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Scientists open the ‘black box’ of schizophrenia with dramatic genetic discovery (washingtonpost.com)
296 points by salmonet on Jan 28, 2016 | hide | past | web | favorite | 107 comments

As a person with a family member who suffers from this disorder, this makes me really happy. It is truly an awful disorder that has very unexpected and terrible effects on the whole family. I was thrilled to hear Ted Stanley donated $650M to the Broad institute in 2014. It looks like that donation could be paying off.

Edit: I'm glad to hear that he learned of this discovery before his death this month [0].

[0] - http://www.bizjournals.com/boston/blog/bioflash/2016/01/broa...

Armchair hypothesis: This aggressive pruning may not have any affect on normal brain functioning in some cases. For example, it might prune a whole sub network off the normal day to day network, leaving a "dark" dysfunctional subnet disconnected from the regular day to day brain's network.

Then, if someone chooses to be under the influence of a drug that enables new pathways to form (pot, psychedelics etc), this "dark" network can potentially be reconnected. The emotional response to this connection (good or bad) strengthens this "bridge" connection, leaving it connected when the influence of the drug wears off. Now the person has a faulty pruned network as part of their normal day to day network. Crap.

The trick from here is to reinforce the normal network and ignore signals from the faulty network until the bridge path's significance subsides enough to not enter day to day functioning.

The brain is not wired with few enough interactions to actually isolate a network like that. The number of connecting synapses is massive, outnumbering neurons by 100-1000x. And more importantly, the connections are spread all over the place.

E.g., when I was in grad school for neuroscience, I attended a multimodal sensory symposium where I learned that huge numbers of neurons in primary sensory cortices (V1, A1, etc) responded to stimuli from other senses. E.g., 20% of your primary visual neurons fire when you get auditory stimuli.

You're assuming these networks can be disentangled. There's no evidence that the brain is modular in the way you propose.

It seems this would be under the assumption that the "dark" network is simply disconnected from the "primary" network, if indeed such a thing exists.

One would assume, especially with the measurable loss in gray matter, that these networks are being destroyed and thus couldn't be reconnected even if stimulated to do so.

But perhaps pruning isn't such a binary process and it is these damaged -- but not destroyed -- networks which cause such severe dysfunction.

I'm excited and grateful to the brilliant minds which give hope to so many. A+, would science again.

Not every person with schizophrenia has used drugs.

No shit. But there is already a link between drug use and sudden onset schizophrenia, which is what I'm talking about here.

Similarly armchair: An alternative to reducing the bridge might be trying to actively increase it - the brain reconfigures (right?) so perhaps we can with careful drug use open up the dark area and allow the regular brain to use that sector again. The difference between cleaning a room in your house and nailing the door shut.

Maybe that is in part what is happening anyway? Or is there evidence to show that the section of the brain becomes under-utilised. (no I didn't RTFA; will get right on it!)

I am pretty sure you hit the limit of the network analogy.

>the brain reconfigures (right?)

Right. New neurons, axons, synapses, and more are constantly being generated in the brain (though, perhaps not under certain conditions).

It seems unlikely that any area of the brain would be unconnected, or at least, unconnected for very long.

It's knowing how to manage a person or situation once you open up a 'dark' area; I'd prefer the terminology that an area is 'dark' is rather referred to as something you're simply conditioned to (or suppressed/repressed) - it's underneath your conscious level, as otherwise it would leave you less able to function in day-to-day life.

Practicing meditation is a kin to understanding oneself.

"I found it easier than many to accept the epistemological notions of the world internal and external as dependent concepts enforced by ignorance and perceptual challenges."


Indeed. Great read, thanks.

How do we distinguish the body's reaction to mental illness from its cause? Wild unprofessional speculation of course, but what if this mass destruction of grey matter was just an attempt to "fix" improperly wired neurons causing schizophrenia in a drastic way? The "synaptic pruning" genes might have evolved as a solution in lineages where schizophrenia was frequently passed on/caused by parents' behavior. Too silly / crazy?

Ive also heard it said in seemingly respectable articles that no one is sure if the grey matter dies off because of the disease itself or because of the medication to treat the psychotic symptoms.

You'd think you could just look at some posthumous biopsied brains of untreated schitzophrenics for comparison.

