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>Finally, its fucking ridiculous the amount of trust people have in "authorities". "No we won't talk to you about your mental issues because fuck you, but hey why don't you go pay to talk to a stranger instead"? What? Why is that better? Isn't a friend/family member much better positioned to understand your problems and offer some perspective?

While it is good to have a supportive environment from friends and family, my experience is that they are very poor at solving these problems. A good counsellor can be far more effective. Supportive family members often give very poor advice. They think they understand your problem when they rarely do. They'll give you all kinds of suggestions that, for you, are clearly useless and only serve to highlight how little they understand your predicaments.

Also, keep in mind, that often friends and family are part of the problem (without intending to be).

I can't and don't want to judge American/Western/whatever attitude towards these serious problem, but I've 2 cents to add:

> Isn't a friend/family member much better positioned to understand your problems and offer some perspective?

While full support from your social environment is important, seeking good professional help is even more important. The more serious the mental issue, the less friendliness can substitute proper therapy.

Agreed for more serious problems. But if you have a milder problem, maybe a little bit of depression or anxiety I think social help is more effective than professional help. And that is the more common case.

Why draw the line at those disorders?

Or ar you perhaps talking about experiencing some of the symptoms of these disorders to a healthy extent - i.e. normal emotions?

Anxiety disorders and depressive disorders can be bad enough to wreak havoc on a persons life.

>Why draw the line at those disorders?

>Anxiety disorders and depressive disorders can be bad enough to wreak havoc on a persons life.

I am sure they can wreak havoc, having faced some myself. Not saying they are not real problems.

I just think that in many cases, support of social groups, exercise etc. are more effective treatments than going to a therapist/psychiatrist or taking medication.

For example, exercise is now proven to be about as effective or more as an antidepressant. Mindfulness is now being talked about as a very effective treatment for anxiety/depression. People have been saying this kind of stuff for years, but they had zero legitimacy and were laughed at before the science came along. Meditation/mindfulness was considered spiritual hippie-bullshit, now all of a sudden its a viable and effective treatment..

So it just makes me think, when we are talking about as nascent and complicated a science as psychology, there is some value in "folk remedies" and "common sense" which are all too often dismissed as not being scientific enough. Yet that still happens. Do we really have to wait for a hundred studies before we accept that there might be better solutions in common wisdom outside of the current science? Particularly given that many of those remedies can't cause any harm, there is no risk to trying it.

Anyways, I am all for therapy and medication if thats what one wants. Just saying that an environment of disconnection breeds more mental illness, like an unsanitary environment breeds more physical illness.

> I just think that in many cases, support of social groups, exercise etc. are more effective treatments than going to a therapist/psychiatrist or taking medication.

I'd be interested to know why you think so.

If I remember correctly, exercise is not proven to be "about as effective or more as an antidepressant", but has been proven to provide some positive effect (i.e. relieve negative symptoms) in those suffering from mild to moderate depression (relative to controls). This might have changed since last I checked though - please correct me if I'm wrong!

Mindfulness has been shown to be helpful in some circumstances, but then in a strictly defined sense - not just any old meditation.

We definitely have to wait for many studies to draw any conclusions, that much is clear. Common wisdom might as well be common ignorance if we aren't rigorous.

Mind you, I'm not trying to justify past or current practices or societal ills; I'm just saying that we can't throw epistemology to the wind because of our experiences, wants or beliefs.

My wife is a psychiatrist. She says that for anything less than severe depression anti-depressants don't work. Exercise and forcing oneself to be active and do stuff is more effective than drugs.

> My wife is a psychiatrist.

With all the due respect, one psychiatrist's opinion is not necessarily the same as many other psychiatrists' opinions.

No it is not. It is however better than my opinion or yours on the subject.

> It is however better than my opinion or yours on the subject.

Sure, it is.

Look, psychology just went through a replication crisis where more than 50% of findings could not be reproduced. All science is not equally valid, so it doesn't make sense to take social science results as seriously as say physics because one is a lot easier to study objectively.

Given that, you could call exercising or mindfulness or (new technique) unproven. I say, if it obviously doesn't cause any harm, and it might help why not try it. "Throwing epistemology to the wind" here has no negative consequence. You can't draw a scientific conclusion about whether X is beneficial sure, but you can sure as hell try it and see if it helps you. Thats what I'm advocating for. Taking some control over your own treatment.

Even the point you brought up about mindfulness being shown to be helpful in some circumstances - that does NOT mean any old meditation is unhelpful. In fact, given no other knowledge than that "X type of mindfulness practiced in Y way was Z% helpful" from a paper, wouldn't you be more inclined to believe that something similar to mindfulness would have similar beneficial effects rather than the inverse that its not helpful? Thats my point - we don't have to stick so rigidly to what is "proven" to be true (especially when the field went through a crisis where half of that so called "proven" stuff wasn't so true..)

> I say, if it obviously doesn't cause any harm

Both may well cause harm.

Ignoring the fact that not treating depression can be fatal for some people we know that some people respond poorly to mindfulness because of the way they've coped with an abusive history.

We also have to be wary of the fact in a number of situations for a lot of people their mental disorders may be being negatively reinforced by unhealthy social relationships or physical limitations.

