
The Sorrows of Psychiatry - headalgorithm
https://www.nature.com/articles/d41586-019-01170-1
======
cubano
I'm almost _positive_ that Freud did NOT think that "early-childhood sexual
fantasies" were the basis of illness, but early-childhood _trauma_ as the
culprit, and I've come to believe that is almost surely the case, although I
am sure no one cares about my insights on the issue.

Not only does this line up squarely with my own personal experience with
addiction and other psychosis I have, but the lack of these issues in my
children as well, who had a radically different early childhood then I and
have no addiction issues whatsoever.

Case in point...I recently saw the documentary about the triplets that were
separated at birth and given to 3 different socio-economic and emotionally-
connected parents and who, by total accident, met at college and came to be
national celebrities in the 70's and 80's.

One of the three eventually killed himself, due in part I'm sure to his much
deeper addiction issues then that of his 2 siblings. The interesting part was
that he was given to the "wealthy, but emotionally distant" family.

By far the most well balanced and successful of the 3 was the one given to the
gregarious and emotionally-connected father, who showered the child with love
and support throughout his whole life.

I could go on for 30 minutes discussing all the takeaways of this documentary,
called Three Identical Strangers...it turns out the children where all part of
an ethically-questionable experiment where, in my mind at least, the end
results basically proves that 95% of the nature/nurture argument goes to the
"nature" side.

It seems that all "nurture" can do is fuck you up and give you lifelong issues
that are incredibly difficult to overcome.

~~~
candiodari
Sigmund Freud was somewhere between a fraud (accessory to rape, in that he
systematically defended rapists), to a serial rapist himself. That any of his
theories are used at all in any psychological course is shameful.

[https://www.nytimes.com/1984/01/24/science/freud-secret-
docu...](https://www.nytimes.com/1984/01/24/science/freud-secret-documents-
reveal-years-of-strife.html)

(search for "real rape" in that article to read one account of Freud expending
a lot of effort to hide obvious cases of rape)

------
pravda
In the 40+ years since that study was done, it seems like psychiatrists still
fail at distinguishing the sane from the insane!

Here's a fun story from Pennsylvania:

[https://www.washingtonpost.com/news/morning-
mix/wp/2018/01/0...](https://www.washingtonpost.com/news/morning-
mix/wp/2018/01/04/a-terrible-mistake-confused-police-injected-anti-psychotic-
drugs-into-wrong-man-lawsuit-alleges/)

~~~
SketchySeaBeast
"Sane" and "insane" are useless terms.

I wonder say that's a blow against the profession, but that is a blow against
the individuals involved. The police are complicit in that whole thing as
well, but we aren't trying to throw all of law enforcement out because of it.

------
csmeder
From recently discovering Dr. Sarno’s work on physical pain (Eg. Back pain).
My current working theory is most psychological pathology comes from repressed
rage. It sounds crazy but thousands of people have been cured from chronic
back pain, depression, IBS, the list goes on from just learning to get in
touch with their embarrassing and painful feelings of rage. Most people have
no idea how much bottled up rage is living in their subconscious.

“Though he may not be a household name, Sarno is probably America’s most
famous back pain doctor. Before his death on June 22 2017, a day shy of his
94th birthday, he published four books and built a cult-like following of
thousands of patients — including Howard Stern and Larry David. Many of them
claim to have been healed by Sarno, who essentially argued back pain was all
in people’s heads. And Sarno himself often said that some 80 percent of his
patients got better.”

“After digging a little deeper, I learned that some of Sarno’s theories are
now even being validated by science — specifically, that there can sometimes
be an emotional basis for chronic back pain. And that’s an important truth
mainstream pain medicine still hasn’t quite figured out what to do with.”

“More specifically, he believed that the brain distracts us from experiencing
negative emotions by creating pain. We may not want to accept the
uncomfortable truths that we are angry with our children, or that we hate our
job, so instead of thinking those thoughts, we focus on the pain.

