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The Moral Urgency of Mental Health

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Re: The Moral Urgency of Mental Health

#31
post #30

Earlier quoted context omitted.

It would be great if that were possible, but a lot of the value of therapy comes from the therapeutic relationship rather than a specific type of therapy. Most types of psychotherapy tend to have the same level of effect in studies, suggesting there is no "recipe" for the type of therapy that works. This phenomenon also suggests (but does not prove) that the human relationship, rather than therapeutic program, accoun…

This seems like a case where you have downgraded the meaning of "AI" to match its current commercial connotations. A relationship with an AGI >= a relationship with a human, at least in intellectual terms. The big hope, that AFAIK we have not abandoned, is that AGIs will be able to walk into a messy human situation, diagnose exactly what the dynamics are, and recommend the optimal thing to do to fix things. This coul…

My broader point was that much of the benefits of psychotherapy can be attributed to social or emotional factors, not intellectual factors. While there is considerable debate about this, a lot of people are of the mind that therapy is not about precisely diagnosing some issue and then saying something to a patient to optimally fix things. If AI becomes emotionally and socially intelligent, maybe they can do good therapy. But if you think that mental illness can be solved through deterministic problem solving, logic and recommending the optimal thing to do to fix things, i would view that perspective as not consistent with our current understanding of neuroscience and mental illness

I'd question whether you are trying to reduce the problem of mental illness to fit the capabilities of the tool you are working with, rather than trying to earnestly understand the problem

Re: The Moral Urgency of Mental Health

#32

Earlier quoted context omitted.

And when it goes wrong the practitioner will lie in your medical records to cover it up. When it goes even more wrong and the person is dead they'll just say "s(he) had serious issues". Having said that, I've seen it do wonders for some people.

It worked really well for me, but I probably wasn't as mentally ill as a lot of people who would seek psychotherapy. Either that or my therapist was just really good or we had a good working relationship. Trying to act on how I feel continues to be the hardest thing I have ever had to do.

Not sure if you're religious it not, but let me phase it like that. God put you on Earth to be you and do it your way. In an evolutionary context, it's a random process where the value of an individual can only be determined in hindsight after you're gone. Hence you need to be you and leave judgement to the ages. If you're at all concerned about that, you're a long way from being cluster B or dark triad, so don't sweat it.

Re: The Moral Urgency of Mental Health

#33

Earlier quoted context omitted.

It would be great if that were possible, but a lot of the value of therapy comes from the therapeutic relationship rather than a specific type of therapy. Most types of psychotherapy tend to have the same level of effect in studies, suggesting there is no "recipe" for the type of therapy that works. This phenomenon also suggests (but does not prove) that the human relationship, rather than therapeutic program, accoun…

I think it would be helpful in a different way. To put it simple, it would give people in suffering, more time to talk. I don’t think it can replace the human relationship, but it could act as helper, a listener, or something between the patient and the therapist. It could listen for hours very cheap, provide feedback, replay things previously said by the patient helping in auto reflection, create a report for the th…

That's a really good point and I agree that those tools could really help people. Anonymous expression of suffering can be therapeutic; people say things to Siri that they've never told anyone

I just have an adverse intellectual and emotional reaction when I hear people suggest AI / some app is the solution to mental illness. It devalues the hard and thankless work that therapists do, reduces people's deep suffering to a trivial engineering problem, naively presumes superiority to the centuries of research humankind has done on the mind and suffering, and is just logically and factually incorrect

There are plenty of ways to improve access to care that would have more cost-effective benefit than AI. If people started investing in those then maybe we could actually see some improvement

/endrant

Re: The Moral Urgency of Mental Health

#34
post #30

Earlier quoted context omitted.

This seems like a case where you have downgraded the meaning of "AI" to match its current commercial connotations. A relationship with an AGI >= a relationship with a human, at least in intellectual terms. The big hope, that AFAIK we have not abandoned, is that AGIs will be able to walk into a messy human situation, diagnose exactly what the dynamics are, and recommend the optimal thing to do to fix things. This coul…

My broader point was that much of the benefits of psychotherapy can be attributed to social or emotional factors, not intellectual factors. While there is considerable debate about this, a lot of people are of the mind that therapy is not about precisely diagnosing some issue and then saying something to a patient to optimally fix things. If AI becomes emotionally and socially intelligent, maybe they can do good ther…

I'm a mental health service user who has experienced psychosis and multi-week hospitalisation. I know what I'm talking about when I express hope for a more objective and -- ideally -- by today's standards seemingly omniscient AGI for treatment/therapy. Human therapists are unfortunately variable in quality, and they often participate in a system of casual oppression of the mentally ill, even if you discount whatever they charge for their services.

So, I don't lack earnestness. On the contrary, I strongly believe in a reductionist model of the brain. Who would deny that a sufficiently advanced AGI should be able to diagnose and treat mental illness, enlisting whatever social and emotional (or biopsychosocial) interventions are necessary or economical.

