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Comment by nradov | Hacker News Reader

I hope you realize that Kelly Brogan is a complete quack. She posts all sorts of feel-good nonsense memes on Facebook without a shred of scientific evidence. For example:

"Saying no to pharmaceuticals is an act of feminism. Every time you open that pill bottle, you are saying 'nope you don't got this' to your body, and you are instilling a message of oppression by a system that says feeling anything is dangerous."

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From where I stand, that's a powerful quote. Your calling that person "a complete quack" based on the quote alone comes off as ideologically narrow minded to me.

Some seem to think that "science based medicine" is incompatible with approaches centered directly at the level of belief and doubt, yet large numbers of doctors regularly prescribe placebos[1,2], some even using things like antibiotics or steroids for this purpose. Perspectives that cultivate positive, empowered spiritual and mental outlooks about one's ability to heal and live well are not "quackery".

Am I against scientific approaches to healing? Not at all. I'm against unfounded allegiance to mediocre, dogmatic forms of "science" that default to shunning any perspective outside of their scope of understanding.

Thankfully, there are open minded doctors and scientists out here shedding crusty dogmas. e.g. http://news.wisc.edu/study-reveals-gene-expression-changes-w...

http://www.caltech.edu/news/microbes-help-produce-serotonin-...

http://www.apa.org/monitor/2012/09/gut-feeling.aspx

[1,2]:

http://www.nhs.uk/news/2013/03March/Pages/97-percent-of-GPs-...

https://www.sciencedaily.com/releases/2008/10/081023195216.h...

It's a shame that this moderately spoken, and well documented counter to the OP's ad hominem attack on the author of the linked article is downvoted so heavily. I appreciate HN's love for science and disciplined understanding of the world, but disappointed by the lack of open-mindedness towards beliefs and perspectives that aren't peer reviewed or approved.

Keep in mind every community is a hive-mind that gravitates to the mean.

Hacker news is good for intelligent discussion, but when the topic is on something that isn't empirically measure-able (IE: mental health in this scenario) conversation goes downhill pretty quickly. I'm quite concerned about how the majority are medicating so quickly, early and in a way that's mostly unchallenged.

I mean we barely understand the I/O of the brain, yet we're claiming some pretty heavy positive bias on chemical remediation. It's a pretty farked situation, being unable to talk about it in a neutral environment frustrates me to no end. The top comment on this thread though, perfectly sums up my perspective on depression:

"It's the realization that I was depressed for actual emotional reasons and not just because of some putative neurochemical imbalance, the idea of which in such huge numbers makes absolutely no evolutionary sense. A trait this common is not a disorder---it's a survival mechanism."

I want to understand depression, it's just such a hard issue to tackle scientifically. The scientific method takes the subject out of the equation, nuking any sort of bias. But that doesn't work when the issue that needs to be understood IS the subject.

I need data, subjective perspective from all walks of life is the best dataset I think I can use to shape my understanding. I want to talk about depression from a neutral, logical, mindful and philosophical perspective. Maybe then I might understand where, why and how medication would or should come into play.

In absence of any valid science what criteria should used to sort out BS from "the good stuff"?

It's a good question -- the way I look at it is that science is the realm of the things we understand using our mathematical representation of natural phenomena (eg. physics, etc). However, it would be foolish to believe that this set of knowledge represents entire understanding of the universe. Thus, given the premise that there is a large (probably near infinite) set of things we don't know outside of our current understanding, I try to keep an open mind towards things that seem estoeric or unfounded.

But how to distinguish this from absolute nonsense? Intuition is probably the number one thing -- what smells like BS? It's not a perfect substitute for objective knowledge, but I think as engineers and scientists, we undervalue our subjective life experiences in shaping our view. Also, it helps to have a discerning eye for the macroscopic message the author is trying to deliver. Many times, we tend to attack the articulation or delivery of a thought, and miss the underlying message. In the context of the author of that article was saying, we can all agree that we have a poor understanding of pharmaceuticals (SSRI's in particular), and it helps to stay with the feeling of depression to know what your body is trying to convey to you, rather than flood the body with more input to make the "negative" emotion leave. I took that thought and discarded all the other specifics -- because I don't expect anyone to be 100% right, and hence I take the kernel in each viewpoint and leave the husk.

I was a little worried linking there since I can't vouch for the rest of her output. But that particular article seems solid to me.

This anti-establishment part of psychiatry certainly attracts fringe views. But I find the core criticisms of neurochemical imbalances and psych drugs to be convincing.

I think it's important to distinguish the hardcore anti-pharmaceutical attitude from the more reasonable position that, while someone may perform better while taking a medication in some measurable aspects, it may nonetheless be ideal to leave people unmedicated if they would not otherwise be destitute. We may thus model the medicated state as a local maximum but perhaps not the desired result (in particular, we have chosen to err on the more familiar side of the state-space). Conversely, I would have a hard time arguing against, if someone found that moderate regular alcohol consumption had a curative effect on a severe problem, their choosing to continue it.

Exactly. There's no doubt that _some_ people (myself included) became much more functional on SSRIs. But we've got the crutches-metaphor and the insulin-metaphor, and we've swung too far to the biochemical side - because it's easier and cheaper.

I have no idea who Kelly Brogan is and would not be especially receptive to crossing these particularly ideological streams the way they have, but the logic they're employing here isn't that dissimilar from the logic underpinning Cognitive Behavioral Therapy, which has been subjected to serious testing.

How are you reaching that conclusion? The unsupported and unscientific assertions made by Dr. Brogan have no relation to evidence-based medicine techniques such as CBT.

I am only responding to that one quoted paragraph. I am not claiming that it is scientifically rigorous, but if you told me that was a pop-sci writeup of ideas based in CBT, I would not be surprised.

Click the provided link, though. It's bad.

The biggest warning sign is that it pitches a serotonin-deficiency model as standard and claims mainstream doctors are "breaking ranks" to oppose it. That's absurd. Knowledgeable doctors don't claim serotonin deficiency causes depression, only that SSRIs can help address depression. The serotonin-deficit hypothesis was advanced because SSRIs treated depression, and discarded when depressed patients proved not to have lowered serotonin levels. Brogan is pretending serotonin deficiency is a crumbling conspiracy, when it's actually a tested-and-discarded hypothesis.

I don't especially object to the pull quote about alcoholism. It's a standard clinical observation that antidepressants don't treat simple serotonin shortages, and work equally well on 'clinical' depression and 'normal' depression like the loss of a loved one. I just object to implying that this isn't commonly recognized.

Thanks for saving me the work of a full three-paragraph screed with your measured, very readable statement of this point.

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