Here's a somewhat relevant study:

"The Influence of Chronic Exposure to Antipsychotic Medications on Brain Size before and after Tissue Fixation: A Comparison of Haloperidol and Olanzapine in Macaque Monkeys"


Important caveat: this is a genetic association study, which means that a small but statistically significant fraction of those studied with schizophrenia have this variant compared to those who do not have schizophrenia; I.e., this variant is not responsible for schizophrenia in all individuals, it just might contribute in some. Even that is not clear yet, we just know the correlation exists.

I am really interested to know if this allele (C4A) has been under selection or not. The fact that it is in the middle of locus of immunological genes could mean it has just been carried along with the actual selection being for immune function against infectious disease.

It wouldn't be the first mental illness possibly caused by an overactive immune system


Well a lot of mental illness associates with "promiscuousness" (hate that moralistix word) so there is an easy argument for heritability especially for onset at peak fertility

Historically being promiscuous was associated with a low effective fertility. The reason why is if you are a peasant the resources required to raise a child to adulthood need both a mother and a father. The children of single mothers just starved to death.

The disordered thinking of schizophrenia invariably reflects the cultural biases of the individual. Pruning, if that is a cause, must affect the filter that allows most of us to reject the thousand crazy ideas that pop into our heads each day, while permitting the few reasonable ones.

This may be why there is an environmental component. If a potential schizophrenic with an overly-pruned filter is exposed to the idea that a magical god came to earth and sacrificed himself to give us eternal life, and if that idea is presented culturally as real, it may be impossible for the schizophrenic to filter that and place it in the DMZ of fantastical-but-culturally-prevalent notions that the rest of us use.

Imagine how disordered one's thinking might become if we had no ability to interpret the spew with "a grain of salt".

The odd thing is that 'disorder' might contribute to one's ability to think 'laterally'. Some schizophrenic tend to exhibit certain amounts of clanging. In extreme instances it turns into what's referred to as 'word salad' (presumably the desire to have the alliterative sounds overwhelms one to the point where one no longer cares about conveying meaning). At the same time, a 'normal' mind definitely appreciates clanging when used as a well executed literary component (say, exhibited by Larkin or Cummings).

Schizophrenia is a real interesting mental disorder because it touches on so many other disorders (e.g. speech impediments like echolalia often seen in those on the autistic spectrum) and it's tendency to exhibit itself relatively late in life (early to mid 20s is very late for on-set as I understand it re: mental disorders).

The Post did a pretty good job conveying a complicated concept in an approachable manner to those who aren't in the field, but as always the primary source is useful, so here's the pre-print: http://www.ncbi.nlm.nih.gov/pubmed/26814963

n.b. My father is in the field and I sent this to him when I saw the mention of Eric Lander (they worked together at Whitehead before Lander left to direct Broad). He regards Lander as highly as I regard DJB. Often the media blows things up, I'd imagine these findings are fairly major within their field, if only because it survived the peer-review process into Nature.

What does your father think of the whole CRISPR fiasco?

IMO, what is most interesting about schizophrenia is complex functions with direct feedback still work. People can still move, recognize objects that they see, understand language etc. It's a problem with internal highly abstract concepts which is a fraction of what the brain does. But, at the same time that internal world can get really messed up.

Yes people with schizophrenia do exhibit specific abnormalities that are a reflection of the culture, but the real environmental factors that lead to schizophrenia are things like stress, which incidentally lead to synaptic pruning.

I think it is better to think of this aggressive pruning idea as a general loss of computational ability. You are correct that a lot of the brain spends energy rejecting hypothesis about the world, so less computational ability would inevitably lead to less filtering and more suspect beliefs.

The brain and nervous system is a mixture of excitatory and inhibitory subsystems. One hypothesis is for certain mental behaviors or dsyfunctions they can be out of balance. What causes the imbalance- genetic, geometery, chemistry, development- is the 64 billion dollar question.

> In patients with schizophrenia, a variation in a single position in the DNA sequence marks too many synapses for removal and that pruning goes out of control. The result is an abnormal loss of gray matter.

I find this to be a terrifying thought. Just the idea that I have some code inside me that's marking synapses for removal, and then they get removed. Those are my memories!

But I'm very excited about this. I'm not a geneticist by any means, but I hope the answer is as simple as replacing this gene with CRISPR.

Actually, the brain is designed to prune. You're born with way more neurons than you need, and you remove the ones that don't wire up properly as you grow. In fact, insufficient pruning probably leads to different diseases. (Was a neuroscientist, but not a neurologist, so I'm guessing epilepsy... and maybe some forms of autism?)

