Common infections can spark psychiatric illnesses in children | Hacker News Reader

Common infections can spark psychiatric illnesses in children

economist.com

224 pointshampelm239 comments

> Dr Pittenger says it is now clear that covid-19 infections can trigger psychosis, fatigue and other neuro-psychiatric symptoms. A misbehaving immune system is thought to be the culprit. The idea that schizophrenia may, at least sometimes, likewise be an auto-immune disorder is also under investigation.

Until I got long covid(generally recovered now after 2 years), I couldn't comprehend this idea. I felt like I was actually going crazy. But then that lead me down a rabbit hole of reading about things like the microbiome and immune system which is a whole new domain yet to be formally explored. I highly recommend people read Ed Yong's book "I Contain Multitudes".

Post acute infection syndromes are a real thing and it is fascinating that we get to see science take on this topic in the spotlight right now. Especially Jeff Gordon and his work on the microbiome and Akiko Iwasaki and her work on long covid.

It makes you honestly question the idea of freewill. Good thing that Robert Sapolsky's new book is coming out next month on the topic!

I remember reading awhile back about a study that showed people with the flu are generally more social while the virus is spreading. There's also those nasty sugar cravings that seem to pop up when people diet, and it may be that the microbiome drives those cravings. It's a curious thing to think that the bugs in our bodies may drive our impulses.

I don't know the mechanism of the flu thing (and i have heard it, after you get infected you're more social until the virus confines you to bed), but the craving sugar thing is 100% gut biome, the grass-fed gut flora release opioids when they eat grass, which get sent, via the blood, to our brains, which make us feel good. not eating grasses means we go through opiate withdrawal!

> not eating grasses means we go through opiate withdrawal!

That's an unreasonable exaggeration. Nobody is getting significant opioid modulation and withdrawals from their microbiome.

And ketchup doesn't have enough nicotine in it, even when applied to potatoes, to notice!

This is fascinating. I wanted to know more about that but my cursory searches didn’t turn up anything except for connections between opioid use and gut microbes. It certainly feels like withdrawal!

oh, i get downvoted every time i bring this up on any social media platform that supports downvoting. see https://news.ycombinator.com/item?id=37129256 for example.

I'm not sure where all of my research PDFs wound up over the last 20 years, but start with that DOI ( 10.1016/0014-5793(92)80414-C ) from 1992(!).

There's a trend to looking into the gut for causes of certain diseases. Prior to the pandemic, there were publications that Alzheimer's, for example, was linked to gut biome.

I get the downvotes, what i say goes against conventional wisdom, that all you gotta do to lose weight is "not eat so much" - but the human body is not just your brain and heart and some tooling to allow intake of fuel as food.

There's a growing (and, depending on your views of "life", alarming) sense that our guts are in more control than we think. This can cause a lot of "free-willers" to get upset and be reactionary.

> remember reading awhile back about a study that showed people with the flu are generally more social while the virus is spreading.

Am I an idiot or is this clearly non-causal?

does seem weird as the flu usually makes me sore and not want to move at all.

You're probably still contagious for a while after the symptoms weaken.

But thinking about it, you're also probably in a good mood at the same time. So yeah, of course you're going to be more sociable.

I assume the poster meant that the infected are more social before they start having symptoms

You're probably contagious before symptom onset.

To clarify, the the claim is that individuals are more sociable when they are infected with the flu virus.

These results show that there is an immediate active behavioral response to infection before the expected onset of symptoms or sickness behavior.

https://pubmed.ncbi.nlm.nih.gov/20816312/

I did a quick skim and the main problems with the study are:

1. no placebo, so it's unclear whether it was actually due to the flu virus or some unrelated factor. The study admits this might be an issue, but casually dismisses it with "We looked for this, and found no such effects."

2. the "flu virus" in question is actually a vaccine. Needless to say there's a big difference between getting a flu shot and an actual flu.

the idea that a virus can change the behavior of the host to make it more likely to spread is one of those things that's beyond creepy. lots of scifi based on this, and the ones that are more subtle are much more effective than getting bit by a zombie trope.

Have I got bad news for you. This is past speculation in certain species:

https://www.nationalgeographic.com/animals/article/cordyceps...

Also in humans, with the rabies virus which makes people be repulsed by water, which would limit the spread of the virus since its vector is saliva.

I mean this is something well proven in parasitic infections. For example snails that climb to the top of plants to be eaten by birds when they are infected.

Also rats that are infected that go hang about places where cats have peed so they get ate spreading the infection to cats.

what makes you think that this is something I doubt? I can accept it happens and still be creeped out by it all the same.

This is already well established in humans for toxoplasmosis, for example. It’s a parasite rather than a virus, but it doesn’t seem crazy that a virus might do similar things.

Did you learn anything that helped in your recovery? I'm 1.5 years in and nowhere near a full recovery yet.

Was about to ask the same. I'm one year in and had a glorious month following reinfection in August but seem to have rebounded the last week or two.

I sure did. I'm writing a book on it right now. I have a couple of posts that might help:

https://jondouglas.dev/long-covid/ (Maybe outdated at this point but tells the full journey)

https://www.reddit.com/r/LongHaulersRecovery/comments/12iv4p... (Probably the most realistic summary)

The most important thing in my opinion that I don't talk about in these posts is to stay informed on the latest research and become study/trial literate. i.e. https://www.science.org/content/article/how-seriously-read-s...

Wishing you the best to recover.

I think it's really a shame that aspirin is not emphasized more as a COVID and COVID-recovery treatment, given that it's known to help reduce clotting which is an important mechanism of COVID etiology. Even Biden's physician had him take it during his case.

Would recommend CBT.

e: I'm downvoted but this is one of the only treatments with best-in-class evidence for its effectiveness in treating long covid as well as CFS and IBS. The body is a complex organism.

Where is the best-in-class evidence that CBT is effective at treating long covid and chronic fatigue syndrome?

https://pubmed.ncbi.nlm.nih.gov/37155736/

There's even more evidence for CFS - the PACE trial is a notable example. These are politicized by certain patient advocacy groups and associated publishing circles but the evidence is considered pretty strong in the broader medical sphere.

This is a very, very tall claim:

this is one of the only treatments with best-in-class evidence

Firstly, one would expect to see indications of the evidence for cognitive behavioral therapy working for a complex long-term illness with multiple documented physiological issues.

Random paper: https://www.sciencedirect.com/science/article/pii/S089662732...

Second, which class of evidence are you referring to?

Third, to back the comparison in the claim you also need to present the lack of evidence for other treatments. This makes your claim very, very tall.

> Firstly, one would expect to see indications of the evidence for cognitive behavioral therapy

There is plenty of evidence if you go looking. It also looks like there is significant overlap between CFS and long covid and the PACE trial demonstrated strong evidence for the effectiveness of CBT in ME/CFS.

https://pubmed.ncbi.nlm.nih.gov/37155736/

> multiple documented physiological issues.

"proposed mechanism" != "multiple documented physiological issues" and even the presence of documented physiological issues (such as in IBS) does not preclude the benefit of CBT because the body is complicated and the mind-body duality is not real.

> comparison in the claim you also need to present the lack of evidence for other treatments.

AFAIK - there has not been any other treatment showing this sort of evidence. It is difficult to prove a negative.

The PACE trial has been widely discredited.

From Wikipedia:

”A 2010 meta-analysis of trials that objectively measured physical activity before and after CBT showed that although CBT effectively reduced patients' fatigue questionnaire scores, activity levels were not improved by CBT and changes in physical activity were not related to changes in fatigue questionnaire scores.“

Source: https://en.wikipedia.org/wiki/Chronic_fatigue_syndrome_treat...

See especially the section on “PACE trial controversy”. It’s easy to see that it’s a poor study.

—

The paper I pointed towards describes multiple demonstrated means of neurological injury from SARS-CoV-2 infection. It’s just one single paper selected at random. It shall not be dismissed as “proposed mechanism”.

—

The unproven and unprovable negative claim was indeed yours to prove.

As I said in another comment,

> These are politicized by certain patient advocacy groups and associated publishing circles but the evidence is considered pretty strong in the broader medical sphere.

The “critiques” of the PACE study are mostly based around p-hacking the objectives until you get the results you want. PACE participants saw significantly fewer hospitalizations, lower mortality, and better reported questionnaire scores as a bonus.

Because there is a lot of ire against recommending CBT among patient advocacy groups (including threatening to kill the authors and their families), some researchers have critiqued PACE because they have found some metrics in post-analysis that PACE did not improve (classic p-hacking). But that does not represent the broader view of the field.

Described by other scientists: “[The critiques come from a] fairly small, but highly organized, very vocal and very damaging group of individuals who have, I would say, actually hijacked this agenda and distorted the debate so that it actually harms the overwhelming majority of patients.'

> It shall not be dismissed as “proposed mechanism”.

That is literally how the paper self described. I am linking you multiple RCTs demonstrating impact and you are linking speculative causes of a disease that do not yet meet Koch’s postulates. But even if a neurological mechanism holds up (not at all unlikely in my view), this is likely to not be the case for all populations currently diagnosed with long covid - but rather a subset. CBT will likely be helpful for both populations, given the evidence I have linked.

My proof of my claim is that I have researched alternative treatments for long covid and CFS and none of them have these effect sizes :) If you have contrary evidence, that’s on you to prove, but fwiw I am not going to keep replying.

And again, I’ve linked RCT evidence for the effectiveness of CBT in long covid, which I guess you have nothing to say about.

From the paper “The Neurobiology of Long COVID”:

Demonstrated effects of reactive microglia after COVID-19 include a reduction in oligodendrocytes and myelinated axons, highlighting disrupted myelin homeostasis.

—

The UK Biobank study discussed above compared magnetic resonance imaging (MRI) data before and after SARS-CoV-2 infection in 401 individuals and 385 matched controls. MRI data obtained an average of 141 days following COVID-19 diagnosis revealed widespread structural abnormalities, including a small but significant global decrease in brain volume, changes throughout the olfactory system, and structural abnormalities in the limbic system, cerebellum, and major white matter tracts (fimbria and superior fronto-occipital fasciculus)

—

Concordant findings in an MRI study of individuals with persistent cognitive impairment after COVID-19 found white matter hyperintensities correlating with verbal memory deficits

—

Another imaging and neuropsychological assessment of 223 individuals who recovered from mainly mild to moderate SARS-CoV-2 infections and 223 matched healthy controls found that among the 11 MRI markers tested, significant differences between groups were found in global measures of mean diffusivity and extracellular free water, which were both elevated in the white matter of post-SARS-CoV-2 individuals

—

And so on and so forth. Those are the first immediately obvious passages describing structural alterations to brain tissue in that one paper.

These are severe physiological issues. This is literal brain damage. This is a paper pointing to craters.

Will CBT help with impaired oxygen perfusion of tissue caused by a pathogen known to cause pervasive vascular damage and severely deranged blood clotting?

https://www.sciencedirect.com/science/article/pii/S002628622...

Also, why does CBT work when it does?

Oxytocin is directly anti-inflammatory and CBT can and does affect oxytocin secretion.

https://www.tandfonline.com/doi/full/10.1080/15374416.2023.2...

