Psychiatry’s Incurable Hubris
theatlantic.com
theatlantic.com
I think that what is disturbing to a lot of computing folk is that psychiatry sounds a bit ill-posed. An imposition of magical thinking onto what we assume are complex, chaotic systems. It just doesn't feel right that something so complex can be adjusted with such gross, brute-force methods.
Imagine debugging a computer and saying, "I think your RAM hasn't enough ones in it. I am prescribing this selective ones-uptake inhibitor to restore the balance." On the other hand, we do have plenty of drugs that are a bit closer to saying, "This packet flow seems to be overwhelming the cluster. We can prescribe this traffic filter to interrupt that flow, allowing other functions to return to normal."
Yet we use encoding techniques to ensure that there precisely are a sufficient number of ones, such that clock can be recovered. https://en.m.wikipedia.org/wiki/Run-length_limited
I am deeply critical of quite a few facets of modern psychiatry, but this thread seems to mistake the stuff that’s slung around in Guardian and Atlantic articles as having any relationship to reality.
“The germ theory was proposed by Girolamo Fracastoro in 1546, and expanded upon by Marcus von Plenciz in 1762. Such views were held in disdain, however, and Galen's miasma theory remained dominant among scientists and doctors.” - https://en.m.wikipedia.org/wiki/Germ_theory_of_disease
> Marcus Terentius Varro was called the most learned of the Romans. But what did he know, and how did he know it? I ask because of this quote, from Rerum rusticarum libri III (Agricultural Topics in Three Books):
> Precautions must also be taken in the neighbourhood of swamps, both for the reasons given, and because there are bred certain minute creatures which cannot be seen by the eyes, which float in the air and enter the body through the mouth and nose and there cause serious diseases.
> I get the distinct impression that someone (probably someone other than Varro) came up with an approximation of germ theory 1500 years before Girolamo Fracastoro. But his work was lost.
It’s the difference between a stoner strumming his guitar, “dude, what if we’re all, like, strings?” and string theory.
Describing disease in great detail is nothing the Romans didn't also do, nor does it have anything to do with the germ theory of disease.
The advice "stay away from swamps; they'll make you sick" does indeed apply to both theories.
Detailed observations also apply to both theories. Everyone everywhere has detailed observations of disease, usually the same ones.
Girolamo Fracastoro did not, as far as I can see, make any hypotheses or predictions that other people hadn't made thousands of years before he was born, nor did he observe in any greater or more relevant detail. He exemplifies the observation "Christopher Columbus is famous for being the last person to discover America". He made what had been common knowledge common knowledge again.
Unless you can identify something he did that was notable? What hypothesis did he make that Varro didn't already know? I ask because "tiny creatures get into your body and cause disease" is pretty much the beginning and end of modern germ theory today.
It isn't even scientifically accurate to believe that mental illness is caused exclusively by brain malfunctions. Other bodily systems, especially the gut, also seem involved - never mind the mysterious role of genetics, and the slightly less mysterious but hard to pin down influence of environmental and social stresses.
The GP was asking because of this statement:
IMO, we already have the mental-disease equivalent of germ theory
She was a guinea pig for decades and it became abundantly clear toward the end that none of these doctors had a god damn idea what they were doing.
The problem is that all of these doctors are operating _without data_. They'll tell you that your seratonin levels are too low, or this or that, but if you ask them how low... they can't answer. If you ask them why they're low, they can give you common answers, but none that are unique to your physiology.
So you have schizophrenia? Let's try bloodletting, leaches, and an assortment of drugs that will affect the balance of chemicals in your brain in unknown ways. Don't worry about the side effects, here's a cookie to help with the blood loss.
There was no guessing involved or hand-wavy incantations, just a thorough assessment of my state of mind, both in the moment and across a span of time. This required me to be honest, which I strongly suspect many people aren't (due to things like fear of judgement) and this will hamper the capability of the doctor in doing their job.
To put this into perspective, while ill I was relatively high-functioning. You wouldn't guess I was ill, but you would likely find me abrasive and prone to apparent flights of fancy. What the worst symptom was, the crippling anxiety, you never would've been able to detect without a goal-driven conversation - the type of conversation I have with my doctor when we meet.