> Just the idea that I have some code inside me that's marking synapses for removal, and then they get removed.

Or maybe your whole mind would be just random noise without such process.

>Those are my memories!

Well, they fell out of scope.

CRISPR won't help for this, it is too imprecise for gene therapy.

That is incorrect: off-target activity is virtually non-existent in CRISPR-CAS9 mediated transformation. Targeting oligonucleotides can be deliberately designed to be less specific, thereby targeting a family of sequences, which is very desirable for e.g. knocking down a gene family. However, specificity is trivial to achieve when desired.

Precision has two components: specificity and sensitivity. While recent versions of CRISPR make it possible to avoid off-target sequences, its impossible to guarantee cutting. Also, while you can make a cut, engineering a specific substitution is still largely a crap shoot. Not suitable for gene therapy.

I'd be curious to hear how we developed successful pharmaceutical treatments for schizophrenia without knowing how the disease works. Was it just luck?

I'd go careful with that "successful" label there. Anti-psychotic medications are good at some narrow range of stuff, but come with considerable side effects. People with schizophrenia die earlier (by about 20 years) than other people, and some of that is because of the damage done by medication.

The only reason the medication is used is because untreated psychosis is often catastrophic.

Just look at the effects the anti-psychotics have had on Daniel Johnston. That it's preferable to untreated schizophrenia shows just how awful schizophrenia is.

We frequently don't know how the treatments to many ailments work either, especially when it comes to anything related to the brain. There's a lot of "X seems it might make Y better, let's test and see if it does, repeat."

Psychiatric medication does not generally target and resolve the "root cause" of an issue, but applies some very blunt instruments to make living with the effects less bad. We have the chemistry to apply some very broad levers to moods/emotions/energy levels, for example, which are helpful in the management of depression. We cannot reach in "fix" the root cause, but often when a patient is allowed to exist in a less-actively-torturous state for a while they get better on their own.

It's somewhat controversial, but schizophrenia treatments can be (arguably) completely ineffective and worse than the disease itself. Robert Whitaker has written multiple books[1][2] about it. (See wikipedia[3][4] for reception by the medical community.)

The argument is essentially that schizophrenia medications were originally developed as a chemical replacement for lobotomy, the newer versions ("atypical neuroleptics") only had to prove themselves no less safe than those original treatments, the drug companies skewed the research by giving patients one large dose of the old treatments versus several smaller doses spread out over time of the newer ones (meaning the new neuroleptics may have actually been less safe than the drugs developed for chemical lobotomy), and recovery rates are actually much, much higher for patients never treated with anti-psychotic medications. The argument claims the US actually has among the lowest schizophrenia recovery rates (~5% in the US vs ~45% for untreated patients who receive non-medicative care) due to the reliance on medication. (Some charts on that: [5][6][7]. Better sources available through [1] and [2].)

IANA doctor or psychiatrist, simply summarizing the anti-medication position. Drug companies and many psychiatrists clearly argue they're necessary medications, and for the absolute worse cases they probably are, and you can certainly find a lot of people who claim they or their family members were "fixed" by medication (though it should be noted that, historically, the same arguments were made for lobotomy and electroshock therapy as well). Schizophrenia also affects people differently, being completely disabling for some and less so for others, which obviously complicates deciding when benefits from medication outweigh the risks.

[1] http://robertwhitaker.org/robertwhitaker.org/Mad%20in%20Amer...

[2] http://robertwhitaker.org/robertwhitaker.org/Anatomy%20of%20...

[3] https://en.wikipedia.org/wiki/Mad_in_America#Reception

[4] https://en.wikipedia.org/wiki/Anatomy_of_an_Epidemic#Recepti...

[5] http://images.slideplayer.com/24/7027169/slides/slide_5.jpg

[6] http://www.madinamerica.com/wp-content/uploads/2010/04/Harro...

[7] http://www.yoism.org/images/LongTermFollowUpSchizophreniaOut...

Re: electroshock therapy, the "modern" version of ECT (i.e. the only version allowed for the last 50 years) is effectively just about inducing small seizures in the brains of anesthetized people, rather than frying anything. Less "burning out the bad parts", more "recalibration of synaptic weights" ala how ketamine is theorized to act in the treatment of depression. Actually scares me quite a bit less than the idea of being given chronic doses of antipsychotics.

