Comment by DanBC | Hacker News Reader

Comment by DanBC | Hacker News Reader

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> Before criticizing modern psychiatry keep in mind:

> 1. mental health patients are extreme in their dysfunction, never common.

I agree with what you're saying, but the US does have a problem of over-testing, over-diagnosis, and over-treating illness. Not just mental ill health, but everything.

In the US about 10% of children have ADHD

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489818/

> Based on the Heath Resources and Services Administration's National Survey of Children's Health, the percentage of children aged 4–17 years diagnosed with ADHD increased from 7.8% in 2003 to 9.5% in 2007, representing a 21.8% increase in just 4 years (Centers for Disease Control and Prevention 2010).

An estimates 3million US children take stimulant medication:

> Experts estimate that approximately 60% of children with ADHD are treated with prescription stimulants (Center for Disease Control and Prevention 2005a); therefore, approximately three million children in this country take stimulants for problems with focusing. At the same time, many studies have revealed the numerous adverse effects associated with prescription stimulants when they are used inappropriately.

These numbers are a bit worrying, especially if medication alone is being used, and it's not provided as a package of bio-psycho-social treatment.

Ahh, sigh. I was writing with ADHD in mind actually.

Up to 10% children really do have ADHD which is a delay in the development of the frontal lobe. Such a delay seems "somewhat common" amongst humans.

More than half catch up, leaving upto 5% of adults with some form of ADHD.

ADHD is serious. It is a severe impairment to planning, self-management, emotional regulation, etc. You are likely to be impoverished without substantial resources to rely on (family, etc.).

> are a bit worrying > it's not provided as a package of bio-psycho-social treatment.

ADHD researchers (serious neuroscientists & clinical psychiatrists) have for DECADES tried "biosocial blah blah". It has failed. ADHD is not a failure of child training (ie., parents "Raising Their Child Right!!!").

Overwhelmingly the effective treatment for ADHD is pharmocological. At this point comments like yours, along with the media hysteria, are doing real harm to children actually getting treatment.

The problem we have with ADHD is significant under treatment and under diagnosis.

It turns out all those "useless" people joked about in human history have not just been failures of character: in need of "social" intervention. They have had a physical impairment, a delay in their brain's development. Not Fixable by a good beating, or whatever the touchy-feely equivalent is.

The suggestion that a child with a broken leg not receive crutches would be absolutely outrageous. Or a person with cancer not receive a daily pill treatment. The very same outrage should be felt here in the suggestion that people with ADHD not receive medication vital to their ability to even pay attention to their lessons (goals, etc.). Vital to their ability to socailize (ie., control their frustation in ways that doesnt alientate other children). And therefore vital to their future success.

Yes there does need to be a fundamental reorganization to western education systems to, from the ground up, be aware of how wide-spread developmental issues are -- and to build in fundamental support structures.

However this isnt a "treatment" for ADHD. There is no cure. This is just bracing the crutches. Overwelmingly the research over the last 30 years has shown the only significant impact on ADHD is pharmocological.

Honestly I think about half the problem is that psychiatric illnesses don't make people bleed, so there's no way to universally tell something is wrong.

The bane of society, I think, is mentally healthy people.

They run politics but have absolutely no appreciation for what works for non-healthy people. Which is all the people who acutally rely on politics/society.

I think conservatism as a personality is a symptom of good mental health: if you arent able to do something, its lazyness. So you must just need some motivation: either a beating or some money. etc.

That's true if you're mentally healthy. If not then the ways you are failing arent even imaginable from the POV of mental health. And they are as communicable as cancer, or any physical illness.

The last century is full of works by people who have recently taken acid telling everyone how "everything is now differnet" etc. How they couldnt even have imagined the things they took for granted in how their minds work were actually variable.

Every mental illness is its own unique form of acid. And unless you've been on an acid trip, or are very well informed medically, you've no idea what it is like.

I dont think any mentally healthy person would want to work in politics.

This is an interesting perspective. I would add that there may be multiple "healthy" modes of being human that are quite different, and some of these modes may be a small minority. In a small tribe these cognitive differences may have been valued (depending on the tribe of course!), but in our modern, highly systematized society these people are often considered a social "misfit" for being unable or unwilling to play along.

For better or worse, the rules of society are designed by the neurotypical majority, who are often unable to see that the concept of "normal" is frequently just a fig leaf for the majority consensus. This can get wrapped up in politics through layers of metaphor but is rarely (if ever) engaged with directly in public debate.

