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Comment by belkinpower | Hacker News Reader

The article touches on this a bit, but I do think lumping straight up disorders like depression together with more “neurodiverse” ones like ASD is the wrong approach. Maybe other people feel differently, but for me personally I think there’s a pretty clear difference. If I could take a magic pill that permanently cured my depression/anxiety/ADHD, I would. But my feelings toward autism are a lot more complicated. Despite making my life more difficult in some ways, it feels much more a part of who I am than the other conditions. If it suddenly disappeared it would completely change my personality and way of thinking, to the degree that I basically wouldn’t be the same person anymore.

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Is that a difference of kind or of degree? Take away my depression/anxiety and I would be quite different and act quite differently, if not to the same degree you're describing. Many things driven by my anxiety have been good for my career in some ways; many other things driven by it have been bad for my career; all I can say for sure is that without it I'd be in a VERY different place.

How would we separate various mental differences into "disorder" vs "diversity"?

I would say there are 3 tiers:

a) Your condition prevents you from being a functioning adult in society. You have to be in someone's care in order to function at a basic level.

b) You're a functioning adult in society but you (or others, or both) perceive your condition as a handicap that hurts areas of your life and needs to be fixed.

c) Your condition is a mixed bag and you perceive it as beneficial in many ways.

I'd say (a) is definite "disorder" territory, (c) is leaning into "diversity", and (b) is a gray area. It could be "diversity" if you choose to embrace it and live with it, or a "disorder" if you're set on keeping it at bay.

All 3 are disorder from where I'm standing :(

I would argue it's purely a difference of kind, not degree: https://news.ycombinator.com/item?id=30884953

You're basically saying you think depression/anxiety/ADHD are disorders but autism is "part of who you are". Is a personality change indicative of whether something is a disorder or not? Is it only when the change is perceived to negative?

Autism shapes personality and worldview, meaning it shapes the person and their sense of self. It doesn't cause suffering in a vacuum the same way other disorders do. The biggest "issues" attributed to autism come from lack of accomodations and the tendency to falsely attribute comorbidities as being part of autism.

A huge difference between autism and the other listed things is that autism is not (and never will be) legitimately treatable, while depression, anxiety, and ADHD are treatable and have been for a long time. Amphetamine targets dopamine dysregulation and it's highly effective at improving quality of life.

Autism has no equivalent. No drug has ever shown efficacy in improving the quality of life of autistic people, nor has any therapy. They've all been damaging, and the mainstream autism junk-science treatment today is ineffective according to meta-analyses[1], is based on gay conversion therapy, has been shown to cause PTSD[2].

Treating autism stops making sense (and thinking of it as important to identity starts making sense) when you realize that having an autistic brain means using a different but equally-effective social model[3], mode of thinking, and algorithms for processing information, that in many cases has tangible advantages.

[1] https://therapistndc.org/aba-is-not-effective-so-says-the-la...

[2] https://www.emerald.com/insight/content/doi/10.1108/AIA-08-2...

[3] https://www.frontiersin.org/articles/10.3389/fpsyg.2020.5861...

Cancer is treatable, doesn’t mean said treatment is effective. Same with ADHD. We’re still in the dark ages.

I agree completely (as someone with ADHD). But, compared to how far behind other psychiatric treatments are...

* Antidepressants are barely better than placebo.

* Benzos are a short-term bandaid, best reserved for panic attacks.

* Antipsychotics have truly horrifying permanent side effects.

Amphetamines are a borderline miracle. Again, comparatively. Nothing else available today comes close in effectiveness at treating any psychiatric disorder. They definitely have their shortcomings, but for people with ADHD they're such a huge boost to quality of life and lead to better overall life outcomes.

There's a chance pharmacological depression treatment will catch up to where ADHD is at if/when ketamine become commonly available. Same with PTSD and MDMA. The future of anxiety treatment looks a bit more bleak... but there's experimental stuff out there with HDAC inhibitors and I think some other stuff causing fear extinction.

Antidepressants are barely better than placebo on average but are, for some people or so I've heard, miracles.

Quite.

On average, the acceptable "separated from placebo" margin doesn't have to be that high, but the range of effect is absolutely enormous, even within close relatives.

Antidepressants that did nothing positive or negative for me or some family members were either extremely helpful or extremely harmful to other family members of mine. (Almost never vice-versa; my biochemistry appears to be quite stubborn about responding to a great many classes of treatment, well _or_ poorly, but at least one medication just made me feel completely numb while being extremely helpful to another relative.)

It can also be a weird multidimensional variable in ways many people don't expect - one medication I'm currently taking for depression is 4 pills twice a day (very short half-life), because I was gradually tapering it up. We tried switching to the same manufacturer's single pill that was 4x the dose, twice a day, and immediately I started feeling extremely nauseous whenever in a moving vehicle, which has never happened before. Switch back, problem goes away.

(I know the above sort of outcome is not exclusive to mental health medications, but in my personal experience, I've never had any other medication type vary in outcome based on whether they gave me one or multiple pills adding to the same dosage.)

Psychedelics (LSD, psilocybin, DMT) have some efficacy as well, and need to be studied more in the context of ADHD. A particularly powerful DMT experience gave me about six months of focus control.

The issue with LSD/psilocybin and ADHD is you can't take it everyday or even every other day because tolerance builds extremely quickly. I don't think there's a way you can time the doses where you'll have the focus benefits daily, but I could be wrong.

You can take it every 3 or 6 months although afaik

Honestly, I believe (at least for my brain), the path is a strong DMT experience, followed up with a regular microdosing regimen (two to three times a week, sub-threshold dosing). I can say that one time, I quartered a tab of acid and took the quarters over four consecutive days, and each experience "felt" the same in terms of intensity (which was very little) and focus control.

As far as I know, LSD and psilocybin both have a roughly two week tolerance curve.

Thank you for taking the time to explain this to me.

They're starting to think that ADHD is part of the autism spectrum. I'd believe it, based on my life experience.

Who is starting to think this?

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