I'm in the US, so this advice is only applicable there, but LabCorp will test your blood for you without a doctor's note. I had to route around my doctor because I caught covid in the initial wave and no one knew what was going on. Your doctor may be able to help you more these days. Anyway, so I got my blood tested for all sorts of stuff, fixed deficiencies that came up, then leaned heavily on specialists to get medication to fix my symptoms. Beta blockers/other for my heart palpitations/other issues from a cardiologist, various inhalers for my lung issues from a pulmonologist, a whole slew of medications and treatments from a psychiatrist. And so much help from my friends. At the worst of it, it was exhausting walking from my bedroom to the kitchen, and I live in a small apartment. It did take years, but eventually I got there.

Learning to never push myself, because that would cause me to relapse and spend a week in bed. They have a name for it now, but that's the biggest thing that helped, really.

Hope you get a full recovery soon!

> It makes you honestly question the idea of freewill.

Hell two months in any psychology course will have you questioning that. We are truly biological beings first and rational agents second.

The middle ground here seems not only theologically sound but biologically coherent as well. We have a constrained will.

Free will has never and will never exist since we are finite beings. We have a _constrained_ will that is boxed in by a number of factors: time, money, biology, knowledge, circumstances, etc. Theologically, that will is also constrained by our nature. There are certain spiritual things we cannot do in the same way we cannot do certain physical things.

By the time your internal monologue makes a decision, the neural network for it fired long ago. Non-physical thoughts don't guide the physical processes; they are simply a side effect of it.

>It makes you honestly question the idea of freewill.

Not eating and getting low blood sugar can much more simply answer the question of "Do I have free will, or am I a subject of my internal chemical reactions".

Or, much more simply stated "You're not you when you are hungry".

> Not eating and getting low blood sugar can much more simply answer the question of "Do I have free will, or am I a subject of my internal chemical reactions".

You cannot control what you feel, but you can control your actions.

> You cannot control what you feel, but you can control your actions.

I'll respond in a way that I hope is clear and relatively objective. This will take the form of an "if-then" claim nested within another "if-then" claim.

IF a person

  (1) accepts philosophical materialism, but
  (2) remains agnostic as to quantum effects at macro scale

THEN then the following response follows logically:

It depends what you mean by "you". If you (a) mean that "you" consists of the body, including the brain; and (b) you recognize there is a physiological difference between _non-volitional_ and _volitional_ choices; then (c) yes, loosely speaking, "you" can control your volitional actions.

If you think carefully, you will recognize the above assumptions also mean:

- a person's surrounding context plays an essential role in shaping the kinds of actions that are available.

- there are no causes other than material ones (such as a soul)

You may notice I didn't use the phrase "free will" above. That is very much intentional. Even if you are a philosopher, that word is nearly impossible to use in a way with a definition that a group of people can agree on.

See also: "Volition and Action in the Human Brain: Processes, Pathologies, and Reasons" by Itzhak Fried, Patrick Haggard, ... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5678016/

I think there's two conceptions of free will, one is as you described -- a body being able to act in and of itself without any influence of an external force (beyond sensation, physical constraints, etc).

That sort of punts on the question of physical determinism, where it doesn't matter if it was possible for you to have done anything other than what you did. You could be a pure clock work automaton making deterministic responses to external stimuli and still have that sort of "free will", but I don't think that would be satisfying to a lot of people.

The second kind of free will, I think would be the ability to have a free choice -- that there is some immaterial entity which can act in somehow a non-deterministic way to choose its behavior, that the course of your entire life wasn't set at the big bang -- that not only can you act independently, but that your choices _matter_ and will result in a future that was not predetermined. I think that is what a lot of people would think of as free will, and it's difficult to define or logically support IMO.

I can appreciate a lot of the sentiments above, but I don't think the comment's "two conceptions" really 'decomplects' (a Hickeyism) the key ideas. If anything, it smooshes a lot of them together: different definitions of free will, meaning, origin stories, the divine, flavors of determinism, and more.

Note that non-material causes can be just as deterministic (if not more so) as matter. Logic and math are physical but not material, for instance.

> Logic and math are physical but not material, for instance.

Logic and math are neither physical, nor material, nor causal.

I think some might be slightly troubled by hearing that logic is not causal. But I agree.

One can _test_ a set of statements to see if they are valid logical deductions from another set of statements. Even if true, this does not mean that the deducible statements are _caused_.

In some cases, that statement from above (the deduced one) might be 'realized' (noticed by people) before its premises are!

We might even be able to logically prove it is true without the other set of statements! Why? There are multiple logical paths (not always mapping to reality) that _could_ prove a particular statement.

When living things or machines do math they are doing a physical thing.

The abstract concept of mathematics doesn’t need to exist for that to happen.

They are physical causes but they are abstracted from matter. The underlying cause originates from the math/logic, not the material instantiation. Physicalism is often conflated with materialism, but the world is physically constituted by more than matter!

A lot of this world is obviously caused by the inherent formal influence of math and logic. There are ongoing mysteries in this, to be sure, but these forms are beyond matter. I’m speaking from the Pythagorean-Platonic-Tegmark school of thought. I’m trying to address the typical atheist layperson scientist who hasn’t thought through immaterial reality (rejecting it as supernatural, thinking it involves ghosts or spirits or something). I know there are reasonable counter positions to argue why math isn’t real, but I don’t subscribe.

> They are physical causes but they are abstracted from matter.

That sequence of words doesn't even denote a coherent concept. To be physical is exactly to be a state of matter/energy.

> The underlying cause originates from the math/logic, not the material instantiation.

No, logic, including math, describes the relationship between abstract concepts. It doesn't cause anything. Implication is not causation.

> I’m trying to address the typical atheist layperson scientist who hasn’t thought through immaterial reality

I'm Catholic, not atheist, and I have no problem with immaterial reality, or even immaterial causes of material effects. But I do have a problem with the simple error of describing immaterial concepts as being physical causes, or with describing systems of concepts and oc describing their relations as causes of anything, except insofar as belief in them causes behavior in the believer.

> I know there are reasonable counter positions to argue why math isn’t real, but I don’t subscribe.

There are certainly senses in which “math is real” is a valid or defensible statement, but bot in the sense of it being a physical thing which can exist as a cause.

Most physicists don’t see the world as “made” of stuff, either matter or energy. But algorithmic laws. The ontology of modern physics is weird.

Physical refers to natural causes. How could math not be causal? Not like, math in a textbook (though I’d argue that is causal too. Ideas are immaterial but they cause effects in the material world. They are thus natural, physical causes!).

Maybe you’d prefer the word “necessitate” over cause? Mathematical and logic necessitate certain effects in material reality? Personally I don’t see a difference, but maybe you do.

Can you?

I'm a type 1 diabetic, I have a continuous monitor that tells me what my glucose level is. This monitors actual interstitial fluid level and not blood sugar, this means there can be a pretty large delay between what's measured just under the skin versus what my blood stream is experiencing. If a rapid drop occurs there can be a lead time that I'm unaware of it, but others are because I'll behave in a 'cranky' or 'sharp' tone. I'm not aware this is occurring when it does. A little sugar and a few minutes and I'm back to regular me again.

You are in far less control of your actions then you believe. Internal self awareness is a poor mirror of reality.

Well said.

> You are in far less control of your actions then you believe.

No. But I say this in a way that might surprise you?

I view 'free will', as most people understand it, as an illusion.

I recognize that I, at best, have a tiny fraction of control. If I consider "me" to be a locus of control w.r.t. volitional action, then I will grant that "me" has causal impact. But what causally impacted "me" at time t? A combination of "me" at time t-1 and my environment. (I'm a materialist who is agnostic w.r.t. determinism.)

So, what does this really mean? "I" (right now) can only have volitional control only if one ignores the precursors. It is a mindbending realization to many, but it is the best theory I've found that fits reality.

There are lots of us around. We might disagree on how we define 'free will'; we may or may not 'deny free will'. But there is a huge commonality among most rational materialists who accept modern science: we do not conceptualize free will in ways that match 'mainstream' notions of it.

I consider free will fundamentally an illusion but at the abstraction level of 'me' (also a faulty abstraction) it does make sense to use these concepts sometimes.

But it's important not to confuse the map with the territory.

I agree that free will functionally doesn't exist. However for the purposes of social organization I see no better alternative than to treat each person as an agent and hold them fully accountable for their actions, regardless of upstream "causal" impacts.

If you're starving/high/whatever and you violate someone else's fundamental rights, the reasons/excuses you give as to why your control was compromised seem irrelevant. Actions and outcomes count, not intentions.

> Actions and outcomes count, not intentions.

There is a whole division in law around mens rea vs actus reus that disagrees with this take.

I'm aware, but the bar for a guilty mind is quite low. You basically have to have known what you are doing, which we assume just about every conscious person does. There are also crimes where mens rea isn't even applied to a perpetrator, but to a reasonable objective analyzer (eg. manslaughter).

> I'm aware, but the bar for a guilty mind is quite low.

Do you mean this in terms of a cross-system comparison (i.e. variation between legal systems)?

Do you mean this in terms of some philosophy that lays out a more sensible stance?

I've been digging into this somewhat; happy to learn more.

> If you're starving/high/whatever and you violate someone else's fundamental rights, the reasons/excuses you give as to why your control was compromised seem irrelevant. > If you're starving/high/whatever and you violate someone else's fundamental rights, the reasons/excuses you give as to why your control was compromised seem irrelevant. Actions and outcomes count, not intentions.

Yes, people _often_ people give rationalizations of dubious merit. These are muddled, complicated 'reflections' of the full reality. So it is wise to not give them too much weight. (But it can be very interesting to try to parse them, but that's another topic...!)

Next point. From a predictive point of view about public safety, the context and situation matters. For example, consider the case of an addict who regularly steals because he is driven by the addiction. If he can break the habit (hopefully with help of many kinds), the theft problem largely goes away. Understanding the dynamic helps us understand downstream outcomes.

yes, a prisoner may be locked inside and have a laid out routine for them, but they do still have a say in the minutiae and their small actions could actually echo into the future.

Another thought, just because our unconscious mind also plays a part, people fear that this implies mostly determinism but really why are we considering that as not also our thoughts too? They're just thoughts that our deeper mind has put forth and our deeper mind doesn't usually want to be questioned, they've got more hard data. Still you can fight this or things like suicide, soldiers. daredevils wouldn't be possible. We just don't get to see how it came to conclusions so we assume it's some hard-wired code.

It's simpler than that. Your thoughts -- the internal monologue deciding what actions to take -- are the result of physical processes in the brain. There is no way those non-physical thoughts are changing the physical processes; they happen after the fact. We have the illusion of being in the driver seat but really we are just along for the ride.

This is assuming you adhere only to what science can prove, and not religious beliefs like the soul.

But yeah, the fact that we are the result of past decisions and outside inputs going all the way back to before we even had consciousness at all is also a nice proof by induction.

> There is no way those non-physical thoughts are changing the physical processes; they happen after the fact. We have the illusion of being in the driver seat but really we are just along for the ride.

How can you conclude this with any certainty?

PBS: Your Brain: Perception Deception

https://www.youtube.com/watch?v=HU6LfXNeQM4

PBS: Your Brain: Who's in Control?

https://www.youtube.com/watch?v=yQ6VOOd73MA

Rationalization is mostly post ad hoc.

There are other interpretations of some of these experiments (e.g. regarding the action potential). In his book on free will, Mark Balaguer elaborates a little bit. I don't remember the details well, but I'll try to sketch what I think he says.

First, in my recollection, Balaguer points out the form of the argument as follows.