I think we're still largely in the dark on the methods of action within the brain that leads to these problems, but we have actually found useful tools in resolving these problems. This isn't to say it is perfect, I was put onto a completely incorrect drug by a non-psychiatrist based on my self-reporting.
The next step is going to be neuroscience explaining the modes of action in a failure state and how these drugs restore normal function.
To anybody out there suffering with mental disease, I'm with you.
edit: throwaway account for obvious reasons
There are many open questions about the mechanism(s) behind them, as well as the extremely frustrating fact that we can never truly tell if we are actually seeing the surfaces of multiple completely separate underlying pathologies that result in somewhat related loose symptom profile clusters.
But if we were to take an extreme example I encountered, a person whose life was basically over to the point of him trying to butcher people over his delusions[1], and you find a medication with which he can regain control of his own mind, can live in society rather than prison, even hold down a job and have fulfilling friendships, and over months you see numerous patients with this same dramatic reduction in symptoms, there is no question that there must be underlying pathology at play.
There might be numerous underlying pathologies all fitting the same symptom cluster, which would (potentially) help explain why even on the same symptom cluster a medication might have drastically different levels of effectiveness on different people.
The best reason to think underlying pathologies behind psychiatric illnesses are real isn't that we have clear the biology behind them, but that there exist treatments that actually have very measurable effects on the symptoms. The other reason is that we already concede our thoughts and perceptions themselves have a biological basis, so it would just be profoundly strange if 'disorders of thought and perception' somehow didn't.
[1] Just an additional note here, I'm using a specific example of a patient with violent delusions and criminal behavior, but it's important to note that people with mental illness are much more likely to be the victims of violence than perpetrators of it, and it is important we counter the unfair stereotype that mentally ill people are prone to violence.
On the 'reality' of mental illnesses, if I can be a little less serious, I do still recognise (as did my favourite professor) that it is still a very odd position to be in, to say that the illness must exist because of the presence of the treatment. Suppose that the treatment had for some reason not been invented, does that mean the illness didn't? Did the illness become 'real' the moment the treatment was discovered to be effective?
We've been waiting for that next step for decades without any progress. The drugs don't predictably restore normal function, we can't predict if they will and we can't explain away this failure as improper diagnosis. In point of fact, the very theories that led to the creation of many of these drugs have been debunked as incorrect.
> Modern medicine pivots on the promise that portraying human suffering as biological disease will lead to insight and cures. Inescapably, this enterprise has a sociopolitical dimension.
The point of the article is that Psychiatry hubristicly still assumes it will find these "methods of action" wholey within the brain. This is despite some pretty compelling evidence that many psychiatric diagnosis present themselves radically differently in different cultures and time periods.
The truth is, we don't know to what degree neurological structures or patterns cause these problems. How much of it is the stories we are told about what symptoms go together, how our brain works and how it can be fixed? How much of it is because of the social structure of cities, media and our work places? How much of it is simply labeling people who naturally function differently as ill and attempting to force them to conform to some ideal for our own comfort and ease?
In all likelihood, there is a complex interplay between some or all of these factors that varies from person to person.
I am very glad to hear that Psychiatry's approach has helped you personally. That does not mean there aren't structural problems with how Psychiatry approaches and talks about mental illness. Indeed, the whole point of the article is that the same structural problems that led to some horrifying results in that past century have not changed much if at all. This is cause for concern.
There is such a thing as "lay psychoanalysis", not involving a professional. I wouldn't dismiss it.
What I would definitely dismiss, as someone who has spent time in a psychiatric hospital as a patient, is the bad faith pseudoscience of psychiatry. Individual doctors may be doing their best, but the profession is very much as described in this article.
It's an interesting question, whether there is such a thing. On one hand, Freud himself was a lay analyst. On the other hand, there's probably a reasonably large contingent of (orthodox) analysts who would assert that it can't exist for structural reasons (the setting, the lack of payment, the nature of the relationship, etc.).