As usual, the press releases and the stories based on those somewhat overstate how far the new study finding takes us on the way to an effective treatment. One of my mentors is a very eminent psychologist (Irving Gottesman) who has spent much of his lifetime (he is old enough to be my father, and I am middle-aged) studying schizophrenia from the genetic point of view.[1] His early paper with an older collaborator

Gottesman, I. I., and J. Shields. "Schizophrenia: geneticism and environmentalism." Human heredity 21.6 (1971): 517-522.

was controversial when it was published, because as Freudianism waned, there was still the supposition among most psychologists then living that parenting was the single biggest influence on the development of mental illness.

When a behavioral trait runs in families, the working assumption is that it is passed from parent to child, but the tricky issue to figure out is whether it is passed mostly by parenting practices (culturally) or by descent (genetically). Gottesman used to be almost alone among psychologists in proposing that the greater influence on development of schizophrenia is genetic, and it took many studies of twins and other close relatives and other study methodologies gradually to make genetic studies of schizophrenia the mainstream approach to research.

That said, there are known cases of identical (monozygotic) twins who are discordant for schizophrenia,[2] so everyone who is active in research on schizophrenia agrees that environmental influences after birth of some kind matter in the development of schizophrenia in an individual patient. Moreover, "the risk to schizophrenia is influenced by quite a large number of common variants, each with a very small effect on risk. How large is not yet clear, but Purcell's analyses suggest that hundreds and more likely thousands of individual genes contribute to the liability to schizophrenia."[3]

The current study, covered in many different popular press reports, indicates a likely gene locus for influence on one clinical finding found in many but not all cases of schizophrenia. Discordant identical twins make very clear that something else matters for the development of schizophrenia. To date, we are a long way from taking the recent genome analysis finding to a stage of testing out any kind of intervention in human patients. First we will have to be sure that the finding replicates in another human patient data set, and then characterize how often that finding occurs in schizophrenic patients, and how often it is missing in healthy controls. There will have to be careful work to find out if any treatment based on the new finding is both safe and effective. But it's a start, and finding out things like this is the research to support basic science research.

[1] http://www.psych.umn.edu/people/profile.php?UID=gotte003


[2] http://www.virginia.edu/topnews/textonlyarchive/March_1994/9...


[3] https://global.oup.com/academic/product/how-genes-influence-...

What are your thoughts on pathogenic causes? The reasoning I've read is that genetic causes would have been eliminated by natural selection.

I've read that poorly timed infections can mess up the immune system, like getting mono as a teen, which then does long term slow acting damage to the brain.

I've also read speculation that maybe than an ancient pathogen was subsumed (?) by our cells and our DNA repair mechanisms are in a constant state of war keeping it at bay, maintaining the balance, which can also be knocked out of whack by an early infection.

My interest is that someone close to me is afflicted. I'm a complete plebe on this stuff. And without the proper background, my comprehension is low (ELI5). And I very much would like to know how to best help, care for my loved ones.

Do you know what the estimate is for the proportion of monozygotic twins that are discordant for schizophrenia?

I don't know that off-hand, but the book I cited may provide enough of the raw data to suggest a magnitude. By memory, I venture to say that more than 10 percent of monozygotic twins of schizophrenia cases (probands) do not have a schizophrenia diagnosis of their own--but I'll revise this figure if someone can find a good reference. What's clear in general about the research is that schizophrenia is a polygenic condition (influenced by many genes) and multifactorial (also influenced by factors other than genes).

IANAB (not a biologist), so I wonder if the same approach can be used to study other mental disorders, such as anxiety and depression.

This is a very general technique called quantitative trait association mapping (such a locus is called a QTL). It's a technique that has been used for decades, back when we used genetic markers and linkage maps (no genomes).

What's interesting about this work is simply the degree of difficulty finding QTLs for mental illness; it's not the only genetic factor, and not particularly strong, so the signal to noise is quite poor. It required assembling a high-quality data set to identify a locus.

It's good work, but nothing revolutionary. Once you can start to pin down the genetic factors, it can make future work easier, so it does bode well.

Interesting, thanks!

Yes. It can.

It can even may be used to study non-disorders ,i.e. how to help regular humans have more happiness , resilience, etc.

IWAB, it is being used to do so.

Funny, nature's off-by-one/buffer overflow error...

Oh, look, another genome-wide association study found a suggestive correlation. Didn't we learn our lesson about this kind of bullshit in the Zeros?

