> because it would involve getting into a discussion on mental health diagnosis and seriously fuck that
I mean, speak for yourself :) I love that sort of discussion. It's my job! Email me.
> You seem to be trivializing this experience in a well meaning fashion.
Thanks for your considered and interesting comment. Respectfully, whether something's being trivialized can be in the eye of the beholder as much as, uh, the eye that made the thing being beheld (lol). So let me say first that that was far from my intention, and I apologize if it read that way, and second, to clarify by quibbling slightly: in saying that many cases clinical depression does actually mean "feeling sad" in the plain English sense of it, my claim wasn't that the grouping of experiences and mental states we for call clinical depression is somehow less serious that it ought to be considered; it's actually that "feeling sad" is way too serious, and too complex, to be left to medicine and medicine-adjacent fields, as it has for more or less a century. In my view, it's precisely the construct "clinical depression", and the industries that have sprung up to lay claim to it, that are doing the trivializing. The reduction of an extremely grave and complicated social, relational, political, economic phenomenon like "feeling sad" to talk of neurotransmitters and synaptic clefts is, if I'm giving the benefit of the doubt, a tragedy. (And if I'm not giving the benefit of the doubt, it's deceptive, and I wonder which forces it serves.) Depression is as much a political phenomenon as it is a biological one. But biology gets the NIH grants, so we're left with a zeitgeist featuring a lot neuro-conversation and little else, which to me is a huge loss, a huge missed chance.
> So, part of the reason that you don't get the precision that you're used to is that the brain is wicked complicated and the other part is it is very difficult to observe. [...]
> We've got a good idea of how different parts are connected, and some models for how some of the pieces might work that are almost certainly wrong (but instructively so), [...]
This is interesting stuff to me, as someone curious about scientific endeavors far from my own, but there are at least two problems with it: the first is that biological psychiatry's now well-worn claim that phenomena like long-lasting low mood are brain diseases remains unproven, with no concrete and replicated backing. It's of course trivially true that mental states are brain phenomena; being depressed, whatever we agree that that means, is a much "in the brain" as my typing out this comment is. The issue remains the disease part. I'm still looking at my watch.
Which leads me to the second problem: none of the brain talk, fascinating though it is, actually matters to the people who experience these things, or to those who treat them. I mean "matters" here as "makes a concrete difference in how we assess and deal with" the phenomena. I've been a clinician in mental health for a decade now, and there's nothing I can call on from biological or neuroscientific research to help me in assessing or helping with things like MDD. Zero. To the extent that I've ever helped anyone experiencing these forms of profound pain, understanding them as having anything to do synaptic clefts or serotonin or the brain has mattered not a whit.
This would be easier to deal with if the inductive project we're talking about were only a few years old; maybe I'd be able to tell myself that there's something on the horizon. But it's not a few years old -- it's 70 years and uncountable billions of dollars old. I'm just one person, of course, but I can read the tea leaves, and I can tell you that a lot of people in the profession are tiring of the endless promises from mental health research that the second coming is right around the corner. The promises of "genes for depression", or the promises of safe and effective pharmacological treatments, or a reliable and valid psychiatric nosology. The list goes on.
(Don't just take me on faith on this, either. It's on the cover of the NYT. Two decades ago, physicians were belittling depressive patients who asked if stopping their antidepressant was making their depression worse. It was extremely taboo to even suggest that psychiatric medications could induce debilitating (and, ironically, seriously psychiatric) withdrawal syndromes. You can read the admonitions in contemporary medical journals: psychiatrists urging each other not to say the w-word for fear of an association with addiction. Now, it's front-page news [1].)
So to hear that the reason we don't have any precision in measurement or intervention in mental health is because of complexity and difficult observation ... well, first, I just don't believe that anymore, and I've got good empirical ground for doing so.
And second, extend the scenario and imagine that we somehow did obtain the holy grail of precise and accurate external observation of mental phenomena like depression, and that "treatments" were developed at that level: for millions, all we'd be doing is making them feel better about living in miseries about which medicine and the bench sciences have nothing to say. It's ghastly to think of curing the depression of, say, an elderly patient who's lost their savings and, in parallel, has been estranged from their family for decades without somehow having a way to address those circumstances at the same time. I'll make another claim: addressing these factors cures the depression. The bottom line for me is that no matter how incredible the findings, neuroscientific research cannot by definition address these factors. And in the US, these other factors are not meaningfully addressed on a large scale.
> but we aren't really 'there' yet
If you're interested in a friendly bet, I'd wager good money that we never will be.
[1] https://www.nytimes.com/2018/04/07/health/antidepressants-wi...