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Comment by kelnos | Hacker News Reader

While your anecdote is incredibly sad and messed up, it does not invalidate the parent's belief that most psych facilities are not like that.

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You mean that one anecdote does not invalidate another?

it's true that one anecdote does not invalidate another, but assuming truthfulness of both anecdotes the first anecdote seems more wide ranging and likely to give a better view of problems in the system.

Then I could counter argue with another anecdote that I visited thousands of such facilities and in all of them cases of magic healing once the insurance money dried up happened.

Merely extending the scope of an anecdote does not change the fact that it is an anecdote and does not provide greater power to convince.

The original comment claimed to be an EMT. That makes their comment a professional experience or professional opinion where as yours is an anecdote.

Professional experience? Inventing new speak for anecdotes on the fly, bravo.

How is that the case? The first anecdote is someone with only glancing knowledge of the people taken to the mental health facility. They pick them up, probably on a very bad day, and drop them off without seeing evidence of wrongdoing. What evidence would they see? A mustachioed doctor twirling his mustache and laughing maniacally? By contrast, the other anecdote has intimate knowledge of an individual affected by the system for the course of their involvement with it.

I don't think either anecdote is compelling, but I do think it is wrong to weigh one as greater than the other.

This is fundamentally the problem of anecdotes and why objective data is needed to resolve these circular arguments

Not to mention the fact that neither comment says which country or region they're based in. I suspect these things can vary a lot by geography, yet both are making very generalized statements.

> objective data

A single anecdote is an existence proof.

(or a lie or misunderstanding)

True. Further complicating matters, I believe there is a correlation between misunderstanding and willingness to share anecdotes (across the general population, not specific to this thread).

Which may be indicative there is not enough data available to support a conclusion, so a person operates with the information most available to them, which may count as a contribution to that data ultimately.

To be fair, one anecdote is the viewpoint from the eyes of someone in the "system" while the other is a viewpoint of those affected by the system. Its essentially recreating the initial conversation of police vs people. One side says all good in the neighborhood, the other says corruption is still a problem.

For one thing, we frequently see many of the same patients again, back on the street or in their communities, which is pretty definitive reason to think they're not locked up indefinitely.

If the primary exploit is siphoning insurance money, is it possible that your frequent fliers have worse insurance than the subjects in the contra anecdote?

Yes, as I acknowledged in another comment.[0]

But it's not especially relevant to the point I was responding to: this program, where police are replaced by healthcare professionals, primarily deals with people who lack housing or income, which makes the commenter's concern a lot less relevant to this particular discussion.

[0] https://news.ycombinator.com/item?id=26033144

In your experience, do they get better after their stint in the psych ward, or are they pretty much the same, or are they worse?

My experience dealing with the homeless on the streets of Seattle is they seemed to either stay the same or get worse. I never saw one person get better from a stay in the psych ward, it seems at best a place to keep them locked up for a little bit and then turf them back out on the street.

Notice how psychiatrists and psych hospitals don't really advertise much anything about "cure rates" or percentages cured. You compare that to any other field of medicine which often talks about percentages of outcomes, especially for fields like surgery, infectious diseases, oncology, etc... and you find the primary reason why I personally (and many others) do not find the field of psychiatry to offer much beyond "medicate and manage" while syphoning insurance money and government funding, and while also causing potentially horrible side effects.

The existence of houses which are not fire does not mean the risk of house fires is unworthy of consideration.

I think it's more along the lines of one anecdote doesn't invalidate Occam's razor, and the Occam's razor in this scenario is that psych facilities are acting in good faith.

There is plenty of evidence of inhumane treatment in psych facilities over decades, including human experimentation, drug trials, debilitating brain surgeries, electroshock therapy etc. Psychiatry is probably the single medical field that has caused more harm than it has cured.

Just to be clear, electroshock therapy is still a thing.

Yes I know and there are some people in permanent psychiatric care without any perspective for improvement with current known methods, some are kept almost like animals or permanently sedated.

It also can be a long term cure more severe drug resistant depression. It worked for my wife. They do not do it without your consent.

It does highlight a perverse incentive that's everywhere within the system. It was useful to me.

It also sounds like a very much American problem due to American healthcare..

Indeed, no such incentives (e.g. financial) are in place in the country in which I am in Eastern Europe, thus, no one is really interested in abusing those things. Were they given financial incentives to do so, they most likely would.

Honest question: how do you know the issue is not hapening?

I used to work in health care for years, and I have an understanding of our health care system. Make no mistake, it still sucks in many areas, and there is some cover up between cops and health care workers when it comes to drug users, or anyone who goes to the detox room (alcoholics, mostly). They treat people inhumanly there.

Before I became a health care worker, I spent some time at the psychiatric ward, and at the detox room (voluntarily). I liked the psychiatric ward, the staff and roommates were nice, and I made some pleasant memories with a girl in there. :)

In any case, you are typically an inconvenience and they do not want you there, especially at the detox room.

