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Comment by ChrisMarshallNY | Hacker News Reader

Um...I have close, personal, and intimate relationships with many people that suffer from mental illness, and have had this for decades.

I do a lot of "extracurricular" work, trying to help folks get back on their feet.

So, not academic. Personal.

> Because in the real world, the therapy method I have mostly seen, was and is keeping people calm with pills.

I consider that offensive. It's a fairly classic "strawman" argument that is used to "dehumanize" people that suffer from mental illness, and also dehumanize people trying to help them. I know many people that would be in very dire straits, if not for medication, therapy, and many years of hard work.

I'm pretty upset by this, and by the reactions.

I am not a therapist. Just someone with "skin in the game."

These aren't "data points." These are people, and chances are good that we all have folks in our orbit that have mental health issues.

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To be fair, you made a claim that "mental health treatment has come an incredibly long way". And the only evidence you have offered to back that up is a vague personal anecdote.

The poster was simply providing their viewpoint on the state of mental health that differs from yours.

I understand these things can cause strong emotions, but you don't do yourself or your stance any favors by letting it get the best of you here.

Vague personal anecdote's versus hutzlibu's vague personal anecdotes.

Quite frankly, the pills work. A lot of people would unable to lead normal lives without them.

> Quite frankly, the pills work.

Sometimes they do and sometimes they don't. I had a seizure because of medication I was put on for a mental illness I didn't believe I had. I wasn't 18 and my parents essentially forced me to take them. The pills didn't do anything for me besides give me a seizure that easily could've killed me (I was hospitalized).

There's also actual research suggesting these pills can increase suicide attempts.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353604/

There is enormous money to be made suggesting these pills are useful, so I don't just assume it to be true. I also know many other people who feel anti-depressants ruined their lives. I also know many people who feel anti-depressants saved their lives.

It's not black and white. Personally, I feel the efficacy of pills for mental health are greatly exaggerated - but it's easy to see why I might be biased.

> a mental illness I didn't believe I had

I don't know your personal journey, but I think it would be fairly easy to find people with very deep, very real mental health problems who fully believe they do not have a problem.

> The pills didn't do anything for me

Again, I don't know your personal journey, but as a counter anecdote when I started taking medication I couldn't tell if they were having any effect at all, but apparently it had such an effect that some of the people around me could tell me the day I started taking it, along with measurable improvements.

Not to invalidate your experiences, just adding to the anecdotal pool

Also the placebo effect is right on their heels in terms of effectiveness

Can the placebo exist without the "real" pills? More practically, does anyone prescribe placebo outside of a clinical trial?

Yes. It is the same real, measurable response you would get from an effective medication even though no medication was given. In many cases the rate at which placebo occurs is surprisingly high. (https://www.medicalnewstoday.com/articles/306437)

I know what placebos are. But the effect is created by telling the patient you gave them medication. So I don't believe it's possible to make "treatment by placebo" a standard.

Homeopathic treatment is largely placebo.

A board certified doc will never prescribe placebo he will get sued, plenty of ppl are getting them via alternative medicine though

They do work. They also harm many people also.

To be fair, even though I am not, myself, a therapist, I have been dealing with them for decades.

It's not "vague, personal anecdotes." It's real world experience.

But you are right. This is upsetting, and seeing the way that it is being treated by people that I respect, otherwise, is upsetting.

This is the last I'll say anything.

Vague personal anecdotes doesn't mean they are not from the real world.

You're taking someone else's valid criticism of the state of the therapy methods available today and taking it personally as well as unwarrantedly attributing it to a lack of sympathy.

You fail to understand that the goal of criticizing the therapy method is precisely so we may find ways to improve it.

What makes this single point of view a valid criticism?

Because, getting back to the original point, stating "Mental health treatment has come an incredibly long way, just in the last couple of decades" without offering any substantive support for this viewpoint (regardless of whether one's anecdotes are "real world" or not) is, in and of itself, a valid criticism. The onus is on the person making the claim to provide a rationale to back it up.

What makes it not valid? It would actually be great to have an answer to that instead of the parent's complaints

"> Because in the real world, the therapy method I have mostly seen, was and is keeping people calm with pills.

I consider that offensive"

You might also consider, that other people might have a "skin in the game", with close, intimate relationship to mental illnes patients, too. Some of them tragic.

And my experience simply is not, that in general psychotherapy evolved a lot. I see rather a trend to favor pills to keep people calm as this is cheaper, than deep psychoanalytical therapy.

So consider that offensive, if you must, downvote, if that makes you feel better, but it does not change my personal experience.

I completely agree with you. I know many people who's lives are made much easier because they have access to medication. The last fifty years have also seen a massive improvement in the lives of people with severe mental health problems (in europe at least).

However, support for people with mental health problems is still severly underfunded. The improvements we have seen say as much about the terrible treatment of the past as they do about how well we are doing now.

Almost all studies I have read find that a combination of medication and other therapies provide for the best outcomes. Most people can only get funding for medication, which is often better than nothing, but it really falls short of what society could, relatively easily, provide.

It is really a tragedy, not just to the individuals suffering from mental health problems, but also to society as a whole which misses out from all the untapped productivity and creativity.

And I have close, personal, and intimate relationships with mental illness and its medication myself and if you do know so much as you claim you would know that many (as in likely most) physicians today think the future will see our current medications on par with lobotomies. Anti-psychotic medicine especially is seen as chemical lobotomies. On top of that when 1/3 of the US population is on antidepressants these medications clearly doesn't work either.

https://www.psychologytoday.com/us/blog/out-the-darkness/201...