If we had a solid reductionist biological theory of mental illness, we would still sometimes discover that the cause was strictly "outside" the patient's own physiology.
Psychologists certainly go along with the fashionable talk of "chemical imbalances", but unlike psychiatrists, they don't really claim any authority when they do it.
My general impression is that the only way to communicate how psychiatry is would be to write a very thick novel with characters who occupy many different positions in relation to the profession. Even then it would be hard to give an all-encompassing impression.
The psychological "trauma model" for mental disorders is a compelling counterpoint to the chemical-imbalance theory. The wikipedia article contains some evidence and links to related research:
"A 2005 meta-analysis of schizophrenia revealed that the prevalence of physical and sexual abuse in the histories of people diagnosed with psychotic disorders is very high and has been understudied. This literature review revealed prevalence rates of childhood sexual abuse in studies of people diagnosed with schizophrenia ranging from 45% to 65%"
https://en.wikipedia.org/wiki/Trauma_model_of_mental_disorde...
This is similar to the problem with cannibis which many psychiatrists view as the primary causal factor for schizophrenia and psychosis.
This is a methods problem in my opinion. See for instance this[1]. There are so many cannibis users and so many people who have been traumatized in some way, while the number of those developing schizophrenia is relatively much smaller.
But ask a psychiatrist how many of their psychotic patients used cannibis regularly and you get a pretty clear answer. The psychiatrists don’t get to talk to the millions of cannibis users that don’t develop schizophrenia and so they tend to form their own non-scientific opinions on the origins of schizophrenia. Same with trauma. How many people get to adulthood without some traumatic event occurring. Even on this board it’s got to be a small minority.
[1] https://marginalrevolution.com/marginalrevolution/2018/04/de...
This argument makes absolutely no sense to me. 40 million Americans now take psychiatric drugs for depression, anxiety and psychosis, about 1 in 6, most of them longterm. How many millions more need to take drugs before this would qualify as a high enough prevalence rate?
https://www.advisory.com/daily-briefing/2016/12/14/what-psyc...
[0]https://www.nytimes.com/2019/01/17/health/cannabis-marijuana...
It's well known that trauma plays a part, but it is obviously not the whole story.
Twin studies: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4623659/ https://www.ncbi.nlm.nih.gov/pubmed/21336711
This has always been my issue with psychology. It is inherently unscientific. Given the preponderance of reported mental conditions, it's also insufficient.
My experience is that the patient is asked a series of incredibly open ended questions. I was struck with the sheer variety of ways that I could respond. And depending on my response, I would receive a diagnosis.
The following were my diagnoses from 3 different psychiatrists: Attention Deficit, Seasonal Affective Disorder, Bipolar disorder.
There was absolutely no consensus, and it's no wonder. Years later a doctor made the connection between chronic pain (Crohn's disease) and my lack of energy.
I had been consuming anti-psychotics purely because of how I answered "How are you feeling today?" and other similar open ended questions in the wrong way.
At that point I worked to improve my chronic pain condition, which was of course the actual issue.
Neuroscience is the way forward to understanding mental disorders. In the meantime, great care should be taken around psychology. The effect of an uninformed approach can be devastating.
Neuroscience is the only true way to approach the problem scientifically, but it has a really, really long way to go. It's like trying to understand how Chrome works when all you have is a voltage meter for measuring the 1s and 0s in memory. And even that is a fairly recent development.
(open to anyone reading, too)
This has always been my issue with psychology. It is inherently unscientific."
To be clear, the chemical imbalance theory and the DSM are part of psychiatry, not psychology.
Broadly speaking, the difference between the two fields is that while they attempt to treat the same issues, mainstream psychiatry (at least for the last 50 years) views the root cause as biological; psychology looks at social or environmental factors.
If you replace "psychology" with "psychiatry" in your comment, it would make more sense.
Likewise, clinician psychologists use the DSM regularly and do loads of testing, including tests for things like personality disorders (which, again, tend to be diagnosed using DSM criteria). Psychiatrists certainly can do testing but many of them (at least in private practice) refer out to psychologists for it.