He also thought that pain was created by reduced oxygen and blood flow to the
muscles and nerves of the body. So our brains unconsciously [sub consciously]
direct blood away from certain areas of our body, and that creates pain.” -
[https://www.google.com/amp/s/www.vox.com/platform/amp/scienc...](https://www.google.com/amp/s/www.vox.com/platform/amp/science-
and-health/2017/10/2/16338094/dr-john-sarno-healing-back-pain)

The problem is that Sarno was at his peak when western medicine wasn’t willing
to look at studies that show that emotions can be the root cause of physical
conditions. Which is crazy because the placebo effect is well documented. Thus
there is obvious evidence that our mind has the ability to effect our body in
various ways (including our immune system).

~~~
pravda
Howard Stern described him as, "the Steve Jobs of pain management."

[https://www.youtube.com/watch?v=xEBI7bwrRO8](https://www.youtube.com/watch?v=xEBI7bwrRO8)

------
tus87
The problem is truly helping the severely damaged is such a difficult task
requiring long term, intense intervention that most mental health
professionals just fall back onto the standard approach of pathologicalizing
behavior and prescribing medication. Theirs is just a job too at the end of
the day, is it reasonable to expect them to carry the weight of society's
failures?

------
Causality1
Some years ago I was told that neurology had started to quietly replace
psychiatry, overwriting its poor reproducibility and conjectures with
testable, reproducible, and consistent chemical and physical explanations. I
hope it continues.

~~~
basetop
I don't know why you are being downvoted. The famed neuroscientist
ramanachandram had a story about how psychiastrists were assigning woman with
all kinds of disparate diagnoses for her occasional erratic behavior. Turns
out neuroscientists found out she was having small strokes and once they fixed
it with brain surgery, her erratic behavior went away.

Psychiatry is like fixing a software bug by telling the customer to simply
avoid doing things that causes the bug rather than correcting the actual code
and fixing the software.

I know some people don't like reductionist reasoning, but the more I think
about it, the more I'm inclined to believe that all psychological problems are
ultimately a brain problem. We just don't know enough about the brain yet to
fix many of those problems.

~~~
tokai
I would guess it's because it is an huge simplification of the relationship
between the two disciplines. The fields of science are not discrete.

------
astazangasta
>chlorpromazine... enabled the demonstration that biochemicals such as
neurotransmitters are involved in mental disorders

It does no such thing. This drug, and most antipsychotics, simply shuts down
the forebrain. It "treats" psychosis by shutting off your mental function. As
soon as you remove the drug (go "off your meds" because you want to think and
feel again), psychosis resumes. This tells us nothing about the nature of
psychosis.

~~~
tokai
It seems to me that antipsychotics are too often used as medicinal
straitjackets. They are indispensable in stopping acute psychosis, but they
don't treat anything.

~~~
soup10
They are rightly called major tranquilizers, "antipsychotics" is relatively
new marketing that oversells them as a cure rather than a bandaid.

[https://en.wikipedia.org/wiki/Antipsychotic](https://en.wikipedia.org/wiki/Antipsychotic)

------
reallydude
> psychiatrists should devote themselves to solving the problem of serious
> psychoses, and should concede responsibility for what she describes as
> mental suffering that is not a true illness to therapists and social
> workers.

> > I disagree.

Saved you the time of reading this fancy opinion piece.

------
Shaddox
Funnily enough, psychiatry seems to function a lot like our field, based on
trends, because ultimately the brain is a black box. You can't see how it
works, you can only feed it input and observe the output, and if it's
consistent enough you can record it as an observation.

Apart from the truly severe conditions that prevent individuals from even
participating in society, IMHO what psychiatry seems to fail to account for is
context. For example, it is said that many people suffer from depression, but
instead of looking into the core causes, they would rather just pump patients
with meds and hope it gets better with time. Often times though, all that
happens is that the patient builds tolerance to medication, so larger and
larger doses are needed. It makes me think: what if those people cannot escape
their condition to begin with? Can't even know if you don't at least try.