You seem to be waving your hands and saying that physical reality is not susceptible to deterministic modelling and interventions; or maybe you just mean that the brain is too complex for AGI to grasp. Either way, I think you overestimate the diversity and functional complexity of mental disorders, and underestimate the capability of a focused diagnostic intelligence. The promise of AGI is that it will get to the bottom of the dynamics of the patient's disorder. Once you have that picture, you can deploy appropriate social/emotional resources (and much more economically, which means it could actually happen in dysfunctional health systems.)

Even if it's just "good enough" and in the right direction. That would be a huge improvement on the existing situation.

As for AI being "the tool I am working with", I'm not involved in AI/ML in any way. AGI to me means human-equivalent intelligence, however implemented. The hope that it could be massively augmented relative to a human expert is uncontroversial (for example, it is anticipated in the way that self-driving car systems will learn from parallel acquisition of data by many vehicles.)

So, as a patient, it seems to me that better insight into the dynamics of the illness (via AI) is a huge potential benefit. Human generosity and empathy is often helpless in the face of severe mental illness -- relatives suffer for years without any hope of improvement. So I'm not sympathetic to the idea that what is needed is just more uninformed but kind and generous front-line human cannon fodder. Mental health is a very difficult profession.

Re: The Moral Urgency of Mental Health

#35

Earlier quoted context omitted.

I think it would be helpful in a different way. To put it simple, it would give people in suffering, more time to talk. I don’t think it can replace the human relationship, but it could act as helper, a listener, or something between the patient and the therapist. It could listen for hours very cheap, provide feedback, replay things previously said by the patient helping in auto reflection, create a report for the th…

That's a really good point and I agree that those tools could really help people. Anonymous expression of suffering can be therapeutic; people say things to Siri that they've never told anyone I just have an adverse intellectual and emotional reaction when I hear people suggest AI / some app is the solution to mental illness. It devalues the hard and thankless work that therapists do, reduces people's deep suffering…

Yeah, a trivial engineering problem, what could possibly go wrong?.

I wonder which are those other cost-effective ways to improve access to care you refer to...

Re: The Moral Urgency of Mental Health

#36
post #22

> Overall, the researchers claim, eliminating depression and anxiety would reduce misery by 20%, whereas eliminating poverty would reduce it by just 5%. Why are these framed as independent factors? For many people the lack of financial stability is a primary source of depression and anxiety. When you truly don't know how your are going to afford next week's food/medication/rent, survival instinct kick in causing anxi…

> as someone trying to figure out how to pay for a new $100/month insulin prescription

Last weekend, another internet stranger recommended prescriptionhope.com, which charges $50/mo/script. [0]

> Why are these framed as independent factors? For many people the lack of financial stability is a primary source of depression and anxiety.

Not only that:

- poverty "can change your genes and increase your chances of depression" [1]

- relieving poverty (by $73/mo) "significantly improves mental health" [2]

- "anxiety disorders in poor moms likely to result from poverty, not mental illness" [3]

Of course, not everyone agrees. Some researchers found that improving mental health led to improved financial situations (and not the other way around.) [4] Regardless of which has a larger causal effect on the other, studies continue to show the two are certainly linked, and not independent factors.

[0] https://imgur.com/gallery/ROYXD

[1] https://www.independent.co.uk/news/science/depression-anxiet...

[2] blog/news writeup: https://www.madinamerica.com/2015/11/relieving-poverty-signi...

abstract: https://link.springer.com/article/10.1007/s10597-015-9950-9

[3] https://www.sciencedaily.com/releases/2012/07/120720083312.h...

[4] https://www.theatlantic.com/health/archive/2011/10/poverty-a...

Re: The Moral Urgency of Mental Health

#37
post #2

> In the United Kingdom, it costs about £650 per patient to provide psychotherapy, which is effective for about 50% of patients. That figure indicates how much governments would need to spend, but does not take into account what they might get back. they don't appear to provide a source for this. The English NHS collects, and publishes, a lot of data for the IAPT (Improved access to psychological therapies programme)…

It does provide a source, if you click on the anchor for the cost, which seems to be the basis for the whole article given that the summary sounds so similar: https://www.penguin.co.uk/books/184573/thrive/

I'm sure that number conveniently omits continuing costs, and provides no standard for what effective means.

Re: The Moral Urgency of Mental Health

#38
post #22

> Overall, the researchers claim, eliminating depression and anxiety would reduce misery by 20%, whereas eliminating poverty would reduce it by just 5%. Why are these framed as independent factors? For many people the lack of financial stability is a primary source of depression and anxiety. When you truly don't know how your are going to afford next week's food/medication/rent, survival instinct kick in causing anxi…

Yes and no. Purpose, structure, exercise/activity, nutrition, sleep, support and not constantly living in uncertainty, stress, misery and/or isolation help. (In my case, treatment-resistant depression is the default setting irrespective of circumstances, Maslow's hierarchy items or socioeconomic status.)

LA's skidrow and Cook County jail's mental healthcare system are quintessential consequences of deinstitutionalization (d20n). Institutionalization, as it existed prior to 1973, was certianly slavery illegal under the 13th amendment (Souder v. Brennan) and not about the panacea of meds or uncaring Reagan. If institutions had simply been funded properly instead of being capriciously abolished, the costs vs. externalities to patients and society would've been far less (ie self-medication, police costs, hospital costs, etc.) Simply, d20n diffused the responsibilities and costs for necessary social services everywhere else, but they didn't and won't magically disappear because people are still people. The moral thing to do is rebuild sufficient and various levels of mental care facilities with proper funding such that patients get services they may not know they need, instead of dying slowly and miserably at a bus station.