Prior to Freud and Jung psychiatrists didn’t even care about the content of delusions and did not consider that anyone diagnosed with an illness could be cured except through physical means such as electroshock therapy.
That’s why I explicitly referred to “mainstream psychiatry”, rather than the “whole field” as you imply in your inaccurate characterization of my comment.
I’ll grant you that the DSM may provide some value for understanding the range of personality disorders at least at a high level. But it’s really messy. Other tools may be more useful for understanding specific disorders, for example the Hare psychopathy checklist.
[edit: replaced “testing tools” with “tools” in previous sentence]
(note that psychopathy isn’t even listed in the DSM, the closest thing is ASPD - just another indication of how messy and imprecise this entire field of personality disorders is, underneath the veneer of scientific rigor)
Similarly, when your therapist asks you a question, your answer is skewed by what you want the answer to that question to be. Or what you want your therapists reaction to your response to be. Or any number of factors.
This idea has led me to start doubting my subjective experience of basically everything. Do I not like someone because of how they act or do I not like them because I don't want to like them? Did I study computer science because I enjoyed it or because I wanted to make a good salary? Not to mention that other peoples' subjective experiences are probably even less reliable.
I have no idea how to answer my therapists questions because I don't trust the answer in the first place.
With that in mind, does it really matter why you studied computer science? You're allowed to feel differently now than you did when you made the decision to study CS.
Somebody I knew drank antifreeze one day, decided he didn't want to die after all, then went to the emergency room. His family wondered where he was for 36 hours and then they found out.
A week or so later he went to a scheduled appointment at a psychiatrist's office, had to fill out his name 10 times and then tell it to 5 different people and was so enraged by the cluelessness that he went home and hung himself that night. That time he succeeded.
E-room workers are trained to believe that the vast majority of suicide attempters are seeking attention. That's true. Inside that population, however, are a small fraction of completers for which a suicide attempt is the mental health equivalent of a heart attack.
Unfortunately books have a long half life. People are still influenced by R.D. Laing, Thomas Szasz, L. Ron Hubbard, and Erving Goffmann long after Ronald Reagan set the insane "free" to roam on the streets. Involuntary commitment was a problem in the 1950s, but today it can seem impossible to check into a mental hospital even for a person who is in a full-blown psychotic crisis.
The helping relationship is fundamentally difficult too. Some people are going to do the wrong thing and face consequences if they do. Sometimes what you think is the right thing is really the wrong thing and vice versa. You can't take responsibility for someone else's life in the end.
"Modern medicine pivots on the promise that portraying human suffering as biological disease will lead to insight and cures. Inescapably, this enterprise has a sociopolitical dimension. To say which of our travails can (and should) come under medicine’s purview is, implicitly if not explicitly, to present a vision of human agency, of the nature of the good life, of who deserves precious social resources like money and compassion. Such questions, of course, aren’t always pressing; the observation that a broken leg is a problem only in a society that requires mobility seems trivial.
But by virtue of its focus on our mental lives, and especially on our subjective experience of the world and ourselves, psychiatry, far more directly than other medical specialties, implicates our conception of who we are and how our lives should be lived. It raises, in short, moral questions. If you convince people that their moods are merely electrochemical noise, you are also telling them what it means to be human, even if you only intend to ease their pain."
This sums up psychiatry and psychiatrists in general. Corrupt pill pushers willing to make money no matter what the outcome for the patient and what it takes. If it takes lying, so be it, as long as it's well intended. If it takes many people committing suicide after buying their bullshit chemical imbalance fiction even they don't believe, so be it. Such disregard for other human lives would usually land one in jail, but we have a whole profession built on it. At the same time, we lock up drug dealers who may potentially and inadvertently have part of the puzzle (lsd, psilocybin, mdma, ketamine). The entire existence of the field is absurd. One book, the dsm justifies these quacks pushing whatever they want and using their patients as guinea pigs in ad hoc experiments that often go wrong and lead to worse outcomes, including death. All because we refuse to believe that things like depression and anxiety might be caused by say an unhappy relationship, family problems, an unsatisfying job, lack of friends and community, and so many almost obvious deficiencies in our society. Absurd.
