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Comment by slfnflctd | Hacker News Reader

The practice of psychiatry is filled with disasters, and has been more of a reflection of our culture than a science for much of its history. It is good of you to point out how there's been steady improvement-- we should remember that the field's utility can be improved.

I still would hesitate to recommend a psychiatrist's services to anyone without an extensive disclaimer, though. [In a way that I wouldn't with a general practitioner, or even a talk therapist.] It would be great if that changed one day.

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One end of the spectrum: modern psychiatry turns out to be kind of like alchemy. Some fundamental ideas have merit to them (the material world shares a common basis, and it is theoretically possible to turn any matter into any other matter), while most of the models/practical implementations are just completely off the mark (if you draw the right symbols you can turn lead into gold), and it’ll take a few centuries of social and technological advances for a scientifically sound discipline that achieves the desired results to emerge.

Other end of the spectrum: the human mind is such a weird complicated thing that it is ultimately impossible to build a systematic discipline that can effect meaningful change in what a particular cultural context considers a mental/behavioral “disorder”.

The hyper rational, scientific part of me hopes for the former; but having worked a lot in education, particularly with children/teenagers who had suffered trauma/were actively suffering trauma, the latter feels truer to my gut.

Wondering what the disclaimer would be? And why wouldn't it apply to a talk therapist?

The key distinction is that a talk therapist doesn't prescribe drugs. These drugs are poorly understood, as are the conditions they ostensibly help treat, and there are a great many concerns about the validity of much of the research that went into justifying their use. There are also large numbers of people reporting long term side effects from said drugs which arguably made the patient worse off. I would caution everyone to avoid them in all but the most clear cut, 'textbook' cases.

I've also noticed - both personally and from talking with others - that a disturbing number of practitioners in this field seem to lack empathy and/or professionalism, which in my view are absolutely critical when dealing with mental health issues.

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