[HN Gopher] Psychiatry Wars: a lawsuit that put psychoanalysis o...
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Psychiatry Wars: a lawsuit that put psychoanalysis on trial
Author : secondary
Score : 45 points
Date : 2022-10-14 20:33 UTC (2 hours ago)
(HTM) web link (www.theguardian.com)
(TXT) w3m dump (www.theguardian.com)
| luqtas wrote:
| 'thousands lines' of gossip to not inform the reader about
| psychoanalysis...
|
| which personally i hope starts to get less and less popular!
| giving placebo to patients that can suicide, for me, should be
| considered as homicide if recommended BEFORE any other type of
| treatment with a rate greater than "eating blades of grass" and
| thinking you are cured or will be cured
| knaik94 wrote:
| The reality is that both models work together. The amount that
| each side contributes in a certain individual is dependent on
| their circumstances and their genetics.
|
| Depression is very much a chemical thing, look into the
| "comedown" recreational users of ecstasy feel after a night of
| rolling. MDMA is a stimulant that also excites the same receptors
| many classic antidepressants work on. MDMA effectively increases
| the effectiveness of Serotonin and Norepinephrine, the effect on
| Serotonin is uninhibited and is what causes the "high". After the
| "dump" of Serotonin into the brain, the brain recalibrates and
| the baseline Serotonin from before feels like less than it should
| for a few days. The symptoms are classic anhedonia depression.
| Clearly an imbalance causes depression.
|
| Depression is also a very situational and mental thing. The
| traumatic loss of a loved one for example causes deep depression
| in many people. Even a breakup after a long term relationship can
| cause deep depression. Therapy and psychoanalysis can help
| someone become more mindful of their thought patterns. It can
| push someone to get past the immediate hurdle and regain momentum
| to live a happy and fulfilling life again.
|
| Neither answer is complete. Trying to find a generic solution is
| part of what is keeping Psychiatry closer to the blood letting
| ages of medicine rather than the fMRI scan age.
|
| My personal experience has left me biased and jaded about the
| current state and future trajectory of Psychiatry and mental
| health management. Both from the medical professional side as
| well as from the society side.
|
| It may be a cultural thing, I come from an Asian background and
| my parents have hung on to that culture. I have stopped bringing
| up the topic and will excuse myself from conversations when they
| bring it up because when I try to speak honestly, they treat me
| like I am trying to peddle. To them there is only a binary
| choice, either live drug free and "clean" life or fiend for drugs
| like an addict. The line isn't based on all drugs in general
| either, there's a very different stigma around psychoactive vs
| non-psychoactive drugs. Beta blockers for blood pressure is okay,
| but beta blockers for performance anxiety and general anxiety is
| not. I know it comes from a deeper belief system of not taking
| mental health concerns seriously.
|
| Reading this article was interesting, because I didn't realize
| western medicine had the same faulty starting point.
|
| I am lucky to have grown up in a time of computer assisted dental
| x-rays. It's a culture shock knowing how recently Psychiatry was
| still in the age of lobotomies.
|
| The US still hasn't officially banned lobotomies. The oldest
| sister of President Kennedy, Rosemary Kennedy was given one in
| 1941. They continued to be performed officially until the 1970s.
|
| The nobel prize in medicine defends the use of lobotomies and
| rejects the idea of rescinding the award given to Moniz.
| https://www.nobelprize.org/prizes/medicine/1949/moniz/articl...
| throwaway0asd wrote:
| Talking about mental health is extremely challenging. On one
| extreme there is stupid: the people who believe none of this
| science is a form of health, or even real. On the other hand
| there is the disabled: the people who likely have undiagnosed
| mental health disorders themselves and are incapable of
| processing any of these conversations.
|
| Such failures to process these vital concerns touch wide reaching
| aspects of discourse from politics to work to culture generally
| and that is quite a problem.
| psychphysic wrote:
| A key issue is also that even within mental health services
| there is animosity towards psychiatry.
|
| Whatever one thinks of antidepressants or antipsychotics (maybe
| less mood stabilizers I think), psychologists hate them. And I
| think while psychiatrists see psychology as helpful for their
| patients, psychologists can see the use of medications as a
| failure.
|
| I could say more but I think I'll just leave it at that.
