
Psychiatry’s Incurable Hubris - scottie_m
https://www.theatlantic.com/magazine/archive/2019/04/mind-fixers-anne-harrington/583228/
======
neaden
Psychiatry today strikes me as being in a similar place as Infectious Disease
before germ theory. We can describe symptoms, we can group them together, and
we can come up with cures that sometimes work but without knowing if we are
talking about a virus or a bacteria we can't really understand what's going
on.

~~~
trevyn
IMO, we already have the mental-disease equivalent of germ theory, it’s just
_far_ more complex and not yet well-understood by enough people to have broad
social impact.

“The germ theory was proposed by Girolamo Fracastoro in 1546, and expanded
upon by Marcus von Plenciz in 1762. Such views were held in disdain, however,
and Galen's miasma theory remained dominant among scientists and doctors.” -
[https://en.m.wikipedia.org/wiki/Germ_theory_of_disease](https://en.m.wikipedia.org/wiki/Germ_theory_of_disease)

~~~
thaumasiotes
[https://westhunt.wordpress.com/2013/10/31/lost-and-
found/](https://westhunt.wordpress.com/2013/10/31/lost-and-found/)

> Marcus Terentius Varro was called the most learned of the Romans. But what
> did he know, and how did he know it? I ask because of this quote, from
> _Rerum rusticarum libri III_ (Agricultural Topics in Three Books):

> Precautions must also be taken in the neighbourhood of swamps, both for the
> reasons given, and because there are bred certain minute creatures which
> cannot be seen by the eyes, which float in the air and enter the body
> through the mouth and nose and there cause serious diseases.

> I get the distinct impression that someone (probably someone other than
> Varro) came up with an approximation of germ theory 1500 years before
> Girolamo Fracastoro. But his work was lost.

~~~
arkades
The ancient Greeks were long ago discussing the possible existence of
“animalcules.” Fracastaro gets credit because he wasn’t just philosophizing,
he described actual disease in great detail with supporting cases (I hesitate
to say “data,” that wasn’t really a thing yet) to argue for its mechanism.

It’s the difference between a stoner strumming his guitar, “dude, what if
we’re all, like, strings?” and string theory.

~~~
thaumasiotes
I think the advice "don't live near a swamp, because the tiny invisible
creatures in there will make you sick, and if you do have a farm next to a
swamp, sell it" is a little more detailed than "dude, what if we're all, like,
strings?"

Describing disease in great detail is nothing the Romans didn't also do, nor
does it have anything to do with the germ theory of disease.

~~~
arkades
That advice applies equally well to miasma (and, in fact, it’s ability to
accurately relate to geography of disease is part of why it was taken
seriously.) Which is why F. gets credit for actually making detailed
observations and hypotheses that we’re borne out.

~~~
thaumasiotes
No, the advice that tiny creatures within the swamp will make you sick does
not apply to miasma; those are competing theories.

The advice "stay away from swamps; they'll make you sick" does indeed apply to
both theories.

Detailed observations also apply to both theories. Everyone everywhere has
detailed observations of disease, usually the same ones.

Girolamo Fracastoro did not, as far as I can see, make any hypotheses or
predictions that other people hadn't made thousands of years before he was
born, nor did he observe in any greater or more relevant detail. He
exemplifies the observation "Christopher Columbus is famous for being the last
person to discover America". He made what had been common knowledge common
knowledge again.

Unless you can identify something he did that was notable? What hypothesis did
he make that Varro didn't already know? I ask because "tiny creatures get into
your body and cause disease" is pretty much the beginning and end of modern
germ theory today.

------
SlimGrimbles42
I watched the chemical imbalance theory absolutely gut the person who used to
be my mother. Over a period of maybe 10 years and multiple medications I
watched her gain weight, get grey hair far too early for her age, she had
periods where she either couldn't stay awake past 9:00pm, or couldn't sleep at
all, periods of near catatonia, periods where rest was impossible.

She was a guinea pig for decades and it became abundantly clear toward the end
that none of these doctors had a god damn idea what they were doing.

~~~
bsenftner
This repeated millions of times across society, it is no wonder we don't
classify them as a criminal profession.

~~~
SlimGrimbles42
Even given my experience, I wouldn't rush to vilify them as criminals. I take
an SSRI daily myself and it _helps_, and I owe gratitude to the science that
has been done to get this far.

The problem is that all of these doctors are operating _without data_. They'll
tell you that your seratonin levels are too low, or this or that, but if you
ask them how low... they can't answer. If you ask them why they're low, they
can give you common answers, but none that are unique to your physiology.

