i'm getting very argumentative on the internet today (under a pseudonymous account because as you might guess from my incessant posting, this issue is personal for me)
trauma (at any time), drug use, other experiences -- all can make schizophrenia more likely in those susceptible. absolutely true.
but it is a biological disease, and healing trauma won't stop its progression. as your source notes, the trauma causes differences in brain development, and once that's done its done.
i don't think coming up with a new drug, the main advantage of which is it doesn't numb you the horrible way existing antipychotics do, is a bad thing.
this is basically a drug that was only created to improve the QoL of people with schizophrenia. if society just wanted to numb them, we already have drugs for that and could just be much more aggressive in violently coercing treatment.
investing in these drugs isn't "looking away", it's putting in a huge investment of many billions of dollars to help the victims live better lives.
"As such, the hippocampus and hippocampal neuroplasticity may also play a key role in resilience and recovery from stress. This is supported by the current finding that hippocampal volume increased following psychological therapy."
I’d like to call you both right on the basis that a working brain at age 40 retired with less than a working brain from age 27 or whenever schizophrenia tends to present.
Outcomes are what we’re hoping to improve. Your data looks like we get brain recovery, which is an improvement to outcomes. Necessary, maybe not sufficient.
All those articles are for PTSD. PTSD is not the same as schizophrenia. Just because psychotherapy helps with PTSD doesn't mean it'll help with schizophrenia. Mental illnesses, and their treatments, are not fungible!
Psychotherapy does in fact help with schizophrenia. It's been a while since I was steeped in reading sources that backs this up, but one thing I came across was the notion that therapy alone is actually more effective than antipsychotics alone for certain symptoms. (If memory serves, therapy is better than drugs for persistent delusions.)
However, I think the best treatment involves both.
I want to be charitable because I think I know the point you're trying to make in your comment, and what I want to say is mostly to the side of that. But I think that this statement at best glosses over what's been a long, expensive, and heated (though sincere) scientific conversation about schizophrenia over the past century and change. It's one that not only includes a substantively fruitless search for any underlying pathophysiology, but a spirited conversation about the validity, reliability, and plain-English usefulness of the concept itself! Further, this conversation is far from the stomping grounds of cranks and scammers; it has taken place inside what you might call the most orthodox psychiatric and psychological institutions: the APA, the major high-impact journals, fancy universities etc etc.
So when an eminence like Robin Murray, knighthood and all, can go into Schizophrenia Bulletin (2017) and write something like ...
"I expect to see the end of the concept of schizophrenia soon. Already the evidence that it is a discrete entity rather than just the severe end of psychosis has been fatally undermined. Furthermore, the syndrome is already beginning to breakdown, for example, into those cases caused by copy number variations, drug abuse, social adversity, etc. Presumably this process will accelerate, and the term schizophrenia will be confined to history, like 'dropsy.'" [1]
... saying that we know it's a biological disease as part of broader claims about treatment effectiveness doesn't tell the whole story. (I encourage everyone to read Murray's reflections in the linked article, as it's a fascinating retrospective on an illustrious career in psychosis research and psychiatry.)
well, okay, then we can say that a lot of people diagnosed with schizophrenia now, even if the concept of schizophrenia is not viable, do have biological disease(s) that cause psychosis alongside what we now call the negative symptoms of schizophrenia. I'm fine with that claim.
it's very different than the common anti-psychiatry claim that the schizophrenia diagnosis is a social construction that gets applied to healthy people who violate social norms.
Excellent comment. A “symptom” of schizophrenia is thinking that one does not have schizophrenia. A “heads I win tails you lose” situation where the single doctor is solely and individually responsible for diagnostics and treatment, but not liable. Criminals are given more rights and protection from abuse, and the legal systems has known and documented failures. For those who are labeled mentally ill there have not been established effective safeguards to protect and support those who might speak out, and by definition of competency their perspectives are not valid. Those who are economically incentivized to argue in favor of a biological explanation can be expected to do so, despite no personal expertise in the matter, and regardless of reproducible evidence.
i think we would agree a lot about the brutality and incompetence of the current system of psychiatric institutions.
however, the reality is, psychosis frequently prevents people from recognizing their own impairment. it's just true that this is very common, and maybe shouldn't be so surprising, since in many other cases (alcohol, drugs, dementia, brain injury) people also are prone to underestimate how impaired they are.
As I read it, the parent comment is making a point about the classification of schizophrenia. It is not disputing that the condition (psychosis) is real, or claiming that people are frequently misdiagnosed with some form of psychosis.
look, if someone has actually have a new drug that works like antipsychotics but doesn't have the nightmare side effects, i am very happy for that person to get filthy rich.
if this pans out the way they hope, by all means give the lead guy a couple yachts or whatever he wants. space tourism, gold statue of himself, whatever. big bonuses all the way down the org chart.
there's the potential to reduce an absolutely staggering amount of human misery here. frankly (again if this pans out) our homelessness crisis would look very different if this drug had existed 20 years ago, when the mechanism of action was discovered.
the people who cared enough and took a huge concentrated risk to do this should just get rich, if in fact it pans out.