Given that: (1) a particular study shows that one's (perception of when they decided to act) _lags_ the (experimental measurement of the person's action potential spiking), what can we validly conclude?

Some people then claim that (2) claims of making a decision are merely post-hoc rationalizations. I get the sense that such a view is widely held among those who have heard of the experiments -- or at least the popular characterizations of them.

Balaguer says e.g. "not so fast". He points out that we need to talk about the logically necessary steps to reason from (1) to (2). He has a section on this; he claims it isn't as watertight as some think.

As I recall, part of the discussion has to do with motor planning.

Another part is this: there could be a volitional choice that precedes and causes both the action potential spike _and_ the perception/recognition. That volitional choice is unavailable to conscious awareness until some time later, presumably. If true, a person could have made the choice, noticed it later, and still be consistent with the experimental findings.

Apologies for the hazy recollection. I recall not being strongly convinced, partly because I wasn't impressed by the book overall, but I also haven't dug into these topics as much as I would like.

Lucky for us, the issue of latency between action and perception is squarely in the wheelhouse of distributed systems engineers!

> There is no way those non-physical thoughts are changing the physical processes; they happen after the fact.

How can the truth of this statement be proven? Non-physical thoughts cannot be observed, so they are out of reach of being tested for being correct.

Eventually we may have sufficiently fine-grained ability to observe brain states, plus a strong enough understanding of neuropsychology, such that an outside observer can accurately predict, for a brain under observation:

1. The subjective internal mental state of the participant (e.g. "you were imagining a red balloon")

2. Actions that will be taken before they physically manifest (e.g. "you will throw rock instead of scissors")

If an outside observer can do these things without access to subjects' thoughts, especially with subjects' deliberate efforts to fool the observers, then IMO it is pretty clear evidence the thoughts are meaningless.

As for the current day, I say the preponderance of evidence is on anyone who claims otherwise. There's lots of evidence suggesting free will is an illusion, and no evidence of telekinesis or the like.

Not even eventually, currently we have AI that can decode 'pictures' from our brain activity.

https://www.smithsonianmag.com/smart-news/this-ai-used-brain...

> Non-physical thoughts cannot be observed

We wouldn't even be able to talk about them, because if we did, there would be a causal chain starting with a non-psysical thought and ending with moving a (physical) tongue. So somewhere along that chain, a non-physical thing would need to make a physical thing move. How exactly?

Neural activity physically exists. Qualia -- the experience of having thoughts -- do not.

> There is no way those non-physical thoughts are changing the physical processes

I don’t believe this to be correct. There is nothing non-physical about thoughts. Thoughts are mater interacting with mater.

Thoughts are to the brain what waves are to the ocean. They are not less physical than the brain itself.

You cannot point to a neurotransmitter or neuron or synapse and say "that's a thought." Thoughts are not material. You might say they are not real. Even if you can point to a group of neurons and processes in the brain and associate it with a particular thought, the thought itself is not real. The neurons and their behaviors are.

First, saying "x is not real" is a proven way to make a mess of a conversation. I suggest we all would be better off avoiding that phrasing, unless we're willing to really dig in and carefully clarify our definitions.

> You cannot point to a neurotransmitter or neuron or synapse and say "that's a thought."

Are you claiming it is (a) categorically impossible or (b) practically impossible? Why not?

> Thoughts are not material.

To be clear, when modern philosophers talk about 'materialism' that tends to include all of the abstractions of physics: matter, energy, waves, etc.

> You might say [thoughts] are not real.

I wouldn't say that. Here is what I would say; there are at least three key different aspects of thoughts:

1. the perceptual level; i.e. the _experience_ of having a thought

2. the conceptual level; i.e. a _concept_ that people use

3. the physical level; the physical things that are happening; may be a set of things; not necessarily contiguous

> Even if you can point to a group of neurons and processes in the brain and associate it with a particular thought, the thought itself is not real.

My top-most paragraph explains that "X is not real" statements tend to have a lot of downsides. Am I missing something? Does this add something to the discussion?

FWIW, when I said "thoughts" in the original comment, I really meant qualia / inner monologue / phenomenological experience, i.e. what you call #1 the perceptual level. Qualia are not part of materialism... which IMO makes them the most interesting thing in the universe, since they are categorically unlike everything else and yet so fundamental to our being.

I mean, yea, maybe in your world you don't want to point at an electromagnetic wave that is a wifi signal... but it is.

Signals are just as real as the components that create them.

Qualia are not a signal. You can't transmit and receive them, you can't physically detect them, there is no way to objectively describe them. When you and I both look at 450nm light there is no hope of ever knowing what the other perceives. You can say "the color of the sky on a clear day" but that is just a reference to yet more subjective experience.

Inasmuch as thoughts have a one-to-one coupling with the physical processes in the brain, then we are saying the same thing.

But qualia (the more accurate/descriptive term for what we are discussing) are inherently subjective and non-physical by definition. Both of us can observe an ocean wave using many different methods (direct observation with light, their effect on a buoy, their impact with the shore, etc). However we can never both observe your qualia. I have no way to determine that your perception of "red" and mine are equivalent. There is no way you can explain vision to a blind person; yet a blind person can have their own understanding of an ocean wave.

The trouble with this argument is it applies to your thoughts about reality, not just to your will.

Your argument implies your thoughts at time t are solely the result of your state at time t-1 and your environment. But if that's the case, your thoughts aren't about reality; they're just a result of reality, a result of whatever state you happen to be in.

But if your thoughts aren't about reality, why should your argument about free will -- or about anything else -- carry any weight?

Causal processes are not the same as logical reasoning, and if you reduce the processes of the mind to the former, you remove the possibility of rational argument.

If you consider the processes of the mind to be acausal, that also removes the possibility of rational argument.

It's possible that I'm a Boltzmann brain with nonsensical memories about environmental stimuli that mislead me about what reality is, but it's tedious to prepend every statement about reality with "the conception of reality that my state at time t-1 and my environment have lead me to believe is the most likely candidate for reality."

That doesn't seem to be a particularly useful objection to the philosophy that GP espoused, instead, you have to assume his same priors - materialist, agnostic w.r.t. determinism, and some basic assumptions about senses and a shared reality.

I didn't claim the mind's processes were acausal; simply that they could not be reduced to cause, to the exclusion of anything else. If they can be so reduced, rational argument is impossible, because causal processes are not the same as rational argument. When I punch "2 + 2 =" into a calculator and the screen says "4", it's a causal process. When my kid grasps that 2 + 2 = 4, it's different. His mind has reasoned its way to this truth; it is not simply that the brain-state "2 + 2" has produced the further brain-state "4". If that were the case, he (and we) could never know that 2+2 resulted in 4; it could just as easily produce 5, or a green rabbit, or whatever else our mind had been caused to think at any given time.

If reasoning has any validity, it cannot be reduced to causal processes.

Therefore any argument -- any attempt at reasoning -- that claims that the mind's processes are merely causal undermines itself in the very process of being made.

> causal processes are not the same as rational argument

Yes.

...I'm taking this step-by-step...

But causal processes can _generate_ rational argument. Agree or disagree?

> But causal processes can _generate_ rational argument.

There is no reason for thinking this. A causal process can be associated and simultaneous with an argument, but it can't generate it, except by accident. The state of mind '2+2' may be followed by the state of mind '4', but it could just as easily be followed by the state of mind '5'. Causal processes may make us believe one or the other, but they will not make one correct and the other wrong; nor will they be sufficient to explain how one answer is correct and the other wrong.

That's why I said 'can'. I didn't say 'always'.

A deterministic computer program _can_ generate rational argument; e.g. it can use logical deduction a.k.a. forward-chaining.

Your claim seems to be that causality (governing the behavior of human thought and action) does not _necessarily_ result in rationality (in that human)? Of course -- this is obvious.

This seems like a miscommunication. Perhaps an unavoidable one? :)

> Your claim seems to be that causality (governing the behavior of human thought and action) does not _necessarily_ result in rationality (in that human)? Of course -- this is obvious.

That's not my claim. Basic observation of oneself or others make this, as you say, strikingly obvious :)

My claim is rather that causality can't be a sufficient explanation for rationality. By this I mean that we can't explain rational thought by referring to the cerebral states that are associated with it. Remember your original claim that 'free will' is an illusion, because what impacts me at time T is [limited to] my state at time T-1, and my environment.[0] I take this to mean that my state at T is caused solely by my state at T-1 and envt. IF you're right about this, AND IF I'm right that causality can't be a sufficient explanation for rationality, then it implies that rationality is impossible.

Why can't causality be a sufficient explanation for reality? We can't explain rational thought by referring to the cerebral states associated with it, because the question of whether a thought is rational is indepedent of its associated cerebral state. There are cerebral states associated with 2+2=4 (rational), and cerebral states associated with 2+2=5 (irrational). But neither of these cerebral states is itself right or wrong. Only the thoughts associated with them are right or wrong.

I know that 2+2=4. It's not just that I have a series of successive, causal states that make me think this; it's that the content of the thought is correct. My mind has grasped a truth about reality. Similarly, someone who thinks 2+2=5 is wrong. It's not just that he has a series of successive, causal states that make him think thus; it's that the content of his thought is incorrect, and his mind has failed to grasp a truth about reality. When we say thought is correct or incorrect, rational or irrational, we refer to the content of the thought, not the brain state.

Thought must be about something other than the brain state to be right or wrong. But if thought is entirely generated, and sufficiently explained, by causal processes, it can only reflect the brain state, and can't be right or wrong. Since thought can be right or wrong, it follows that rational thought is something more than the product of causal processes, and is (at least partially) independent of them.

[0] I have added the words in square brackets myself, but I think that's your meaning.

Thanks for giving it another try.

> My claim is rather that causality can't be a sufficient explanation for rationality. By this I mean that we can't explain rational thought by referring to the cerebral states that are associated with it.

I'm zooming in on "explain" here. And I'm not getting it.

I'm not agreeing or disagreeing -- I'm not even following -- and I have some guesses as to why:

1. Are you offering a critique of the lack of free will argument I made?

2. If so, I'm not able to figure out where it lands: for? against? something else?

3. Either way, I haven't yet figured out what you mean by "explain" here.

4. Most broadly, I'm not seeing why this matters. I want to understand, but I haven't yet figured out how to get there.

If you are laying out a known philosophical position, could you please point me to a resource that explains it?

> We can't explain rational thought by referring to the cerebral states associated with it, because the question of whether a thought is rational is [independent] of its associated cerebral state.

If you had to write this over again to a broader audience, would you choose the word _explain_ here? In the context of this conversation especially, 'explain' is highly overloaded. Which sense do you mean? Perhaps what you mean is closer to _assess_ or _prove_?

Are you essentially saying this: the rationality of a statement is _assessed_ by the degree to which it adheres to the logic of rationality?

Since this is obvious, I'm inclined to think I'm still not following what you are actually trying to get across.

> When we say thought is correct or incorrect, rational or irrational, we refer to the content of the thought, not the brain state.

Yes, I agree. You've setup an example that emphasizes _conceptual_ understanding of what a person is thinking _about_.

This part is obvious too. But you want to take it further. I'm trying to puzzle that out next.

Ok, I think I'm working my way towards the part of the argumentation that has a bearing on free will.

> But if thought is entirely generated, and sufficiently explained, by causal processes, it can only reflect the brain state, and can't be right or wrong.