Can you elaborate on why you think this particular correlation is not significant?

In the zeroes, we didn't correct for multiple hypothesis testing in a very good manner. I don't know if that's changed; it's a hard problem.

What Zeros?

The last decade, the noughties.

Wait, what? Does this means schizophrenia isn't caused by refrigerator moms, as psychiatry once claimed (https://en.wikipedia.org/wiki/Refrigerator_mother_theory)? And that endless therapy won't actually do any good, contrary to what psychiatrists and psychologists have held?

I expect to watch neuroscience nibble away at the territory now held by psychology, until (as Lewis Carroll wrote about the Cheshire Cat) there's nothing left but the smile.

Yes, 70 years ago psychiatry had some odd ideas. It's frustrating that you only make these comments about psychiatry - you don't pop up in geography threads to say "Wait, what? Does this mean geographers don't still believe in fixed immovable continents?".

Endless therapy is not recommended for anything, and certainly not for schizophrenia. There are recommended lifestyle interventions, but these are aimed to reduce or stop smoking, to control weight gain, to keep people out of hospital, or to help people gain and keep employment.

A therapy might be involved if a person is hearing voices, but isn't particularly bothered by them. In that situation it doesn't make much sense to medicate away those voices (because the medication has severe side effects) so the person might get a "therapy" that helps them cope with voices, and learn when and how to seek help if the voices become too much.

Fixed immovable continents is a theory that has reasonable prediction power: if you assume that, you can do lots of things without having results that are too inaccurate to be worth calculating. That is not true of the kinds of highly-specific theories that people seem to be more prone to come up with in some fields. The kinds of things that even fairly recent "science" in fields such as psychology and (sadly, all too often) medicine reads more like "the world is balanced on the back of a tortoise" or "there is an evil genie that makes things fall to the ground; his name is Fred and he wears a black cape" than "continents are fixed" or "physics is deterministic, particulate, and local".

Well to be fair, having parents be "warmer" to their children and engage with them more probably also has positive results, regardless of the flawed reasoning for it.

And yes, young scientific fields quickly disprove themselves, that's kinda the point of science. Hard sciences like physics and chemistry also had some very very flawed theories in their youth, like aethers, alchemy, etc. but have had a few hundred years to get past that.

> Well to be fair, having parents be "warmer" to their children and engage with them more probably also has positive results, regardless of the flawed reasoning for it.

I agree, but imagine this:

You have a children with a bad illness. Then some moron comes and accuses you of being the cause of the illness. Let's hope he is right, otherwise he deserves to burn in hell for the eternity. (Or whatever infinite penalty is compatible with your beliefs.)

70 years ago? Psychiatry still has odd ideas. The complete and total refusal of social scientists to accept the reality that behaviors are largely genetic in origin has led to this absurd proliferation of blank-slate-based crackpot theories with very low reproducibility.

Behavioral genetics is very real, but our irrational fear of ( studying genes == hitler ) is stunting the potential of social science across the board.

> Yes, 70 years ago psychiatry had some odd ideas.

Yes, that's true, but in the name of accuracy, the Asperger's fiasco wasn't 70 years ago, it played out seven years ago, when the condition was finally abandoned after an epidemic of phony diagnoses (http://www.nytimes.com/2009/11/03/health/03asperger.html).

The Recovered Memory Therapy fiasco wasn't 70 years ago, it played out in the 1990s -- you remember, when virgins could claim to have been raped and be believed (http://arachnoid.com/trouble_with_psychology)?

The homosexual fiasco wasn't 70 years ago, it played out in the 1970s, when homosexuality was finally abandoned as a diagnosis (https://en.wikipedia.org/wiki/Homosexuality_and_psychology).

But in all these cases, the abandoned diagnoses can still be offered by mental health professionals, and some still are, simply because there isn't any science sufficiently persuasive to say "no" to anything psychiatrists and psychologists care to do.

> It's frustrating that you only make these comments about psychiatry - you don't pop up in geography threads to say "Wait, what? Does this mean geographers don't still believe in fixed immovable continents?".

Geologists don't have clinics. Geologists don't issue press releases telling us how sick we all are, and how desperately in need of talk therapy.

> A therapy might be involved if a person is hearing voices, but isn't particularly bothered by them.