How completely inhumane. From a strictly numerical perspective you are correct, but it is disgusting and vile.
I know plenty of people without mental health issues who can't get jobs that make 20k and I know a few with degrees who can't.
Making healthcare a for-profit venture guarantees that poor people suffer disproportionately. Making chemicals is cheap and most of the innovation happens on government grants and funding. A government run healthcare system is obvious a cheaper solution with less suffering.
> Making healthcare a for-profit venture guarantees that poor people suffer disproportionately.
This is true of literally every industry; the poor always get less than the rich.
Why not nationalize everything so that the poor always get the same as the rich? Surely if the government can run healthcare it can run toy shops and grocery stores.
I agree that price feels shockingly high. However, the government can subsidize treatment. As can private insurance policies, before the sufferer becomes homeless, or if they qualify for a family member's plan.
The population suffering these illnesses are already costing the public a lot of money in various forms, it could be worth the investment.
> Homeless people are unlikely to pay $20 000 per year which is the price of the drug though.
True, but think about all the people who are fully functioning and productive members of society and got afflicted with this disease. This med will increase the likelihood that they continue to be highly functioning and compliant with the treatment. This will allow them to keep their jobs and cognitive abilities.
Every person I know with this disease has trouble sticking to meds due to side effects, and not sticking to the meds and relapsing multiple times is probably one of the most important reasons that their condition regresses.
"frankly (again if this pans out) our homelessness crisis would look very different if this drug had existed 20 years ago"
Are there numbers, for how many homeless people, are suffering from schizophrenia?
I would assume only a very small number of homeless people has the clinical condition, but those who have it, are just very visible. Most homeless people are hidden usually and avoid attention.
If I were to guess, I would say that while many people may experience bouts of homelessness, the ones with schizophrenia are more likely to be persistently homeless.
this is completely true, but they take up a very disproportionate amount of time and energy from social service providers, people who work in shelters, etc, and make all spaces for homeless people much more chaotic.
the crisis would look very different if it was just a mix of people dealing with drug addiction (but basically lucid and rational) and with poverty.
"drug addiction (but basically lucid and rational) "
Serious drug addicts are seldom lucid and rational.
But I very much do get the point, that solving the schizophrenic problem, would help a lot with everything else. (I am just way more sceptical, that this drug can deliver that)
i'm curious what is the longest conversation you've ever had with an untreated schizophrenic person?
it's so obviously a "real disease" even if we don't fully understand the biological basis. it's subjective but honestly, there are just a ton of completely obvious cases.
abuses of the psychiatric system are very bad, but schizophrenia is so so clearly real.
outside of the actual pornography, more and more of anime is just emotional pornography for people with attachment troubles.
it can be a great art form. even some of the emotional pornography can have artistic merit (recently: Frieren). but increasingly, despite diversity in genre and visual presentation, all anime just tries to push the same emotional buttons of loneliness, belonging, connection, in a very heavy-handed way that is more about provoking the emotions in the body than about artistic expression.
not everyone has those buttons, which is why anime fans are a devoted minority, and why it seems like lonely, traumatized, and marginalized people are drawn to it.
Mass-produced media always recycles the same thematic stories.
Western cartoons aimed at kids recycled the "power of being yourself" to death. Ask my tweens about the shows they've watched, and they'll pick apart how repetitive the story beats are between them.
The beats that anime is recycling may be different, but all of them get tiresome and feel pandering.
It's a bit social commentary (not very heavy but you can feel it). But I don't think it's about loneliness or relations much at all (I guess the Walrus and the Nurse Llama have a bit of a romantic fling but I don't consider it a major part of the show).
I'd say one of the major villains is someone who has fallen into the stereotypical gachapon gamer / whale / hikkomori type shut-in that sounds like you'd enjoy him as a villain.
So rather than catering to that demographic, OddTaxi skewers it by clearly marking that character as villainous.
It's just a solid Film Noir murder mystery, except the main character is the Taxi Driver with damn near perfect memory and facial recognition rather than a proper detective. It takes some time and discussions with various people around town to figure out the murder plot, but I was quite satisfied by it.
It's a dry show with a lot of talking. The bulk of the show is just the Walrus / Protagonist picking up customers around town, talking with them for 5 minutes and dropping them off.
But it's those discussions alone that leads him to the murder plot. It's really fun to see how everyone around town was so close to the murderer.
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I agree with you that there's a genre of anime that celebrates or dramatizes the Hikkomori / shut-in type (ex: Re:Zero, Jobless Reincarnation). But at this point, the Hikkomori is a stock character, just one tool to tell a story.
There's a lot of different uses of the "emotionally stunted Hikkomori" (ex: Anohana is the Hikkomori who through the drama of a Ghost coming back to talk with him, he gets pulled out of it and emotionally heals).
