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Comment by urthor | Hacker News Reader

Psychiatry & neuroscience today are some of the closest equivalents to physicians applying leeches in the 16th century.

Through no fault of their own.

We, simply, have legitimately very little knowledge of those fields of science. Our understanding of the human brain is just not there.

So much of Psychiatry is throwing pills at symptoms after talking about your life.

That's often the state of the art in the field.

Genetic sequencing, and the ability to use genetic markers to diagnose illness, hopefully will change things. A cheap and effective diagnostic tool that isn't based on guesswork and "tell me your life story."

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Leeches actually work though and we still use them today.

Cupping is probably a better analogy. Also, there was a long stretch of time there where we didn't use leeches, at least in part due to the stigma associated with the older practice.

I agree. I have thought that in 200 years, people will look back at mental health care at this time with a mixture of horror and pity.

We detached this subthread from https://news.ycombinator.com/item?id=33270325.

If a neuroscientist can explain a truly brain, they would be able to explain a much simpler thing such as a CPU or GPU. But, can they? No, they can't.

Psychology is in great part pseudoscience. Lots of studies that are neither falsifiable or reproducible.

Psychiatrists are the modern equivalent of barber surgeons, or trying to make fine jewelry with a chisel and a hammer.

Diamonds are still cut with chisel and hammer. Most of your comment sounds like a bunch of logical fallacies.

ADHD is actually one of the things that’s actually rigorously and quickly testable (assuming you’re willing to take self-reported effects / observations, you can’t read a number off a lab test) but it’s never done because it involves giving someone without any medical diagnosis a schedule 2 drug and we moralize that for some reason.

You just give the person a stimulant and see what happens. If they get really awake, hyperactive, excited, anxious, shaky, hyperfocused, etc. then nope, if they get calm, content, or sleepy then yes. And it’s not like this is crazy in general, we do “just treat it and see if they get better” as the test for plenty of things.

Nobody bats an eye when we do the same thing for depression, it’s super common for people who exhibit the symptoms to be asked to try a few antidepressants and see if they work.

I get that some people abuse stimulants but they suuuuuuck. Life changing because they allow you to function but you will also curse them for it. The side effects are awful. So much so that I tried a bunch of non-stimulant medications until I found one that worked. Nobody who doesn’t have ADHD is gonna wanna regularly take adderall or vyvanse just because it would be miserable and that’s before the fact that they aren’t cheap.

Edit: /rant Mental health is wild because smart and well meaning people designed a system that actively prevents people from being honest and getting help. Want to talk to your therapist about your suicidal thoughts, bulimia, or self-harm, nope. Not unless you want to take a mandatory grippy sock vacation away from your support network and get set back in school or lose your job all things famous for improving mental health. Wanna tell your psychologist that you think you might have ADHD because you were at a party, tried something and it made you felt way different than everyone else, haha drug seeker.

Many people with depression don’t improve on antidepressants so this seems of questionable accuracy.

Both things are true. If you improve on them you have it, if you don’t then it doesn’t mean you don’t.

They work great for me (adderall and friends). I don’t use them because of the side effects. When I can arrange my work life to be one or two things I like I can focus and work 10 hours productively and it feels easy. Make me manage a lot of trivia and distractions happen and I fall apart. So, I pick hard things and do them and just ignore the rest. It has worked out okay.

WARNING

The above post is utterly false.

This was always known to be false, but was a popular opinion in pop-psychology for a time.

It is untrue.

Stimulant medications DO NOT have this claimed opposite effect on people with ADHD. This is not a view that is supported by science and is not a valid diagnosis method.

If true you should let me, someone who can be put to sleep by adderall and caffeine, the degenerates I know (and love but cannot understand) who take adderall specifically for those opposite effects, and my therapist and psychologist who both ranted to me about their frustrations diagnosing their ADHD patients because they can’t use this test.

I’m not even saying you’re wrong, but it doesn’t match my personal experience at all (in both directions), and the belief is apparently widespread enough that real professional mental health providers believe it.

It would be genuinely surprising to me if someone who works all day with people who take these medications and talk about their effects wouldn’t be armed with a million counterexamples if at minimum the observations didn’t line up. Like they’ve got to be seeing some real effect even if the explanation is wrong.

Such a drastic change in effect—a drug inducing powerful stimulant effects in one group, and sedating effects in another—should be easily measurable by study, no? Is there any scientific literature documenting this?

So I’m not saying that I agree that it’s AS difinitive as this guy makes it out to be; but as someone with diagnosed ADHD, I can 100% validate the experience of stimulants having the opposite effect on me vs my neurotypical close-contacts.

I can comfortably take a nap after popping 10mg of dexamphetamine, whereas most people would be atleast moderately buzzed. And this has been the case since day 1 (I was diagnosed at 26), so it’s not just a factor of tolerance.

Another great example is the fact that the single biggest benefit to ADHD meds for me has been a complete reversal of my life-long anxiety.

I’m now zen as f..k, whereas before being proscribed meds I was a very anxious, hyper-self critical person.

> a drug inducing powerful stimulant effects in one group, and sedating effects in another

I firmly believe this has more to do with dosages than anything else. Sure, give a random person a 10mg Adderall and one might be more sedated or hyperactive. Give them 100mg (almost double therapeutic max), and I guarantee they won't be calm sedated.

Sure, everyone has a different threshold that needs to be hit for whatever underlying reasons just like alcohol. One beer might make some feel buzzed, one beer might not do anything. But for an average person (not a chronic alcoholic), I guarantee they'll be fucked-up after 6+ beers.