This used to be a big issue in the Soviet Union, but for political instead of financial reasons:

https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry_...

This often veered into straight-up torture, including electric shocks and drugs that caused pain as a means to "cure" people from not believing in communism.

Or drilling healthy teeth without anesthesia and setting dental fillings so there would be no proof that the teeth was healthy.

Did you know Electric shock is still a very lucrative business in the USA, while the United Nations has deemed involuntary ECT (which is allowed if court-ordered in the US) as torture?

Meanwhile the FDA recently re-classified ECT as Category 2 "Safe and effective" devices, even though there are hundreds of studies showing they cause long term memory loss.

I'm not even sure why we still haven't reformed the FDA, but it is long overdue.

In my experience such facilities aren’t any better in some “nice” northern European countries.

The incentives might be slightly different, end results the same.

For example in Finland involuntary commitment is somewhat frequently used as an impossible-to-appeal alternative to investigative detention. You’d have to be crazy to do crimes, right?

Involuntary commitment is just inherently suspectible to abuse, I’m not sure anyone should have that power.

The American part seems to be that our penny-pinching private insurance companies finally provide a benefit in protecting us from being committed forever?

Because plenty countries have private hospitals who can keep billing the govt as long as they can keep you there.

Why would this be the case? Do healthcare facilities not receive "insurance money" based on patients in the rest of the world? Because I'm pretty sure they do. Whether is abused or not is a different matter.

Its not unique to the US. Just a few years ago a high profile case happened in portugal where a man had a dispute with his parents and was forcibly committed for 2 years without the doctor his parents went to ever seeing him.

That's not really an example of the issue mentioned:

> "Having known several friends who got committed and held against their will in psych wards when there was no good reason to, because their insurance was good, this is an issue."

This is pretty much specific to the US (in developed countries). It would be impossible in Portugal.

Basically, the only advantage of American healthcare is that if pays for innovation better than others. The world benefits from it, Americans suffer due to it. As long as they're happy, good for them.

If the government is paying the facility to continue holding/treating the “patient”, I don’t see how it’s in any meaningful way different nor impossible in Portugal.

The way the fraud works is different. In the US it is their insurance is good, keep them in. In Portugal everyone has the same insurance so it is keep our faucility as full as possible, only releasing just enough people to make it appear like we are doing something.

I have no idea what fraud occurs. In either system. I know enough humans to know that some are honest and some are not. Thus if it is possible to get away with fraud odds are someone is.

The government doesn't pay the facility, it runs the facility.

It certainly creates its own set of problems, but not that one.

According to the first hits on google, roughly half of Portugal's hospitals are private.

Number of hospitals are not a relevant measure, since all the major hospitals are public. Here are more relevant measures: 70% of the hospitalizations and 73% of urgent care occur in public hospitals.

I don't have the numbers for psychiatric hospitalizations, but I would guess the number is higher than 70%.

Raoul Wallenberg was allegedly thrown into a psychiatric ward in Russia when he came on a political visit, and held there till the end of his life.

The incentives may change by country, but it is pretty common to setup wards like prisons, for practical reasons. And that can be abused, as every form of power will eventually be.

USSR had a long history of putting disidents in psychiatric wards. Those who dared to criticize communism ("the greatest system ever") would be labeled as crazy and locked in a hospital.

Raoul Wallenberg wasn't what you'd call a dissident criticizing communism, and was mostly known for saving Jews from the Nazis by offering them Swedish protected passports.

Officially he was arrested by the Russians for espionage in Budapest in 1945, during the war, with later reports suggesting he was actually involved in an espionage effort. He allegedly died in prison a few years later. There were claims that he was sighted in prisons and psychiatric hospitals as late as the '80s but if they're true then this certainly wasn't used as a cover, he was already claimed dead. The psychiatric ward angle doesn't really make sense in these circumstances, there's no need for a cover story when the official story already sounds like a cover, and even presumably legitimate.

He was arrested in Hungary during the siege of Budapest. Everything after that is pure speculation. When he went to meet General Malinovsky he famously said he didn't know if he'd be a guest or a prisoner.

I've never heard any of this about a psychiatric ward before and he was definitely not arrested in Russia on a visit.He was also an OSS asset - and there is a more than decent chance that the Russians knew it. I do not see any way this very special case with this very special man can be used to make a statement about broader issues to do with mental health. I walk by a memorial to him near Deák ter on a regular basis and think of him often.

Happend in germany too: https://en.wikipedia.org/wiki/Gustl_Mollath

To silence someone being inconvenient to the powers that be, no less.

It always reminds to the USSR where critics where put in wardens as well, instead of arresting them.

When you write "anecdote" it seems you also didn't read the linked buzzfeednews article.

There's statistics in there, but it's quite long so I understand if most people won't read it

anecdote vs belief, wonderful... If I have to choose, I would pick anecdote over someones personal believes everytime!

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