I know you used the "many cases" as a caveat, and appreciate the angle you're taking in making the point, but the notion that "an environment of disconnection breeds more mental illness" wont be the case for a lot of sufferers, and we shouldn't be leading the discussion down an avenue where if someone doesn't have those support networks, ability to get the benefit from exercise or has screwy personal relationships they feel as if that's a personal failure. (i.e. it'd be helpful if we normalised all avenues)

> exercise is now proven to be about as effective or more as an antidepressant

Do you have a source for that? Because this cochrane collaboration seems to disagree with you.

http://www.cochrane.org/CD004366/DEPRESSN_exercise-for-depre...

> Exercise is moderately more effective than no therapy for reducing symptoms of depression.

> Exercise is no more effective than antidepressants for reducing symptoms of depression, although this conclusion is based on a small number of studies.

> Exercise is no more effective than psychological therapies for reducing symptoms of depression, although this conclusion is based on small number of studies.

> The reviewers also note that when only high-quality studies were included, the difference between exercise and no therapy is less conclusive.

> Attendance rates for exercise treatments ranged from 50% to 100%.

> The evidence about whether exercise for depression improves quality of life is inconclusive.

There has been a more recent meta analysis, but it's a bit frustrating to hear people keep repeating the claim that exercise is a treatment for depression, or that exercise is as effective as anti-depressants. The proper claim is that exercise might help with "resilience" - it might help prevent depression or prevent a relapse.

The jargon buzzword is "bio-psycho-social".

Mild to moderate depression may respond to anti-depressants, may respond to an evidence based talking therapy, may respond to something like a gardening group activity, may respond to debt planning and financial advice.

Treatment plans for depression should not focus on a single aspect of the bio-psycho-social stuff, but should try to address all of it.

That's a bit like saying "if all you have is a sinus infection instead of full on cancer, I think asking your friends for help is more effective than going to see a physician."

Your friends aren't efforts in how the brain works. Depression isn't just "feeling sad because something bad happened to you." Depression is a disease and it doesn't have to have an external cause. Indeed, it's often the perception "what do I have to be sad about" than keeps people from seeking treatment.

Can't wait for some psychiatrists to come in here and say something about, "yeah, unless you've got a big site like Facebook, you should probably just ask your friend who is sort of good with computers to make it for you."

The only example I can think of where that's obviously true is bipolar I disorder, where the most effective treatment (lithium) is very dangerous, but leaving it untreated can be very dangerous too. For other conditions professional treatment often does more harm than good.

Is that really the only example you can think of?

What about schizophrenia, borderline personality disorder, PTSD, serious major depressive disorder, and so on?

Those can be successfully managed with community support. American culture favors medicalizing those conditions, but I've not seen any convincing evidence that it results in better outcomes. BP-I is different because lithium very effectively stops mania, but effective dose is almost as high as the toxic dose, and long term treatment has a high risk of causing kidney damage even with accurate dosing. This unique combination of danger + effectiveness makes medical supervision mandatory IMO.

> Those can be successfully managed with community support.

Citation needed.

How the hell will community support lessen the symptoms of schizophrenia? It's a chemical imbalance in the brain.

> For other conditions professional treatment often does more harm than good.

Citation needed.

Do we have evidence that "professional" help results in better outcomes than otherwise? I've not seen such evidence, so if someone has hard evidence I'd love to see it.

I'm sure many psychiatrists assert this to be true (pay us, don't use free resources!), but an RCT would be great.

I don't know in general, but I'm discovering a new life thanks to doctors.

The psychologist helped a bit; the first psychiatrist and some chemistry helped much more; the second psychiatrist and less of the same drug made a miracle. I couldn't even imagine life without panic attacks, and there it is!

I too share your doubt, however psychology is a "soft science"[1], so you will not find much "hard evidence".

[1]https://en.wikipedia.org/wiki/Hard_and_soft_science

It really depends on the kind of mental health issue and the kind of solution.

As I understand it the 'standard' treatment for phobias and panic attacks, for example, is extremely effective compared to 1) earlier psychotherapy approaches, and 2) no treatment.

CBT more generally seems to have decent rates of efficacy, at least with things like anxiety disorders. And at least based on my personal experience and a handful of people I know, it often proved effective where earlier psychotherapy was not, where a good social support system was not, and where doing nothing led to the increasing anxiety levels in the first place.

That said, I'm skeptical of a lot of things in the field, so I don't want to sound like I'm fully defending it.

EDIT: apologies for not providing hard evidence. One book that references studies in regards to this issue is "What You Can Change and What You Can't" by Martin Seligman, but I don't have it nearby.

There's a lot of evidence, in various directions: http://www.bacp.co.uk/research/resources/

> Finally, its fucking ridiculous the amount of trust people have in "authorities".

True. Some people would even call the police to handle a psychotic episode.

> Isn't a friend/family member much better positioned to understand your problems and offer some perspective?

Not at all, they can be the worst advisor. Being emotionally involved and not trained as professionals makes them very biased. Having relations that extend in the past and future makes it even more difficult to be unbiased, not judgmental and honest.