Comment by derbOac | Hacker News Reader

Comment by derbOac | Hacker News Reader

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I don't know why this doesn't get more attention. It's a classic ethical dilemma in psychiatry, and ultimately the basis for many science fiction works.

Let's say, for the sake of argument, you have a pill that can make people feel really positive and boundless, that they love their lives and nothing could make them feel better. This pill will work regardless of their circumstances. On the other hand, their environment is horrible: they are in poverty due to societal injustices and systemic failures, and loved ones are dying from completely preventable diseases due to those same societal failures.

Works like The Matrix explored this theme in an extreme form, almost to a fault, where the premise is so absurd that it becomes dismissed.

It's difficult to argue about treatments that will help people feel better and be better in their lives, whatever that means for them, but I can't help but be angry, even furious at the paradigm that underlies current behavioral biomedical research, where everything is seen as being a problem within the individual. It's not so much that there's something wrong with doing research like this, it's that other research, focused on more environmental factors, is seen as soft or unsexy, or the domain of some other field, or some such thing.

I can't help but feel that our society is hurtling at astonishing speed toward an ethical crisis that gets almost no attention. What happens when we can alter behavior and experience with extreme precision and power, but still live in a worldview that treats individuals as the primary determinants of their own fate? What happens when withholding treatments or enhancements becomes a salient problem, when opportunity costs become a form of corruption?

You're talking about too many different points in one:

1. How much of someone's suffering and/or depression is due to brain chemical imbalance vs society and environment around them.

2. Would alleviating someone's depression and/or excessive anxiety would make them happy but with indifference to their surrounding, making them oblivious to the environment around them while being in a state of bliss.

3. The ethical dilemma of "fixing" someone by handing them a pill, instead of working on actually improving the real issues that may be contributing to their psychological pain.

I think these are different issues that are not necessarily easy to answer one way or another. Non of these issues are self evidently clear which way should we go about them.

So, I wouldn't argue that no one would benefit from a pill, or that there aren't situations and/or people who need a change of perspective, or an alleviation of pain so they can survive long enough to get through the storm.

It's not so much that I think drugs are bad for treatment of psychological problems; it's that I think that of your issues (3) is radically neglected in contemporary psychiatry.

"Treatment resistant depression" as an idea in studies such as this is sort of telling in that it assumes the problem is the pain, rather than whatever potential external problems someone is dealing with.

A good analogy to me would be someone who keeps coming into the ER with bullets in their body every couple of months (maybe in a conflict zone like Ukraine), but where the case is construed in terms of the pain the bullet causes, rather than the fact there are bullets in their body and the person is in a situation where they keep getting shot at. I don't want to oversimplify things, as the environment and situation is generally attended to, but the paradigm as a field is to treat the disease as the pain the patient is suffering ("depression" as a disease), rather than the scenario as a whole, and to act as if the pain is an attribute of the patient rather than as part of an appropriate response to a problematic situation.

So yes, depression as a phenomenon is a complex mixture of things, but I think in general, at least in the US, it tends to be seen as a disease that's a biological property of the person. There are historical reasons for this, some good and some bad, but I think it's had unintended consequences as a result.

"A good analogy to me would be someone who keeps coming into the ER with bullets in their body every couple of months (maybe in a conflict zone like Ukraine), but where the case is construed in terms of the pain the bullet causes, rather than the fact there are bullets in their body and the person is in a situation where they keep getting shot at."

Interesting analogy, but if my body was ever riddled with bullets and I was taken to the ER, I'd definitely want the doctors to treat the damage the bullets made, remove them from my body, and relieve the pain.

If the ER ignored the bullets in me and assured me they'd instead be sending a police car to the neighborhood in which I was shot then I'd yell, "no! please treat me first!"

There's a lot to be said for symptom relief. Of course, the underlying causes should also be addressed, and there is evidence that psychedelics allow therapists to do just that. In particular, MDMA appears to allow patients to face and deal with their trauma without the pain and aversion that trying to face their trauma ordinarily causes. It also allows many to forgive themselves or their family, to experience love for the first time, and resolve family issues. This is treating the cause, not just the pain.

Of course, traumatising external circumstances must also be changed, when possible. I believe psychedelics can help here too, by making people aware of them (psychedelics often have the effect of opening people's eyes to just how screwed up our society is) and by making people more empathetic and connected to others and to nature.

They will not magically solve all our problems, but they can play an important role in helping us to solve those problems ourselves -- if they are used constructively and in the right context.

What you say is true, but are broken people who are barely able to take care of themselves (and who may be acting out in all sorts of destructive ways) supposed to pull themselves up by their bootstraps and make a positive change in the world (one which often requires a lot of resources, bravery, and long-term commitment)?

Many of our leaders themselves are traumatized and dysfunctional in many ways, and do themselves deserve treatment.. treatment that may open their eyes to how dysfunctional they and the system they're part of has been.

There's a good argument to be made that the in order to heal the world one should heal oneself first. It's like putting on an oxygen mask in a depressurized airplane before putting one on someone else. If you are incapacitated you will be unable to help.

It's healthy, resilient people who will be best suited to both recognizing the problem and helping to fix it in the long-run.

That said, it doesn't have to be one or the other. Those of us who are awake enough already can spread the word about what's wrong with the world, and those of us in good enough shape and with enough motivation to contribute should try to make things right (an important part of which, in my view, is to end the War on Drugs and give affordable access to psychedelic therapy to those who need it).

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