Not so. The above claim is confusing two things: (1) how a thought is generated (causality); (2) what a thought represents (conceptualization)

Whether a conceptualization is true or false is _independent_ of its causal origins.

This is obvious to me. But not to you? Or is more miscommunication afoot?

To expand the conversation a bit with the hopes of breaking out of what seems to be some kind of language trap ... Let's talk about how a person and a computer can arrive at / prove truth.

A person's brain can generate true concepts in many ways. One way is careful logical thinking based on true premises. Another is some other manner of thinking (pick whatever you like) which ends up being true.

Speaking of combinatorics and algorithms now, there are many ways to validate truth. It depends of course on the style of logic in play. Depending on the set of logical primitives available (e.g. modus ponens), there are many different computational pathways get from a set of premises to a conclusion. In other words, there are many ways to prove the Pythagorean Theorem.

I don't think we'll disagree. But maybe? Or maybe we'll get clear on some language barrier?

> But if that's the case, your thoughts aren't about reality; they're just a result of reality, a result of whatever state you happen to be in.

According to my premises (materialism being the key one), thoughts are the result of the combination of (a) what happened before and (b) the laws of the universe.

So thoughts can be both: (1) a causal result (previous paragraph) and (2) _about_ reality, from the point of view of one's consciousness.

Any disagreement here?

> Causal processes are not the same as logical reasoning, and if you reduce the processes of the mind to the former, you remove the possibility of rational argument.

(I'm not sure if this applies to what I was saying or not; I'll put that aside.)

I'll rephrase the comment above to help ensure I'm talking about the same thing. The claim, as I understand it, goes like this: if one believes the mind is governed by causal processes, then there is no possibility of the brain doing logical reasoning.

Am I understanding the argument as you intended?

I'll proceed with my understanding of it... I don't buy it. Computers are causal and can do logical reasoning just fine.

> Your argument implies your thoughts at time t are solely the result of your state at time t-1 and your environment.

The laws of physics also matter.

I think we're still on the same page here.

I'm trying to figure out if we disagree, and if so, where.

My mother was a T1 diabetic back in the days where insulin injections were basically a best guess based on what you had eaten and planned to eat. It was always fun as a child not knowing whether my little screw-ups would bring an exasperated sigh and a chuckle or the low-glucose demon.

I'm so happy that managing your disease is much more straightforward than it was in the 70s or 80s. It also appears that life expectancies are much higher since it's easier to avoid the extreme roller coaster of too high and too low blood sugar. Best wishes.

Of course you can control your actions. But that doesn't mean they can't be influenced by external factors like drugs, weather, or in your case low blood sugar.

You don't have absolute total free will in all situations. That's why development of willpower is such a huge discipline (religion, meditation, etc).

There's a range where your blood sugar starts to influence your actions, with more willpower and cultivating a less cranky personality you could certainly extend that range.

Some people have similar non-beneficail reactions to high stress situations, other people develop the skill to abstain from those actions and maintain control in those situations.

Willpower occurs after awareness. They are objectively different things.

If you are not aware of something, you cannot choose to make a reaction for or against it. For example, imagine that your body did not detect heat. If you put your hand on a burner you would instinctively withdraw from it (and yes this happens in people that do not feel pain).

Willpower is in the ballpark of conscious awareness. "I choose to do X or Y"

Training on the other hand attempts to remove the conscious decision part from the mind after awareness occurs. "If X then Y", this way you're not wasting time and brainpower trying to figure out what's going on.

I'm not sure what you are trying to say, but free will, I think, requires consciousness. If you want to train to keep your hand on a burner wouldn't that be free will. Are we implying that because we can sense pain and other things that we don't have free will. Free will doesn't mean you are omnipotent. You can choose to put your hand on a burner and you can choose to practice keeping it there, both are examples of free will. An instinct to avoid pain isn't negating the free ability to make choices.

My wife is also T1, diagnosed a couple years back with a week in ICU. She pulled through and now has a CGM and pump.

What really surprised me was her blood sugar rockets up when she has video meetings with a certain difficult colleague. While other chilled colleagues have no such effect.

That made me wonder if interacting with difficult people causes more physiological changes than I realised.

There are observable changes in the structure of the brain when people take up meditation. Not to get too crass, but we are the meat in our heads and bodies.

I'm not into mediation, but I watched something that said the brain scans of meditating experts resembled someone having a seizure or something. But the person with sat quietly.

I'm not drawing any conclusions. But I found it fascinating.

Epinephrine causes the body to release sugar into the bloodstream - it's one of the reasons you get shaky when your blood sugar gets low (if you're not T1DM at least) - your body is attempting to increase blood sugar by epinephrine. So in reverse, stressful situations that cause the release of epinephrine increase blood sugar.

There's a similar issue with e.g. running as a T1DM (as I understand it, not being one) - when you're running, your body will pump out sugar, but when you stop running, it doesn't stop instantly, so your blood sugar can spike high post-exercise. Or you can run out of sugar and crash hypoglycemic.

It's amazing that CGMs exist that can, to some degree, compensate for these things, but man the body's autoregulation on 50 different axes is fascinating.

You have clearly never met someone having a hypoglycemic event. It can absolutely change their personality, as significantly as a head injury.

The sound of breaking dishes in the kitchen, a trail of damaged but unopened candy wrappers, sitting on the floor next to the cabinets with their doors ripped off, with the sugar bowl half-spilled, thankfully recovering with some sugar under their tongue and no major bodily injury. Terrifying.

Hyperglycemia does too. (High blood sugar.) It’s known as diabetic rage. A number of things are happening there. Part of it is brain inflammation – experienced as suffering – and brain inflammation is directly behavior-modifying, causing aggression.

And indeed that’s what happens with traumatic brain injuries.

The same mechanism is behind the aggression sometimes displayed by cocaine users. Cocaine tamps down brain inflammation short-term, increases it long-term.

And indeed, people with traumatic brain injuries and central nervous system inflammation tend to have more problems with cocaine abuse.

In theory that sounds great. Unfortunately the idea that humans are highly rational is over rated. We are first and foremost, for better or worse, emotional beings.

Your fame of mind (i.e., feelings) plays a role in decision making, which drives action.

In short, beliefs (to which emotions are connected) drive behavior.

I assume you have no bad habits?

Can you instantly get back to sleep?

You never snap at anyone?

Diet is 100% what you want it to be?

Exercise on time daily?

Read HN only as much as you know it benefits you?

Marine you’re the 0.0001% who has all this down but most don’t. I’m sure there are many other examples of how most people barely control our minds and actions.

ADHD...

Uncontrolled aggression is one of common symptoms of low blood sugar. If you are not diabetic it should not just happen, your body should deal with situation. But it does happen to diabetics and they have to watch out for that.

No, you are Danny Devito. Here eat a snickers.

The sophistry here is the unsupported framing of the two as mutually exclusive. What do you think "you", the entity that does or does not have free will, are, other than a system of internal chemical reactions? Are you a soulist?

There is little evidence that consciousness comes from any particular processes at all.

It's as much conjecture to say it is just an artifact of matter as opposed to something metaphysical.

To say consciousness just appears from material complexity is actually quite absurd with little evidence.

The central epistemological question with regard to PANS / PANDAS is not free will, but rather: how do you study or measure a phenomenon that violently fights back and is possibly even willing to die in order to prevent your attempts to measure or study it?

Try getting someone who is working overtime to try and harm you and destroy everything around them to have a blood draw done, or to lie down for 45 minutes for an MRI. It's not a cake-walk. Sure, you can sedate them, but the sedating medications skew the tests. In fact, in the context of an immune-mediated disease, any sort of measurement that induces stress may alter the immune system's state and skew your results, because the immune system and stress interact.

Trying to bring objectivity to the study of PANS / PANDAS is kind of like trying to bring objectivity to quantum-physics. Good luck getting a wildly chaotic, stochastic system to reveal its "truth" to you.

I suspect you could say the same with regard to free-will.

In fact, I sometimes think of consciousness and perhaps the brain itself as an extension of the immune system. There are interesting structural similarities between lymph nodes and the brain. That would then recast all psychological problems as a sort of auto-immune condition.

Nerd-sniped: Free will is an incoherent idea. We don't choose our preferences, which dictate our choices. (And even supposing you can choose a preference, that's only due to the preexisting desire to have such a preference. Turtles all the way down.) What would an unconstrained choice even be? Just random, arbitrary? That doesn't sound "free" either.

> We don't choose our preferences

As a doxastic voluntarist, I reject this notion entirely.

> Doxastic voluntarism is a philosophical view that people elect their own beliefs; that is, that subjects have a certain amount of control over what they believe

Do you hold such a view as a first principle? Or did you arrive at it via consideration of other factors?

Do you mean to ask if someone can choose not to be a doxastic voluntarist?

You can't choose to be a doxastic voluntarist as much as you can't choose not to be one. One can only become one involuntarily.

Ah, now this is getting fun.

> Do you mean to ask if someone can choose not to be a doxastic voluntarist?

No, I did not. :)

My question remains: "Do you hold such a view as a first principle? Or did you arrive at it via consideration of other factors?"

If you look closely, you can see my question doesn't assume choice was/wasn't involved. Simply how you got there.

I decided to change my preferences and it worked. It's simply evidentially true.

(involuntary laughter) well played

Ancient religion and philosophy taught that habits influence desires far more strongly than desires influence habits.

It is possible to want different desires (if you disagree, ask any recovering drug addict). So even conflicting desires can exist simultaneously on multiple planes of consciousness.

A powerful way to change your desires to be what you want them to be is to change your habits.

Yes, and that raises the question: by what mechanisms do we change our habits?

I like an idea mentioned by James Clear (author of the "Atomic Habits" book) that each action we take is a "vote" towards establishing or breaking a habit.

There are connections between this notion and neurochemistry, such as Hebbian learning.

One important mechanism for changing habits is to join a community of people who are practicing the habits you wish to practice. A thoughtful, intentional choice of whom to associate with is one of the most powerful forms of agency we possess.

Zooming out a bit, local communities of people who practice virtuous habits are an indispensable cornerstone of society, for by them we gain agency to desire and do what is virtuous.

> Zooming out a bit, local communities of people who practice virtuous habits are an indispensable cornerstone of society

That's a pretty big claim, and I'm the kind of person that tends to challenge almost everything ... but heck, I have to admit that I largely agree. Well said.

I've lived many places, and the lived experience in some particular places, in some particular ways, just works better. It often has to do with most people being both trusting and trustworthy.

I would add that _locality_ isn't only about spatial dimensions. Some online communities have high degrees of locality, in a sense.

> for by them we gain agency to desire and do what is virtuous.

Again, at first I was going to push back on how you used 'agency' here, but I think I see what you probably mean: being in a better environment _helps_ an individual to choose from a better set of options, allowing them to be the best version of themself.

Sure, but what motivates that change in habits? Does it spontaneously arise? Does is trace back to some other event? Neither of these illustrate a degree of freedom.

The idea isn't incoherent so much as the word free invites a lot of creative interpretations.

Free will is really all about making decisions that guide the evolution of the universe, rather than being a powerless observer. The fact that our decisions are constrained due to circumstances does not change the fact that we make them.

