Comment by cat_plus_plus | Hacker News Reader

Comment by cat_plus_plus | Hacker News Reader

I have a feeling that future generations of doctors will look at today's mental health care in the same way as we now look at bloodletting. Belgian town of Geel has demonstrated that many mentally ill can lead content, functional life with a different attitude from society. Current mental health care emphasizes drugs with uncertain mechanisms of effectiveness and severe side effects, and Freudian style therapy that presupposes that one's difficulties have a particular cause in the past that can be corrected through analysis.

I would like to see more focus on teaching people skills to navigate different aspects of self and others - dating, friendships, career, relaxing, finding something to be happy about. And also providing opportunities to actually practice those skills, modern society has become intrinsically stressful and isolating.

Obviously I am not talking about someone who suffered a complete break from reality and is sitting catatonic for days without interacting with anyone. But I bet a lot of patients admitted to ICU are not in this category, as evidenced by common sense measures described in the article working.

Technically I think Freudian analysis is very uncommon in a clinical setting in 2023. Most often it’s some variant of CBT, and for some conditions DBT, that have more outcome oriented approaches and frankly can be more systemically applied by less skilled clinicians.

And also work long term, unlike psychoanalysis.

Psychoanalysis is more adapted to non clinical psychology, I.e., helping people cope with trauma and life events that cause issues. It is a decent adjunct to behavioral techniques. CBT etc are less about understanding and dealing with causal factors and more about thought and behavior adjustment towards some goal. In a practical society this is often valued over personal understanding and resolving complex personality challenges. But for the individual post CBT analysis and psychodynamic therapy is what truly locks in gains and mental health.

What the original commenter wants is called "occupational therapy."

CBT, in application:

- is focused on quick results

- does not evaluate the patient as a system

- does not enable practitioners to recognize the limits of their practice

- does not have a concept of trauma as a barrier to using CBT.

This references my experience as a complex patient: I have a childhood brain injury that went undiagnosed until age 30. From 0-18, my parent's negligence hindered diagnosis; from 18-30+ I ran into the limitations of medical professionals and the medical system. In addition, I have read hundreds of experiences across time and space that align with these statements.

I have noticed that experienced CBT practitioners have a habit of seeing "failure to respond to CBT" as a failure of the patient to use it correctly. Less experienced practitioners are not as confident, and actually more open to the idea that their technique is wrong for the patient.

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