| yamrzou wrote:
| Fascinating story. Thanks for sharing.
|
| > Ray's mother asked the Lodge to give him antidepressants. But
| to the Lodge psychiatrists the premise of this form of treatment
| - to be cured without insight into what had gone wrong - seemed
| superficial and cheap. Drugs "might bring about some symptomatic
| relief", Ross, Ray's psychiatrist, acknowledged, "but it isn't
| going to be anything solid in which he can say, 'Hey, I'm a
| better man. I can tolerate feelings.'"
|
| I remember a HN comment from trained pharmacist
| (https://news.ycombinator.com/item?id=32103546) that argues the
| same thing: "I promise you that no drug that you can take can
| make any permanent changes to _edit_ your mind"
|
| Ray looked at two different stories about his illness, the
| psychoanalytic and the neurobiological, but both "failed him". I
| would say that the psychoanalytic story has a better chance of
| explaining his case, but for some reason he wasn't receptive to
| it.
|
| Relatedly, the chemical imbalance theory of depression was
| disproved in a popular study published two months ago. Here is a
| good summary: https://youtu.be/TZhgvr2rbwE. But SSRI are still
| effective, at least in reducing symptoms. We basically don't
| understand why and how they work.
| 98codes wrote:
| While what they're saying is true, to me it rings just as
| misguided as not taking pain medicine when you have a broken
| leg until it has properly set first.
|
| Medication for neurological issues isn't and shouldn't be the
| end-all-be-all but can indeed be a way to manage the issues at
| hand while teaching the tools needed to deal with the symptoms
| via therapy if possible.
| pessimizer wrote:
| Nobody is doing studies to prove that morphine works better
| than placebo.
| themitigating wrote:
| The effects of morphine are profound and obvious. It's like
| asking for a study to prove crack does something.
| knaik94 wrote:
| Studies to show morphine is better than placebo in treating
| what?
|
| Here is a link for Study protocol for a randomised,
| placebo-controlled, single-blind phase II study of the
| efficacy of morphine for dyspnoea in patients with
| interstitial lung disease (JORTC-PAL 15)
| https://bmjopen.bmj.com/content/11/5/e043156 .
|
| I would suggest you look into the drug approval process in
| the US, I think you will learn a lot.
| e40 wrote:
| There are always side effects and there is a real fear by
| many that they will be dependent on those drugs and have to
| live with the real side effects.
| hutzlibu wrote:
| You can also get addicted to pain killers. They still can
| help, but are surely no long term solution.
|
| Antidepressants fall in the same category for me, even
| though I always avoided them. But if things are really
| dark, I would use any tool.
| haswell wrote:
| I would place antidepressants under a different umbrella
| - closer to insulin or other chronically required
| "maintenance" medicine required to sustain life.
|
| Anti-depressants don't take pain away. In some cases,
| they make it possible to even feel pain.
|
| I'm ~6 years into my therapy journey at this point and
| I'm not on antidepressants at the moment, but I have been
| in the past when I needed them.
|
| I'm fortunate that I was able to stop, and that was
| partly because I put my work life on hold to go on
| sabbatical and use all of my capacity on myself for
| awhile. But that doesn't mean everyone can or should.
|
| I think it's also worth noting that especially now,
| mental health issues are increasingly caused by
| advancements in technology we don't yet know how to cope
| with, and from which there's very little escape.
|
| Meds allow one to do the hard internal work that would be
| significantly harder to achieve if they don't have the
| capacity to keep a well functioning life up and running.
|
| I think only embracing one or the other exclusively is
| where things start to go wrong, and what I took from the
| article.
| themitigating wrote:
| Then it's a balance between side effects and the original
| issue.
|
| Isn't this common knowledge and accepted? I feel like
| debate makes no sense unless your motive is create more
| mistrust in science
| knaik94 wrote:
| It's weird that we treat psychoactive drugs differently
| than other drugs. We don't have a fear of a diabetic
| becoming dependent on insulin or someone with high blood
| pressure becoming addicted to beta blockers. There are side
| effects is a bad generalization of all drugs used to treat
| mental health issues. When I say I am taking beta blockers,
| most people comment on how I am a bit young to be taking
| them, but when I was prescribed benzos for the same
| condition, everyone decided to become my doctor and tell me
| what I should and shouldn't take. Endless stories about how
| then knew someone who god addicted to pain killers and
| became homeless and how they heard benzos are just as bad.
