Comment by triumphblr | Hacker News Reader

Comment by triumphblr | Hacker News Reader

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> Also, psychology is a dying profession. A mental illness is described as a set of symptoms manifested from physical biological systems we don't fully understand yet. But once understood, psychology becomes obsolete.

That's a fundamentally reductionist perspective and assumes everything is biological in its etiology? For example, you could say we don't need a justice system once we have the biology worked out, or arts, or sports. At some level it's a fundamentally authoritarian argument as well: if you have the biology worked out, what's to keep the holders of power from altering people to whatever norm they want? Having the biology completely worked out won't magically reveal natural disorder states.

The biological explication of a behavior doesn't obviate the need to have some norm for intervention decisions. Biology doesn't have norms, psychosocial systems have norms. Non-behavioral medicine is still full of ethics. And that doesn't even get into issues about whether you could ever identify any biological substrate as synonymous with a human experiential state or history.

If you understand the systems that manifest a mental illness then you can treat it more directly with medicine, you can test for the mental illness directly with physical sampling. We've already seen this shift from psychology to medicine with the invention of anti-depressants. Less people are seeking counsel from psychologists and instead just getting a prescription from their doctor. While the systems and even antidepressants aren't fully understood we have seen the shift away from psychology due to advances in treating the physical biological system. Simply projecting this natural trend to its limit is not reductionist IMO.

> If you understand the systems that manifest a mental illness then you can treat it more directly with medicine, you can test for the mental illness directly with physical sampling. We've already seen this shift from psychology to medicine with the invention of anti-depressants.

Except they only work in 30% the cases, regardless whether the patient has strong indication for depression and it's noted throughout literature that treatment with medication should go hand in hand with psychological counseling, because it increases recovery rate and leads to the patient not relying on medication anymore. They're also massively overprescribed, have as of yet unexplainable side effects in a significant part of the population and there is surprisingly little information on how they achieve their intended effect.

I think you're also misrepresenting why people don't seek counseling: It's because it's far from readily available.

The arguments you provide are really one sided and it feels like you're intentionally leaving out information to justify your position.

Sure, people are prescribed psychotropic medication for depression. But as more stringent scrutiny has been paid to those, the effect sizes have gone down over time and with more adjustment for publication bias.

There's no shortage of demand for psychotherapy services, and head-to-head they are comparable and both in combination fare best.

There is no blood test for depression, and if there is, no one uses it in practice. Sure, we're seeing this sort of thing with alzheimer's dementia but that's one thing that has never been amenable to psychotherapy, and even then there's a lot of psychotherapy around it in a palliative and coping sense because it's still uncurable.

FWIW, I was involved in the creation of DSM-5 so I'm very familiar with the whole area of mental healthcare.

How familiar are you with factor analysis? I worry that because the best mathematical minds are often not attracted to psychology as a field, that psychologists as a group are somewhat blind to implications of statistical choices and assumptions that they inherit or make.

What would you like to say about factor analysis? Lay it on me

It’s poorly understood by many who use the DSM, and without understanding how arbitrary and or subjective it can be it may be difficult to avoid “overfitting” in the clinical setting.

I'm not sure I'm particularly convinced that this is an issue with the method of factor analysis and by extension psychometrics, per-se. Unless one specifies a causal model and actually tries to do a risky test of their theory, any other method is liable to the issue of arbitrariness and subjectivity. Psychometrics itself has come a long way and there have been many advancements to put it on firmer footing. If anything, the issue isn't with the method, but by the user of the method. I don't know if I agree that it's an issue of understanding a method, rather than an over-reliance on data (analysis) over theoretical guidance and trying to take a hammer to theories.

It’s not a problem with FA, it’s a problem with people using the DSM who don’t understand how the math behind it influences what they are doing. Ditto for IQ. If you use IQ measures professionally, you should grok FA.

But what would you have them do instead of FA? I think we're partially agreeing here, but my thinking is that no analytical technique on its-own will be a panacea whether the users really understand it or not. Why would increasing their understanding of the technique affect what they do, when there's not really any other truly different methodological alternative?

Even if we, as humans, collectively have the knowledge to reduce something down to some fundamental axioms, it does not mean there is no value to separating the disciplines. All fields of engineering are fundamentally just physics, math, and some civil knowledge. Likewise, being a biologist doesn't necessarily qualify you to be a doctor.

> We've already seen this shift from psychology to medicine with the invention of anti-depressants. Less people are seeking counsel from psychologists and instead just getting a prescription from their doctor.

I think that peaked somewhere between the 80s and 2000s; there's been a pushback both popularly and in parts of the medical community and therapy as opposed to jumping straight to medication is having a big moment currently.

I haven't seen such a shift at all. My country has a record shortage of psychologists, and mental health epidemics, particularly in the young. Antidepressants kind of suck too, major side effects and often barely better than placebo in studies.

I think it's questionable to treat something like depression with medicine without even fully understanding what causes depression, and how the medicine works. Of course it's the least bad option for some cases, but for many milder cases therapy, or even physical exercise, is likely to be a safer, and quite possibly just as efficient option. It's just not as profitable and easy to prescribe as SSRI's.

Do you have a source to back up your claim that "less people are seeking counsel from psychologists and instead just getting a prescription from their doctor"?

The shape of that argument works equally well for unduly centering psychosocial mechanisms, though. That's how we got pseudoscientific garbage like the "refrigerator mother" theory of autism, the "anal retentive" theory of OCD, "tabula rasa" theories of social behavior, and so on.

Maybe what I'm getting at is that double standards abound when it comes to mental illness, and it's fucking exhausting work to even attempt to avoid them. I'm not blaming anybody (least of all you). I suppose it's just one of those Lovecraftian/Cronenbergesque sorts of things where once you see it, the world never quite makes sense again.

Regarding the refrigerator mother theory, autism as a diagnosis has expanded over 100x since that was first debunked and I have no idea why people have any confidence whatsoever that bad parenting cannot cause Autism. This was from a time before people as functional as "Rain Man" were the norm. Twin/Sibling studies were used to debunk this but twin studies don't totally control for shared environmental influences.

It seems more like a politically controversial thing than something which has been seriously scientifically examined either way. It can't be the smoking gun only cause but I see no actual evidence that it's impossible that parental neglect can't be a contributing cause. I will note that it is more politically convenient to simply blame a child's inherent defects instead of parental neglect, since the children relative to their parents lack political power.

I'll also point out that contemporary autism diagnosis relies on parent reports to establish a diagnosis, and people often only get diagnosed if a parent actively seeks out a diagnosis. Autism is also based on observation, if somebody was socially impaired due to neglect, how exactly would an examiner know the difference between that and somebody being socailly impaired due to say epigenetics? I would be rather surprised if who raised somebody doesn't have a rather large impact on if somebody will end up with an autism diagnosis. As in an especially well resourced and attentive parent might mean somebody who would be considered autistic might not be, and somebody who was overstretched and inattentive might have a child who would otherwise not be considered autistic be considered autistic.

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