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Comment by beambot | Hacker News Reader

Your psychiatrist runs a practice and you're mad that they are practicing rather than researching? That seems like an unrealistic expectation. If your doc was doing more research, then they probably wouldn't be practicing as much. It's like asking you to be a professional developer and do cutting edge CS research -- that's pretty rare.

Tracking nicotine vs your mood strikes me as being "research" -- especially since there wasn't a previously-known scientific correlation, as demonstrated by the recently-published results! Instead... I'd be glad that there is finally some evidence to explain your observations, and be hopeful that it results in new treatments.

(Also: Pawning off laziness onto others is a cop out. You could've pushed the research forward by doing more than just telling your doctor. But you didn't, I presume. Why is that...?)

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They're called analysts for a reason, their daily work is much closer to research than refactoring code for yet another form-based web app. Humans seem to innately require a kind of redemptive soteriology. For many cultures, this was the role of the shaman/medicine man. Insofar as therapists/psychologists/psychiatrists now fill that niche, it would seem right that they offer the analysand new/fruitful/exploratory possibilities, rather than mere regurgitation. A critic of capitalism might consider both the psychiatrist's laziness and your own dismissive tone products of an unexamined assumption that the "division of labor" optimally solves all problems economic and existential alike. The division of labor works well on the assembly line, but does it work well for the health of the human being, especially psychological?

Indeed, therapy / psychology / psychiatry are the closest analogs to modern-day shamanism -- and there's a lot of room for improvement.

Unfortunately, those fields are bound by professional regulations that prevent "experimentation". Which makes the difference between diagnosis & treatment -vs- research pretty clearly defined. The latter has vastly different requirements (eg. double-blind studies, IRB approvals, etc, etc).

I think it's a perfectly reasonable state of affairs to have psychiatrists sit somewhere on the "practice <---> research" spectrum. Don't like that your psychiatrist sits on the practice part of the scale? Find a different provider.

I don't believe he is mad that his psychiatrist is not doing academic research, but instead mad that he is not listening to his claims about smoking having a benefit to his mental illness.

To be fair, it is very easy to dismiss what crazy people believe.

Not just psychiatrists. A significant proportion of M.D.s of all subspecialties are surprisingly uncurious and unwilling to listen seriously to patient symptom reports (even detailed reports of careful observations), whenever anything doesn’t match their narrow past experience. Instead of admitting they just haven’t seen anything similar before or suggesting ways to follow up with research literature etc., doctors often second-guess their patients’ reports in such cases and chase people away with speculation about hypochondria, etc.

I think medical school / career pressures do a good job of selecting strongly for folks good at following instructions and memorizing information provided by some authority at the expense of curiosity or critical thinking. This works great when someone goes in for a common condition and needs routine treatment, but can get pretty frustrating for patients suffering from anything atypical.

Or maybe I’m being unfair and this is just true of people in general.

Or maybe the doctors are rational, and patients are just generally less reliable than medical authorities are. Additionally, it's very hard to tell reliable patients from unreliable patients, and personal bias ends up playing a huge role.

> Your psychiatrist runs a practice and you're mad that they are practicing rather than researching?

I just write code and I have to research stuff, why oh why would mental health professionals not be required to do so?

Your code does not need to go through the FDA nor cost millions of dollars to run a valid trial.

He could work for NASA in which case his code would go through millions of dollars of analysis before it's run. ;)

Because when you're a medical professional you can lose your licence for experimenting on patients.

There's a big difference between "reading research papers" and "doing research." The former is expected. The latter generally is not. Most professional computer scientists do not write peer-reviewed papers in top academic journals during the course of normal professional development. (There's a big difference!)

A doctor should be quite curious about a something that might alleviate a common and serious ailment. Other things to do might be having a look in recent literature if 'nicotine' and 'schizophrenia' show up in the same paper, ping a colleague in research, or alternatively, explain the error of OP's reasoning in simple terms.

More fundamentally, an educated person should be able to have two different ideas in their head at the same time without having to suppress or reject one or the other:

a) nicotine is unhealthy

b) nicotine can be a cure

So... bear with me: Patient comes in and says "I noticed that nicotine helps with my symptoms." Doctor does some searches & reading and sees no results (because this study hadn't been published yet). Doctor tells patient, "There is no published, scientific evidence between nicotine use and treatment of schizophrenia. But there is evidence that smoking is bad."

That seems perfectly reasonable for a practicing doctor before this study was published. How can you be mad at that?! Do you thoroughly research every correlation you encounter in your field of expertise when you have other clients & projects to address?

(It seems reasonable to me.)

A reasonable reaction would be 'tell me about the difference it makes to your symptomology' and maybe helping the patient figure out a way to track this systematically. Likewise I would have thought that mentioning my extensive experience of psychedelic drugs (also now suddenly fashionable) would have merited something other than 'uhuh', such as questions about how the temporary improvement in mood manifested or how long it lasted. I manage to have very interesting conversations on subjects I know nothing about by the simple method of asking people questions about the domain knowledge they've acquired, and I doubt that any psychiatrist has ever lost their license for listening too closely to their patients.

That reaction makes a lot of sense. Indeed, that would be the most effective method!

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