So you have schizophrenia? Let's try bloodletting, leaches, and an assortment
of drugs that will affect the balance of chemicals in your brain in unknown
ways. Don't worry about the side effects, here's a cookie to help with the
blood loss.

------
shrinkhelped
As somebody who has actually benefited from psychiatry, I have to disagree
strongly with a lot of people in this thread (respectfully). It isn't a lot of
hand-waving, and what seemed like open-ended questions in the beginning were
designed to work toward an ultimate truth - my issue.

There was no guessing involved or hand-wavy incantations, just a thorough
assessment of my state of mind, both in the moment and across a span of time.
This required me to be honest, which I strongly suspect many people aren't
(due to things like fear of judgement) and this will hamper the capability of
the doctor in doing their job.

To put this into perspective, while ill I was relatively high-functioning. You
wouldn't guess I was ill, but you would likely find me abrasive and prone to
apparent flights of fancy. What the worst symptom was, the crippling anxiety,
you never would've been able to detect without a goal-driven conversation -
the type of conversation I have with my doctor when we meet.

I think we're still largely in the dark on the methods of action within the
brain that leads to these problems, but we have actually found useful tools in
resolving these problems. This isn't to say it is perfect, I was put onto a
completely incorrect drug by a non-psychiatrist based on my self-reporting.

The next step is going to be neuroscience explaining the modes of action in a
failure state and how these drugs restore normal function.

To anybody out there suffering with mental disease, I'm with you.

edit: throwaway account for obvious reasons

~~~
pryce
I've been involved in treating patients with florid mental illness, and among
people with that experience there really isn't any question that most of these
illnesses must exist with some kind of underlying pathology.

There are many open questions about the mechanism(s) behind them, as well as
the extremely frustrating fact that we can never truly tell if we are actually
seeing the surfaces of multiple completely separate underlying pathologies
that result in somewhat related loose symptom profile clusters.

But if we were to take an extreme example I encountered, a person whose life
was basically over to the point of him trying to butcher people over his
delusions[1], and you find a medication with which he can regain control of
his own mind, can live in society rather than prison, even hold down a job and
have fulfilling friendships, and over months you see numerous patients with
this same dramatic reduction in symptoms, there is no question that there must
be underlying pathology at play.

There might be numerous underlying pathologies all fitting the same symptom
cluster, which would (potentially) help explain why even on the same symptom
cluster a medication might have drastically different levels of effectiveness
on different people.

The best reason to think underlying pathologies behind psychiatric illnesses
are real isn't that we have clear the biology behind them, but that there
exist treatments that actually have very measurable effects on the symptoms.
The other reason is that we already concede our thoughts and perceptions
themselves have a biological basis, so it would just be profoundly strange if
'disorders of thought and perception' somehow didn't.

[1] Just an additional note here, I'm using a specific example of a patient
with violent delusions and criminal behavior, but it's important to note that
people with mental illness are much more likely to be the victims of violence
than perpetrators of it, and it is important we counter the unfair stereotype
that mentally ill people are prone to violence.

~~~
jpovenden
Thank you for bringing some light into this cavern of ignorance.

~~~
pryce
I'm glad my comments are useful to someone.

On the 'reality' of mental illnesses, if I can be a little less serious, I do
still recognise (as did my favourite professor) that it is still a _very odd
position_ to be in, to say that the illness must exist _because_ of the
presence of the treatment. Suppose that the treatment had for some reason not
been invented, does that mean the illness didn't? Did the illness become
'real' the moment the treatment was discovered to be effective?

~~~
DataWorker
It’s why Fraud advocated cocaine use for hysteria. The work he did with Fliess
is worth looking into as it’s relevant to you point about pathologies being
revealed by the use of medication, cocaine in their case.

------
mindgam3
"At last count, more than 12 percent of Americans ages 12 and older were
taking antidepressants. The chemical-imbalance theory, like the revamped DSM,
may fail as science, but as rhetoric it has turned out to be a wild success."

The psychological "trauma model" for mental disorders is a compelling
counterpoint to the chemical-imbalance theory. The wikipedia article contains
some evidence and links to related research:

"A 2005 meta-analysis of schizophrenia revealed that the prevalence of
physical and sexual abuse in the histories of people diagnosed with psychotic
disorders is very high and has been understudied. This literature review
revealed prevalence rates of childhood sexual abuse in studies of people
diagnosed with schizophrenia ranging from 45% to 65%"