It is also necessary for billing purposes. Insurances want to put labels on things so they can price and track things. This is true of all medicine, however. When do you call high blood pressure too high? Greater than 140 mmHg? 130? Someone has to pick an arbitrary threshold for practical reasons.
"The pathological basis of almost all mental disorders remains as unknown today as it was in 1886" (article quote) I don't think this is true. We don't know enough to make targeted treatments quite yet, but we do know a lot more about the brain now and have much more reliable theoretical conceptions of mental illness.
There is a ton of research going on in understanding mental illnesses at computational and circuit levels, and we're already starting to see the fruits of that research. Researchers are developing targeted treatments using transcranial magnetic stimulation (TMS) and similar modalities to directly perturb circuits that are believed to be deranged.
I think psychiatry will change significantly over the next decade or so as we learn what is wrong with a specific individual's brain and intervene directly at the circuit level. I don't see how drugs will play a major role in this as it is very difficult to develop a drug that could target specific circuits.
This time really is different. (Psychiatrist in training here)
We have no choice but to stratify disease into low, medium and high when there are only low, medium and high dose interventions.
For the most part, this works because individualisation is such a pain.
But if individualisation wasn’t, you’d get 1 of a thousand different doses to optimize and eek out slight additional benefits.
We could apply high frequency trading algos to an implanted infuser, or deep brain stimulator or wearable TMS when we get around to accepting/funding them for more common and non-extreme diseases.
What is the scientific basis for the theory that mental illness is due to "deranged circuits"?
That's like saying if someone gets shot and dies it's because they merely had a faulty brain -- it's ignorant of the actual cause.
Neurons don't exist in a vacuum, they respond to social, environmental, and biological inputs.
How does psychiatry scientifically decide if a persons deranged mental behavior is due to mere deranged circuits or deranged social, environmental, or biological inputs?
But just take depression for example. Let’s say Bob goes to a psychiatrist with depression. Bob recently lost his job and his girlfriend left him. He has every reason to be depressed. He would probably feel a lot better if he had a job he likes and wasn’t so alone. The problem is he’s too depressed to look for a job or to go out and meet new people, the things that would help his depression. This is where I think psychiatry can be helpful; some people just need something to break them out of their depression for long enough to be able to make the social/environmental changes in their life that will help them in the long run. Therapy alone may be enough for some people but not for everyone.
I agree, thanks for the honest response!
Of course it isn't an exact science, maybe not even a science at all.
I like to think of it this way.
Think of your mind like an iterative non-linear system with thousands upon thousands of inputs.
It operates completely by cause and effect, but because it's non-linear, that doesn't mean it's easy to figure out how it got stuck in a loop.
>In the mathematical field of dynamical systems, an attractor is a set of numerical values toward which a system tends to evolve, for a wide variety of starting conditions of the system. System values that get close enough to the attractor values remain close even if slightly disturbed.[1]
Sometimes when our mind gets stuck, the efforts on our part to get out aren't enough to get us unstuck.
Psychologists or psychiatrists are people who are familiar with some of these mental paths and how it can lead people to become stuck.
They are also familiar with some of the paths that lead to an exit from those undesirable states.
They are attempting to deal with such a complex system, that I don't think it's fair to hold them to the same standard as the so called 'hard sciences.'
For another perspective on the problem of 'getting stuck', from a Buddhist point of view (which is also based on cause and effect) see [2].
[1] https://en.wikipedia.org/wiki/Attractor
[2] https://www.dhammatalks.org/books/KarmaOfQuestions/Section00...
Many of the psychiatrists I have encountered "believe" in their medications, and when questioned as to how (and how well) the drugs they were informed about work have no real substantive argument for all their years of med school.
But fuck, do they get paid better. You won't see many shamans on a Pfizer sponsored golf trip in Hawaii.
Does the argument work as well for shamans? Maybe,except that I was kind of implying a materialist point of view behind psychology, which might not apply to shamans.