But anime and anime culture is above all, about stock characters that are borrowed, remixed, and turned into something new in the next story. The emotionally-stunted Hikkomori can become the hero in Re:Zero, the antagonist of OddTaxi, or a source of Comedy in Devil is a Part-Timer.
Frieren seems to cover a lot of Hikkomori Tropes (emotionally stunted character who is suddenly learning how to deal with emotions as she interacts with humans). So I think you're right in that she's seemingly related to the trope. I don't think I thought of her like that before but it seems to match up more-and-more that I think of it. She has all the markings of a Hikkomori in terms of attitude and even story progression (Himmel had to convince her to get up and try)
this is a good point about stock characters. a very lively and thriving art form can rely on these (as theater, movies, novels have at various times).
that’s not all of what bothers me though. if you look at Frieren, every main character is going through some kind of lonely attachment thing, even the ones that follow other stock character archetypes. it’s the whole show. It’s also the main drama in Spy x Family (another show that’s good on the merits).
I recently watched the first episode of “Wind Breakers”. They set you up for 5 minutes to think it will be about a strong guy fighting his way to the top. Surprise! It’s actually about belonging and finding friends who care about you.
Fine to have works of art about lonely people coming together and finding belonging. But it really is weird how much of a dominant theme this is, seemingly in the majority of new anime and manga.
“Chainsaw Man” is interesting because it sets up and subverts this at every possible turn, over and over.
I wouldn't say that that's a recent trend in anime at all, but rather a side effect of following what's coming out at any given time. In other words, recency bias.
If you dig through the older stuff for just the gems, you'll be ignoring a mountain of "emotional pornography" shows from the past that are largely ignored today because they weren't especially good art.
one of the books he lists this year is "Of Boys and Men: Why the Modern Male is Struggling, Why It Matters, and What to Do About it" by Richard Reeves. It's about exactly what you say.
at the very least, they can induce manic episodes for some susceptible people. that alone proves these are real psychoactive drugs that have powerful effects on the brain.
there is still a question of whether they are really an overall good treatment for depression. i think the answer is "yes", but certainly people could disagree in good faith.
my problem is the most common anti-SSRI argument is that they are just placebos that do nothing at all, which is ridiculous.
very, very early on in Signal, back when it was still called TextSecure, they did actually federate with other servers, in particular with servers run by CyanogenMod (predecessor of LineageOS, briefly a commercial startup, now defunct).
my theory is that schizophrenia is so difficult that most people prefer not to think about it. People seem to have a mental block or resistance about the fact that some people have the disease of schizophrenia, and about what its symptoms and prognosis look like.
if true, maybe that’s why it’s usually not mentioned in discussions about the politics of mental health, and why people don’t even consider “schizophrenia” when they see someone behaving strangely.
sports betting, table games, etc: gambler motivated by excitement, somehow thinks they are going to win and make money. often racks up massive losses due to desire to "win it all back" as you say. this is stereotypically the "male" style of gambling addiction. like your friends.
slot machines, video poker: the psychology is very different. the heaviest slot machine players don't have any expectation that they are going to come out ahead. they play the game partly because it puts them into a soothing flow state (though in many cases it is just compulsive behavior with no good motivation). losing money overtime is understood as the cost of playing.
slot machine gambling is stereotypically associated with women. you wouldn't see this either because it's a more solitary activity (unlike table games/sports betting) but it can be very dark -- I think probably worse than the classic gambling addiction.
i think the gender distinctions are real although obviously it's not hard and fast (plenty of male slot machine players, plenty of women losing money placing bets). i think it's probably partly brain differences and partly who casinos/bookies vs. video slot companies choose to market to.
a lot of people have truly deficient social skills. technology didn't make them this way they're just bad at it, so bad that they can't even have enough social interactions to improve and practice. can't even hold a conversation with a cashier. they simply lack the skills to be part of a community.
ideally such people could build remedial social skills by practicing with a real therapist. but that's costly and difficult to make accessible, because "bad at conversation and annoying" is not a mental illness.
an LLM here could help. just to give someone a sense of how to hold simple, normal conversations and practice very basic theory of mind, to the point where they could start building real social skills.
the problem is whoever builds that system may choose to exploit the users and build dependence. but that's a choice, it doesn't have to happen.
trauma (at any time), drug use, other experiences -- all can make schizophrenia more likely in those susceptible. absolutely true.
but it is a biological disease, and healing trauma won't stop its progression. as your source notes, the trauma causes differences in brain development, and once that's done its done.
i don't think coming up with a new drug, the main advantage of which is it doesn't numb you the horrible way existing antipychotics do, is a bad thing.
this is basically a drug that was only created to improve the QoL of people with schizophrenia. if society just wanted to numb them, we already have drugs for that and could just be much more aggressive in violently coercing treatment.
investing in these drugs isn't "looking away", it's putting in a huge investment of many billions of dollars to help the victims live better lives.
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