Comment by Roark66 | Hacker News Reader

Comment by Roark66 | Hacker News Reader

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I wish I could upvote your comment twice. Based on my observation how a childhood friend of mine was treated for a psychiatric condition I think all of the "science" of using drugs to treat mental issues is at the level of advancement comparable to medieval blacksmiths doing dentistry. It essentially comes down to "hey, try this, are you better or worse, worse? Try something else. Better, have more of it". All the theories about lacks of certain neurotransmitters causing certain problems, all of it is like a bunch of cavemen trying to fix a transistor radio with their stone axes and coming up with ideas to explain various noises they hear when they whack it. Of course many conditions are so debilitating even such random experimentation is better than nothing. I don't blame individual doctors and practicioners, but I think this whole field should be much more humble about what is it they can treat, what kind of long term outcomes one can expect etc. Certainly they shouldn't be giving random drugs that really can f** with a developing human mind to treat imaginary mental illnesses that cause ones grades to be insufficiently good etc.

> I think all of the "science" of using drugs to treat mental issues is at the level of advancement comparable to medieval blacksmiths doing dentistry.

Discounting an entire field of science like this, based on a second-hand observations, is exactly the kind of hubris the parent comment was talking about: There’s something about psychiatry and neuroscience that makes a lot of people who are good at engineering/software think that they are qualified to also be experts on the field of psychiatry.

You’re right that psychiatry and medication is a lot of trial and error, but that’s the most efficient and accurate way to determine which medications work with a patient. In a hypothetical perfect world we’d have more tools to predict ahead of time and this is an active field of study. However, nothing comes close to the speed and efficiency of just trying medications based on what has worked for many other patients with similar conditions.

Note they practitioners aren’t just guessing and hoping for the best. They are using a large body of research, clinical experience, and shared knowledge of their peers.

> You’re right that psychiatry and medication is a lot of trial and error, but that’s the most efficient and accurate way to determine which medications work with a patient.

> Note they practitioners aren’t just guessing and hoping for the best.

Soooo, which is it? You can't have it both ways, either trial and error or "educated guess".

> Soooo, which is it? You can't have it both ways, either trial and error or "educated guess".

Sure you can -- trial and error doesn't mean the things you're trying have to be picked out of a hat at random. You can choose a starting point based on existing research and iterate from there based on the results experienced by the patient.

Psychiatry has a long history of being absolutely sure that this time, they have it right, then doing something hideous, and then moving on. No, no, this time, we have it right. If you want hubris, look to psychiatry. Nobel Prize for lobotomy in 1949, two decades later that is over with. Not to mention its relentless collusion with governments local and larger.

Sure, science progresses. As well it should. But psychiatry occupies a particular corner of a square with self-certainty on one axis and "how much could you really know about that topic" on the other.

Think you're tilting at windmills friend. You've described the same situation they did, just in esteemed tones.

I think most folks expectation is that since we know so much about so many things that our level of understanding about the brain and psychiatric treatment is more advanced than it is, who are then surprised to find out that some (all?) treatments are basically just modifying the behavior of a messenger chemical across the whole of the brain.

"They are using a large body of research, clinical experience, and shared knowledge of their peers."

If a psychiatrist prescribes a placebo instead of a kick to the groin they are "......using a large body of research, clinical experience, and shared knowledge of their peers" that show kicks to the groins are bad for patients, and placebos cause them to report improvements. You can defend anything with this sort of language, it's posturing.

> There’s something about psychiatry and neuroscience that makes a lot of people who are good at engineering/software think that they are qualified to also be experts on the field of psychiatry.

This isn't always hypocrisy: There's a self-consistent idea here that you're missing: we recognize that psychology (and by extension psychiatry) is extremely hard. Human brains may be the most complex systems in the entire universe. I didn't get the feeling GP was claiming to be an expert, but rather he was claiming "there are no experts in psychology yet". I don't think that's as strong a claim as you seem to think. In fact I think most Ph.D.-level psychology researchers agree with just how tremendously difficult the subject is, and how little progress anyone is able to make.

It's consistent and defensible to believe both that it's absolutely critical for humanity to study its own brains, and also that we haven't done a good job at it yet. It's consistent and defensible to believe both that psychology researchers are smart, dedicated people doing admirable, important work, and also that they have really not made anywhere near the kind of progress to justify the level of confidence that pop-sci magazines, non-fiction writers, and podcasters exude. You don't need to be an expert in psychology to believe these things, either. You simply need to understand how deeply, fundamentally difficult the subject is.

As somebody who is mentally ill and has tried lots of different drugs in a very unscientific way, with mixed results, you'd think I would agree with you. But actually, I don't.

Take lithium for example. We have now over 100 years of evidence that lithium is effective for treating bipolar disorder. Do we understand the action mechanism? Not really. And yet it's helped countless people live a better life.

This is just how technology works. Often, the tech precedes the science. Humans are very good at experimenting. There are huge gaps in modern psychiatric science, but also, there are loads of trials being run and evidence being collected about what generally works and doesn't work. But human brains are too different from each other for the same thing to work in every case.

So here we are. It's flawed, but we're getting somewhere, and we have to keep moving forward because mental illness is no joke and people need care. Same is true with experimental cancer treatments.

Sadly, what we have is bro science vs super cozy doctors and pharma industry. One group is largely ignorant, while the other wants to make money. You shouldn't trust either one blindly.

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