Comment by nwah1 | Hacker News Reader

Comment by nwah1 | Hacker News Reader

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Look into the history of autism research and you'll find a history of fraud. People like Bruno Bettelheim simply lied their way to prominence and now we are on a road of ever-expanding diagnostic criteria and an ever-growing autism industry to the point where it is now trendy to self-diagnose on social media.

Recall that psychology has had a gigantic replication crisis, and that the founders of the field like Freud and Jung were charlatans, and that there is no agreed-upon mechanistic explanation for autism, and that a primary diagnostic tool is a literal questionnaire, and that psychology and psychiatry have been abused for political reasons by every totalitarian government of the 20th century.

Given all this, we should have some humility about this topic. Maybe let's not leap to medicalizing large swathes of the human condition and just accept eccentrics as part of life.

And maybe we can normalize the idea that employees have special emotional needs that can be accounted for on an individual basis without medical permission slips or any need for wielding constructed identities.

When I was in grad school, I worked in a lab that performed research on children with Asperger's syndrome (AS), mainly through fMRI and DTI brain imaging techniques. AS was merged into Autism Spectrum Disorders (ASD), but at the time was considered a high-functioning form of autism. I met dozens of children with AS; they were typically between 9-13 years old. All the children I met were clearly autistic. I'm not going to attempt to describe what that means here, but the nature of their disorder was evident, compared to other disorders and compared to the age-matched controls [1]. Back then I'd confidently tell you I could easily pick out the kids in a classroom with an AS diagnosis. These days, I have no confidence I could do so (mostly due to false negatives).

[1] anecdote: at the end of explaining the fMRI procedure to the participant children and their parents, I'd ask if the child had any questions. Neurotypical children would usually ask about any reward $ for completing the task. AS kids would usually ask something poignant about the experiment.

I agree that there is a "there" there. But I'm not confident in the ability of our culture to define it in a mature way, or use the knowledge responsibly. I don't want to see therapy culture continually creeping into the mainstream. I don't want people to start medicalizing the traits of those in their families and social circles.

And since every phenotype exists along a normal distribution, there will always be resemblances and fuzziness, and no clear lines demarcating order from disorder.

But it is also obvious that nonverbal people who are stimming most of the day and can barely tie their own shoelaces exist, and these people need to be cared for and studied by responsible professionals in mature and private settings with their loved ones.

I still remember my psychology class in high school pretty well. It was memorable cause we’d spend a week learning about some theories Freud came up with, and then there would be a very short footnote of “turns out it was all totally made up and never scientifically verified in any way”. I was like what? So psychology isn’t science??

Recently a friend explained to me that Freud really wasn’t a scientist, but he was so influential in getting western cultures to think about the mind in new ways that we still learn about him. Like nobody cared about psychology until he get famous

The 19th century was a wild time. Everything was a science back then. That's why communists speak of the "immortal science of Marxist-Leninism." Marx literally said he was performing science, but that wasn't seen as an absurdity because that is how everyone spoke.

It wasn't until the mid-20th century when people started to get more serious about defining science. Philosophers started critiquing it in the early 20th century like the Vienna Circle and Popper, and eventually the definition of what constitutes science was narrowed down to one that was defined as a particular sort of empiricism.

That, too, has its own problems.

Feyerabend: the only rule is "anything goes"

I don't think it's any less science, inasmuch as science seeks to explain the natural world. It's just at a higher level of complexity and a different point in the learning curve than more externally observable levels of science.

Would we say that Copernicus was a charlatan or not a scientist because the heliocentric model turned out to be wrong? As you acknowledge, Freud pushed the collective understanding further.

The heliocentric model turning out to be wrong made Copernicus more of a scientist. Freud didn’t even make it to the level of falsifiability.

Then how do we know that Freud was "wrong" or "inaccurate" or "just made up" or "a fraud"?

It's definitely a lot more murky and there are massive gaps in our understanding between biology and neuroscience and psychology, and fundamental differences and limits on methodology that we may never surpass, but his work still has its place on the timeline of progress does it not?

What about something like phrenology? It's easy to laugh at it now and consider its proponents charlatans or lunatics but at a time it was considered a worthy avenue of exploration, that turned out to be a dead end, but that's part of science.

Maybe let's not leap to medicalizing large swathes of the human condition and just accept eccentrics as part of life.

I agree that a healthy dose of skepticism and acknowledgement of our rudimentary understanding is warranted, but it does start to sound a little anti-science. I don't think there's anything wrong with continuing to explore and attempting to explain or put words to these things even though they are near the highest level of complexity in nature and the hardest to empirically evaluate.

Are NSAIDs considered to be medicalizing large swathes of the human condition (or caffeine, or alcohol for that matter)? Where is the line between a universally accepted and ubiquitous pharmaceutical and an overmedicalized one? I think we should be moving more towards the question of "do you feel like this medication benefits you or would benefit you?" than "do you check these boxes in the DSM and officially receive this diagnosis".

Given that we can’t do the latter due to gestures vaguely at everything then it seems like the former is actually a rational reaction.

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