Can Psychiatry Turn Itself Around? • Hacker News Board

Re: Can Psychiatry Turn Itself Around?

#91

Post by pm90 » Fri, Aug 12, 2016, 4:37 AM UTC

Yxven wrote: post #82

phren0logy wrote: post #41

Earlier quoted context omitted.

1. These experiences are not the norm, but still much too common. 2. Psychiatrists might not recommend talk therapies for a number of reasons (even though they probably should). Many insurance plans don't cover it, and lots of people aren't interested and want a "quick fix" to the problem in the form of a pill. Finally, the education for licensed therapist varies WILDLY , and there are a lot of really bad ones. That…

How does one find a good psychiatrist?

Unfortunately, it seems to be a lot of trial and error.

Re: Can Psychiatry Turn Itself Around?

#92

Post by pm90 » Fri, Aug 12, 2016, 4:53 AM UTC

heygiraffe wrote: post #48

phren0logy wrote: post #41

Earlier quoted context omitted.

1. These experiences are not the norm, but still much too common. 2. Psychiatrists might not recommend talk therapies for a number of reasons (even though they probably should). Many insurance plans don't cover it, and lots of people aren't interested and want a "quick fix" to the problem in the form of a pill. Finally, the education for licensed therapist varies WILDLY , and there are a lot of really bad ones. That…

Thanks for the reply. > Finally, the education for licensed therapist varies WILDLY , and there are a lot of really bad ones. I hear you there. I had some iffy experiences early on. But a few years ago I found a really good one. He retired, but recommended someone else to me, who also turned out to be really good. I'm seeing him these days. Maybe what needs to happen is for the norm to be that psychiatrists who see t…

I emphatically agree with your recommendation that more people should seek counseling, even those who lead seemingly happy and/or successful lives. Increased urbanization has unfortunately resulted in less socialization for a lot of people. Especially (at the risk of sounding sexist) for men, who tend to be more introverted. So I see a lot of my male friends struggling with social problems which I think some genuine counseling could really help them with.

We need to remove the stigma attached with seeing a psychiatrist/shrink as something done only by those suffering from mental ailments. And to be honest, I've seen a lot of people turn to self-help "gurus" who just confuse things further by not getting to the root of the problem.

Re: Can Psychiatry Turn Itself Around?

#93

Post by [deleted] » Fri, Aug 12, 2016, 4:55 AM UTC

_greim_ wrote: post #84

Doesn't scientology have some kind of weird self-declared feud with psychiatry? I wonder if they've perhaps been sowing FUD whenever and wherever possible.

[deleted]

Re: Can Psychiatry Turn Itself Around?

#94

Post by pm90 » Fri, Aug 12, 2016, 5:02 AM UTC

morgante wrote: post #90

artimaeis wrote: post #88

Earlier quoted context omitted.

What a strange question, what does it mean to cure a patient? Say a patient goes to a doctor and is diagnosed with heart disease - is there anything that can be done to cure this? Or do we simply alleviate the symptoms to make way for a better life? This is the case with so many illnesses: diabetes, cancer, arthritis, the list is so long. But do you have the same skepticism of a doctor? Of a surgeon? We are not simpl…

It means to restore them to a level of health where they are not dependent on the doctor or medicine for continued care. > Say a patient goes to a doctor and is diagnosed with heart disease - is there anything that can be done to cure this? And they'd say there possibly is (such as lifestyle changes), and encourage them to pursue those changes while providing temporary medical relief. > This is the case with so many…

Forgive me, but it seems like you have an exceedingly negative view of psychiatrists.

> And they'd say there possibly is (such as lifestyle changes), and encourage them to pursue those changes while providing temporary medical relief.

But Psychiatrists provide prescriptions as well (drugs, therapy etc) which may or may not lead to lifestyle changes.

> But psychiatrists don't have permanent cures for anything

I think this is being too harsh on psychiatrists. The mind is perhaps the most complex and least understood component of the human body. It is an exceedingly complex organ not yet completely understood. The heart, kidney etc are all functional organs, and their mechanisms for working are pretty well understood at the present time. There is much ongoing research to understand how the brain does work though; just probably not by Psychiatrists.

Re: Can Psychiatry Turn Itself Around?

#95

Post by pm90 » Fri, Aug 12, 2016, 5:08 AM UTC

digitalarborist wrote: post #81

slededit wrote: post #65

Earlier quoted context omitted.

You know the one interesting thing about these "sane person stuck in a mental institution" stories, is they always talk about how nuts the other people were. If it were as common as suggested that normal people end up there for slips of the tongue or other mundane reasons then I'd expect there to be more "normal" people finding each other in these stories.

Probably that otherwise normal people just don't make it into the stories because they're not as memorable. Though often you'll hear of people otherwise healthy who are down on their luck, addiction problems, abuse, or just general anxiety and depression. The other problem is that the definition of sane changes depending on context. I recall watching a documentary on Japanese school children and their attitudes towar…

I feel this comment really hits the spot on the current "epidemic" of ADHD diagnosis and prescriptions. Parents are sooooo worried about their kids not being "normal" (i.e. docile and obedient) that they will do anything to make that happen. I almost feel that it was better before we had modern medicine when parents were resigned to dealing with their kids' unique character instead of chemically forcing them into submission.

Re: Can Psychiatry Turn Itself Around?

#96

Post by morgante » Fri, Aug 12, 2016, 5:13 AM UTC

pm90 wrote: post #94

morgante wrote: post #90

Earlier quoted context omitted.