> the rules of society are designed by the neurotypical majority

That's another way of putting it. I'm not sure the majority are neurotypical however.

I think, rather, "neurotypicality" is a background assumption of certain institutions because it's easier to design for an average even if it doesn't exist (no 1 human being is mean in every respect).

However those who experience life-long mental health, and esp. for most of their childhood, I think are overwhelmingly "conservative" in their personalities. And I think these sort do tend to find themselves in more elite/visible positions.

Political systems represent those who hold power. They do not represent a majority (power is the mechanism of representation, not mere existence).

In democracies, there is more "tending towards the majority". But still, it is very much a symptom of who can be elected, who is elected, etc.

> I think conservatism as a personality is a symptom of good mental health: if you arent able to do something, its lazyness. So you must just need some motivation: either a beating or some money. etc.

This is a really cynical view of conservatism and I have a hard time seeing how you don't see half the country as evil if that's what you think.

Another view might be: this stuff is so complicated, and as you pointed out it's so difficult for political leaders to have real empathy for people in these situations, there is a high degree of chance we will screw this up and make it worse while trying to help. Example: homosexuality being in the DSM. Or really much of the history of how state institutions have treated the mentally ill, which has mostly had to do with keeping them away from the non mentally ill and not actually treating them.

I don't see it being cynical. I think it's the opposite of evil. It paints conservatives as entirely reasonable people making entirely reasonable suggestions but simply failing to appreciate difference.

A failure to appreciate difference is not evil, its part of how everyone acts in entirely well-intentioned ways.

Also, I dont think anywhere near half of any country has a conservative personality. Certainly the GOP are not today defined by their conservatism, whatever it is, it is radical.

I would say a fundamentally conservative personality is something most common in the vaguely upper-middle classes. It is present, to a degree, in the more traditional working class environments (eg. mom-and-pop store children, etc.).

It's all about seeing your success follow from your actions in a way that you control. It's about being able to plan, execute, and understand consistently -- for most of your life.

I think that's rarer than half, maybe 1/3? At a guess. And i think its not partisan: there are leftwing and rightwing conservatives.

> The bane of society, I think, is mentally healthy people.

> They run politics

Assumes facts not in evidence.

I think the conflict here is more in that way:

Do you want to give people medicine so they can conform to what society expects from them, or do you instead try to change society so it doesn't have this expectations in the first place.

With ADHD what a lot of people see is this: You are not being efficient, so that is a flaw that needs to be fixed. But where is the line? Should we really optimize for maximal productivity or are other forms of society possible?

You might be looking at ADHD too much through the lens of buying some Adderall before a uni exam so that you can nail it.

ADHD interferes with everything from social relationships to doing anything that you want to do. We have to be productive insofar as to pay for food and shelter, but you're addressing a very narrow aspect of what ADHD medication treats. For some people, it's the ability to socialize, finish a joke, and achieve their life ambitions.

Yes, this "Social" view of disability has I think, gone too far.

A dog with three legs is much worse at being a dog.

There is really something it is to be a human, and it isnt just defined by culture and present-day society.

We live on earth. We eat food. We socialize. We, by being human, do a very large number of things merely because we are human. And if you damage part of our body, we can't do those things. And doing those things is a fundamental part of what we do.

ADHD really is a neurological impairment on this scale. It isn't "being less productive". It is a torture, a trauma, an on-going alienating, destabilizing impairment.

You might say "well couldn't there be a society where ADHD was an advantage"... i'd say basically No, not without changing the human species.

Yes, maybe we could imagine one. A society perfectly designed for people with ADHD, but when you describe that society in detail, you'd discover its profoundly impairing to people without ADHD.

As in, imagine we all lived as if we had no arms. That would be an extreme oppression to the almost everyone who does. And that's because on-earth, doing the things human beings do, arms are inherently part of doing those things well. That is why not having arms is a disability, not a lifestyle choice.

Similarly for vision, hearing, etc.

ADHD is an impairment to advanced cognitive function. It's an impairment to your minds ability to "see" itself.

The moment we start to say, of children with ADHD, that they should have this impairment.. that it's our "culture" that decides this impairment is bad... I think that's a gross abuse of those children.

It's turning your own lack of dependence on pharmacology, your own health, into a trap for people who do need it.