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

~~~
DataWorker
From the same page, “the logic that childhood trauma causes insanity has a
serious flaw: If the claim was true, the abuse of millions of children over
the years should have caused higher prevalence rates of mental disorders than
the literature reveals.”

This is similar to the problem with cannibis which many psychiatrists view as
the primary causal factor for schizophrenia and psychosis.

This is a methods problem in my opinion. See for instance this[1]. There are
so many cannibis users and so many people who have been traumatized in some
way, while the number of those developing schizophrenia is relatively much
smaller.

But ask a psychiatrist how many of their psychotic patients used cannibis
regularly and you get a pretty clear answer. The psychiatrists don’t get to
talk to the millions of cannibis users that don’t develop schizophrenia and so
they tend to form their own non-scientific opinions on the origins of
schizophrenia. Same with trauma. How many people get to adulthood without some
traumatic event occurring. Even on this board it’s got to be a small minority.

[1]
[https://marginalrevolution.com/marginalrevolution/2018/04/de...](https://marginalrevolution.com/marginalrevolution/2018/04/defensive-
gun-use-difficult-statistics-rare-events.html)

~~~
dsego
Most psychiatrists I talked rejected the notion that cannabis causes
schizophrenia. They mostly claim genetic causes. My personal opinion from
observing close people to me is that if you have predisposition, a
psychoactive substance can be enough to nudge you over the edge into
psychosis. It's a snowball effect. Of course, more likely is it would be
something that raises your dopamine levels, like speed (amphetamine) or
cocaine.

~~~
DataWorker
I’ve had the opposite experience but maybe it depends on the demographics of
the patients that those psychiatrists see. As this peice points out,
clinicians are increasingly likely to see the causal link even if researchers
are having a hard time establishing that link.[0] I think a large part of that
is due to measurement issues and methodological difficulties I alluded to. It
took many years to establish the link between cigarettes and cancer. There are
scientists who argue against global warming too. So much of science is driven
by bias and group think and the pendulum has perhaps swung too far on
cannabis. You might ask the psychiatrists you talk to what percentage of their
patients with bipolar/schizophrenic type disorders are regular cannabis users.

[0][https://www.nytimes.com/2019/01/17/health/cannabis-
marijuana...](https://www.nytimes.com/2019/01/17/health/cannabis-marijuana-
schizophrenia.html)

------
extragood
> At last count, more than 12 percent of Americans ages 12 and older were
> taking antidepressants. The chemical-imbalance theory, like the revamped
> DSM, may fail as science, but as rhetoric it has turned out to be a wild
> success.

This has always been my issue with psychology. It is inherently unscientific.
Given the preponderance of reported mental conditions, it's also insufficient.

My experience is that the patient is asked a series of incredibly open ended
questions. I was struck with the sheer variety of ways that I could respond.
And depending on my response, I would receive a diagnosis.

The following were my diagnoses from 3 different psychiatrists: Attention
Deficit, Seasonal Affective Disorder, Bipolar disorder.

There was absolutely no consensus, and it's no wonder. Years later a doctor
made the connection between chronic pain (Crohn's disease) and my lack of
energy.

I had been consuming anti-psychotics purely because of how I answered "How are
you feeling today?" and other similar open ended questions in the wrong way.

At that point I worked to improve my chronic pain condition, which was of
course the actual issue.

Neuroscience is the way forward to understanding mental disorders. In the
meantime, great care should be taken around psychology. The effect of an
uninformed approach can be devastating.

~~~
mindgam3
"> The chemical-imbalance theory, like the revamped DSM, may fail as science,
but as rhetoric it has turned out to be a wild success.

This has always been my issue with psychology. It is inherently unscientific."

To be clear, the chemical imbalance theory and the DSM are part of
_psychiatry_ , not psychology.

Broadly speaking, the difference between the two fields is that while they
attempt to treat the same issues, mainstream psychiatry (at least for the last
50 years) views the root cause as biological; psychology looks at social or
environmental factors.

If you replace "psychology" with "psychiatry" in your comment, it would make
more sense.

~~~
staticautomatic
This isn't really an accurate characterization. It's true that a lot of
psychiatrists focus on meds and biological root causes these days but lets not
forget that the whole school of psychoanalysis grew out of psychiatry. It's
simply wrong to say the whole field is focused on biological issues.

Likewise, clinician psychologists use the DSM regularly and do loads of
testing, including tests for things like personality disorders (which, again,
tend to be diagnosed using DSM criteria). Psychiatrists certainly _can_ do
testing but many of them (at least in private practice) refer out to
psychologists for it.

~~~
mindgam3
“lets not forget that the whole school of psychoanalysis grew out of
psychiatry. It's simply wrong to say the whole field is focused on biological
issues.”

That’s why I explicitly referred to “mainstream psychiatry”, rather than the
“whole field” as you imply in your inaccurate characterization of my comment.

I’ll grant you that the DSM may provide some value for understanding the range
of personality disorders at least at a high level. But it’s really messy.
Other tools may be more useful for understanding specific disorders, for
example the Hare psychopathy checklist.

