are artists who rely heavily on their experience and preferences. Literature is hardly discussed. The DSM is the bible. 2. Yes, the best and most practical test we have is an EEG that, at best, tells you that something wonky is going on in this vague region of the brain. Good for seizure disorders, little else. The other tests we can run are to detect physiological causes of psychiatric symptoms external to the brain, like thyroid disorder, uremia, overdose, etc. Nobody sends a patient down for a routine fMRI. What tests are you referring to? 3. I'm not advocating to wait until we've achieved a complete understanding of the brain, but rather we explore more conservative managements while we get a better understanding of the mechanical workings on the brain. CBT, DBT, psychotherapy, etc, should be actively encouraged by psychiatrists as first-line options for many of these conditions. They simply aren't.

joyeuse6701 13y ago

>"We need better mechanical and abstract understanding of the mind before we douse it in chemicals" That's what research is for and is doing, but in the meantime what you're suggesting is that we sit on the sidelines and watch those that need help suffer because what we know isn't up to your standard? So we're going to take your anecdotal experiences in the psychiatric community about how psychiatry is anecdotal and is thus largely discredited? Would you really be willing to let millions of people suffer because of that hypocrisy? Very frightening.

skunkworks 13y ago

No, psychiatry is not a very, very loose and abstract field as much as it's an attempt to wrangle and understand a very, very loose and abstract subject, which is the essential nature of our thoughts and how we actionize them into behavior. Criticism of its lack of rigor may be fair in many cases, but for you to call it a "sham field" is reactionary and completely inflammatory. Don't backpedal with "I don't want to discredit the entire field" when you're going to lead your comment with, "Good riddance."

kyro 13y ago
Fair comment. My initial comment was too reactionary.

alexhomer1 13y ago

"I do know friends and family who have benefited from psychiatric medications, although that could entirely be due to placebo effect." It isn't just you. EVERYONE knows people that have benefited from medication. I've seen people go from horrible, twisted states of mind turn into happy, functional people within months by taking medication. The idea that this is just a placebo effect is completely counter-intuitive, for too many reasons to list. Don't believe for a second the idea that studies or science have anything to do with the author's opinion. People have been saying the same things ever since these medications were first released, without any facts or reasoning to back up their claims. It isn't a surprise that after 30 years they've been able to come up with a couple of studies to back up what they're saying. What is surprising is that they'd be willing to ignore the tens of thousands of doctors all over the country that have seen these medications work, and the millions of people that have benefited from them. Studies have shown that about 75% of patients treated with antidepressants make a recovery. This is a miracle of modern medicine. The idea that treating depression is a "loose and abstract field" is absurd. Millions of patients suffer from a range of similar systems. They get treatment, those symptoms are gone. There is nothing abstract about it. Yes, patients react differently to different medications, which is true for thousands of non-psychiatric conditions as well. In these cases, doctors also use trial and error. Public figures against antidepressants are no better than Christian scientists who encourage patients not to seek treatment for cancer. They're also much more influential: they've persuaded hundred of thousands of people suffering from depression not to seek treatment.

deleted 13y ago

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ZirconCode 13y ago

I strongly disagree. It's an extremely young field, and like Artificial Intelligence, is rapidly growing and seeking to understand the brain (a very, very difficult thing to understand after all). As evidence of that growth, NIMH just recently abandoned their vast use of an older method to diagnose patients. Until now that was the best thing they had. Fortunately, new technology opens new doors, and they are willing to walk through them. [1] Psychiatry is a very young field, but it is very necessary. Positive psychology is also a relatively new field which focuses on making patients happy, rather than diagnosing their problems, which seems to be major nitpick you have with psychiatry. Of course in some cases medicine is required simply due to physical malfunction. [1] http://www.huffingtonpost.com/dr-harold-koplewicz/dsm-mental-health-research_b_3247960.html http://www.huffingtonpost.com/dr-harold-koplewicz/dsm-mental...