It means to restore them to a level of health where they are not dependent on the doctor or medicine for continued care. > Say a patient goes to a doctor and is diagnosed with heart disease - is there anything that can be done to cure this? And they'd say there possibly is (such as lifestyle changes), and encourage them to pursue those changes while providing temporary medical relief. > This is the case with so many…

Forgive me, but it seems like you have an exceedingly negative view of psychiatrists. > And they'd say there possibly is (such as lifestyle changes), and encourage them to pursue those changes while providing temporary medical relief. But Psychiatrists provide prescriptions as well (drugs, therapy etc) which may or may not lead to lifestyle changes. > But psychiatrists don't have permanent cures for anything I think…

> Forgive me, but it seems like you have an exceedingly negative view of psychiatrists.

You would be correct. :)

> But Psychiatrists provide prescriptions as well (drugs, therapy etc) which may or may not lead to lifestyle changes.

Sure they do. But if I go to a doctor about my heart disease, they're going to ask me to me about my lifestyle and encourage me to make changes which would improve my condition (in addition to providing medication).

Meanwhile, in my experience psychiatrists will jump straight to medication without any discussion of the underlying lifestyle and adjustments which could improve it. At best, they encourage you to see a therapist as well. (To be honest, I'm somewhat skeptical of the hard division between the disciplines. A cardiologist is not a nutritionist, but they can give you a basic idea of the nutritional roots of heart disease and potential remedies, but psychiatrists seem to be entirely uninterested in anything besides drugs.)

> I think this is being too harsh on psychiatrists.

Is it? I don't necessarily think it's necessarily their fault. As someone else in this thread said, mental health seems to be like medicine prior to germ theory: a whole lot of confidence in symptom reducers of questionable efficacy.

Re: Can Psychiatry Turn Itself Around?

#97

Post by tcj_phx » Fri, Aug 12, 2016, 5:26 AM UTC

If Psychiatry wants to "turn itself around", it needs to do some house cleaning.

In a recent "skeptic" magazine [1], Harriet Hall, M.D. had this to say about the situation:

"Psychotropic drugs are far from ideal. They don’t work well for everyone, and they can sometimes cause devastating side effects. But they do save lives, and they do allow some patients to lead a more-or-less normal life. They are the best we have at the moment. " (emphasis added)

[1] http://www.skeptic.com/magazine/archives/21.1/

This is an apology for the status quo, and distracts from the main issue. My girlfriend is one of the ones for whom "psychotropic drugs" don't work at all - in fact, I believe that the psychotropic drugs that she's been prescribed have a lot to do with her present predicament. Haldol - sold as an anti-psychotic - is well known to cause the condition it supposedly treats. Dr. Hall states that these drugs "save lives", but I wonder what the ratio of "lives ruined" to "lives saved" is.

There are non-psychotropic drugs that have been very helpful for my girlfriend, but her psychiatrists don't know to use them. I've spent a few hours today revising my latest petition to the courts asking them protect my girlfriend from the palliative treatments that she has been ordered to endure. The main thrust of my argument is that the medications aren't working because they do not address the causes of her condition. The causes are perfectly obvious to me, but the doctors have all been "shooting in the dark", hoping that the next pill will work better than the last one.

I suspect that "exhaustion" is related to most psychiatric problems. New research linking psychosis to an inability to produce cortisol is a good clue: https://www.jcu.edu.au/news/releases/2016/june/stress-hormon...

Re: Can Psychiatry Turn Itself Around?

#98

Post by sosuke » Fri, Aug 12, 2016, 5:28 AM UTC

Yxven wrote: post #82

phren0logy wrote: post #41

Earlier quoted context omitted.

1. These experiences are not the norm, but still much too common. 2. Psychiatrists might not recommend talk therapies for a number of reasons (even though they probably should). Many insurance plans don't cover it, and lots of people aren't interested and want a "quick fix" to the problem in the form of a pill. Finally, the education for licensed therapist varies WILDLY , and there are a lot of really bad ones. That…

How does one find a good psychiatrist?

Personal referrals.

But the real success in treatments now tends to be self education. Not WebMD I mean reading the actual research papers to evaluate what options would work for you. Know yourself.

Re: Can Psychiatry Turn Itself Around?

#99

Post by sosuke » Fri, Aug 12, 2016, 5:33 AM UTC

gonehome wrote: post #59

phren0logy wrote: post #21

I'm a psychiatrist. It is always amazing to me that despite four years of medical school, six years of residency and fellowships, and four board certifications, the assumption is that I have no idea what I'm talking about and have evil motives. There are fair criticisms of psychiatry, there are bad psychiatrists, but mostly there are crappy generalizations. Good psychiatrists have an understanding of what medications…

I think part of the difficulty is that we don't have a great understanding of consciousness or how the mind actually works. It feels a bit like medicine prior to germ theory. Even for relatively more understood things like depression it's not like we can test the serotonin levels to validate it before SSRIs and then check them after. It seems to be a mixture of this seems to work, but given the high variation among p…

It is a difficult field I'd say only out done in complexity by nutritional science. What works for one person fails on a dozen others.

Re: Can Psychiatry Turn Itself Around?

#100

Post by epistasis » Fri, Aug 12, 2016, 5:43 AM UTC

force_reboot wrote: post #83

There seems to be a huge gap between what psychiatrists believe and how psychiatric knowledge is presented to the general public. For example, I'm not aware of any scientific evidence that depression is qualitatively different from being unhappy, or that depression can't be caused by events that would make a typical person unhappy, or cured by the opposite. And I'm fairly certain that very little such evidence exists…

If you'd look you'd find plenty of evidence of the sort that you think doesn't exist. Try a popular book like Against Depression as a starter. I think that the existence of such evidence also invalidates the rest of your prejudices that you express.