Comment by anon291 | Hacker News Reader

Comment by anon291 | Hacker News Reader

Schizophrenia can be managed, not treated. Lost in all the talk about mental healthcare and drug addiction are two important topics.

(1) Medicine does not have an answer for all mental illness. Many are incurable, and only manageable.

(2) Sometimes even the management is not good enough.

My uncle is extremely intelligent. Also has schizophrenia. Like Michael... extremely intelligent, PhD (received after diagnosis), etc. It's been many years. He has kids and grandchildren, etc. But... he still breaks from time to time. He's even attempted flat out murder. There's no answer really. His wife (my aunt) can get him to calm down, as can his children. But, it's still there, despite everyone's best efforts.In my view, short of completely numbing his personality and individualism, I can't see how anyone can 'fix' it.

Further lost in our conversation as it pertains to drug abuse is the importance of not creating the problem to begin with. Schizophrenia is no joke. Several commonly available (some decriminalized) drugs can induce schizophrenia. We must do what is necessary to ensure this never happens. The mind is a terrible thing to lose.

EDIT: Also, having also worked at Bain, I do not suggest anyone work in management consulting if they want their sanity.

I think schizophrenia could be prevented… most people manifest psychosis in teenage or young adult years. There is at least a good decade before it develops where something could be done, maybe. Just worth thinking about, at least.

This is inline with what my wife thinks. She's a psychology PhD who studied schizophrenia in young adults.

The way she phrases it is that the current best guess is that schizophrenia is a developmental disease.

Knowing that it is a developmental disease does nothing to prevent / treat it. There are many diseases that we can recognize as developmental, yet do nothing to prevent (autism for example).

You're using "does nothing" to mean "doesn't automatically solve" here. Understanding how something develops gives you places to look to attempt a treatment. You don't stop sending firetrucks because some houses have burned despite firetrucks.

I'm not denying that. I'm just saying we need to formulate our laws such that they recognize that some diseases are untreatable. That means proper asylums where those who are not responding to treatment can safely live.

>Several commonly available (some decriminalized) drugs can induce schizophrenia.

I don't think this is true. Some drugs can have effects that superficially resemble schizophrenia and then doctors mistakenly "diagnose" schizophrenia.

No. drugs like LSD can cause schizophrenia after they are stopped or even after one dose in susceptible individuals.

And I think that is the myth.

I can tell you from personal experience that's not a myth. (Not me, personally, my immediate family member).

One LSD trip triggered permanent psychosis.

Umm...are you sure? Are you sure the LSD triggered "permanent psychosis"?

Yes, this is what I personally witnessed happen to an immediate family member, minus the scare quotes.

The LSD trip definitely caused psychosis and the psychosis has been permanent thus far (this was over a decade ago!). I literally saw it happen.

So when you say permanent psychosis, what are the symptoms?

https://pubmed.ncbi.nlm.nih.gov/30442059/

"Cannabis use doubles the risk of developing psychosis in vulnerable people."

That's just the thing. Psychosis can be a symptom of mental illness or it can be a symptom of smoking cannabis.

I think the question is whether or not smoking cannabis increases your future risk of psychosis. If it does, then it ought to be highly controlled, if not outright banned. If it does not, but can cause psychotic like symptoms during its use, then regulations should be made that it can only be indulged in in appropriate places.

By that logic we should ban peanuts, or at least highly control them.

Another nuance lost is, that there are many millions for which the sickness is a gift.

What becomes a conspiracy theory of the government following for one, becomes a thriller book for another, that switch to differentiate between hallucination and reality that artists have and patients dont have. My brother was quite the creative powerhouse, before the sickness took him.

My dad and his siblings are very smart (graduate degrees, doctors, all of them). However, the way my dad tells it, my uncle was exceptionally smart growing up, and I wonder if it was due to pre-schizophrenia traits (or pre-diagnosis... who knows).

Despite being asian, my dad was always 'afraid' of smart children. In his mind, schizophrenia was caused by lack of rest and relaxation. He always encouraged my brother and I to relax, and not work too hard. Apparently, it is now known that schizophrenia is correlated with sleep disorders as well.