The parent comment mentions Robert Sapolsky and I can't resist linking a talk where he explores various physical and environmental factors that influence human actions - https://www.youtube.com/watch?v=GRYcSuyLiJk

If anyone finds the video above interesting, also check out his Behavioural Biology lecture series on YouTube - https://www.youtube.com/watch?v=NNnIGh9g6fA&list=PL848F2368C...

His upcoming book can be found here - https://www.amazon.ca/Determined-Science-Life-without-Free/d...

Prior to getting into tech, I had an internship at the NY State Psychiatric Institute (NYSPI) where I did work helping people developing assessment tools for schizophrenic prodromes (people before they develop schizophrenia), as they were working on a predictive assessment questionaire.

Basically they were looking for risk factors but also to predict who might actually develop the disease imminently among those at risk, because if you monitor folks at risk, folks who might have subclinical symptoms, and can know who is going to have a psychotic break, you can manage and control it and have much better outcomes.

The largest predictive factor of folks who were at increased risk of developing schizophrenia is if they have a family history of it as I recall. Stress, in a variety of forms, is also a big factor.

However the reason I write is because I remember that late fall and winter conception of the individual has been shown to create a small but statistically significant increase in the likelihood of developing the disease. It's unclear exactly why, but one theory is that increased risk of viral infection for the mother during certain stages of pregnancy may be a factor.

Teasing apart these sort of facotrs, even to the extent possible often requires complex multivariate analysis of general and clinical populations and either time based or retrospective analysis of risk factors. Even then the mechanisms are fairly opaque.

Covid infection may lead to increased understanding of psychotic and subpsychotic disorders, but it's more likely to simply complicate any analysis; just teasing apart the actual effects of the disease and the stress that results from the social changes necessary to contain it, in terms of development of mental illness, may not be fully possible.

Related: "Treating the Prodrome", a discussion about early treatment of schizophrenia and some speculation about possible mechanisms. [1]

This sort of work is very exciting to me! Treating schizophrenia early seems like a win for everyone - less of an impact on the individual, less of a need for antipsychotics, and less societal impact.

I've also seen some speculation about a prodrome for major depression, with a period characterized by anxiety or agitation before a full episode. Early detection of psychiatric episodes seems like a really ripe approach.

[1] https://slatestarcodex.com/2018/09/20/treat-the-prodrome/

I believe there was a RadioLab episode that discussed schizophrenia and reduced thermoregulation. Very interesting; it explained why some schizophrenic people wear lots a clothes (a phenomenon one might notice out on the city streets). Could also be used as an early diagnostic tool.

Recent research suggests that schizophrenia may also be immune-mediated or at least immune-system involved. See:

https://www.frontiersin.org/articles/10.3389/fpsyt.2022.8805...

I was at a psychiatric conference once where the presenter highlighted that the last condition that psychiatry actually "cured" was neurosyphilis, an infection-triggered version of schizophrenia, back in the 1940's.

Could you tell the story of what experiencing schizoid symptoms was like? I’m always curious!

I have a number of blogs that somewhat include these feelings:

https://jondouglas.dev/little-dark-age/

https://jondouglas.dev/the-stress-of-life/

https://jondouglas.dev/save-your-soul/

https://jondouglas.dev/obsessive-compulsive/

https://jondouglas.dev/love-of-fate/

https://jondouglas.dev/from-the-ashes/

Lots of depersonalization, heightened nerves, low lows, and desire to be alone. If you've ever read Leo Tolstoy, the best description is in his novella "The Death of Ivan Ilyich".

There was a medical article the other day that popped up where a daughter received the first kidney transplant without life-long anti-rejection drugs. Instead they reprogrammed her immune system to see her mother's tissue as self instead of foreign body. She was on anti-rejection meds for months instead of life. I presume so they could test whether their plan worked or not.

If they can do that for life or death situations, I have hope that we can refine the process for other auto-immune diseases that are everything from lifestyle threatening up to life-threatening. My issues are middle of the list, but if arthritis had a solution other than immunosuppression while I still have cartilage, that would make me so happy.

And I'd really like to be able to eat croissants and baklava again, if that can be arranged.

> It makes you honestly question the idea of freewill. Good thing that Robert Sapolsky's new book is coming out next month on the topic!

Watching someone go through certain kinds of dementia can have a similar effect. Simplify the input and make situations repeatable (from their perspective) on very-short timeframes and it’s hard not to notice how much we behave like automatons. It’s being able to hold a lot of context that makes us seem like we’re ordinarily not, I reckon.

For any parents reading this and wondering if their kid is affected, I highly recommend reading up on PANS and PANDAS.

Watching our happy, healthy kid change before our eyes with sudden-onset OCD, vocal and motor tics, terrible mood lability and sleep issues, and other strange symptoms like handwriting regression was heartbreaking.

His doctor suggested it was Tourette’s and I happened to notice that his symptoms included a dry vocal “cough” and insisted on him being tested for strep, which he had. We got the antibiotic and it went away. That cycle happened 2 times until the 3rd time, the symptoms persisted and he no longer had strep. That lead me to discover PANDAS and we then began getting him treated for that.

If you’ve noticed similar changes in your kids, definitely read up on it and find a doctor who understands the link and is willing to explore treatment options with you.

I realized I didn’t finish the story on this comment.

5 years later, our son’s recovery is a daily miracle. He’s a happy, healthy 13 year old with only a shadow of his former symptoms.

We were able to achieve symptom reduction through long course antibiotics, inflammation reduction supplements and medications (Tylenol and steroid bursts), and eventually having his tonsil’s out. After that we would have done IVIG if needed.

We maintain some inflammation reduction supplements but he’s off the rest of the meds and doing really remarkably, knock on wood. If you’re going through this with your kid, I send you all the love in the world, and hope that you’re able to relieve their symptoms as well.

What inflammation reduction supplements did you use?

Turmeric extract (ehanza), vitamin-d, omega, and Advil during flares.

Very interesting. We're on long-course Keflex (cephalexin) and 2 Aleve daily.

Very similar story over here. Similar treatment and recovery, BH. For people curious about this syndrome, the most salient symptom is a sudden onset of multiple things that people don't usually develop in later childhood, let alone all at once. (OCD, tics, etc)

I have been told that kids with PANS / PANDAS often get better spontaneously when they hit puberty as well, which some speculate is due to changes in the immune system that occur at that phase of development (the body stops producing T-cells), so there is hope for families that have young children that things can improve gradually with time on their own if you hang in there as well.

And yet, despite mounting evidence, people are still opposing even basic measures of hygiene in way too many schools. Air filters, if they are even present, are often just plugged out. Windows can't be opened at all. Way too few loos for way too many students, most of them vandalized to hell, no soap dispensers to be seen.

On top of that come all the parents who send their kid to school despite clearly being sick.

There's also underfunded research on far-UV light, which at the right wavelengths kills pathogens without apparently affecting humans. It might really be that simple.

https://www.smithsonianmag.com/innovation/could-uv-light-red...

https://www.cuimc.columbia.edu/news/new-type-ultraviolet-lig...

I found the NIMH factsheet on PANDAS very clear and comprehensive [1]. If this article is relevant to you, I suggest reading it too. Summary:

Children who have strep sometimes develop psychiatric symptoms as well. This is a condition called PANDAS[2]. The characteristics signs are tics, OCD-like symptoms, and anxiety, occurring in children roughly ages 3-12. The symptoms usually occur suddenly, "overnight".

So, the action is: If a child develops this sort of psychiatric illness, get them tested for strep, and possibly treat them for strep before the psychiatric condition. And awareness among doctors is low, so you might need to be the one to identify the condition and advocate for it to get treated.

The suspected mechanism is the immune system attacking human cells during an immune system response to stress. Some other commenters are discussing psychiatric responses to long COVID, schizophrenic-like symptoms, and effects of PANDAS on adults. There's also something called PANS for kids getting psychiatric conditions from infections that aren't STREP. This is very interesting to me too but the research still seems murky enough to not have an obvious course of action.

[1] https://www.nimh.nih.gov/health/publications/pandas

[2] The expanded acronym is very long: Pediatric Autoimmune Neuropsychiatric Disorder Associated w/ Streptococcal Infections

Have a friend with a PANDAS child. Really hard to even hear about. Total personality change, constant battles, even when it gets better the fear of reoccurrence. Truly awful.

https://en.m.wikipedia.org/wiki/PANDAS

> Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is a controversial hypothetical diagnosis for a subset of children with rapid onset of obsessive-compulsive disorder (OCD) or tic disorders.

> The proposed link between infection and these disorders is that an autoimmune reaction to infection produces antibodies that interfere with basal ganglia function, causing symptom exacerbations, and this autoimmune response results in a broad range of neuropsychiatric symptoms.

When you consider that chronic and acute autoimmune disease is totally a thing. For instance Hashimoto's disease where the immune system attacks the thyroid is chronic progressing. Thyroiditis, is acute and resolves.

It would seem the burden of proof is on those that say the brain isn't subject to autoimmune disorders. Because everything else is.

>It would seem the burden of proof

Or maybe we could reserve judgement about all possibilities that cannot be ruled out until more evidence comes in?

I remember feeling pretty normal until I had a strep throat infection when I was 7, after which I got really introverted and twitchy/compulsive ever since. Maybe a coincidence but I sometimes wonder if that did something to me.

edit: I swear I made this comment this before reading the article. It starts off with a boy at 7 with strep that got twitchy, which is 100% in line with my experience. Crazy.

I had a similar experience! I can’t recall if it was strep or what, but I do remember a particularly nasty illness from which I never really feel I recovered from neurologically.

That is terrifying

I had strep as a child and I developed tics and compulsive speech. Also some OCD. I'm almost 40 and I still have the compulsive speech. When I have awkward thoughts, I start cursing under my breath.

Another kid in my class has strep, and he has OCD so bad, that some days he can't leave the house.

Wow weird, me too and never thought to connect it to strep. Any idea what about strep throat might be causing that?

PANDAS. Known condition and well documented.

Strep is the “S” in “PANDAS” - something about the strep infection seems to become resident in the brain causing the immune system to attack it. MRIs show a speckled inflammation in certain areas of the brains of kids with an active PANDAS symptoms / Strep infection.

We worked with one of the pioneering doctors when our child was suffering, and she said their best theory is that there was a version of strep which caused Rheumatic Fever / Rheumatic heart infection, which affected many kids each year. Sometime in the 90’s that dropped off, and then they started to see kids with strep infections and then sudden onset OCD, tics, mood lability, and sleep disorders.

Her theory was that the strep which caused Rheumatic fever mutated to instead stay resident in the brain rather than the heart, and the immune system kept trying to attack it, especially when triggered by other stimuli like exposure to other colds, viruses, or allergies, leading to “flares” of the illness.

We had a dramatic proof that the illness was related to our kid’s symptoms when we discontinued the antibiotics and his symptoms flared terribly.

Ultimately, we were able to achieve symptom reduction through a long course of antibiotics, tonsil removal (which seems related to the immune system’s over-reaction in PANDAS cases), and a dramatic reduction of exposure to other illnesses while we all were in covid lockdown for years.

I know other families who don’t achieve acceptable symptom reduction move to IVIG after trying other treatments, and have found some success with that. I’ve also heard similar success stories from people with OCD/Tics following Lymes diagnosis who get IVIG.

It may be worth seeing if you can find a doctor willing to examine the issues you’re experiencing as a post-infection syndrome and discussing inflammation reduction protocols and other treatments.