But who says that shamans might not 'cure you' of your depression just as well?
I believe we started with a faulty premise, that perfectly natural states of mind are an "illness". They may not be pleasant to behold but our brains have these mental states built in, for whatever reason. The mental health system wants to aggressively impose conformity of psychology across the population, which causes real mental illness. And the most evil thing we do is giving psychoactive drugs to kids.
I tend to agree, but this is only partly true. It isn't because something is "natural" that it is therefore healthy and desirable. Some mental states, whether genetic or environmental, are very debilitating to the individual that has to live with them. So there is value in trying to "cure" certain mental afflictions.
But yes, the field of psychology suffers from a fashion-based ideology that appears to want to mold every individual to the same narrow (and flawed) ideal. But in my experience, this fashion trend diminishes with expertise: most behavioral and forensic psychiatrists I've sproken explicitly eschew that type of prescriptivism.
I sort of think psychiatrist is someone who treats personality disorders like schizophrenia, bipolar, borderline, etc. Almost always will involve use of medication as primary treatment.
Psychologist more for depression, anxiety, mood disorders. Not an MD so can't prescribe meds but often works with the patient's primary care physician if this is needed.
Clinical social worker for .... not sure? Interpersonal issues, behavior issues, anger management, etc.?
But no idea if that is even close to being on target.
Psychologists are usually more of a traditional conversational therapy - and there's different forms of that, CBT, DBT, etc.
Social workers - I'm not 100% sure but in my experience they're more of a "intermediary" - they diagnose and refer you to an appropriate therapy. That or they're more of a "general psychologist" say with a school. I don't think you really meet with them regularly. There's a huge shortage of Psychiatrists/Psychologists at least here in Michigan, and a becoming a social worker requires less schooling I believe.
(I've suffered from depression for years, I've met many doctors, social workers, etc. and currently see a Psychologist and Psychiatrist regularly)
Also CBT/DBT are not forms of psychodynamic therapy (which is what people usually think of when they think of talk therapy). That's why they're called "behavioral" therapies.
Not sure what you mean by "CBT is not a form of talk therapy". The first sentence according to the Mayo Clinic is "Cognitive behavioral therapy (CBT) is a common type of talk therapy (psychotherapy)." [0]. Are you confusing CBT with CBD?
[0]https://www.mayoclinic.org/tests-procedures/cognitive-behavi...
In modernity, insurance reimbursement policies incentivize psychiatrists to focus on medication management, but there are still many of the old guard (and cash-only practices that set their own rates) who will perform psychotherapy. Additionally, in certain states, Licensed Psychologists (PhDs and PsyDs) who have completed additional training in psychopharmacology are allowed to prescribed a limited set of psychotropic medications in collaboration with a fully licensed MD (not necessarily a psychiatrist). Also in the prescribing realm are PMHNPs, mid-level providers trained in the nursing model who focus on psychiatric care. As with psychiatrists, they tend to focus on medication management, but are able to provide talk therapy as well.
Psychologists (PhDs and PsyDs) are Doctoral level providers trained in research, talk therapy, and administering psychological assessments such as personality inventories, IQ tests, and capacity determinations for forensic purposes.
Licensed Clinical Social Workers, Counselors, and Marriage & Family Therapists are all Masters-level providers trained to provide talk therapy. There are different histories and underpinnings that have created these distinctions and is reflected somewhat in the specifics of their graduate studies, but it's largely irrelevant to you as a client; much like engineering, therapy is as much art as science, and most of the "real" training comes once you have graduated and begun working in the field.
The current trend in outcomes research indicate that the license and professional background is not a significant factor in the efficacy of psychotherapy. To quote Irvin Yalom, a giant in the field of talk therapy (and a psychiatrist by training), "it is the relationship that heals".
I would also note that bipolar is not a personality disorder, it is a mood disorder like depression.
When you're a hammer, everything starts to look like nails.