~~~
candiodari
The first and biggest mistake people make with psychiatry is that it will
somehow fix anything, or do anything not relating to the patient. You're
absolutely right. There are environmental reasons for phobias, PTSS, Autism,
Traumas, ...

So if you're being abused, there's absolutely nothing that psychiatry can do
for you, because they can do nothing about the abuse (other than taking you in
and throwing you back into the abuse after 2 months). Same with ancillary
fields: social workers will NEVER do anything about that teacher that's
abusing your kid, they will only "treat" the child (maybe with force, maybe
with internment, maybe against the will of both child and parent, but only the
child).

Likewise, many issues are caused by poverty, or other effectively
environmental factors that just won't change with psychiatric treatment. There
is absolutely nothing that can be done.

You're also forgetting, with those medications, what the patients will build
tolerance for and how that happens. Opiates, Xanax, "Benzos" and SSRIs all
have different mechanisms, but it boils down to the following: you will NOT
like the long term effects. You can responsibly take these medications for
periods from hours to a few weeks (to end what they call a manic episode or a
huge panic). More will have permanent consequences. Eventually you will become
permanently depressed, to the point that "zombie" will be a word used to refer
to you. The way your body adapts is by raising the threshold of dopamine it
takes to reward you, to a point that no non-medication-induced (and eventually
any non-overdose amount) will make you happy. You won't get out of bed, you
won't learn, go for a walk, wash yourself, ... hell Miss/Mister World could
walk into your bedroom, offer anything goes sex, and you _still_ wouldn't be
able to find the motivation to do anything. Once that threshold is raised to a
point that only medication can provide rewards, you're not coming back
anymore.

~~~
Shaddox
Interesting addendum. Thank you.

Are there any statistics or studies regarding the becoming of these zombies? I
thought that the body, if long enough under such medication, becomes incapable
of producing its own dopamine, not that the threshold becomes higher.

------
aszantu
Well, my depression went away when I cut out plants and sugar. Not much more
to say.

~~~
spacegod
Mine didn't

~~~
penagwin
Same here, multiple different kinda of diets, eliminating anything I'm
allergic to, etc.

Not saying it won't help out some people, but at least what I tried didn't
help me.

------
kweinber
As we learn more about neural networks, I predict that we'll hit new advances
in psychology and psychiatry.

If one oversimplifies neural networks and thinks of them as pattern-matching
machines, it would make sense that our brain's neural network would have
trouble if they were fed a lifetime of bad training data (abusive
childhood/relationships) and therefore had bad/nonconstructive reactions to
normal stimuli.

~~~
candiodari
You need to visit a psychology department, or worse, a social sciences
department, and then visit a computer sciences department. This will never
happen, or at least, not without a few generations passing at minimum.

For the same reason that people who have changed a tire on a bike cannot
repair a jumbojet. The statistics accepted in psychological papers ...

[https://en.wikipedia.org/wiki/Replication_crisis](https://en.wikipedia.org/wiki/Replication_crisis)

Or, more dramatically:

[https://phys.org/news/2018-10-real-fake-hoodwinks-
journals.h...](https://phys.org/news/2018-10-real-fake-hoodwinks-
journals.html)

~~~
bonoboTP
Neural net research also has problems with replicability.

