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Comment by deanresin | Hacker News Reader

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.

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> 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"?

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