1. With the specific goal of treating my condition with medication,
2. An ongoing condition which was diagnosed years ago,
3. I am already treating the condition with therapy, and have decided that therapy is not enough, a conclusion which others agree with,
4. The condition responds well to a variety of different medications, and is considered "very treatable",
5. The medications do not have much risk for abuse. We're not talking dexedrine or xanax, here. I couldn't sell these medications on the black market if I wanted to.
For sure there are plenty of psychiatrists and psychologists out there which aren't very good at their jobs, and I've heard plenty of horror stories. Fortunately, the people I know who have had bad experiences have switched doctors or switched therapists.
There is plenty of selection bias. For me, and the people I know, the purpose of visiting a psychiatrist in the first place is in order to evaluate medication. If you don't want to take medication, then you don't schedule an appointment with a psychiatrist, which is hard anyway (due to the psychiatrist shortage--it's difficult in at least the US and UK, to my knowledge). If you want therapy, you see a psychologist, LCSW, or someone else. And if you think that you need therapy, I don't find it unreasonable when the therapist agrees with you!
I don't mean to diminish the problems in the field of psychiatry, but by no means is the field on the level of alchemy or astrology.
And if you or anyone is trying to navigate the mental health system, I am more than willing to provide what little advice I have.
To paraphrase, when a person’s paycheck depends on not understanding something it’s hard to make them understand it.
The voting on disorders that go into the DSM would be laughable if it wasn’t sad and creepy from a norm-defining control perspective.
Additionaly, though I give psychedelics much credit, if we are going to point to the value and promise of subjective first person research into the nature of the mind, its worth mentioning meditation and mindfulness, another subject area that is widely studied by psychologists, psychiatrists and neuroscientists and is also gaining wide spread adoption clinically, for instance in the treatmentment of depression and anxiety.
Additionally, though both psychadelics and meditation have only really been studied widely in the west recently (you mentioned two generations, might be a bit more) they are both built upon long traditions of study in cultures around the world. I would argue that budhism contains one of the most in depth, analytical and methodological studies of the mind from a direct and subjective first person experience amongst millions of practioners for thousands of years. I am truly inspired by the synergetic results of combining the scientific and emperical tools of science with the considerable knowledge and tools of these traditions.
It seems to me that the biggest problem in tapping into these worlds is that science just doesn't like self reported subjective studies, it really likes to measure things objectively, hence all the brain imaging etc. However, it seems as though with a system as complex as the brain, it might just be that the best tool to measure and understand the mind we have is our own mind. I hope that the scientific pardigm can shift to make use of it.
While in theory AI could have been explored as a science, trying perhaps to simulate human or animal thought processes in hopes of understanding them and perhaps coming up with useful abstractions that could help us reason about them, the field has never really evolved in that direction.
As such, nutrition science is literally less than four hours of medical school education (my wife's first son is finishing his residency at his first-choice program, one of the East Coast's premier programs). [To learn more about this, I highly suggest the fantastic documentary "Eating You Alive". I have switched to a whole food plant-based diet as a result and feel better every week (it's been about eight weeks now, with a few cheat days along the way).]
We are only now realizing the direct link between our gut biome and our mental health, and our gut biome is directly related to the foods and/or poisons we ingest. Once again, the for-profit corps provide foods that harm us but cannot be proven to do so, medicines that harm us but cannot be proven to do so, and an environment polluted by their machines and chemicals whose effects cannot be measured enough to hit them in the only place they care about: their purses via tort law. They have crafted the laws and staffed the regulatory agencies while lobbying the government to dismantle and detooth those agencies' abilities to provide scientific oversight. Every single one of these factors affects our mental health, and all the while there is very, very little research being done on nutrition and how to measure toxicity and remove it from the body.
And yet that only peripherally approaches the truth of our human baseline because our human nature goes deeper still, and yet that pervasive corporate mentality to put profit over human well-being is intrinsically related to what we are as moral beings. We each have a moral compass, however subtly different our societal tunings. It is an intrinsic part of our human nature, and our lack of moral teaching as societies is the source of all our problems including our inability to address psychological issues. We have sick societies the world over and it is foolish insanity to think that mental illness is not an absolutely natural result of such selfish, competitive societies.