~~~
SketchySeaBeast
Not knowing machine learning - are neural nets deterministic at all? Given all
their randomness, I'd assume not.

~~~
cr0sh
> are neural nets deterministic at all? Given all their randomness, I'd assume
> not.

That's actually an interesting question; I'm probably not the person to answer
it, since my experience with NNs is admittedly on the "still learning" side of
things, and that learning has not been via any credentialed sources...but I'm
willing to take a stab at it.

NN models - that is, the thing that results from training a neural network,
are typically "fixed", in that once trained, the model doesn't change - at
least classically. I imagine that somewhere out there, there may be NN models
which can change as data they are processing is run through them, learning on
the fly so to speak. I'd have to research it; I'm sure it's something that's
done or been done?

But normally, once a NN has been trained, it's model is "fixed" and doesn't
change when inputs are presented to it. The training phase is - or appears to
be - fairly stochastic. I'm not sure I'd want to call it random, though,
because I don't recall any kind of random numbers being used during back-
propagation.

But the data that is presented to the neural network is usually randomized in
presentation - and sometimes content. That is, say you're training the NN on
recognizing horses. You might have several thousand images of horses, but you
don't want to show just those. You might want to generate many more - rotate
each one just a bit, skew it just a smidge, maybe change the color and/or
contrast/brightness, etc - to in effect generate a bunch more positive (and
just as many negative - so you don't get bias or overfitting happening)
examples to train the NN on what is a "horse" vs what is a "not horse".

So that data is somewhat "random" \- but from what I recall, the actual
mechanics of training - the algorithms of forward passes and backwards passes
(backpropagation) don't have any randomness to them; just to be sure, I
checked this - which is a great explanation (not the simplest, but not
impossible to follow):

[https://mattmazur.com/2015/03/17/a-step-by-step-
backpropagat...](https://mattmazur.com/2015/03/17/a-step-by-step-
backpropagation-example/)

I don't know what your math skill level is here, so don't let any of the
calculus and "chain rule" stuff get to you if you aren't familiar with it (tbh
- I suck at it), just look at the equations and explanations. It's plain that
there is no random number generator to be found in the process.

So - in theory - if the model, after it has been trained and "baked in place"
so to speak - is presented with the exact same inputs, it should generate the
exact same output.

But the input has to be exactly the same; in the case of an image, the neural
network's input layer is usually an "unrolled" 1-dimensional array
representing the pixel values of the image (left-to-right, top-to-bottom - as
a 1D array - usually). Those values are usually grayscale or color values,
presented either as integer data or floating-point values.

As long as that image data is presented exactly the same to the NN model, the
output should be the same; for instance, if shown a set of pixels values that
represent something, the output of the model will always be the same if shown
those exact same pixel values.

But usually, these systems aren't built to take in "exact data" but rather
data from sensors of the real world. So - the data that would probably be fed
into the NN model likely comes from, say, a camera - and that sensor will not
always present the exact same data to the NN model, even if purposefully set
up to do so - because all such sensors have noise and aren't perfect
(different pixels from the camera's sensor can and will return different
values, even if shown a calibrated blank image in a fixed mode, with
consistent fixed lighting, with the best camera sensor available, etc - it's
just a fact of the real world).

So, because of this - the output of the NN model will in effect be "random" \-
but only because the input is effectively "random". That's actually ok,
because what the model outputs (even if set up as a classifier) are values of
probability - percentage values, where (ideally) the "spike" in the overall
set of values represents the actual identification for the network, and that
any inherent randomness in the system (sensors and whatnot) is filtered out
and (hopefully) doesn't effect the outcome.

Though as we know, this too can be exploited; because the model is "baked in",
you can show a series of images to the network, and get an identification on
the other end, and probably with some statistical analysis you can work out
what the layers in between might actually represent (probably not exactly
though) - and identify flaws that could cause misidentifications on the
output. More or less "hacking the NN model middle layers" and using that
information to craft an "exploit" for the input to cause a particular mis-
identification on the output side.

As we know - this is possible; at least, we know it's possible to get a
network to output a wrong result by simply changing the pixel values of the
input image slightly (even subtly that can't be seen by a person looking at
the image - basically a steganographic style attack?). Such a "hack" could be
used for any number of purposes, but mostly they show how fragile such NN
models can be.

Does this mean they are random, or deterministic? I'd argue for the latter at
this point, but again, I'm not really the person to ask. Hopefully someone
else can answer (or has, by the time I post this).

~~~
SketchySeaBeast
Thank you for taking the time for such a lengthy and in-depth reply. Greatly
appreciated!

