Comment by brookside | Hacker News Reader

Comment by brookside | Hacker News Reader

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Firstly, it must be incredibly difficult to work with severely mentally ill populations, so I commend and thank you for taking on that responsibility.

It troubles me, however, to to give a government the capability to detain citizens based on the (forgive the scare quotes) "medical" expertise of a psychiatrist. This has been abused [1] and I find significant issues with the credence given to testimony by psychiatrists in the US court system [2]. The lack of science in ever-shifting diagnosis criteria is saddening, and these diagnoses will mirror the prevailing social and political winds. Within some of our lifetimes, of course, homosexuality was a pathology in the DSM.

I'm not sure of the answer here. We do need a way to keep people who are a threat to themselves and others in a safe place, but psychiatry has been and is such a troubling and far-too non-scientific endeavor, long drawing profit from conclusions far beyond our true capabilities to understand the human mind and behavior. I don't want people in the field with anything other than an attitude utter humility and possibly shame exerting control over others' lives.

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

[2] http://www.newyorker.com/magazine/2009/09/07/trial-by-fire

I understand your points, and there have been many appropriate checks and balances introduced to avoid past abuses (which were very real).

That said, I have a hard time feeling that allowing a person to go untreated and end up in jail or prison is in their best interest.

Here's a quick link about "transinstitionalization": http://www.namisacramento.org/advocacy/docs/Mental%20Health%...

It's a neat categorization to say troubling psychiatric practices are in the past - I don't think it's accurate.

An example apart from how Psychiatry profits from inserting itself into the legal system - we have society-wide acceptance of the chemical imbalance theory of depression - still without evidence. Because this model is a billions-of-dollars money pipeline for drug companies, who take the bad PR on the nose, and ...psychiatrists.

I have written much less than I could, but I find almost everything about psychiatry - it's influences from Freud, etc. to be problematic.

I know there's no chance of swaying anybody personally invested in the field towards this viewpoint. It's like telling a start-up founder they aren't actually changing the world for the better : /

[1] https://joannamoncrieff.com/2014/05/01/the-chemical-imbalanc...

You might be surprised. I also find the reach of industry to be very troubling, and there's a clear incentive for profit. Many of us continue to push back, and demand better evidence. The erosion of federal funding for research is a concerning development, as it leaves much of the funding to industry sources, who are motivated by profit.

In direct response to these kind of concerns, the NIMH has initiated a totally new research framework to study mental disorders: https://www.nimh.nih.gov/research-priorities/rdoc/index.shtm...

> we have society-wide acceptance of the chemical imbalance theory of depression - still without evidence. Because this model is a billions-of-dollars money pipeline for drug companies, who take the bad PR on the nose, and ...psychiatrists.

Are you just referring to overuse of antidepressants caused by that theory, or are you suggesting that antidepressants don't work? Because there's good evidence that at least in severe cases of depression, antidepressants do work and are more effective than other therapies alone. [1] Even if we don't really know how they work…

[1] https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2...

> I'm not sure the answer here.

Has anyone started making lots (like tens of thousands) high-resolution, 3D, video (i.e., not still snapshots, but over time and ideally during episodic moments) MRI and CAT scans of diagnosed psychiatric patients, pointed a deep learning system at the scans, and see if patterns can be detected? If the deep learning systems can pick up patterns we didn't notice before, then that could be a valuable empirical tool to add.

Yes, but this is expensive and difficult, and not many people volunteer to participate.

"Yes this should be tried", or "Yes, someone has started doing this"? If the latter, can you please post a link to their effort?

http://journals.plos.org/plosone/article?id=10.1371/journal....

Maybe somebody could get ahold of Dr. Daniel Amen's data. Amen (almost an actual phrenologist!) also makes another great example of prominent nonsense in the field. https://www.washingtonpost.com/lifestyle/magazine/daniel-ame...

The Finnish "Open Dialogue" approach is an interesting alternative. It's more about family and community integrated treatment than residential commitment. Recommended search: https://www.google.com/search?q=finland+open+dialogue

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