It's weird that you have such a strongly negative reaction to my post.

Especially this bit:

> > it's not provided as a package of bio-psycho-social treatment.

> ADHD researchers (serious neuroscientists & clinical psychiatrists) have for DECADES tried "biosocial blah blah".

Medication is the Bio bit. "Your children are not wilfully disobedient, please stop hitting them" is the psycho-social bit.

I'm half reacting to a reading of your post that many readers will have, even if it's not one you intended.

On the whole I appreciate you introducing the real prevalence of ADHD, etc.

However the lack of engagement with the reality of treating ADHD and the implied "concerns" is a very easy prelude to a rant about middle class mothers, and the medical establishment.

If I'm a little harsh to you, its only as a stand in for what your post would otherwise be used for: the occasional reader unthinkingly associating it with an attack on effective treatment.

Your points about ADHD requiring a pharmacological approach reminds me of the discussion here: http://lesswrong.com/lw/2as/diseased_thinking_dissolving_que...

Specifically, that the only distinction between 'disease' and 'character flaw' which makes sense is that you can't fix someone's disease by yelling at them.

> "...you can't fix someone's disease by yelling at them."

Actually, I think if you believe in neuroplasticity (sp?) that might not be accurate. True, yelling might not be the best approach. But it can still work if applied the right way - to some extent.

I've read a lot of your posts on this thread and appreciate your perspective. I agree with a lot of it. Honest question for you though: isn't it a bit weird to label something as a disorder if 5-10% of the population has it? Isn't it just a fairly standard human existence then? I think that's where a lot of the discomfort comes from.

Not the parent, and I don't mean this sarcastically, but isn't that akin to saying "Only 5-10% of people fracture a bone, so why bother treating it. It's just a standard part of human existence."?

Also poor eyesight, color blindness, partial deafness, &c. The reality all of these diseases/disorders are readily and inexpensively treated and not an issue in modern society.

There is a wide difference in the prevalence, severity of condition and extremity of treatment in some of these conditions.

Poor eyesight afflicts a large portion of the population, but the severity of the issue and the extremity of the treatment are not high. It doesn't impact your ability to maintain social relationships, for instance, and the treatment is very well understood and has low/no side effects.

Color blindness, partial deafness etc., are readily and inexpensively treated, but they do not afflict 5-10% of the young and healthy population.

The issue comes in when we start saying 5-10% of the population has an extreme condition (ie: impacts ability to maintain work, social relationships etc.) with a relatively severe (ie: fairly large % of users experiencing side effects) treatment necessary. When you put that in the context of our massively volatile understanding of mental illness over the last 50 years, as well as the massive incentives for pharmaceutical companies to push a specific narrative, it is difficult for me not to see a red flag.

"...massively volatile understanding of mental illness over the last 50 years...": The sort of volatility you undertake on a path toward drastic improvement.

And yet by many measures mental health issues are increasing not decreasing so where is all this drastic improvement?

https://www.psychologytoday.com/blog/our-changing-culture/20...

Improvement is in treating.

Don't false equivocate. If we were to open more mines than there were in 1900 we may well see more broken legs. However we're far better at treating a broken leg.

Though it is not at all clear that "mental health" is deteriorating. It may be that some forms of mental health issues are more prevalent today (eg. anxiety and depression). But that is no where near the whole picture.

An entire generation of people were traumatized by WW1 and WW2, and by the generation of parents who through that traumatization, traumatized their children.

Extreme disorders of the personality, PTSD, etc. simply were seen as normal then because they were so overwhelmingly common. PTSD didnt exist as a diagnosis till 70s, and yet it would characterize a generation of people under war.

If I were to speculate, I would say that we are overwhelmingly better in our general mental health.

That we recognise it as an issue suggest a profound advancement.

> If I were to speculate, I would say that we are overwhelmingly better in our general mental health.

By what measure? Because I just posted a bunch of studies that show the opposite, and they actually address a lot of the issues you brought up.

> By what measure?

Did you even read my reply?

I looked at those studies. They do not at all address issues like PTSD, personality disorders, trauma and other mental health issues which, for example, would certainly characterize huge numbers of people in the interwar and post-war period. Yet, where as these numbers?

PTSD didnt exist at the time. Trauma wasnt even considered, in part, because it was so wide spread.

Domestic violence, murder, rape, assault, theft, etc. were crazy high only 30 years ago.