Same, I've got the very awkward thoughts and constant cursing under my breath as well. The twitchiness is still there but under much more control than when I was a child.

I wonder if Tourette syndrome has anything to do with strep.

I can’t remember how I felt when I was <7 :(

I'm curious how quickly you got on antibiotics, if at all. I had strep multiple times in my life, including tonsillitis that nearly hospitalized me one time. But my family was quick to spot the signs and get me treatment and I don't recognize any long term impact from it.

Unfortunately I don't remember.

Pittenger is doing the most important work in this area. There is also a good clinic at Stanford.

This is a good interview with Pittenger that give more detail on what his group is up to: https://aspire.care/clinicians/antibodies-pandas-bind-cins-a...

It seems that the Sci-fi future of medicine is one where we can closely understand what the immune system is doing and manipulate it.

A fight against a virus is all-out war in the body. In any big war, there will be significant collateral damage. The body has to "bomb" brain and nerve cells to kill infected cells, and obviously if you have enough of them taken out, it will have lasting impact on your function.

Some grow back, some don't, and even those that grow back need to be retrained. For those that don't grow back, other cells and body parts have to learn to compensate.

Please keep up on your inoculations.

Meta comment: I’m looking forward to the day my phone comes with an inbuilt summarizer that puts an end to opening an article and seeing “It was a sunny day in September 2007…”.

When I was around 12 or 13, I had the Epstein-Barr virus.

For a couple of *months* I couldn’t: - Walk straight. Always looked like I was completely drunk - Speak normally. Each word I spoke was only half-finished and I had to constantly re-pronounce any words again and again - Write on paper. I just couldn’t write a single sentence, it just didn’t work. I had practically lost the “precision ” of any movements

Not to mention the constant headache and pain in the throat.

I am wondering why it lasted that long and if it had left any sort of permanent effects.

Unfortunately it has not gotten the attention it deserves from the medical community. Their consensus is that you only get it once(generally). I've had 3 documented cases, the last in 2019, and that one put me out of commission for basically an entire month. I'm hopeful that future medicine eliminates this disease entirely.

I had it at 16, and like you I was down for a month. Barely could do anything - I don't recall bad mental effects but physically I was zero energy for a long time. I feel like my constitution never really recovered. Even today I get bouts of illness unlike anyone else my age or in my family, and I'm otherwise a very healthy person (healthy weight, work out regularly, etc.).

I never really thought about it until the long COVID discussions and learning more about things like this, but it really is something people barely understand today.

There's some evidence that NAC can improve long COVID-like symptoms:

https://medicine.yale.edu/news-article/potential-new-treatme...

Other than antibiotics to clear a lingering infection, are there interventions that we might take in the aftermath of bacterial or viral infection to remediate long-term effects?

The scariest part of this is that it appears to be country dependent how seriously it is taken and how those presenting with symptoms are addressed. I have no idea if I'm in a pandas-accepting country, but knowing this now I'd certainly find a jurisdiction willing to entertain it's existence if my kids had symptoms. It shows how subjective and uncertain medicine really is.

Hormones are generally regulated by our gut. When we introduce new species it affects who we are. Very interesting.

Met a kid with this my first pediatric clerkship in med school. I was told it was super rare and then had to memorize a bunch more stuff and forgot all the details about the visit. Always wish I could remember that patient better

I've seen multiple cases like this professionally, and they don't always have the typical PANDAS profile, either in terms of sequelae or putative causes. Kid gets illness, very clear signs (very high temperature for example), sometimes admitted, dramatic personality change afterward. The cases I remember most were around 7-12 but I recall one that was more around the age of 17.

It was unnerving for multiple reasons the first time I worked on these types of cases; one of those types of experiences that made me realize there's a fair amount of very serious illness out there that "goes under the radar" in the sense that there's serious consequences and little to no way to prevent it and poor understanding afterward of exactly what happened.

These cases aren't nearly as rare as the medical system would have you believe. Go to a residential psych hospital for kids, or a day treatment program for level 3 or 4 EBD children, and you'll see a bunch of them, many of whom have been languishing there for years.

These kids are are more of an ugly and inconvenient truth that the medical world would prefer to ignore, so these kids get chucked over the wall to the mental health system instead, which is better prepared to simply lock them up and quarantine them from the rest of society.

For the most part, I think doctors want to work mostly with helpless and grateful children, who willingly submit to tests and follow orders, not angry, aggressive children who claw and bite you no matter what you do or say. If you don't "behave" then medicine doesn't want you. Go see a shrink.

This is part of why I hate the term "behavioral health," because the emphasis is on restoring compliance. There was a movement in the 90's to rebrand "mental health" as "behavioral health" in order to make it seem more reputable and science-y, but I think that move back-fired. I think we delivered more compassionate care when the emphasis was on trying to some notion of a person's healthy subjective mental state, rather than trying to get them to behave.

> Such findings may have significance beyond a single obscure, debilitating illness. For they fit an intriguing, and growing, body of evidence that other kinds of psychiatric conditions might also result from infections

Nobody tell Henry Cotton.

Long-time HN lurker here, and I think it's finally time to finally create a profile and post my first comment.

I'm the CEO of an outpatient mental health organization with 50+ employees (mostly just run the tech in the background these days), I have been a professional in the field for 18 years in a wide variety of settings, and two of my four children have intermittently had symptoms that match the description of PANDAS / PANS for the past four years. Happy, gentle kids prior to it, often complemented in public for their good manners, then sudden onset for both of them after a Step-A infection, starting with neurological signs (occular shudder), then Berserker-level constant violence afterwards.

What is most maddening for parents is how powerless the whole experience leaves you feeling. I know this field, had worked with kids with these symptoms in a professional setting where I was widely viewed as the most successful clinician they had ever seen, I leveraged every asset I had to try and get my kids help (called up a family favor with the owner of a Children's hospital) and STILL the response from the hospital was to say that there was nothing wrong with my children, everything they were seeing was simply "behavioral," report me to child protection, and accuse me of Munchausen's. Close family members concluded my wife and I were child abusers when we asked them for help, and ran for the hills as soon as they got a glimpse of what was actually going on.

At the end of the day, the reality of PANS / PANDAS is even possible is not something that anyone is prepared to handle. That an innocent child could suddenly be turned into a violent weapon of mass destruction at any moment in time at the drop of a hat is a notion from a zombie apocalypse movie, not reality. Zombie apocalypse movies are actually the best possible way to imagine what it is like to live with a child with PANS / PANDAS, including the intermittent groaning biting.

To give you a clinician's perspective, when I was a young clinician working with these kids, we didn't believe it either. Neuro-autoimmune disorders were not even on the map back then, and we were always told to assume that some sort of trauma was underlying the violent behavior, because what else could possibly drive someone to do those things? Parents would tell me, "but this came on suddenly, out of nowhere, they were a happy normal kid before," and we would just assume they were lying, clueless, or some combination of the two because we could never definitely rule out that some sort of awful trauma had happened. Sure, these kids never responded well to known trauma treatments, which definitely suggested something additional was amiss, but then again there has always been a subgroup of individuals with complex trauma who do not respond well to treatment, so...

Now that I am a parent, however, and these are my own kids, I can with a high degree of confidence rule out trauma as a diagnosis in a way that I never could back then. My kids are home-schooled so it's not like we missed some sort of bullying at school, my wife and I are both professional mental health therapists so we know every parenting and behavioral conditioning trick in the book, I'm moderately wealthy and can afford to provide them with anything they need, and yet still the violent behavior continues, in complete defiance of everything I was ever taught. I sincerely wish I could apologize somehow to all those families I worked with way back when...

One of the things that makes me the most angry is the fact that the mental health system I work in is complicit in maintaining the illusion that they can help these kids. Occasionally someone will observe one of my kids acting out and will say "you should take your kids to see a therapist," as if a little routine behavioral insight could get this all fixed up in a jiffy. And if you took such a child to a therapist, they would probably be happy to attempt useless interventions on these children for years (hopefully not at my business, but perhaps even there), but the truth is that the world of mental health has nothing to offer these children. Zero, other than perhaps some palliative care for the trauma of going through and endless waking nightmare and perhaps some slightly nicer containment and quarantining facilities than you might have in your own home. I've worked in the settings where these children tend to accumulate and for the most part they simply don't...get...better. Why? Maybe because the core problem is not "behavioral," but with therapy being "so hot right now," nobody can seem to tolerate the notion that it's not a panacea for everything.

For those of you who have posted comments about your own experiences with children with PANS / PANDAS, I commend your courage and determination to continue pursuing ways to help your kids in spite of the resistance and the absolutely terrible advice the world has likely given you on how to help them. Know that you're not alone. It seems like every time I tell my story to someone, they know someone who is going through the same thing. It's possible that the frequency and prevalence of this problem is actually increasing over time, but we don't have good numbers on what exactly is happening because most of the world is still busy denying that the problem exists. I am consequently glad to see this issue getting more mainstream traction, both in the Economist and on HackerNews.

Side-note: like with most things involving the brain, I think we are unfortunately still a long way from understanding how PANS / PANDAS actually works. We have some theories, but those theories tend to not hold up well in studies (which is why PANDAS was renamed PANS to broaden the range of possible etiologies) but likely the syndrome is complex and multidimensional, with a wide variety of pathways leading to a similar endpoint (including pathways that don't even involve the immune system), sort of like Autism. So don't assume that there is a simple answer either. There are lots of stories about things like antibiotics or IVIG helping, but they don't work for everyone and each case is likely to require a slightly different approach, so the more important thing is to never give up and commit yourself to a systematic process of trial and error until you find something that works for your kids and your family. If you can, get some medical-grade genetic testing done, teach yourself some rudimentary bioinformatics, then put your tech skills to good use by mining that CRAM file for gold. That process led to tremendously helpful insights and intervention strategies for my family that would never have been uncovered otherwise.

So I'm unclear based on the article and some other reading around, can a strep test detect PANDAS, at least in some cases?

PANDAS is better described as a syndrome of symptoms all occurring at once. It's caused by strep (and in our case at least) can also be triggered by covid vaccines or other things as well) so a strep text only tells you if the child has strep. In our case, the treatment was the test, in that if it didn't work, it would (arguably) help rule it out. But it did work, for which we're grateful.

According to the conventional PANDAS theory, due to biological mimickry antibodies against Step A bind to neurons and attack them, so there are antibody tests that focus on Strep A that are used as diagnostic tools in PANDAS, such as antistreptolysin O (ASO), anti-DNAse B (ADB), and streptococcal carbohydrate (anti-CHO).

However, there a lots of kids diagnosed with PANDAS who have high levels of those antibodies at some times but not at others, and there are kids with the exact same history and presentation who never show high levels of those antibodies at all. So it could be that there are actually a wide variety of situations in which antibodies that the body creates end up attacking neurons (see anti-NMDA encephalitis), and only some of them are even known about yet.

Wow, thanks for such a well-researched reply.

I wonder if these findings may partially explain the often derided theory that childhood vaccines can cause autism. The article directly mentions that an autism misdiagnosis can result from psychiatric symptoms resulting from an autoimmune response after certain infections.

This opens up a can of worms since now the question is can a pregnant mom pass this down to an unborn child.

I see your text is fading.

Um sir, take your crack pot theories out of this post which provides evidence of a different previous crack pot theory.

Science has no room for folks who don't preach the dogma.