[edit: replaced “testing tools” with “tools” in previous sentence]

(note that psychopathy isn’t even listed in the DSM, the closest thing is ASPD
- just another indication of how messy and imprecise this entire field of
personality disorders is, underneath the veneer of scientific rigor)

~~~
staticautomatic
Do you mean diagnostic tools? The DSM isn't a testing tool.

~~~
mindgam3
Fixed.

------
PaulHoule
Psychiatry doesn't need a biological theory, it needs a different approach to
service delivery.

Somebody I knew drank antifreeze one day, decided he didn't want to die after
all, then went to the emergency room. His family wondered where he was for 36
hours and then they found out.

A week or so later he went to a scheduled appointment at a psychiatrist's
office, had to fill out his name 10 times and then tell it to 5 different
people and was so enraged by the cluelessness that he went home and hung
himself that night. That time he succeeded.

E-room workers are trained to believe that the vast majority of suicide
attempters are seeking attention. That's true. Inside that population,
however, are a small fraction of completers for which a suicide attempt is the
mental health equivalent of a heart attack.

Unfortunately books have a long half life. People are still influenced by R.D.
Laing, Thomas Szasz, L. Ron Hubbard, and Erving Goffmann long after Ronald
Reagan set the insane "free" to roam on the streets. Involuntary commitment
was a problem in the 1950s, but today it can seem impossible to check into a
mental hospital even for a person who is in a full-blown psychotic crisis.

~~~
DataWorker
It’s not “approach to service delivery” it’s lawyers and medical ethics,
neither of which can be blamed on the profession itself.

~~~
PaulHoule
Also the issues of paying for it. You could say private health insurance is
bad, but just try Medicaid.

The helping relationship is fundamentally difficult too. Some people are going
to do the wrong thing and face consequences if they do. Sometimes what you
think is the right thing is really the wrong thing and vice versa. You can't
take responsibility for someone else's life in the end.

------
_bxg1
Highlight:

"Modern medicine pivots on the promise that portraying human suffering as
biological disease will lead to insight and cures. Inescapably, this
enterprise has a sociopolitical dimension. To say which of our travails can
(and should) come under medicine’s purview is, implicitly if not explicitly,
to present a vision of human agency, of the nature of the good life, of who
deserves precious social resources like money and compassion. Such questions,
of course, aren’t always pressing; the observation that a broken leg is a
problem only in a society that requires mobility seems trivial.

But by virtue of its focus on our mental lives, and especially on our
subjective experience of the world and ourselves, psychiatry, far more
directly than other medical specialties, implicates our conception of who we
are and how our lives should be lived. It raises, in short, moral questions.
If you convince people that their moods are merely electrochemical noise, you
are also telling them what it means to be human, even if you only intend to
ease their pain."

------
mnm1
> Nor does ironic accurately describe the actions of an industry that touts
> its products’ power to cure biochemical imbalances that it no longer
> believes are the culprit. Plain bad faith is what’s on display, sometimes of
> outrageous proportion. And like all bad faith, it serves more than one
> master: not only the wish to help people, but also the wish to preserve and
> increase power and profits.

This sums up psychiatry and psychiatrists in general. Corrupt pill pushers
willing to make money no matter what the outcome for the patient and what it
takes. If it takes lying, so be it, as long as it's well intended. If it takes
many people committing suicide after buying their bullshit chemical imbalance
fiction even they don't believe, so be it. Such disregard for other human
lives would usually land one in jail, but we have a whole profession built on
it. At the same time, we lock up drug dealers who may potentially and
inadvertently have part of the puzzle (lsd, psilocybin, mdma, ketamine). The
entire existence of the field is absurd. One book, the dsm justifies these
quacks pushing whatever they want and using their patients as guinea pigs in
ad hoc experiments that often go wrong and lead to worse outcomes, including
death. All because we refuse to believe that things like depression and
anxiety might be caused by say an unhappy relationship, family problems, an
unsatisfying job, lack of friends and community, and so many almost obvious
deficiencies in our society. Absurd.

------
outlace
Psychiatry indeed has a pretty bleak history, and it's fair to criticize that
history. It is true that the DSM as it categorizes mental disorders is not
biologically valid in general, however, most psychiatrists today recognize it
just as a communication tool. Two psychiatrists with patients exhibiting
similar symptoms can be concisely described using DSM vocabulary.

It is also necessary for billing purposes. Insurances want to put labels on
things so they can price and track things. This is true of all medicine,
however. When do you call high blood pressure too high? Greater than 140 mmHg?
130? Someone has to pick an arbitrary threshold for practical reasons.

