Hacker News Reader

Comment by viach | Hacker News Reader

> therapy is more useful than drugs, even if drugs are needed eventually.

Is it your opinion based on... ?

There is a growing body of research [1] that questions the usefulness of drugs for mental health. I personally know a case at a local hospital (in Europe) where a switch off meds and into therapy brought serious improvements in elderly patients.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582668/ , https://blogs.scientificamerican.com/cross-check/are-antidep... , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/

says the whole world. almost every european country requires you to do minimum hours of therapy before and to keep with therapy during the drug usage.

to begin with, I could refer you to the study the article is about. it correlates a social setting with high occurrence of depression. then it proceeds to promote the solution with medication. when the obvious solution is changing the social setting! that is the definition of the 80s joke "prozac for bad hair day"

Or, in other words, (at least some part of) the medical industry is driven by the neoliberal ideal that it's never anything else that's the problem, only yourself, and you're meant to deal with it with minimal impact on anyone around you?

Work must never be an issue, or we might have to treat workers well. Society and societal structures must never be an issue, or we might have to care about each other on a more than skin-deep level and drop this whole "we are all independent beings who are completely unaffected by external factors" madness.

At least some part of mental healthcare is essentially a system designed to help people cope with a society which does horrific things to them, and then gaslights them into believing it's their fault for not coping with it.

> and then gaslights them into believing it's their fault for not coping with it.

I don't understand why you say that.

Are you saying therapy make people feel guilty of their own self?

No, society does that. Our society is, apparently, perfect, and if you have trouble living in it, it's your fault - says society. However, how we often approach mental healthcare - as something individualistic and separate from society - is one of the things that normalises it.

> is one of the things that normalises it.

Why ?

It depends, coping with the imperfection of society is also something to work on. Accepting its flaws lets you walk around it. Sometimes it's not the individual who is the problem, but it doesn't mean he should not accept how the society is flawed.

Mental healthcare and therapy have an individualistic approach because that's what they do, how else? To change society you would need politics, and that's another matter entirely.

I often say that mental illness doesn't really exist, because as long as we don't understand the brain there is no "normal" behavior. But as the same time you can't deny that society has its norms.

> To change society you would need politics, and that's another matter entirely.

That's the point - it's not another matter entirely. If society is damaging people's mental health, it's entirely unethical to look the other way and pretend it's each individual's problem. If mental healthcare professionals want to ensure the wellbeing of their patients, they need to be fighting alongside us for widespread societal change, and they need to fight against the myth of poor mental health being an individual anomaly.

But getting to that point requires an understanding that mental health isn't individualistic in the first place, which is not what we're told, and it's not what our doctors are taught. What we have right now is, a lot of the time, treating symptoms and providing coping mechanisms instead of treating the causes. Imagine a doctor did that with a broken leg - refused to touch it, but instead provided you painkillers and explained how to plan routes around the city with lots of seats you can sit in when the pain gets too much.

I see what you mean, except mental illnesses can't be treated like a broken leg can be.

Mental health is a difficult subject.

Imagine the problem it can be to treat homosexual as equals in the political scene, it will be another story to have consideration for the mentally ill.

The more we become a society of people with knowledge rather than social norms and morals, the more we will be able to progress.

I also really believe that group therapy should be the future of therapy...

Maybe you should have a conversation with a psychologist or a therapist and talk about those things. A possibility is also that patients need to be told that nothing is their fault. It can take a lot of time to defuse the person's belief that a he/she is not "defective". There is no shame in going to therapy, it's all about talking, because that the most concrete thing you can do with a brain.

Maybe individual people have this attitude, but it is certainly not a tenet of medical/psychological practice.

>>"we are all independent beings who are completely unaffected by external factors"

>Maybe individual people have this attitude, but it is certainly not a tenet of medical/psychological practice.

This is indeed evidenced by the big pharma "chemical imbalance" sales pitch, as it implies your brain is a self-enclosed system

Much like being in a kind of depressive state from time to time is now considered depression because you need to be at 100% productive all the time.

1. In the United States most insurance will pay for a handful of Therapy sessions.

2. I had a breakdown years ago. Looking back it was just a massive Panic Attack. What really surprised me is I woke up the next morning feeling o.k., then out of the blue--life crushing anxiety. Anxiety so bad I just physically shook, and was always in tears. This went on for years.

3. After a week into the anxiety, I saw a Ph.D in psychology. I spent all my savings on these sessions. The result--not a bit of help. Now, they will claim that twice a week for 9 months is "not giving it enough time", but at a $100 a session it was just a waste of money.

4. I was finally referred to a Psychiatrist. He put me on all the antidepressants. None worked. He put me on a long half life benzodiazepine, and with a bottle of wine I was kinda functional.

5. My point is try Psychology/Psychiatry. Remember it's more of an art, than a science. I didn't realize this when I was in my twenties. Over the years, I have seem the spark dwindle from my Psychiatrist's eyes. I think if he had a do over, he would have picked a different speciality.

6. If I had a do over, I would have skipped it all. I did eventually stop drinking, but for years it was the only drug that worked, besides having to beg for low doses of benzodiazepines. I'm now trying to get off benzos, but figure why, at this point in my life. It's still a bitch getting any controlled drug from most doctors.

7. I can say this. So many of you will just get better with Time, but it might take awhile. (The "Professionals" conviently leave this out. There are some studies praising time verse therapy/drugs, but they are buried, and were small studies. I my case, it felt like I wounded my brain that night of the huge anxiety attack, and it would take years to heal. The experts told me most people do get better in a few weeks. I didn't. The depression arose because my life went from great to just lucky to get to sleep. Exercise did help eventually. At first, it didn't at all. I needed alcohol. I didn't want to blow out my liver in my twenties, so I only drank when I absolutely needed it. Don't overload that liver.

8. I once had a talk to a resident Psychiatrist. At first, he was a a cheerleader for his decision to specialize in psychiatry. After some debate, and honest reflection, he admitted to me all the modalities/drugs work a tiny bit in some patients, and the profession has a way to go.

9. I do know this, patients whom have been on a drug for a period of a few years shouldn't have to go into those prearranged sessions, just to refill a script. If the drug does not require blood monitoring, the patient should get refills. I know so many people who self medicated with alcohol, because our American system of treating mental illness sucks.

10. Time. I know, who has time. I need to function tomorrow. You have my heart.

But you can have the best social setting, and mental illness will still happen and still affect you dealing with things. Depression makes it just as hard to get out of bed on nice days as foul ones.

Quite. Sadness, apathy and anxiety are all symptoms of mental illness. But they're symptoms of all sorts of things too -- including social setting etc, and so people tend to conflate the two.

yes, but thats off topic to the article, which focus on a very specific region/profession/time.

You are confusing therapy being the front-line treatment with it being the most useful treatment.

Not the OP but Feeling Good states that people responded to CBT as good or better than drugs, though, both at once were more effective again.

They could also be thinking of Anatomy of an Epidemic where long term results of people on drugs are worse than those off. Specifically that there's never been such a finding for CBT having a long term negative impact.

(Disclaimer: I'm not a medical specialist just a sufferer and reader)

Reply on news.ycombinator.com