My point is very simple -- the health resources directed toward psychiatry and psychology, for what are fact either nonexistent or biological ailments, are wasted, and would be better spent on real science. Thomas Insel's (director of the NIMH) proposed abandonment of the DSM was a good first step (http://www.newyorker.com/tech/elements/the-rats-of-n-i-m-h), but more needs to be done.

I think it's also worth noting that (at least in the United States) Psychiatrists and Neurologist share a certifying body -- The American Board of Psychiatry and Neurology. What's the big difference between the two specialties? When we understand the mechanism it slowly becomes neurology. This "slowly nibbling away" is by design.

Well. I think you might be getting a little bit too eager with your reductionist approach to mental illness. Sure there is a large genetic component to schizophrenia - I was terrified for years that I might have it because my mother did. I think it more likely that shizophrenia is a heterogenous illness - there are many pathways to the same disease state. It is quite a bold statement to say that none of these pathways are in any way effected by the environment in which we develop. Especially given what we know about the association between early traumatic experiences and various disease states.

It may not fit nicely into your mental model of the world, but biology is extremely messy business. It appears that biological systems, although heirachical and modular are, unlike human engineering, highly interconnected across all the levels. Particularly: The health of the mind effects the health of the body and the health of the body effects the health of the mind. If you do not believe this you have not learnt enough, or like many, you have ideoligical issues with this reality.

Yes. It surprises me that people are so quick to so readily assume a biologically deterministic cause when these types of findings are presented. People seem too eager to discount environmental factors - even when it should be obvious to all that our biology is intimately related to our environment and circumstances.

For a good summary of the contemporary positions of the biological and environmental camps when it comes to the causes of schizophrenia I can't recommend this lecture highly enough: https://www.youtube.com/watch?v=QxVY2Vptfwg&feature=youtu.be

Long story short; both camps have valuable insights and a lot to learn from each other.

> Well. I think you might be getting a little bit too eager with your reductionist approach to mental illness.

Schizophrenia is a classic case of a mental illness that isn't one, a condition that doesn't appear in people who don't have a specific genetic predisposition.

> It may not fit nicely into your mental model of the world, but biology is extremely messy business.

Yes, that's true, but according to the new finding this thread is about, biology is now able to (a) detect schizophrenia in people who lack symptoms, and (b) dismiss the possibility in those who show symptoms (for example by an actor trained to imitate the symptoms). The reason? Schizophrenia isn't a mental illness, it's a physical illness with mental symptoms.

Dustin Hoffman nailed autism in "Rain Man". If Mr. Hoffman appeared at a mental health clinic and performed his character, do you suppose he would be turned away by the psychiatrists as a fake? Now consider this alternative -- if there was a genetic test for autism (there isn't at the moment), do you suppose he would be turned away by the biologists?

> ... you have ideoligical [sic] issues with this reality.

Science isn't about ideology, it's about evidence.

Well, first of all, I don't think that psychiatry has for decades claimed that "schizophrenia is caused by refrigerator moms", even though the downfall of that claim may have been more due to political pressure than medical research.

And secondly, whether therapy does any good is a completely different question from what is causing schizophrenia - although here we are talking about triggering it rather than causing it.

I have a friend who came up with schizophrenia just when graduating from university, and it was indeed devastating. But the endless therapy helps him a bit.

He was down voted because he/she cherry picked one of their easy targets, or theories? It sounds like he/she has intimate knowledge of just how deep the hole Psychiatrists, and subsequent Therapy has fallen?

Did he stereotype a entire profession--yes. If any profession has a lot of explaining, and hands on knees apologizing--it's Psychiatry, and Psychology.

Sometimes the truth hurts. Hacker news should be that place where the truth is exposed?

I'll stop, but if you don't question Psychiatry/Psychlogy after being fooled by the SSRI's, the addictive drugs, the endless office visits, and the horrid rates of therapy cures; you haven't been in the system, or you are very prone to placebo.

The latest research on schizophrenia is this; patients whom are not on long term medications have a better quality of life. Yes, it's a judgement call on the doctor, but why do I have a feeling, since the residency doesn't attract the best, and brightest anymore--little nuggets like this latest research is not passed along to these vunerable patients?

As Ricky would say to Lucy, "Psychiatry has a lot of explainin to doo?" As to Psychology, well at least they least can't prescribe.

Psych does have a bad history (e.g. http://link.springer.com/article/10.1007/BF01541182) and maybe present. But the things you're raging against can help a lot.