The early research in support of this conclusion (despite the fact no subsequent research has born it out) was pure charlatanism, bad science and the theory is rightly derided because those who continue to propagate it do so out of naked self interest and financial gain: https://www.youtube.com/watch?v=8BIcAZxFfrc

I thought that theory was based on a fraudulent study?

No, you don't understand, "vaccines" are just biological agents now. They're no longer merely "weakened" forms of what we're trying to protect against. Don't you see? Vaccines can't cause this sort of injury, because they're not the disease!

Definition of the word "vaccine": Nov, 2020: "Definition of vaccine: a preparation of killed microorganisms, living attenuated organisms, or living fully virulent organisms that is administered to produce or artificially increase immunity to a particular disease"

c.f. current definition: "Vaccine: b): a preparation of genetic material (such as a strand of synthesized messenger RNA) that is used by the cells of the body to produce an antigenic substance (such as a fragment of virus spike protein)"

don't worry, i'm sure it doesn't mean anything.

> don't worry, i'm sure it doesn't mean anything.

It means we invented mRNA vaccines, which were never organisms of any kind. But they're clearly vaccines. Whatever dictionary you picked updated its definition accordingly. Strictly speaking, according to your "Nov, 2020" definition, smallpox is a cowpox vaccine. I think that's silly. I'd prefer a definition like:

> vaccine (n): a substance that supplies antigenic information to the immune system to protect against a disease, while causing less harm than the disease that the vaccine immunises against.

I submit that my problem with this is that mRNA therapeutics aren't vaccines, they're mRNA therapeutics. The word "Vaccine" comes from "cow" because of cowpox.

Changing the definition so pfizer et al can rake in $50 billion is what i take issue with. If they had said "This isn't a vaccine it's genetic modification" or whatever, no one would have signed up for it. It was a concentrated effort to change language. Control words, control thoughts - George Carlin was commenting on this in the 1990s!

I am not the only one that takes issue with all of this crap.

I think a lot of people would still "sign up for" mRNA therapeutics that had the benefits that the COVID vaccines did.

It wouldn't have been true to say it's genetic modification. Many viruses do perform genetic modification, and it's theoretically possible to develop mRNA therapeutics that perform genetic modification (by having the cell construct the protein machinery required to do so) but mRNA vaccines don't do that. Doing that is hard, and unnecessary.

It's like the difference between an image and a computer program. Sure, you can sometimes construct a WebP image that executes arbitrary code, if you have enough information about the execution environment, but that doesn't make all (or even most) images programs, and it doesn't mean we should delete all the diagrams from our textbooks. Or the difference between a spoon and a razor blade. Metal can be shaped into sharp blades, but that doesn't mean we should swear off putting cutlery in our mouths.

More to the point, I don't see the argument for not calling mRNA vaccines vaccines. Did you think that live attenuated viruses don't have RNA in them?

The theory that there was never any actual evidence for? The only explanation for the theory as far as I know is fraud…

Not the happiest news I've read (and somewhat poorly written for a paywalled article).

Don't viruses and bacteria alter genetic expression? Usually it's just hijacking certain cellular organelles to replicate, but it makes sense this or other processes could trigger genetic expressions with longer lasting affects.

Really unfortunate to think that it's some sort of dice roll when you catch an infection.

This is sad: "years spent campaigning to get doctors to take the illnesses seriously."

It's like that saying, "Capitalism: The worst economic system, except for all the others". Our medical system where we rely on individual doctors for primary care is really flawed but it's better than any alternatives that we have (or that we can afford anyway)

>Our medical system where we rely on individual doctors for primary care is really flawed but it's better than any alternatives that we have (or that we can afford anyway)

The US one I presume? Says who? Based on what metric? We can, and other countries have, do much better.

That this parent "is “exhausted” by years spent campaigning to get doctors to take the illnesses seriously" doesn't say much.

It's not like she had to go the public health system and didn't have the option to go on "individual doctors for primary care" if she could afford it (in fact it would have been way more affordable than in the US).

She campaigned to spread awareness for the cause, not for them to treat her own special case.

Second, the average person would be much more exhausted when chacing their own (or kid's) treatment trying to afford hellishly expensive treatment in the US, sacrificing their kids college fund or their own pension (or even ending in bankruptcy (CNBC: "Two-thirds of people who file for bankruptcy say medical bills or other issues related to illness contributed to their financial downfall").

which countries have a different system than individual doctors for primary care, and how is it better?

Japan has a ‘go to any specialist nearby and be seen’ system. Very few GP’s, and a multitude of specialists for their own area of expertise.

I had my pick of three ortholaryngologists today (all of them less than ideal according to reviews, but they were there).

I think in most countries people don't have to ask their PCP for permission to see the proper specialist. I don't have much other basis for comparison because I don't think I've ever met any PCP more than once anyway.

The Canadian system absolutely requires a referral from your GP to see a specialist. And even in the US, when you do have insurance that allows you to see a specialist without a referral, there are some specialists who won’t see you without a referral anyway, I assume because they don’t want to deal with random people off the street.

>The Canadian system absolutely requires a referral from your GP to see a specialist

I presume that's only when you want your expenses covered. If you pay with your own money/private insurance you can see whoever you want, no?

There are some rules hobbling the private system in Canada that don’t exist in every country with universal healthcare. As I understand it, if a doctor participates in the public system they’re limited in their ability to accept private-pay patients. Happy to take correction here from Canadians who know better.

> The US one I presume? Says who? Based on what metric? We can, and other countries have, do much better.

The article is about UK doctors not recognizing PANDAS as a real illness.

They even quote one doctor who refused to treat "an American illness".

The US NIH has a page on PANDAS and our (US) diagnostic and treatment recommendations here: https://www.nimh.nih.gov/health/publications/pandas

If you wanted an example of "US healthcare bad" then this is not it. The article is about UK doctors not recognizing a condition and the activities in Parliament to address the situation.

>The article is about UK doctors not recognizing PANDAS as a real illness.

I know, I read it before commenting.

I'm not saying the article is about the US system. I'm saying the comment I responded to appeared to say that the US system is better, and how those countries with other systems like the UK have it bad.

"Doctors not recognizing X as a real illness" can happen, and has, anywhere. It's not a result of how the medical system is structured with regard to public/private, universal healthcare or not, and so on.

There is no shortage of stories from the US about doctors refusing to take some illness or condition as real that was later proven otherwise (or vise versa), dismissing patient concerns that were later proven, and so on.

I have no experience with the US system. I made no mention of public/private, universal health care or not and so on.

Your last sentence (minus the specific country) is exactly what I was talking about. There is no shortage of stories where doctors don't get it right for a million reasons. There is room for improvement.

What are you talking about? What country doesn't use individual doctors for primary care?

Yup. "well you're unlikely to have that at your age so go home and don't worry about it". I had it.

The problem is more complicated than it sounds. The official treatment protocol for PANDAS is to perform a throat culture for strep and then treat with antibiotics if the result is positive. (Source: https://www.nimh.nih.gov/health/publications/pandas ). In other words, it's the same as normal treatment protocols for strep.

The idea of PANDAS from occult (aka hidden, not producing positive test results) strep infections is less proven and considered rare, although it is mentioned in official treatment recommendations such as those above.

The problem providers face is that some parents will read about PANDAS on the internet and assume it is the explanation for their child's problems, despite having negative throat culture. They jump from doctor to doctor demanding antibiotic treatment despite the negative test results, guided largely by their internet research. It's not hard to find PANDAS parent groups on Facebook or Reddit where someone can post vague symptoms and a chorus of group members will response "sounds like PANDAS".

The difficult part is that for some of these patients, PANDAS might be the right diagnosis. However, once a diagnosis becomes a cult favorite on the internet doctors get inundated with parents demanding antibiotics because their Facebook groups told them that's what their child needs.

On the other hand, if someone has a child who is aggressively attacking anything and everything in site, no matter how they might have heard about PANDAS, I would argue that antibiotics might still be the lowest risk intervention and most prudent option to try if they fit the profile.

Yes, antibiotic resistance is a concern if you start handing out antibiotics like candy, but if PANDAS is truly as rare as everyone would have you believe, then prescribing antibiotics to every kid that comes in with a PANDAS profile is not going to move the needle much with regard to global antibiotic resistance.

Alternatives:

Prescribe them anti-psychotics or some other medication to sedate them?

Likely much higher side-effects and risk profiles than antibiotics.

Send them to a therapist in hopes that the therapist can behaviorally condition that aggression away?

Bad news: talk-therapy for aggressive behavior in children has terrible outcomes. Most likely scenario in the mental health system is that they end up in an intensive group treatment setting somewhere with other aggressive children, learn more sophisticated aggressive behaviors, and gradually get worse.

On the other hand, antibiotics have a fairly low risk profile. Some pediatricians do literally hand them out like candy when kids come in with an ear infection or sore throat. Maybe stop prescribing antibiotics for those kids, tell them to try some tea tree oil or some other natural remedy, and save the antibiotics for the kids who fit a PANDAS profile instead?

> or that we can afford anyway

That’s the big one in my experience. Functional medicine doctors are some miracle workers, but only if you can afford hundreds of dollars per visit / thousands of dollars in lab tests that insurance will never pay for.

I recommend you check out the Direct Primary Care model and share your thoughts. This model is not to be confused with Concierge Medicine, which largely suffers from the same problems you identified about Functional Medicine doctors. I just commented about DPC, you can find my thoughts about it at the top of my profile.

Overall, I think this is a great, affordable first step for redefining primary care - one that makes sense for doctors and patients, but is not a replacement for specialties like Functional Medicine.

I don’t understand why doctors are so dismissive and mean people

Emotional fatigue.

Sorry that is terrible phrasing. You don't understand why doctors act in a dismissive manner that seems mean.

Rephrase it and it becomes the start of a solution. What should happen in a patient doctor interaction where the doctor is not able to reassure a patient that the prescribed treatment plan is the best plan.

I don't really care if you think it's terrible phrasing. It accurately portrays how I feel.

And your feelings are absolutely understandable, valid and a sign of how the medical system needs to improve. You should have mentioned them in your original comment.

I've commented on the past on Direct Primary Care practices - it's a different model of care that is rapidly growing; you can read my previous thoughts on this model here: https://news.ycombinator.com/item?id=33682407

I largely think that doctors, especially primary care doctors, are being limited/held hostage by the insurance companies and the health care corporations that they work for.

They are not reaping the profits from the care they give, and can't focus because of patient loads being way too high. As it was explained to me by my doctor, this is because of how insurance companies pay out (per visit, no matter the duration) and the places that employ doctors usually expect that they see a certain volume of patients. Most doctors have a large amount of student loan debt, and usually feel helpless to fight against it - starting a new practice is very costly.

Once you really look into how oppressive/restrictive the system is to our doctors, the issue with our health care becomes pretty clear. People can't get timely, accurate care -- they have to wait for most prescriptions (because as long as doctors take insurance, they cannot fill medications), and they are always guessing (fearing might be more apt) how much a particular medication, test, or scan will eventually cost, causing hesitancy to seek out care. And most importantly, no longer do patients (or their doctor) have to worry if their insurance company will cover XYZ medication or treatment under this model of care.

My doctor negotiated with a local lab company, and that company offers my doctor's patients pretty much any test at-cost - this is another business dealing that is restricted by insurance companies.