"The pathological basis of almost all mental disorders remains as unknown
today as it was in 1886" (article quote) I don't think this is true. We don't
know enough to make targeted treatments quite yet, but we do know a lot more
about the brain now and have much more reliable theoretical conceptions of
mental illness.

There is a ton of research going on in understanding mental illnesses at
computational and circuit levels, and we're already starting to see the fruits
of that research. Researchers are developing targeted treatments using
transcranial magnetic stimulation (TMS) and similar modalities to directly
perturb circuits that are believed to be deranged.

I think psychiatry will change significantly over the next decade or so as we
learn what is wrong with a specific individual's brain and intervene directly
at the circuit level. I don't see how drugs will play a major role in this as
it is very difficult to develop a drug that could target specific circuits.

This time really is different. (Psychiatrist in training here)

~~~
50656E6973
>as we learn what is wrong with a specific individual's brain and intervene
directly at the circuit level

What is the scientific basis for the theory that mental illness is due to
"deranged circuits"?

~~~
outlace
Well neural computations happen at the level of individual neurons up through
complex multi-neuronal circuits, cognition and behavior are the result of
neural computation, therefore if cognition is abnormal then computations at
the level of neurons up to circuits must be deranged. Nothing fancy.

~~~
50656E6973
>cognition and behavior are the result of neural computation

That's like saying if someone gets shot and dies it's because they merely had
a faulty brain -- it's ignorant of the actual cause.

Neurons don't exist in a vacuum, they respond to social, environmental, and
biological inputs.

How does psychiatry scientifically decide if a persons deranged mental
behavior is due to mere deranged circuits or deranged social, environmental,
or biological inputs?

~~~
outlace
I see where you’re coming from. I think a great deal of mental illness is
social and environment. We did not evolve to live in the circumstances of
developed societies. So absolutely if we could change environment and social
factors that would help a lot.

But just take depression for example. Let’s say Bob goes to a psychiatrist
with depression. Bob recently lost his job and his girlfriend left him. He has
every reason to be depressed. He would probably feel a lot better if he had a
job he likes and wasn’t so alone. The problem is he’s too depressed to look
for a job or to go out and meet new people, the things that would help his
depression. This is where I think psychiatry can be helpful; some people just
need something to break them out of their depression for long enough to be
able to make the social/environmental changes in their life that will help
them in the long run. Therapy alone may be enough for some people but not for
everyone.

~~~
50656E6973
>some people just need something to break them out of their depression for
long enough to be able to make the social/environmental changes in their life
that will help them in the long run

I agree, thanks for the honest response!

------
gerbilly
I think it's very easy to be dismissive of counseling.

Of course it isn't an exact science, maybe not even a science at all.

I like to think of it this way.

Think of your mind like an iterative non-linear system with thousands upon
thousands of inputs.

It operates completely by cause and effect, but because it's non-linear, that
doesn't mean it's easy to figure out how it got stuck in a loop.

>In the mathematical field of dynamical systems, an attractor is a set of
numerical values toward which a system tends to evolve, for a wide variety of
starting conditions of the system. _System values that get close enough to the
attractor values remain close even if slightly disturbed._ [1]

Sometimes when our mind gets stuck, the efforts on our part to get out aren't
enough to get us unstuck.

Psychologists or psychiatrists are people who are familiar with _some_ of
these mental paths and how it can lead people to become stuck.

They are also familiar with some of the paths that lead to an exit from those
undesirable states.

They are attempting to deal with such a complex system, that I don't think
it's fair to hold them to the same standard as the so called 'hard sciences.'

For another perspective on the problem of 'getting stuck', from a Buddhist
point of view (which is also based on cause and effect) see [2].

[1]
[https://en.wikipedia.org/wiki/Attractor](https://en.wikipedia.org/wiki/Attractor)

[2]
[https://www.dhammatalks.org/books/KarmaOfQuestions/Section00...](https://www.dhammatalks.org/books/KarmaOfQuestions/Section0009.html)

~~~
viivaux
Your entire argument works just as well for shamans as psychiatry; except the
drugs shamans use have far fewer and more benign side-effects, with thousands
of years of history instead of 20-40.

Many of the psychiatrists I have encountered "believe" in their medications,
and when questioned as to how (and how well) the drugs they were informed
about work have no real substantive argument for all their years of med
school.

