Comment by extragood | Hacker News Reader

Comment by extragood | Hacker News Reader

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> At last count, more than 12 percent of Americans ages 12 and older were taking antidepressants. The chemical-imbalance theory, like the revamped DSM, may fail as science, but as rhetoric it has turned out to be a wild success.

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.

This is why I've never gone to a psychiatrist; only therapists. Instead of pretending to have scientific rigor, many therapists focus on the more human side of mental health, working out knots and releasing mental tension like a masseuse does for physical tension.

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.

Absolutely agree w.r.t. Neuroscience: it’s really exciting to work on. Reach out via email in profile to hear a few compelling anecdotes on an “advanced volt meter.”

(open to anyone reading, too)

...just post them?

"> The chemical-imbalance theory, like the revamped DSM, may fail as science, but as rhetoric it has turned out to be a wild success.

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.

This isn't really an accurate characterization. It's true that a lot of psychiatrists focus on meds and biological root causes these days but lets not forget that the whole school of psychoanalysis grew out of psychiatry. It's simply wrong to say the whole field is focused on biological issues.

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.

Psychoanalysis was considered bringing psychology to the psychiatric profession.

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.

“lets not forget that the whole school of psychoanalysis grew out of psychiatry. It's simply wrong to say the whole field is focused on biological issues.”

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)

Do you mean diagnostic tools? The DSM isn't a testing tool.

Fixed.

A lot of psychiatry is essentially someone following a rote decision tree process to arrive at a DSM diagnosis. So if you do 1hr of research beforehand you can probably get a psychiatrist to diagnose you with any condition - and you'll also see how unnuanced most of their questions are. In your case with the anti-psychotics, you made the mistake of believing the psychiatrist actually cared and that answering that question honestly automatically put you in the subtree of their decision tree that ended up getting medicated with those.

I agree. It reminds me of those personality tests like the Myers-Briggs INTJ/ENFP/QR5X. Everyone has an idea of what kind of personality they want to have and answers the questions in a way so that the result is biased towards their desired personality.

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.

Have you ever tried keeping a journal? We all make decisions based on what we know and how we feel and both of those things change over time.

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.

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