DPC takes all the mystery out (I pay $45 a month for this service, all visits are free): all common procedures/lab/scan/medication costs are up on the website (they are very reasonable/wholesale/at-cost), and I don't have to fight to get that information; I don't have to fight to get an appointment, I can text/email/etc. my doctor whenever and get a prompt response. Because he limits the amount of patients he sees this is possible.

I think if primary care was overall something like this model, but perhaps a bit more accessible (more doctors practicing this way); not only would a lot of illness be treated before it is chronic, people would be less afraid to seek care out, and hospitals and specialists would be less overloaded.

Nothing that a good vaccine cannot fix.

Or miracle pill!

Government and Corporations have been leading to a lot of these health issues for decades, including diabetes and obesity in children, ADHD from being locked in a prison-like school environment, and more. Incidentally, diabetes and obesity are major factors for morbidity in coronavirus infections.

But also the for-profit industry finds it a lot more attractive to medicate kids downstream (eg prescribing Amphetamines for ADHD) and overdiagnose everything from Autism to ADHD to Gender Dysphoria. This is a band-aid approach, because it’s harder and less profitable to change society than it is to medicate everyone.

Hollywood definitely played a role in changing culture and people’s behaviors (including Westerns glamorizing gunfighters, PR campaigns getting women to smoke, product placements, etc)

But the industries actually start earlier than that. Merchandising selling stuff to kids. Broadcasting ideas — kids love to pick up on what their peers are watching, not their parents.

This PBS documentary goes intk detail:

https://www.pbs.org/video/frontline-merchants-cool/

There are record levels of depression, sadness and suicidal ideation among teens, especially teen girls. Whether it’s Hip-Hop or Tik-Tok, the negative externalities from the centralized, for-profit industries disseminating youth culture pile up and our communities should at least request the CDC to investigate further:

https://www.wsj.com/articles/teen-girls-experiencing-record-...

They do this with adults too — one in five middle aged women is on antidepressants. And let’s not even get started on the opioid crisis. More people than ever are angry at “the other party” in many countries, it is not an accident.

But they don’t focus on culture and society and for-profit industries. They only focus on diffuse causes like a virus that’s going around, or “random infections”.

State and Federal governments collude with industry to keep us distracted. Whether it’s the fructose sugar they genetically engineer into the fruits, or the high-fructose corn syrup they put into everything, or water use, or the non-biodegradeable plastics, or the factory farms and overuse of antibiotics — in nearly every case the government sides with the corporations — eg governments in agricultural US states criminalizing the filming and exposing of animal cruelty, since their tax revenue comes from these corporations — or enforcing patents for Monsanto and Big Pharma etc. etc. and letting the lobbyists write Medicare Part D to make sure Medicare won’t negotiate drug prices etc.

What they do is they always tell us that we can do something as individuals (recycle, diet and exercise, go vegan etc) or lead to polarized narratives like Women (feminism) vs Men (redpill) White vs Black, so we’d be too divided and blaming each other instead of demanding systemic reforms to impose a cost on our corporations getting away with the negative externalities:

https://magarshak.com/blog/?p=362

I strongly believe that if we had a UBI in this country, funded by these pigovian taxes imposing costs, we’d have a population that organically would start to push industry towards healthier practices for everyone and the planet. Because the public would directly get the windfall of these tax revenues.

While I mostly agree, I'm not for UBI. It makes people dependent on centralised state even more. We need decentralisation to avoid dictate for masses that you described above.

Interesting how this topic is discussed now. After lock downs, spending most time afront of screen, without socialising with other, constantly breeding with catastrophic scenarios withou any hope for future... In some countries even with forcing to take vaccines that do more harm to children than covid itself.

We should seriously ask if we do it for our children protection or fear from propaganda.

I woul look carefully to the pills that was subscribed to that infection.

Are you thinking of antibiotics affecting the gut or about something else?

Seems like both the infection and the antibiotics could have an effect. You can't really count either out until further studies are performed.

I was on a length course of Doxycycline (for borreliosis). It had the side effect of acting as an antidepressant. I got better (from the borreliosis), the treatment ended, and so did the antidepressant effect. It may be a study of n=1 but antibiotics affect bacteria selectively, including gut bacteria. It could be that the H. pylori solution is pointing the way to greater things.

Hmm? The mechanism discussed here is the immune system attacking human cells during an immune response to strep. What do pills have to do with that, and do you mean antibiotics or do you mean psychiatric medications?

Honestly I feel like the science community’s disregard for religion has caused them to completely fail at dealing with human psychology. Science has spent the last 1.5 centuries presenting itself as a counterpoint to religion, but they fail to understand that religion is just an early attempt at talking about the subconscious.

So the science community continually misidentifies issues stemming from the subconscious as pseudoscience. Jung was right.

This is stated as if religion has never had it's own pseudo-science/medicine beliefs that conflicted with actual issues. "we don't know what's going on, so it must be a possession" type of things when it could have been something more more like schizophrenia or some other medical condition.

> "we don't know what's going on, so it must be a possession" type of things when it could have been something more more like schizophrenia or some other medical condition.

Maybe the spiritual representation is more 'accurate'. Is the concept of love more useful or the concept of oxytocin?

>Is the concept of love more useful or the concept of oxytocin?

are we trying to make someone feel better about themself or cure the problem?

I never said religion was correct. I said that science tries so hard to differentiate itself from religion that it labels anything that doesn’t appear to be logical as pseudoscience. Since the subconscious isn’t logical, subconscious issues get ignored.

The science community often includes religious people.

Jung may be right. He wasn't out to prove "science" wrong. He did his own thing.

I haven't seen many people outside Richard Dawkins, Lawrence Krauss and Neil Degrasse seriously try and blame religion for scientific failings.

Psychiatry is a religious community that occasionally includes scientists, but they're largely regarded as delusional or backwards, and derided or ostracized as needed.

It’s comments like this that completely prove my point. The idea that psychiatry is “religious” is absurd.

Well it's not a popular idea. Perhaps you're deeply immersed only in religion, or only in science, and sometimes we can't see the forest for the trees. I forgive you.

But it's a tale as old as time: when any community schisms, and there's a rejection of the "original traditions" the new guys limp along without 'em for a long time, and gradually, piecemeal, they realize they miss those things, or those things were essential to life, and they reinvent them and they put new names on them, but if you examine their essence then you'll see how similar they are to the "old ways".

It happens within Christianity itself! All the time! Protestants spent 500 years rejecting and reviling Catholics, but then they became Mormon, and everything old is new again.

What's happening in the world is a widespread secularization of nations. You know, disestablishmentarianism - the First Amendment. If no religions or allowed, or if all religions are promoted equally, then something will fill the vacuum and become re-established, you can bet your bottom dollar.

Nations who attempt to outlaw and persecute religion get a somewhat bad rep. Nations who legalize all of them are literally a city upon a hill!

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

The strategy of atheist states is to generally subjugate Church to control by the State. If this cannot be done, that religion must be exterminated. China's a good example, and Mexico did their part. Atheist states by no means would/could eliminate religions; they know what service is done for the masses.

The State has its own flavor of religion, its own rituals and priests, sacraments and sacramentals, liturgies and rites. Look at Old Glory, baseball games, military customs, Congress in session, look at the architecture of DC and try to tell me that that's not the New Secular Athens.

Psychiatry is the moral arm of the state, with temporal and spiritual power, authority, and jurisdiction over the citizenry in regards to our internal forum. Psychiatry is granted the rights to teach doctrine, to coerce sacraments, and to revoke rights. I won't elaborate on the whole picture, because your opinion won't change, but try to open your mind, eh?

I don’t disagree with the fact that all these things (government, psychiatry etc) function similar to how religion used to function, but I do vehemently disagree with the fact that these things are bullshit. Ever thought that the reason why things never disappear is cause they have a function that’s useful? And maybe the reason why they’re constantly changing is because the people who study them are in a constant process of identifying their useful aspects and isolating those useful aspects from the dead weight: throwing out the bath water and keeping the baby so to speak?

Edit: and most importantly, the fact that they have changed makes them something new that should be re-evaluated on its own.

You know, I thought about it at length tonight and I totally agree with your assertion. The comparison is ridiculous and absurd and I was way out of line. The downvotes were just.

  There is nothing biblical or doctrinal about the DSM/PDR

  There is nothing clerical about doctors, nurses, or orderlies, they don't have no ordination kind of ceremonies and they certainly don't wear any kind of distinctive garb that sets them apart, nor are they authority figures who are respected and obeyed by the community. These dudes all have casual temporary jobs, it's not like a vocational calling or life profession, you know.

  There is nothing sacramental about psychotherapy (where a person enters a small room and whispers her secrets to a professional and gets helped) and there's certainly nothing Eucharistic about medications. I mean seriously, compare "My Body, My Choice" to "THIS is My Body, which will be given up for You."

Honestly, I write a lot of stuff on HN and send it before I even doublecheck it. Consider this an errata and please do accept my apologies.

  There's nothing communal or familial about health care. In contrast to worship and churches, health care is private, secret, done in small offices one-at-a-time; we're separated in hospitals and during plagues due to infection controls

  Nobody sings anything ever

  Christianity and most other ancient religions are built on millennia of unchanging doctrine, practices, apostolic tradition, and familial bonds, passed on to all children. Medicine and psychiatry invalidate their doctrines every couple of hundred years and reinvent themselves anew. Practices and beliefs from history books are ineffective, barbaric, reviled and abhorrent to moderns.

  Most religions rely on donations from the faithful, and few can actually compel such; psychiatry demands tribute and wealthy corporate supporters who can step in and guarantee their solvency, plus the state can usually use laws and punishment to coerce more people into joining and participating.

What a wild comment

I reject your sweeping statement "science has spent the last 1.5 centuries presenting itself as a counterpoint to religion."

Science is a process of trying to explain why things as they are and to predict how things will behave in the future. Many (in ye olden days nearly all) scientists have been religious. There is a conflict only when the two come to different explanations of the same thing. That conflict wasn't the goal of science, unlike what you seem to imply.

I don’t think I was implying that science intended to reject religion. I don’t think it matters what the scientific community intended though. Currently, science socially functions as a rejection of religion regardless of what the leaders of the scientific community think or say, and that social function results a bias against subconscious issues for the reason I explained in my other comments. The reasons why science functions that way are probably way too long and complicated to list (and probably are the result politics more than anything else), but you can’t tell me that that’s not true. The majority of the world think that science and religion are clashing forces, and it’s a self-fulfilling prophecy.

> The majority of the world think that science and religion are clashing forces, and it’s a self-fulfilling prophecy.

That is really a broad claim. Science isn't one thing and religion isn't one thing. Both are clouds of ideas/claims/customs and there is some overlap. I'd argue that most of the time there is no conflict at all and most people don't perceive it as a "clash".

There will always be people who will say that we shouldn't have invented airplanes -- God would have given us wings if he wanted man to fly, but they are in the minority. Most of the time, there is a news item that "science" has invented a battery anode that results in a battery with 20% more capacity and people cheer it and don't think it stepped on God's toes. Religious people will say that God wishes for us to not eat meat on certain days and nobody looks to science to see if that is true or not.

Stephen Jay Gould was famous for his "non-overlapping magisteria" claim [1] -- which I'm arguing is true most of the time, but also see that Gould was painting way too broadly as there certainly are cases where the two are in conflict.

[1] https://en.wikipedia.org/wiki/Non-overlapping_magisteria

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