But fuck, do they get paid better. You won't see many shamans on a Pfizer
sponsored golf trip in Hawaii.

~~~
everdrive
I think this is a very valid counterpoint, but I'd just like to point out that
Shamans must have actually helped people throughout history as well. Now, I'd
argue it might have been some combination of talk therapy, social expectation,
and whatever else.

------
Pimpus
> The biology of mental illness is still a mystery, but practitioners don’t
> want to admit it.

I believe we started with a faulty premise, that perfectly natural states of
mind are an "illness". They may not be pleasant to behold but our brains have
these mental states built in, for whatever reason. The mental health system
wants to aggressively impose conformity of psychology across the population,
which causes real mental illness. And the most evil thing we do is giving
psychoactive drugs to kids.

~~~
tremon
_I believe we started with a faulty premise, that perfectly natural states of
mind are an "illness"_

I tend to agree, but this is only partly true. It isn't because something is
"natural" that it is therefore healthy and desirable. Some mental states,
whether genetic or environmental, are very debilitating to the individual that
has to live with them. So there is value in trying to "cure" certain mental
afflictions.

But yes, the field of psychology suffers from a fashion-based ideology that
appears to want to mold every individual to the same narrow (and flawed)
ideal. But in my experience, this fashion trend diminishes with expertise:
most behavioral and forensic psychiatrists I've sproken explicitly eschew that
type of prescriptivism.

------
setgree
Related: A psychiatrist who didn’t believe in mental illness (2013)
[https://news.ycombinator.com/item?id=19242553](https://news.ycombinator.com/item?id=19242553)

------
ams6110
So, let's say I think I am depressed. Should I seek out a psychiatrist, a
psychologist, or a clinical social worker?

I sort of think psychiatrist is someone who treats personality disorders like
schizophrenia, bipolar, borderline, etc. Almost always will involve use of
medication as primary treatment.

Psychologist more for depression, anxiety, mood disorders. Not an MD so can't
prescribe meds but often works with the patient's primary care physician if
this is needed.

Clinical social worker for .... not sure? Interpersonal issues, behavior
issues, anger management, etc.?

But no idea if that is even close to being on target.

~~~
penagwin
Psychiatrists can prescribe medication (I think the "ch" are related -
psychiatry and chemical?). They _can_ do what I'd call "conversational
therapy" but they're main job is dealing with medication.

Psychologists are usually more of a traditional conversational therapy - and
there's different forms of that, CBT, DBT, etc.

Social workers - I'm not 100% sure but in my experience they're more of a
"intermediary" \- they diagnose and refer you to an appropriate therapy. That
or they're more of a "general psychologist" say with a school. I don't think
you really meet with them regularly. There's a huge shortage of
Psychiatrists/Psychologists at least here in Michigan, and a becoming a social
worker requires less schooling I believe.

(I've suffered from depression for years, I've met many doctors, social
workers, etc. and currently see a Psychologist and Psychiatrist regularly)

~~~
staticautomatic
You've got this somewhat wrong. It's true that many psychiatrists these days
focus on med management rather than therapy, but until maybe 30 years ago
psychiatrists were actually the only mental health professionals who were
allowed to become psychoanalysts, the folks who more or less pioneered talk
therapy.

Also CBT/DBT are not forms of psychodynamic therapy (which is what people
usually think of when they think of talk therapy). That's why they're called
"behavioral" therapies.

~~~
penagwin
My answer is based on what I find true today and from my experience. I'm only
20 so that explains that part.

Not sure what you mean by "CBT is not a form of talk therapy". The first
sentence according to the Mayo Clinic is "Cognitive behavioral therapy (CBT)
is a common type of talk therapy (psychotherapy)." [0]. Are you confusing CBT
with CBD?

[0][https://www.mayoclinic.org/tests-procedures/cognitive-
behavi...](https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-
therapy/about/pac-20384610)

~~~
staticautomatic
OK let's call it "psychodynamic" instead of "talk"

~~~
penagwin
I'm just using a phrase that the average joe understands (And is also used by
the Mayo Clinic). We can agree to disagree if you want, but to be fair what I
call it doesn't really matter, I'm but a young lowly programmer :)

~~~
staticautomatic
It matters in the sense that the difference between a "list" and an "array"
matters. I'm just trying to clarify the language so anyone who reads is on the
same page. When most people think of talk therapy I think that they think of
lying on a couch and not stuff like CBT but perhaps I'm wrong.

------
bellerose
The topic of Psychiatry is interesting to observe. I'm reading pessimists vs
optimists in the comments and find it amusing because of the impossibility of
knowing who is right. I want to believe society has best intentions and is on
the right path. Yet what does the science really exhibit? A lot of psychiatry
has been horrific the past hundred years and cases exist where the person does
benefit. So what's the majority verdict because even snake oil has some
satisfied customers.

------
doitLP
Seems like oil companies and climate change denial.

To paraphrase, when a person’s paycheck depends on not understanding something
it’s hard to make them understand it.