You might have "skin in the game" but then it is depressing you do not know that almost all mentally ill people would in the long run be healthier without these pills. They mostly only work short-term and absolutely destroy ones health long term. You should be advocating for people to get short-term medically help and long term medicine-free therapeutic help if you really care.

This is a terrible sentiment. You aren't a mental health expert. I have seen more than a couple of people come back from the edge because of medications. We use pills for other issues like heart disease, diabetes, etc and people live a relatively normal life. The brain is just an organ. Sure some people would be better off without medication, but lots more would be dead or locked up in a mental institution. Lots of people have chemical imbalances and no matter how much "lie back and tell me your problems" they get they will never be well. Are medications over-prescribed I'm sure that's true in some cases as well.

I have worked directly and indirectly in inpatient mental health settings intermittently. The parent poster's view is correct with regards to my experience.

Yes, for some people antipsychotics, antidepressants, etc. are a godsend and the difference between living a mostly normal and productive life vs. jumping off a bridge, dying in a homeless encampment because they cannot feed themselves, or committing violent acts against others. To clarify, none of these are hyperbole or exaggeration -- those are two extremes on outcome with mental health issues and antipsychotics can be the difference between the two.

That being said, many, if not most, physicians I have worked with agree with the parent comment. For many patients these medications are not effective and are used as chemical restraints [0] rather than with the goal of normalizing their mental health. Eventually the logic becomes "we'll never fix them, but we can sedate them so much they won't hurt themselves or others" so dosages progressively increase until the patient becomes more sedated and somewhat zombie like. This isn't hospital specific; I have seen it across 3-4 different hospitals in different states. Neuroscience and psychiatry is a very young field and the truth is that we do not know what causes mental health issues or how to deal with them. The chemical imbalance theory is just that, a theory, and more importantly, one with very little scientific proof and backing [1].

[0] https://www.medicinenet.com/what_is_an_example_of_chemical_r... [1] https://www.healthline.com/health/chemical-imbalance-in-the-...

I would be much more willing to believe the chemical imbalance concept if someone could actually explain which chemicals, and what the correct balance is.

Serotonin you may say? Okay, how much is the correct amount of serotonin then? Can you just give me a test to see if I have the right amount?

What’s going on here is not quantifiable science. It’s throw something at the wall and see what sticks.

You might be surprised at the number of medications which are effective for specific conditions or symptoms but for which we don't know the mechanism that achieves the effect.

Yes, modern medicine has a large component of throwing stuff at the wall to see if it sticks.

If it sticks, and it passes all the usual clinical trials to prove it does more good than harm, it's approved, even if we don't understand exactly why it works.

Try looking deeply into almost any specific condition - let's take heart disease. Cholesterol, for instance - is it bad? Is it necessary? Do you need a certain amount or does the amount not matter so long as you have the correct ratio of fats? Why are some people perfectly healthy with cholesterol numbers off the roof, and others can have atherosclerosis with cholesterol numbers off the charts low? Will reducing cholesterol for that second person help them? Hurt them?

For the record, the treatment plan my cardiologist put me on was explained as "all these things seem correlated with not having heart attacks so we'll just do them all and hope it helps you".

I think the best the pill can do right now is to at least making some disturbance to change the balance and hoping it produce desirable outcome.

Yes basically throw something at the wall and hoping it stick.

Is the chemical imbalance theory accepted by all the experts? I remember seeing an article that questioned it. It also pointed to a study which showed that a lot of the antidepressant effect can be attributed to just placebo. I personally don't know much about the subject though so I don't know what sources to trust.

It's not, but it's something that has been lobbied and astroturfed into being offensive to disagree with, and is about 2 years from being censored on twitter and facebook (if it isn't already.) There are millions of people who, in the middle of severe episodes, were given particular drugs. They eventually recovered from these episodes (or they didn't, but we don't hear from those people.) They've been told that they they will quickly end up back in the middle of the despair they were in if they cease taking them (lots do while continuing to take them, but we don't hear from those people.) Now you're questioning (and implicitly threatening) their lifeline.

These people are fighting for their lives, and are taken advantage of by an industry. It also doesn't help that plenty of antipsychotics are crucial for people to take, but that's because those are drugs that actually make it difficult to think for people whose thoughts get out of control. They don't claim to be eradicating the chemicals or deficiencies of chemicals that cause all psychosis.

The tactic of pharmaceutical companies creating patients' groups to get sufferers together and lobby "on their behalf" has been going on since the 80s. It's bulletproof, and impossible to attack. In the case of antidepressants, they've also guided them into defending these drugs as a class, rather than on an individual basis.

Funded patients' groups also played a huge part in the prescription opiate epidemic; it doesn't matter how much science says that long-term opiates aren't helping chronic pain, you have to be heartless to dismiss someone with a known painful condition or injury when they're pleading for opiates. Even though you know that people who had nothing wrong with them before going on opiates would plead just as intensely.

I am in agreement with a fair amount of what you said about overprescription, the lack of scientific backing for the chemical imbalance theory, and the less than stellar effectiveness of antipsychotics. But the way you're presenting it makes it sound like a conspiracy theory and truthfully comes off somewhat illogical and paranoid. That takes a lot away from your argument. Maybe there is a conspiracy, but if there is, then you need to back it up with proof or sources.

On another note, there is one thing you are absolutely incorrect about: antipsychotics are not ineffective managing many mental health disorders. Large clinical trials are done before these drugs are even approved for the sole purpose of proving they are better than no treatment.

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