Are you claiming that the test identifies a subset, or ALL people with ADHD?

Seconded.

There’s a REALLY obvious difference.

It’s visible as an effect in studies too. In various forms. At random, one paper of many which captures one aspect: https://doi.org/10.1111%2Fj.1469-7610.2010.02333.x

Any sources?

ADHD is a diagnosis based on symptoms. It has a number of causes. Your mental health professionals would prefer different diagnostic criteria. Those other criteria would result in a different set of people being diagnosed with ADHD. The current diagnostic criteria are symptoms that cause problems for the sufferer. Thus successful treatment of ADHD as currently diagnosed improves lives. Why is the diagnostic criteria you describe better?

Nobody has ever suggested I have ADHD and I've never tried Adderall, but a nice cup of coffee is an ideal bedtime drink for me and a couple of Red Bulls before a lecture in college would have me fall asleep in the class.

I used to drink an energy drink before bed and people thought I was super weird for it! I didn’t find out it was an ADHD thing until my therapist asked, I guess knowingly, how caffeine affected me and I went on this whole rant about it.

That is also because you regularly consumed caffeine, no?

If you took a 6 month long tolerance break, I would be interested to see if you still had that effect. Insomnia is not that uncommon of a symptom of stimulant withdrawal.

> my therapist and psychologist who both ranted to me about their frustrations diagnosing their ADHD patients because they can’t use this test.

Why? I thought there was a clear and insurmountable amount of evidence behind all their little psychometric tests? /s

> real professional mental health providers believe it.

Plenty of doctors and professionals believe incorrect information all the time. Just because one went to a fancy medical school does not make them infallible no matter how much their ego may try to convince you otherwise.

Suppose I've taken ritalin and gotten very calm from it, why could that be? Certainly not placebo because I expected hyperfocus when I took it.

Being able to control your focus allows you to ignore things and reduce sensory overload.

I've heard this before but similarly to the other replies this doesn't match my lived experience at all. Are you just talking about the function in the brain, e.g. it does the same thing to the neurotransmitters, or are you talking about the effects it has on the person taking it?

> Stimulant medications DO NOT have this claimed opposite effect on people with ADHD.

Do they, as far as you're aware, have this opposite effect one some people - but it's not considered to be correlated to whether they have ADHD?

As a kid, when sugar came around and other kids would get hyper, it always had this effect on me and I was really confused.

But some of that may have been environmental because I had experience with hyper friends breaking my stuff and so learned to be cautious, so I might have developed increased caution in response to stimulation for non-physiological reasons.

> As a kid, when sugar came around and other kids would get hyper

That might not actually be real: https://www.science.org.au/curious/people-medicine/does-suga...

One related I've noticed is that people respond to certain drugs way differently to me. For example, cannabis acts like a stimulant for me (especially the first 1-2 hours) whereas it practically puts some to sleep.

>Want to talk to your therapist about your suicidal thoughts, bulimia, or self-harm, nope. Not unless you want to take a mandatory grippy sock vacation away from your support network and get set back in school or lose your job all things famous for improving mental health.

It takes a hell of a lot more than this to be involuntarily taken into a psychiatric hospital.

The stuff you are saying is flat out wrong. It's also extremely harmful. I say this as someone who volunteers on a suicide hotline and takes calls like this every night I'm on shift.

No one is going to involuntarily take you to hospital unless you are in really, really imminent danger (as in, you have a loaded gun and insist you will use it in twenty minutes level of danger). Just having suicidal thoughts or even self-harming will not result in your autonomy being taken away.

Please, if you are having harmful thoughts, the best thing you can do is talk to someone. Don't let the nonsense above scare you away - you CAN talk to your therapist about this stuff. It's why they exist.

> Don't let the nonsense above scare you away - you CAN talk to your therapist about this stuff. It's why they exist.

I’ve had every therapist I’ve ever seen give me a rehearsed speech about what things they’re required by law to take action (i.e 5150 although technically a different number here) for and it’s always self-harm and suicidal-thoughts, but not ideation. Maybe it varies by state?

The speech always came with a wink wink just don’t tell me explicitly and we can talk about it here so I think they agree with you.

“Action” is different from involuntary commitment.

All I can say is that out of the many thousands of calls yearly to the Seattle-area hotlines, the number of direct involuntary interventions was on the order of a few dozen a year at most.

Yes, if you are in imminent danger, people will come to you and try and talk you out of it, and there are lots of voluntary hospitalizations, but it’s honestly rare for someone to be taken against their will and usually only happens in cases of heavy psychosis.

The thing with a therapist is that many are not set up to be crisis counsellors and so they will want you to talk to someone who can help in a crisis rather than once a week for an hour. But that’s all.

> It takes a hell of a lot more than this to be involuntarily taken into a psychiatric hospital.

I’m not sure that’s true. These are not mine, but supposedly true to life:

https://reallifecomics.com/comic.php?comic=july-31-2020

https://reallifecomics.com/comic.php?comic=august-3-2020

https://reallifecomics.com/comic.php?comic=august-4-2020

https://reallifecomics.com/comic.php?comic=august-5-2020

Putting aside other factors for a moment, a rigorous test surely depends on the dose.

Stimulants like lisdexamfetamine can be titrated over a period of several weeks to determine effectiveness and tolerance of the dose, which are unknown until tested - that doesn't seem quick to me and indicates that clinicians can't expect a binary response from a one-off dose.

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