The voting on disorders that go into the DSM would be laughable if it wasn’t
sad and creepy from a norm-defining control perspective.

------
marssaxman
I think psychiatry is in for an interesting surprise soon when it discovers
that the information it lacks has already been uncovered through an extensive
series of informal experiments being conducted in a collective, ad-hoc,
slapdash fashion through a seemingly unrelated field - that is, the world of
recreational psychedelics. There's a whole global community of pioneers who
have been quietly working hard at understanding the insides of their own
brains for at least two generations now, and they've made a lot of progress.
To make things even more interesting, many of these people are connected with
the world of technology and computing, which has been expanding rapidly into
an understanding of consciousness through the work on neural networks, deep
learning, and artificial intelligence. All of these worlds are about to
collide, in the next 10-20 years, and something really interesting is about to
happen.

~~~
cairo_x
Nonsense. I have Bipolar. Psychedelic microdosing consistently triggers a
manic episode. Extreme trips are known to trigger psychosis in those with
related mental conditions. There is very little empirical evidence that
microdosing has any benefits at all. James Fadiman is a serial fabulist. The
original creativity study he was involved with (and I use the term involved
very loosely), and constantly keeps harping on about, was a terribly conducted
farce. Just keep that in mind.

~~~
marssaxman
I'm sorry to hear about your struggle. These things can be difficult and not
every tool works for everyone. Keeping one's mind in balance and on track can
be a lot of work. I don't know who James Fadiman is and I can't speak to the
science involved, but from what I've seen in the experiences of people around
me who have had mental health struggles, a mild form of mania can be a really
useful state of mind for getting lots of work done. Mania becomes a problem
when people get so wrapped up in the storm of thoughts that they can no longer
communicate effectively with the people around them, but as long as people
stay grounded and keep some empathy open, being in a state of mind where you
feel full of energy and connected to the big picture really helps in
motivating yourself toward productive action. Nothing lasts forever, people
need space and time to rest and recharge, but nudging yourself a bit in that
direction isn't necessarily harmful if you have some work to do.

------
OneWordSoln
The problem with psychology and psychiatry is that they have _ZERO_
understanding of the definition of a baseline healthy human being who has an
integrated set of physical instincts, emotional responses and mental processes
such that they lead a fulfilling, happy life. Without a definition for
"health" there can be no defintion for disease. Of course, our modern medical
systems are rarely concerned with cures and are thus ultimately content with
the financial outcome that results from treating the symptoms. This is a
result of the for-profit corporate structure's dominance of all aspects of our
world, and affects what gets studied and, more importantly, what does not get
studied. (See: Chris Rock's "ain't no money in the cure" bit.)

As such, nutrition science is literally less than four hours of medical school
education (my wife's first son is finishing his residency at his first-choice
program, one of the East Coast's premier programs). [To learn more about this,
I highly suggest the fantastic documentary "Eating You Alive". I have switched
to a whole food plant-based diet as a result and feel better every week (it's
been about eight weeks now, with a few cheat days along the way).]

We are only now realizing the direct link between our gut biome and our mental
health, and our gut biome is directly related to the foods and/or poisons we
ingest. Once again, the for-profit corps provide foods that harm us but cannot
be proven to do so, medicines that harm us but cannot be proven to do so, and
an environment polluted by their machines and chemicals whose effects cannot
be measured enough to hit them in the only place they care about: their purses
via tort law. They have crafted the laws and staffed the regulatory agencies
while lobbying the government to dismantle and detooth those agencies'
abilities to provide scientific oversight. Every single one of these factors
affects our mental health, and all the while there is very, very little
research being done on nutrition and how to measure toxicity and remove it
from the body.

And yet that only peripherally approaches the truth of our human baseline
because our human nature goes deeper still, and yet that pervasive corporate
mentality to put profit over human well-being is intrinsically related to what
we are as _moral_ beings. We each have a moral compass, however subtly
different our societal tunings. It is an intrinsic part of our human nature,
and our lack of moral teaching as societies is the source of all our problems
including our inability to address psychological issues. We have sick
societies the world over and it is foolish insanity to think that mental
illness is not an absolutely natural result of such selfish, competitive
societies.

The misunderstanding of the cocaine rat study illustrates this all-too-well.
When the studies were re-run years later with non-overcrowded, healthy
environments the rats wanted nothing to do with the cocaine.

The solution to all our problems is to selflessly choose, first individually
and then collectively, to form cooperative, caring societies instead of the
dog-eat-dog world of economic competitiveness we currently live under,
competitiveness that oft leads to physical competitiveness. Beyond promoting
mental and physical health, such compassion lets one see the true nature of
the other person, which is essential when one is dealing with psychopathy or
sociopathy. Psychiatry is built upon a lack of compassion and its systemic
harms all result from their hubris, ignorance and profit motive.