Western societies were incredibly violent and predatory placeo, and this gets significantly worse the further you go back. At the beginning of the 20th C. 1 in 20 women were dying in childbirth, murder was 10-a-penny, almost everyone was impoverished. Children routinely went hungry.

But oh year. Now we're a bit more depressed.

THe 20th C. was a century of trauma. Child abuse was institutionalized. Domestic violence was how families worked. WW1, WW2, Vietnam (and many other wars) left a generation of men absolutely traumatized.

The studies have no reliable data to work with, as there was no empirical psychology for the bulk of the 20th C. collecting societal-level information on mental health.

Subjective "happiness" reporting has not much to do with mental health. A financially secure person who was routinely sexually assaulted as a child may well report being happier in 1985 than a poorer, less economically stable person today with otherwise excellent mental health.

For several decades economic securiyt has been decreasing in the west causing people to feel less "happy" (ie., to be more often worrying). This has an impact on their mental health, but I'm sceptical it comes close to the impact of the vietnam war.

The 20th C. was horrific and a horror for everyone. Any "psychologist" nostalgic for the 20th C. either knows nothing of psychology, nothing of history or both.

Hi, FWIW I did not downvote you and don't agree whoever did.

> I looked at those studies. They do not at all address issues like PTSD, personality disorders, trauma and other mental health issues which, for example, would certainly characterize huge numbers of people in the interwar and post-war period. Yet, where as these numbers?

Exactly, we don't have them. But I don't see any measures of any kind of mental health improving, with the exception of teen suicide rates in the early 90s. I do see quite a bit of data going back that shows depression, for instance, getting worse, and specifically comparing post WW2 generations to millenials: https://www.ncbi.nlm.nih.gov/pubmed/2648043

So I repeat my question, how are you so sure things are getting better when there is very little or no data saying that, and a fair amount saying the opposite? Wouldn't you expect depression to also be a symptom of experiencing intense trauma and thus a fairly good proxy for PTSD?

> For several decades economic securiyt has been decreasing in the west causing people to feel less "happy" (ie., to be more often worrying). This has an impact on their mental health, but I'm sceptical it comes close to the impact of the vietnam war. The 20th C. was horrific and a horror for everyone. Any "psychologist" nostalgic for the 20th C. either knows nothing of psychology, nothing of history or both.

So this is exactly why it's important to consider this with data instead of logical models. By all means the events of the early 20th century were so horrific that there should be some fairly obvious measurement of mental health that upticks by the end of the 20th century. But we don't see that anywhere, afaict. So that's what I'm hoping you can provide.

> Color blindness, partial deafness etc., are readily and inexpensively treated, but they do not afflict 5-10% of the young and healthy population.

Isn't color blindness in men right in that range?

Off hand I have no idea, but it's also the severity aspect here that is different. Color blind people do not have problems with executive function, maintaining social relationships, depression etc.

A significant amount of blacks worldwide had sickle cell anemia. In the past when humans lived in more isolated and homogeneous societies this was the standard existence. In fact, it conferred a resistance against malaria. Today, we have better treatments for that disease that don't carry the same side effects.

A more prescient and present example is that almost all humans are subject to cognitive biases. A wise man known as Citizen G'Kar once said "In the past, we had little contact with other races. Evolution taught us that we must fight that which is different in order to secure land, food, and mates for ourselves. But we must reach a point where the nobility of intellect asserts itself and says no, we need not fear those who are different. We can embrace those differences and learn from them."

> In fact, it conferred a resistance against malaria.

I think this is one of my main points: if such a large percentage of the population has something that we think of as a large negative, it's probably a good time to take a step back and wonder if we aren't understanding the whole picture because evolution tends to take care of such low hanging fruit.

Evolution takes care of things that stop you from reproducing, not things that make you unhappy.

> "...but the US does have a problem of over-testing, over-diagnosis, and over-treating illness. Not just mental ill health, but everything."

I'd argue this is a symptom. The root disease is the profits to be made from various testing positive.

I'd add that it's aided by the fact that most people believe the doc can (and should) script you a pill for just about everything. Prevention? That's not going to happen. The patients know it, the doctors know it, and the insurance company pays for it.

Do I think everyone should have access to healthcare? Yes. But everyone should also be mindful if personal health. That isn't the case. And since soneone else is always paying for it, and the med pro are too broken to push back, we get what we have.

Illness as a badget of honor.

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