Therapy is horribly difficult and can fall short for all sorts of reasons, ones out of anyone's control. It's helped me tremendously day-to-day, but my ultimate problems are pretty intractable.

> patients whom are not on long term medications have a better quality of life

Perhaps that their quality of life isn't so impaired is why they're not on medication? Such a short anecdote can be interpreted as suggesting anything.

It’s been standard practice to treat schizophrenia with anti-psychotic drugs as the first-line treatment for decades at this point in time.

Do you have some weird grudge against psychologists?

More optimistically, psychologists might hope that genetically-based sub-grouping of patient cohorts might help to determine those who best respond to the various types of psychological interventions.

Of course, genetic testing and gene therapy may obviate the need for psychotherapy in some circumstances, but that's many years away.

Fake and gay.

Founder of psychiatry drove around in a lobotomobile for 40 years giving lobotomies to haunted people for $25 each.

(With an icepick) (Check the movie/wikipedia lobotomobile)

the treatments since then have gotten only slightly less barbaric, like being tied down for 20 hours a day, or drugged and locked away.

still none of their bullshit has worked. and 75 - 150,000,000 cases of mental illness today (if you add the un-reported cases estimate) aka 1/4 the population (maybe 1/2).

Can everyone please stop downvoting this guy because he said a bad word? He appears to have a mental condition, but lots of people do. I found his posts interesting.

Aside from their fondness for PHP and lack of fondness for the shift key, I see no evidence for mental illness that can be gleaned from internet comments aside from a few curse words and minority opinions.

It's something about his pattern of writing that seems different to me. Maybe I'm just projecting.

I mean it's certainly possible I just meant it wasn't obvious to me, that's all.

You're asking for an advanced degree of empathy that goes beyond what the collective here is capable of so far. I'm sure many individual members are capable, but the nature of large groups is that the whole is less than the sum of its parts.

I wonder if we can eventually get there, though.

You really shouldn't accuse anyone of being barbaric when you sling around words like "gay" as an insult. Don't be a caveman.

Not defending them, but that phrase is a meme and has a different meaning than the individual words.

> that phrase is a meme

So what? That bigotry is a meme doesn't make it any less bigotry. He used gay as an insult, there is no excuse for that behavior period.

How does something being a meme excuse it.

I didn't say it did - in fact, I explicitly said I wasn't defending them. Perhaps I didn't phrase it strongly enough.

they tried castration, lobotomy, and drilling a hole in the persons skull to drain the blood (they had no power tools so a hand crank drill)

on children. on teenagers. on the old. and on the stupid.

to cure voices...

you dont know what your talking about guys.

were talking about elective surgeries, that people could not refuse, and testified later to the supreme court they were done without permission, and sometimes tortured or beaten if refusing the surgery.

I didn't say they weren't barbaric but this isn't about them, it's about your behavior; you're being a bigot. Gay is not an insult, don't use it as such and think you can preach from any high ground.

Agreed but it's a pity the only response is reacting to the homophobic slur here; it is truly criminal and worth talking about how much leeway pseudo-scientific "doctors" are given, to this day, to abuse the human rights of those different enough to be deemed "mentally unsound".

In the US at least, a mentally ill person can only be committed against their will if they are deemed an active threat to themselves of others, and it has been that way for decades. The days of involuntary in-patient institutions are largely over.

In many cases this is basically a rubber stamp. I know several people who were committed against their will after as little as a cursory 5 minute conversation. To anyone who knew them at all, they pretty clearly weren't violent or a threat to others. Another person I knew was hospitalized for a suicide attempt, at which the doctors, for no particular reason and with no evidence, assumed she must be hearing voices, and had her on anti-psychotics for around a week before her family managed to convince them otherwise.

Clinical psychologists and psychiatrists weld a frightening amount of power over the people who may not be aware of just how easy it is to be locked up for seeking any kind of help or therapy. At this point, I consider pretty much any contact with clinical psychs to be every bit as dangerous as talking to a cop without a lawyer.

> I know several people who were committed against their will after as little as a cursory 5 minute conversation.

Not to call you a liar, but quite simply I don't believe that. Having dealt with wanting to get someone committed against their will, I found it was all but impossible unless they're actively and obviously dangerous to themselves or others.

> Clinical psychologists and psychiatrists weld a frightening amount of power

They really don't. They can't just commit people because they talked to them and decided hey lock that guy up.