Even our precious traditions that should be leading us towards that loving
ideal have been conquered by the animalistic persons who live for mammalian
alpha-dominance games within and among groups, be they defined by class,
ethnicity, form of religion, political affiliation, gender identity or sexual
preference. We _must_ live in groups to survive and prosper and our moral
nature's purpose is to nudge us towards peaceful cooperation so that we may
_ALL_ happily explore this world, whatever our predilection. This is why there
is a Law of Karma that only works at the human level, where we reap the
happiness or unhappiness we sow in others; it is the feedback mechanism that
nudges us towards humane cooperation and away from animalistic
competitiveness. Our Creator does not intervene because the gift of free will
to choose either selflessness or selfishness, love or its antitheses, wisdom
or ignorance, the good of the whole or the benefit of the few -- that gift of
free will is freely given. Thus, a group of Nazis can go about their hateful,
oppressive business just as freely as we Sufis can ours. It is up to each one
of us to choose the better path, for ourselves first and then as societies.

As the great Poet of God, Rumi said, "The Way goes in.", but in this
materialist world culture of self, there is a communal disdain for and utter
denial of the internal spiritual pursuit that leads us to moral perfection,
first individually and then collectively. As such we cannot comprehend the
difference between physical mental illness (caused by disease or nutritional
imbalance) and a person who's just a selfish, sociopathic bastard and a person
who is just naturally having a difficult time dealing with our sick society
and the sick world that is making us physically ill via its pollution and
constant stress.

The fundamental truth is that no one's health, mental or physical ("Not two,
not one"), can _EVER_ be successfully treated without clear-minded,
compassionate care, and that must involve first getting them away from
negative environmental factors and into a nurturing environment. Creating such
a compassionate society requires compassionate human beings, and that requires
the humble work of self-reflection and self-evolution beyond the negative
traits we all possess.

Peace be with you all. We love you.

------
nickhalfasleep
astrology became astronomy

alchemy became chemistry

we're still waiting to find out what psychology and economics are gonna turn
into

(With apologies to Dr. Taber, who originated the joke.)

------
zxcvvcxz
Psychiatry is not a science. And their business model literally depends on you
not getting better. Those $200/hr sessions aren't big business unless you keep
coming back for more.

While we're at it, let's prescribe some pills for underlying deficiencies we
can't measure in the first place.

~~~
algorithmsRcool
I don't think your first point very well thought out.

Any doctor (or mechanic, accountant, etc...) could benefit by providing
false/sub-standard services to keep the client returning regularly.

As for the measurement, it's almost entirely based on feedback from the
patient.

I can see how a depressed or mentally ill person could be more susceptible to
accepting medication that wasn't in their best interest, but that problem
seems intrinsic to all medication.

~~~
zxcvvcxz
Wrong. Doctors would (hopefully) lose licenses and have big legal
consequences. Mechanics are also subject to some form of objective measurement
as even the average driver has some sense if a problem is being fixed or not.

But psychiatry? Forget it. You pay to talk to someone, they have a nice couch,
soothing voice, make you feel good for an hour, but nothing really changes.
But hey, I liked that hour, I should keep coming back!

------
soup10
Modern Psychiatry in a nutshell:

Patient acting crazy? Label them schizophrenic, schizo-affective or
bipolar(doesn't really matter which, they are all subjective); Hit em with
some major tranquilizers and dopamine inhibitors and rack up that sweet
insurance money.

~~~
cairo_x
I think you mean American Psychiatry.

Your use of Schizophrenia and Bipolar as examples are both at the top of the
heap in terms of what modern psychiatry has been successful in managing.

Depression, as a general term, and anti-depressants on the other hand, not so
much. The world of psychology is far more of a fail. CBT therapies,
mindfulness, and various other fads have all turned out, in meta-studies to be
either hot air or incompetent application of the scientific method.

The human brain is the most complex organ in the known universe. At least
psychiatrists are required to have an MD to practice. Psychologists just wave
their hands around and maybe scrape by on some basic statistics to get
qualified to rummage around like demented apes in the windmills of your mind.

~~~
DanBC
CBT has a large evidence base and appear to work for 50% to 60% of the people
who take it. We have huge amounts of data from the English NHS IAPT scheme.

That number needed to treat is pretty good. You may want to compare it to
other routine medication such as statins or blood pressure meds.

~~~
cairo_x
CBT has been debunked by multiple meta-studies. Psychology, as a science, is a
joke. The brain is the most complex structure in the known universe, but to be
a psychologist you don't need even a basic MD. It should be struck off as a
science all together.

