

The Illusions of Psychiatry - Maci
http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/

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diogenescynic
Depressive realism is the proposition that people with depression actually
have a more accurate perception of reality, specifically that they are less
affected by positive illusions of illusory superiority, the illusion of
control and optimism bias. The concept refers to people with borderline or
moderate depression, suggesting that while non-depressed people see things in
an overly positive light and severely depressed people see things in overly
negative light, the mildly discontented grey area in between in fact reflects
the most accurate perception of reality:
<http://en.wikipedia.org/wiki/Depressive_realism>

~~~
schrijver
I’ve read some findings that saw depressive patients perform better on risk
assessment tests than people who were not depressed. It doesn’t surprise me.
Because having an accurate perception of reality is problematic. One actually
needs an overly positive view of live to a) enjoy it and to b) get things
done.

You can get consolation from your past only because you forget the pain more
quickly than the beauty. You can look forward to the future only because you
project the exciting moments rather than the boring ones (which will surely be
more numerous). And the most relevant in the context of Hacker News: when you
get enthousiastic about a project, you tend to grossly underestimate the time
and effort it will cost to complete it. Had you been realistic at the outset,
you might not have started at all.

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dr_
The article is correct in stating that extended psychotherapy may be as
helpful as psychopharmacology in treating many conditions but the problem
remains is that it is not well reimbursed. That is something the government
needs to take a lead on with Medicare and Medicaid payments.

Some of the most egregious examples actually take place with the elderly, many
of whom may be diagnosed with a form of dementia and are then placed on "anti-
dementia" meds, which are almost useless in their efficacy but neverthless
prescribed because there is "no other option" The other option, really, is to
not institutionalize them, offer therapy sessions in a supportive home
environment where assistance is available and with easy access to family
members. Right now though, the government won't pay for much of this.

~~~
hammock
The other option of course, is to shrink medicare (and payroll tax) and let
people spend money the way they want to.

~~~
jshot
That would require all individuals to have the disposable income to cover all
their own medical costs. The further down the income ladder you go, the less
an option it appears.

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j_baker
_One would be hard pressed to find a two-year-old who is not sometimes
irritable, a boy in fifth grade who is not sometimes inattentive, or a girl in
middle school who is not anxious._

Just like one would be hard pressed to find an adult who is not sometimes full
of themselves, sad, or paranoid. Mental illness is usually an exaggeration of
some normal behavior. There's a world of difference (albeit a sometimes
difficult to see world) between being inattentive at times and not being able
to function normally due to not being able to pay attention.

I don't mean to say that everything is fine with psychiatry. I just think this
fundamental distrust of it is not good. I personally wouldn't be where I am
today without it.

~~~
danenania
Ah, but what does it mean to ´function normally´? And why is that a worthwhile
goal, especially if 50% of population needs to be pumped full of drugs to
achieve it. If a guard in a torture camp experiences anxiety and despair, is
that mental illness or an appropriate response to a perverse situation? You
can ask the same question, albeit on a much lesser scale, about energetic ten
year olds forced to sit through boring classes and learn by rote.

There is a lot of bs in psychiatry. That doesn´t mean there isn´t some wisdom
there or the potential to help some people, but it is built on top of an
extremely flimsy pseudo-scientific foundation, and it´s questionable whether
it helps as many people as it hurts. If you find a good psychiatrist and it
works for you, that´s great. I still think a fundamental skepticism is
warranted, especially given the potential for serious physical and mental
damage caused by these (very powerful) psychoactive drugs.

~~~
singular
I think to function normally is to not be disturbed by things which bear no
reasonable relation to external reality - that to me is the fundamental
indication that there's _something_ wrong, which varies from serious mental
illness (e.g. psychotic delusions) to low-level depression.

It's dangerous to dismiss the whole thing as b.s., it's like throwing the baby
out with the bathwater - we don't want to validate the idea that 'we can't
define normal, so therefore there is no basis on which to call somebody
mentally ill'.

I think a lot of the reason these things are 'soft' is that we don't have a
strong enough understanding of the brain, and certainly no strong diagnostic
tools to be able to analysis what's going on in someone's mind in order to
determine whether something is 'wrong' for a given definition of wrong. Until
then we have to hack away around the problem.

I do agree, however, that skepticism is vital in this area as in every other.

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Alex3917
If anyone wants to know more about why the subjectiveness of the DSM is
problematic, check out Crazy Like Us by Ethan Watters, and then also this
Wired article:

<http://www.wired.com/magazine/2010/12/ff_dsmv/>

I realize this is only a book review and not an attempt to fully explain the
issues, but even still the author of this piece doesn't do the best job at
actually explaining the various issues. (Albeit it's still a good read.)

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Maci
Part 2 of
[http://www.nybooks.com/articles/archives/2011/jun/23/epidemi...](http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-
mental-illness-why/)

Previously discussed here: <http://news.ycombinator.com/item?id=2639359>

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Produce
A complete disregard for using psychedelics to treat psychological disorders
is the reason I can't take modern psychiatry seriously. We have compounds
which are capable of producing deep, lasting changes yet the field is so
political in nature that we simply brush them off to the side. Just as there
were serious consequences stemming from the influence of the church on society
a couple of hundred years ago, so it is with business today.

~~~
singular
You have to be careful with psychedelics - they can potentially cause very
serious problems as well as (allegedly) improve things.

A close family relation and a number of his friends took relatively small
amounts of LSD and as a result experienced very serious mental health issues,
anecdotal but I think not unrelated, also I believe this is backed by studies.

~~~
Produce
Psychedelics are tools, albeit very sharp ones. I could use my knife to kill
myself or chop some vegetables for a healthy salad. I think that the risks are
greatly diminished when psych's are used the in right setting, for the right
purpose. Failing those safeguards, I imagine that the psychiatrist would have
some anti-psychotics and benzodiazapines to pull the patient back out. Also, I
imagine that in a therapeutic setting the patient would be evaluated to
determine their risk of developing schizophrenia or other mental illnesses,
and cut off if said risk is too high.

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atsaloli
More quotes from psychiatrists on the subjectiveness and ineffectiveness of
the DSM:

[http://www.cchr.org/sites/default/files/education/appendix/0...](http://www.cchr.org/sites/default/files/education/appendix/05-fact-
sheet-1.pdf)

[http://www.cchr.org/quick-facts/disorders-voted-into-
existen...](http://www.cchr.org/quick-facts/disorders-voted-into-
existence.html)