The misunderstanding of the cocaine rat study illustrates this all-too-well. When the studies were re-run years later with non-overcrowded, healthy environments the rats wanted nothing to do with the cocaine.
The solution to all our problems is to selflessly choose, first individually and then collectively, to form cooperative, caring societies instead of the dog-eat-dog world of economic competitiveness we currently live under, competitiveness that oft leads to physical competitiveness. Beyond promoting mental and physical health, such compassion lets one see the true nature of the other person, which is essential when one is dealing with psychopathy or sociopathy. Psychiatry is built upon a lack of compassion and its systemic harms all result from their hubris, ignorance and profit motive.
Even our precious traditions that should be leading us towards that loving ideal have been conquered by the animalistic persons who live for mammalian alpha-dominance games within and among groups, be they defined by class, ethnicity, form of religion, political affiliation, gender identity or sexual preference. We must live in groups to survive and prosper and our moral nature's purpose is to nudge us towards peaceful cooperation so that we may ALL happily explore this world, whatever our predilection. This is why there is a Law of Karma that only works at the human level, where we reap the happiness or unhappiness we sow in others; it is the feedback mechanism that nudges us towards humane cooperation and away from animalistic competitiveness. Our Creator does not intervene because the gift of free will to choose either selflessness or selfishness, love or its antitheses, wisdom or ignorance, the good of the whole or the benefit of the few -- that gift of free will is freely given. Thus, a group of Nazis can go about their hateful, oppressive business just as freely as we Sufis can ours. It is up to each one of us to choose the better path, for ourselves first and then as societies.
As the great Poet of God, Rumi said, "The Way goes in.", but in this materialist world culture of self, there is a communal disdain for and utter denial of the internal spiritual pursuit that leads us to moral perfection, first individually and then collectively. As such we cannot comprehend the difference between physical mental illness (caused by disease or nutritional imbalance) and a person who's just a selfish, sociopathic bastard and a person who is just naturally having a difficult time dealing with our sick society and the sick world that is making us physically ill via its pollution and constant stress.
The fundamental truth is that no one's health, mental or physical ("Not two, not one"), can EVER be successfully treated without clear-minded, compassionate care, and that must involve first getting them away from negative environmental factors and into a nurturing environment. Creating such a compassionate society requires compassionate human beings, and that requires the humble work of self-reflection and self-evolution beyond the negative traits we all possess.
Peace be with you all. We love you.
alchemy became chemistry
we're still waiting to find out what psychology and economics are gonna turn into
(With apologies to Dr. Taber, who originated the joke.)
While we're at it, let's prescribe some pills for underlying deficiencies we can't measure in the first place.
Any doctor (or mechanic, accountant, etc...) could benefit by providing false/sub-standard services to keep the client returning regularly.
As for the measurement, it's almost entirely based on feedback from the patient.
I can see how a depressed or mentally ill person could be more susceptible to accepting medication that wasn't in their best interest, but that problem seems intrinsic to all medication.
But psychiatry? Forget it. You pay to talk to someone, they have a nice couch, soothing voice, make you feel good for an hour, but nothing really changes. But hey, I liked that hour, I should keep coming back!
Patient acting crazy? Label them schizophrenic, schizo-affective or bipolar(doesn't really matter which, they are all subjective); Hit em with some major tranquilizers and dopamine inhibitors and rack up that sweet insurance money.
Your use of Schizophrenia and Bipolar as examples are both at the top of the heap in terms of what modern psychiatry has been successful in managing.
Depression, as a general term, and anti-depressants on the other hand, not so much. The world of psychology is far more of a fail. CBT therapies, mindfulness, and various other fads have all turned out, in meta-studies to be either hot air or incompetent application of the scientific method.
The human brain is the most complex organ in the known universe. At least psychiatrists are required to have an MD to practice. Psychologists just wave their hands around and maybe scrape by on some basic statistics to get qualified to rummage around like demented apes in the windmills of your mind.
That number needed to treat is pretty good. You may want to compare it to other routine medication such as statins or blood pressure meds.
their cure for depression is pills that zonk people out too