| I chose to switch off benzos to beta blockers.
|
| Doctors and the patient are the best judge for the benefits
| and risks of living with certain conditions vs being
| medicated for them. In most cases there aren't side
| effects.
| anotherman554 wrote:
| "It's weird that we treat psychoactive drugs differently
| than other drugs. We don't have a fear of a diabetic
| becoming dependent on insulin or someone with high blood
| pressure becoming addicted to beta blockers."
|
| It not that weird. The brain is the most complicated
| organ in the human body. Science understands how the
| kidneys work but largely doesn't understand how the brain
| works. These metaphors comparing these treatments to
| kidney treatment, or whatever, are not great.
|
| "Doctors and the patient are the best judge for the
| benefits and risks of living with certain conditions vs
| being medicated for them."
|
| Okay, but if you were to follow this advise you should
| scold anyone who says "People with mental health problems
| should take drugs..." But you only scolded the person
| pushing back at this statement.
| renewiltord wrote:
| People are pointlessly scared of drugs. When I had fractures
| all over my body after a motorcycle accident, I was on
| oxycodone and hydromorphone. When they operated on my hand, I
| was on fentanyl. Over the next 4 weeks I stepped down the
| opiates. I have some in my cupboard. I exercise zero willpower
| to avoid them, though they gave me incredible relief when I was
| in the hospital. Now, when I think to myself "Oh, let me try
| some" the overwhelming feeling I get is not one of disgust or
| of fear but of "ah man, though, I will lose maybe 4 hours of my
| time to this. I really don't feel like it".
|
| I think if someone had given me this half-wit spiel I might
| have killed myself trying to get out of my ICU bed to yell at
| them. Fortunately, orthopaedic medicine is a more advanced
| field than psychiatry and has a replication rate higher than
| the 39% that psychiatry does. God forbid I ever encounter a
| field where 60% of their science is fraudulent. Thank god my
| amnesia is limited to the incident itself.
| 7952 wrote:
| I take SSRIs for anxiety and feel like the opportunity cost of
| trying to survive without them is too great. The good things in
| my life would be too disrupted by the extra load of tolerating
| those feelings. And those good things are protective against
| anxiety.
| threatofrain wrote:
| The population of depressed individuals who receive either talk
| therapy _or_ pharmaceuticals do better than those who don 't
| receive treatment, and those who receive _both_ do better than
| those who receive only one mode of treatment. Nevertheless
| modern medicine doesn 't have an adequate solution for
| everyone. C'est la vie.
| jbandela1 wrote:
| How good are we at explaining large ML model outputs?
|
| My understanding is not very good?
|
| And that is with us having a very deep understanding of the
| hardware, software, algorithms, and mathematics involved.
|
| Now let's suppose that you run your ML model on a computer and
| you get bad results.
|
| Two experts show up. One says that you have a faulty memory chip
| and that they can fix what is wrong with the memory chip and then
| the model should work.
|
| The other says that because of the training data the model was
| exposed to, some of the weights are bad, and by providing focused
| new data for the model to train with, they can adjust those
| weights so the model produces better output.
|
| While you are deciding, these two then get into a big fight each
| accusing the other of being a charlatan.
| [deleted]
| [deleted]
| mjburgess wrote:
| I'm unsure as to the thesis of this comment: what's your point?
|
| Perhaps I just don't buy your premise. We understand ML models
| very-well, but we don't like the explanation. Models are on a
| spectrum from parametric where a data distribution is assumed,
| to non-parametric, where it isnt. In the non-param case, models
| largely remember compressed "averages" of historical data.
|
| The sense in which we dont "understand" how, eg., a NN comes to
| a prediction is only in the sense that we cannot, a priori,
| locate the specific subset of historical data that it has taken
| a weighted average-of... but we know well that this is what its
| doing. ie., something incredibly dumb and boring.
| matheusmoreira wrote:
| And neither of them really knows anything, they just came up
| with reasonable hypotheses to explain observed behavior,
| figured out what to do about them, ran tests to confirm and
| then approved those treatments on the basis that they worked
| more often than not. What does this stuff even do? Not sure,
| they just have proof that it's effective.
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