Another big failure of d20n was the canyons which patients fell into when they were sent to underfunded, poor execution of Kennedy's legacy for Community Mental Health Centers, which left many homeless and in limbo. Instead of a spotty patchwork of services, US counties must be required to coordinate services and provide any missing that comprehensively address: drug treatment, social rehabilitation, housing, work, training/education, health/dental/vision/mental health and social work without the patchwork of duct-tape, missing services and callous neglect that exists today. Homeless people are people.

Re: The Moral Urgency of Mental Health

#39
post #34

Earlier quoted context omitted.

My broader point was that much of the benefits of psychotherapy can be attributed to social or emotional factors, not intellectual factors. While there is considerable debate about this, a lot of people are of the mind that therapy is not about precisely diagnosing some issue and then saying something to a patient to optimally fix things. If AI becomes emotionally and socially intelligent, maybe they can do good ther…

I'm a mental health service user who has experienced psychosis and multi-week hospitalisation. I know what I'm talking about when I express hope for a more objective and -- ideally -- by today's standards seemingly omniscient AGI for treatment/therapy. Human therapists are unfortunately variable in quality, and they often participate in a system of casual oppression of the mentally ill, even if you discount whatever…

Thank you for the detailed response, and I apologize for the assumptions I made about your background. I just get a bit upset and irrational sometimes about this subject, because it is one I care a lot about

I understand that human therapists can do just as much harm as good and that a lot of patients are treated terribly by the system. I think the best way to have near term positive impact on patients with mental illness is to expand access to current evidence based care and high quality practitioners. I am not talking about generous and kind front line human cannon fodder, but service models that expand access to high quality evidence based care and support and empower the mental health professionals that deal with severe, complex patients so these patients don't have to deal with terrible destructive therapists

For serious mental illness and psychosis, I understand that expanding access to services is not always enough, although we do have existing pharmaceutical interventions that can help certain patients, and that improving access to some of these medications could be helpful.

I appreciate your comment that I am "hand waving", but I believe that proponents of an AI solving mental health are likewise hand-waving and assuming that mental illness can 1) be reduced to a problem that is tractable with current or near term AI tools or 2) that the singularity and godlike AI is inevitable. As far as I know, both of those are beliefs, not foregone conclusions. I am open to being convinced, but i have not seen any solid evidence or specific hypotheses for how AI would help mental illness beyond chatbots, and while chatbots can certainly help some people they will not be a cure all

I would love to see evidence that I am overestimating the diversity and complexity of mental illness. From what I understand we don't know enough about these conditions to know how complex and diverse they are, but our current tools have failed to bound or characterize the complexity or diversity of mental illness in a way that make them tractable problems. Decades of study of the genetics and mechanisms of depression have failed to yield any breakthroughs, and we couldn't even predict which genes are associated with the disease (no serotonin / dopamine genes are that strongly correlated with disease). Fmri and eeg have horrible resolution and do very little to elucidate biochemical pathways. No new drugs with novel mechanisms have been developed for psychiatric disorders in decades. I'm not an AI expert by any means, but without tools to collect useful data, I can't see how AI could deliver much that is useful in terms of characterizing the biology of disease and intervening

Rather than invest in AI, I would like to see more investment in higher resolution, dynamic tools to analyze molecular pathways in the brain in Vivo. That would probably generate enough low hanging fruit that you could develop better treatments without AI tools

I went to a talk by Tom Insel, the former head of NIMH who was at Verily and now at a MH startup, and he told a story about how he gave a talk on the research of genetics in mental illness to a group of patients and their families. A parent of a child with sever mental illness stood up and said "you don't get it. The house is on fire and you're talking about the chemistry of the paint". Maybe I'm missing something, but I sort of feel like this when people talk about AI or apps for mental illness

Anyway I appreciate you sharing your thoughts so objectively, fairly and openly and hope that mental health care will improve through AI or other means

Re: The Moral Urgency of Mental Health

#40

Earlier quoted context omitted.

That's a really good point and I agree that those tools could really help people. Anonymous expression of suffering can be therapeutic; people say things to Siri that they've never told anyone I just have an adverse intellectual and emotional reaction when I hear people suggest AI / some app is the solution to mental illness. It devalues the hard and thankless work that therapists do, reduces people's deep suffering…

Yeah, a trivial engineering problem, what could possibly go wrong?. I wonder which are those other cost-effective ways to improve access to care you refer to...

Was probably aggressive to characterize it as "trivial"

Some examples of cost effective interventions include better mental health and substance abuse treatment in primary care (methadone tx for example), integration of medical and behavioral health reimbursement and relaxing some onerous rules like not being able to bull for medical and behavioral services on the same day (though I think this is improving), better training and supervision for mental health professionals, more rigorous research into group therapy, Better education on psychiatric meds for PCPs, more follow up etc

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