I guess we are lucky in that my uncle has never been able to do anything wrong. He did attempt murder I suppose (in paranoid delusion), but luckily his brothers stopped him. I suppose it helps living near family and having a lot of siblings. Nowadays he's mostly limited (due to old age) to gathering apostles on the internet for his new religions. Probably the best outcome you can hope for.

I believe the biggest lesson from this article though, is that it is dangerous when we legislate based on hope. The 1950s and 60s saw the beginnings of the desire to eliminate asylums due to civil rights concerns. The 'solution' was a technology that at the time didn't exist, but which they hoped would exist after the law was passed. It is dangerous to create law while ignoring current reality, and depending on hope.

>I believe the biggest lesson from this article though, is that it is dangerous when we legislate based on hope.

Could not agree more. Self-hypnosis and can do rhetoric is a real poison when it comes to mental health. Its also very comon though, as humans can not really percieve mentally different people. We percieve other as flat copies with mirror neurons. So every person somebody else sees, is always "similar to me".

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

If that does not work out, the brain evaluates the persons actions result. If its nothing we regard as valuable, we classify the person as "stupid/lazy/etc", if it has good outcomes, we classify the person as "brilliant/genius/etc".

This inability to even percieve the other and the behaviour they are locked in eliminates alot of the possibilities for help. "I would never do that, unless im lazy. I would think really hard and snap out of it." is way to often the conclusion.

I'd add a third point about misdiagnosis. Schizophrenia is maybe more straightforward, but there are other debilitating mental illnesses that are often diagnosed incorrectly. I suppose, though, that just leads back to your 2 points, making it more likely that the medication/management don't help.

> diagnosed incorrectly

This is a tough one, because mental illness is not generally well-understood. Yes, we have diagnostic criteria, but they're all quite fuzzy, and very few kinds of mental illness take an obvious form like most physical illnesses. You can test for cancer and be certain; you can't test for depression or anxiety or PTSD or obsessive-compulsive disorder and be certain. Most mental illnesses exist on a continuum where, even if we could accurately identify their traits with any consistency, we would still be left to decide "are you depressed enough to be diagnosed?" I suppose in that sense, it's not unlike, say, prostate cancer, where the question is, "Is this bad enough to be worth treating?" But, generally speaking, you either have cancer or you don't; but with mental illness, there's no such binary, at least none that we've usefully identified for the vast, vast majority of forms of mental illness.

Yes, I agree...that's deeper into my feelings about it. By "misdiagnose", I mean there's quite a lot of slapping labels onto people and handing out the drugs that go with the label. And all done with "high confidence" language to the patient. There's sometimes the missing honesty about what an imperfect world it is.

Curious to hear your Bain war stories.

Well unlike Michael, I left after six months. I thought the job was a lot of BSing (and I decided to work at Bain after my SW eng interships which I felt did not move fast enough and had a lot of wasted time; I can be very type A and demanding for constant stimulation). There was a lot of time spent basically making things up to satisfy customers. There was also huge pressure to spend ungodly sums of money as an associate, because everyone's posing to one up the others (I'm talking about.. let's go do a birthday in Cabo every other weekend). So I had decided I didn't like it, but wanted to last at least a year.

Anyway, my colleague / mentor who's supposed to be helping me, instead tells me that I need to do better at making things up for customers essentially. It's quite the intense conversation. I can feel I'm not his favorite associate. Anyway, he ends his criticism by telling me not to jump out a window (we're on the 33rd floor).

Well, a week later, an associate at Goldman Sachs (which had an office in the same building) does indeed jump out a window.

A week later, I resigned.

All in all, it was very enlightening. I got to see how the rich really live. And most importantly, I realized they're no different than anyone else, just willing to sacrifice more. As my actual boss told me... family was for when I turned 30 (I was engaged already at the time I joined Bain). I recently began listening to 'Woke Inc' by Ramaswamy, and he has similar experiences at Goldman Sachs. Including the fake philanthropy stuff.

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