Comment by DanBC | Hacker News Reader

Comment by DanBC | Hacker News Reader

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Which country are you talking about? This treatment plan for a person with borderlinePD is likely to cause harm.

> where the psychologist practices Cognitive Behavioral Therapy (as CBT is the only government-approved therapy), which has no affect

CBT is a short form therapy, normally about 8 weeks.

Do not use brief psychological interventions of less than 3 months. https://www.nice.org.uk/donotdo/do-not-use-brief-psychologic...

> Alice's psychiatrist puts her on quetiapine.

Antipsychotic drugs should not be used for the medium- and long-term treatment of borderline personality disorder. https://www.nice.org.uk/donotdo/antipsychotic-drugs-should-n...

> The psychiatrist moves her to lithium.

Drug treatment should not be used specifically for borderline personality disorder or for the individual symptoms or behaviour associated with the disorder (for example, repeated self-harm, marked emotional instability, risk-taking behaviour and transient psychotic symptoms). https://www.nice.org.uk/donotdo/drug-treatment-should-not-be...

What Alice probably needs is a long form talking therapy. Have a look at Meeting the Challenge, Making a Difference for more information: http://www.crisiscareconcordat.org.uk/inspiration/meeting-th...

I don't know whether you or the person you're replying to is more correct, but it doesn't change their point: That these decisions are not something the average person should be making for themselves. If anything, your disagreement kind of makes the point even clearer.

Maybe there might be an argument for people to be able to choose to obtain drugs like the ones mentioned by GP, but not without some kind of control-mechanism to at a bare minimum ensure they have been presented with the risks and have given some level of demonstration that they understand them.

E.g. I quite like the mechanism now in place for online pharmacies in the UK, where you can buy prescription drugs like Viagra, or OTC but restricted products like Daktacort (combination anti-fungal and steroids), but need to convince a doctor (for the former) or pharmacist (for the latter) in writing that you've at least bothered to read what they've written about the drugs (since nothing stops you from just faking the symptoms, but you at least need to describe relevant symptoms free-form semi-coherently, or they'll do additional checks before selling to you).

It has weaknesses, and certainly won't stop people from abusing abusable drugs, but it at least makes it possible to pick up on the most idiotic attempts at misusing drugs they don't even understand.

Alternatively, I've used PushDoctor a couple of times - a UK service that connects you with an actual GP via video chat; the last time it took me 10 minutes from I scheduled an appointment until I'd uploaded pictures of a rash, had a conversation with the GP and had the prescription passed to a local pharmacy electronically; even if one were to consider taking away their "gatekeeper" role in terms of letting them deny treatments they don't think are necessary, I don't think it'd be unreasonable to still at least require a consultation like that for the most dangerous drugs to give an opportunity to at least inform.

But these are "customer protection" laws, which are intended to make sure people are informed and to make it reasonable to shop in the street, not to protect against people who intentionally try to break them.

They are easily opted out of - they won't prevent you from e.g. buying whatever you want from China, and that's by design. There's no point in protecting a customer that doesn't want your protection.

As opposed to drug laws, which are designed to make drugs hard and dangerous to buy, even if you really want them.

And that's how I think it makes sense to treat narcotics too.

> Which country are you talking about? This treatment plan for a person with borderlinePD is likely to cause harm.

I'm aware of the harm. But it is the start of therapy programs in several nations, Australia, New Zealand, France, United States of America, among others.

> Do not use brief psychological interventions of less than 3 months.

Precisely, but the therapy with the most proven effectiveness, dialectical behaviour therapy, has little support from the government programs. In fact, CBT has proven to be harmful for those suffering from BPD, but is a requirement when you first begin treating a patient in some of the above nations.

> Drug treatment should not be used specifically for borderline personality disorder

However, it is commonly used to start treatment, and supplement ongoing talk therapy, with the ultimate goal of removing it.

> What Alice probably needs is a long form talking therapy

Which is not available to her.

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