> They can't just commit people because they talked to them and decided hey lock that guy up.

They're free to assess you however they want and then use that as an excuse. Who is going to argue with and stop them? The judge? Your lawyer? Someone else who lacks a medical degree and "psychiatric expertise"?

There are so many ways it can go wrong for you. Maybe they thought you said something you didn't. I was once accused of making suicidal statements that I never did - not even a matter of being misheard, but completely making up things that I had never said. Maybe you just seem twitchy or distracted or they think they see signs of some other symptom. Maybe they just decide to lie because they think they know best.

I'm not claiming that every psych is out to get you, just that you really roll the dice when you talk to an unknown one. Hence the comparison to dealing with police. From my own experiences and people I've known, it gets worse when you aren't involved of your own free will or aren't the one directly paying for your own treatment.

In your case, I'd be curious whether whichever working clinical psychiatrist that was assigned to this person also felt as strongly that they should be committed, and had similar lack of success doing so?

Some non-anecdotal evidence either way would be more convincing, but this is the impression I've gotten considering the uniformity of experiences I've observed. Only one person I can think of actually felt they were helped by and had a positive experience with a psychiatric institution, and that was through a college health service. The only paper[1] I could find on it reports that "retrospectively, between 33% and 81% of patients regard the admission as justified and/or the treatment as beneficial," which is a uselessly broad range and could be used to conclude either way.

[1] http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.2006....

I think you're remembering a time long past. The system doesn't work that way anymore. Committing someone against their will is no longer trivial or easy if even possible. You have to have evidence and it has to be an immediate threat like within a few days and it's f'ing hard. These people do not have the power you think they do anymore. The thing you're complaining about has already been fixed.


You don't know what you're talking about. Joe Asshole can't lock random people in the hospital on psychiatric hold, but a psychiatrist can.

Only for a very short time and only with evidence they're a danger, and we aren't talking about joe asshole, and I know as much what I'm talking about as you do buddy. This isn't the world where a psychiatrist has that much unchecked power; it isn't the movies.

Two instances of police corruption that have no relevance to this thread. In neither of those cases was the psychiatrist responsible and in both cases they were released within days. Dirty cops telling lies cause all sorts of problems, that's on them.

Police officers, whether dirty or clean, cannot commit anyone. In both cases the psychiatrist was responsible.


They can lie to psychiatrists to get a temporary commit which is what happened in both of those cases, and yet again you link to something that only shows a few day temporary hold; that does not support your case. You cannot commit someone for more than a few days against their will and that fact alone demonstrates that psychiatrists do not have very much power anymore.

It varies by state, but I just looked up New York, California, and Texas and they are surprisingly uniform. Getting a 72-hour hold is pretty easy, and a psychiatrist can tell the court if s/he deems it necessary to hold for an additional 14 days (ostensibly, so they can verify that whatever medication they choose to administer has taken effect). These courts are pretty much set up to rubber stamp whatever the psychiatrist wants to do; many hospitals that have psychiatric services have these courts in the same facility. After that, although the patient has the right to leave the hospital whenever they want, but in many cases they aren't told that, or that they may need to call a lawyer to take them court in order for the judge to issue a release.

I'm sorry you've had this impression. It's not just violence, most of the time people are involuntarily committed if they are suicidal. I obviously have limited information, but perhaps those doctors who gave your friend anti-psychotics thought he/she was bipolar, or was not responding to anti-depressants? The atypical anti-psychotics are often the standard treatment for bipolar disorder, and are also used in cases of depression if SSRIs do not work.

Again, I'm sorry you have gotten this impression. Both my parents are clinical psychologists; I can assure you that these cases are taken very seriously, and committing a patient is always a measure of last resort.

It's not a pity at all, someone spouting hatred doesn't deserve to be heard until he learns to stop spouting hatred.

No. That is the method of problem solving espoused by Jerry Springer culture. It is literally beneath HN.


Congratulations on your tenure. I'm not sure what it proves but you should be proud.

No one said it proves anything, but nice dodge on your bad English.


What's wrong with being gay.

I think you miss the the irony of someone acting like a bigot calling other people stupid. If you want people to hear your message, stop pushing it with such hatred. Intelligent people stop reading and down vote you because of your bigotry; you're not even being heard. All the facts in the world don't matter when you throw out bigoted insults a 10 year old would use; be smarter. Bigotry is for the ignorant.

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