DannyBee 13y ago

I used to think much the same thing. I have, however, had the wonderful experience of being treated (for ADHD) by two very science oriented psychiatrists. They know the research articles cold, suggest approaches based on actual research, can explain the best scientific understanding of why something should work, and when it doesn't, why that theory may be wrong, etc. Now, as for " What needs to happen first is that we need to attain a much deeper understanding of how the brain works on the low and high levels, mechanically and abstractly." I couldn't more strongly disagree. What you say could be applied to every area of medicine. We have been very wrong in very many fields about very many causes of very many diseases. We only gain understand through trying and failing, and trying and succeeding. Sitting around waiting for scientific knowledge to magically increase through some unspecified process will do nothing. If you want to argue psychiatrists are overconfident and usually wrong, that's one thing. If you want to argue that the diagnosis criteria are essentially vague bullshit that reads like the stuff they used to use to convict people of being witches, i'm right there with you. But you seem to be arguing we should stop trying with medications until we understand things better. If we did that, we should stop roughly all modern medication, because in large part, we only know it works, not why or how, at any real level. We irradiate cells to try to solve cancer. This is basically at the level of using leeches. We have theories. People are trying these theories out on real live people through making test medications, performing trials and treatments. Sometimes they pan out, sometimes they don't. Sitting around doing MRI imaging studies (and any other kind of study you can think of) of the brains of various mentally ill people has been done, and the results analyzed. It has not helped. So let's start simple: What exact process would you use to increase knowledge to the point you suggest? Past that, if your real argument is that more conservative approaches should be favored over medication first, well, the problem there is simple at it's core: Nobody is willing to pay for it. Insurance companies are happy to cover a pill at 10 bucks a month for months. Most people can't get outpatient CBT/DBT except at significant out of pocket cost. So the fact that you have plenty of psychiatrists willing to sit around and prescribe med after med is partially an artifact of "that is what they can do for their patients".

marvin 13y ago
Nice to see someone who has noticed that a good doctor actually bases his opinions of science. You could be fooled by the massive disdain for medicine in this thread, or at the very least be led to believe that no one here has ever talked to a doctor.

phren0logy 13y ago

I'm a psychiatrist, and I disagree with much of your post. I see below you mentioned going to a psychiatry conference many times, but if it was with the same docs why did you expect a higher level of scientific discourse? It's true that there are crummy psychiatrists, but please don't throw the rest of us under a bus. At our patient conferences, not being to cite articles to back up your treatment plan would be considered an embarrassment. I think this article puts psychiatry's dilemma into some good perspective: http://www.sciencebasedmedicine.org/dsm-5-and-the-fight-for-the-heart-of-psychiatry/ http://www.sciencebasedmedicine.org/dsm-5-and-the-fight-for-... I do think that it's interesting how people conceive of psychiatry. We cannot really objectively measure or test pain. There's no blood test or scan that confirms it. But as everyone has experienced it, nobody doubts it exists. There's migraine headaches, which are, like psychiatric illness, diagnosed based on history and symptoms. It's pretty uncontroversial. Yet, as everyone believes themselves to be an expert in behavior, if they have not experienced or known someone with mental illness, it's suddenly all invented.

saber_taylor 13y ago
> We cannot really objectively measure or test pain. http://en.wikipedia.org/wiki/Dolorimeter http://en.wikipedia.org/wiki/Dolorimeter Perhaps you meant in the brain.
- phren0logy 13y ago
  This is a systematized way to elicit a subjective report. My original point stands; we cannot measure it objectively (if, indeed, there is even merit to such a concept).
- ubercore 13y ago
  I think the point stands, since that test is reliant on a patient reporting a sensation of pain. In the same way, psychiatrists must rely on patients expression the emotional problem they're feeling. Reading that wiki entry, it looks like any objective measurements that arose from dolorimeters are not in active use, because they weren't helpful.
13y ago

DenisM 13y ago

>Psychiatry by and large is a sham field >Now, I don't want to discredit the entire field. Looks like that's exactly what you want to do. Luckily, you're not doing a good job of it. >What needs to happen first is that we need to attain a much deeper understanding of how the brain works Yes, and until then what? Do nothing and let the suffers suffer? Per your own admission many people are helped. Perhaps that should be your clue to lay off the righteous indignation at lack of precision. Yes, we all want something that works in all cases, but in the mean time we should use something that works occasionally.