The Illusions of Psychiatry

http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/

by Maci • 15 years ago

50 15 15 years ago

nybooks.com

Maci• 15 years ago

Part 2 of http://www.nybooks.com/articles/archives/2011/jun/23/epidemi...

Previously discussed here: http://news.ycombinator.com/item?id=2639359

dr_• 15 years ago

The article is correct in stating that extended psychotherapy may be as helpful as psychopharmacology in treating many conditions but the problem remains is that it is not well reimbursed. That is something the government needs to take a lead on with Medicare and Medicaid payments.

Some of the most egregious examples actually take place with the elderly, many of whom may be diagnosed with a form of dementia and are then placed on "anti-dementia" meds, which are almost useless in their efficacy but neverthless prescribed because there is "no other option" The other option, really, is to not institutionalize them, offer therapy sessions in a supportive home environment where assistance is available and with easy access to family members. Right now though, the government won't pay for much of this.

hammock• 15 years ago

The other option of course, is to shrink medicare (and payroll tax) and let people spend money the way they want to.

jshot• 15 years ago

That would require all individuals to have the disposable income to cover all their own medical costs. The further down the income ladder you go, the less an option it appears.

diogenescynic• 15 years ago

Depressive realism is the proposition that people with depression actually have a more accurate perception of reality, specifically that they are less affected by positive illusions of illusory superiority, the illusion of control and optimism bias. The concept refers to people with borderline or moderate depression, suggesting that while non-depressed people see things in an overly positive light and severely depressed people see things in overly negative light, the mildly discontented grey area in between in fact reflects the most accurate perception of reality: http://en.wikipedia.org/wiki/Depressive_realism

schrijver• 15 years ago

I’ve read some findings that saw depressive patients perform better on risk assessment tests than people who were not depressed. It doesn’t surprise me. Because having an accurate perception of reality is problematic. One actually needs an overly positive view of live to a) enjoy it and to b) get things done.

You can get consolation from your past only because you forget the pain more quickly than the beauty. You can look forward to the future only because you project the exciting moments rather than the boring ones (which will surely be more numerous). And the most relevant in the context of Hacker News: when you get enthousiastic about a project, you tend to grossly underestimate the time and effort it will cost to complete it. Had you been realistic at the outset, you might not have started at all.

wallawe• 15 years ago

This just leads you further down the rabbit hole. To say that someone has a "more accurate perception of reality" then begs the question of what reality is. When it comes down to it, reality is simply how you perceive the external world. If you perceive it in a positive light, this shouldn't be dismissed as an optimism bias and vice versa.

Some of the happiest and most successful people rely on "never-ending optimism," which then fuels hard work thus creates success, confidence, happiness, etc. If you view the world in a negative light, the opposite is likely to happen.

Essentially, what it comes down to, is that you create your own reality. That is why I have a tough time believing the legitimacy of present day psychiatrists' prescription happy ways. Even if the conscious mind is cured through antidepressants, etc. there is still trouble boiling below.

Alex3917• 15 years ago

If anyone wants to know more about why the subjectiveness of the DSM is problematic, check out Crazy Like Us by Ethan Watters, and then also this Wired article:

http://www.wired.com/magazine/2010/12/ff_dsmv/

I realize this is only a book review and not an attempt to fully explain the issues, but even still the author of this piece doesn't do the best job at actually explaining the various issues. (Albeit it's still a good read.)

j_baker• 15 years ago

One would be hard pressed to find a two-year-old who is not sometimes irritable, a boy in fifth grade who is not sometimes inattentive, or a girl in middle school who is not anxious.

Just like one would be hard pressed to find an adult who is not sometimes full of themselves, sad, or paranoid. Mental illness is usually an exaggeration of some normal behavior. There's a world of difference (albeit a sometimes difficult to see world) between being inattentive at times and not being able to function normally due to not being able to pay attention.

I don't mean to say that everything is fine with psychiatry. I just think this fundamental distrust of it is not good. I personally wouldn't be where I am today without it.

danenania• 15 years ago

Ah, but what does it mean to ´function normally´? And why is that a worthwhile goal, especially if 50% of population needs to be pumped full of drugs to achieve it. If a guard in a torture camp experiences anxiety and despair, is that mental illness or an appropriate response to a perverse situation? You can ask the same question, albeit on a much lesser scale, about energetic ten year olds forced to sit through boring classes and learn by rote.

There is a lot of bs in psychiatry. That doesn´t mean there isn´t some wisdom there or the potential to help some people, but it is built on top of an extremely flimsy pseudo-scientific foundation, and it´s questionable whether it helps as many people as it hurts. If you find a good psychiatrist and it works for you, that´s great. I still think a fundamental skepticism is warranted, especially given the potential for serious physical and mental damage caused by these (very powerful) psychoactive drugs.

singular2• 15 years ago

I think to function normally is to not be disturbed by things which bear no reasonable relation to external reality - that to me is the fundamental indication that there's something wrong, which varies from serious mental illness (e.g. psychotic delusions) to low-level depression.

It's dangerous to dismiss the whole thing as b.s., it's like throwing the baby out with the bathwater - we don't want to validate the idea that 'we can't define normal, so therefore there is no basis on which to call somebody mentally ill'.

I think a lot of the reason these things are 'soft' is that we don't have a strong enough understanding of the brain, and certainly no strong diagnostic tools to be able to analysis what's going on in someone's mind in order to determine whether something is 'wrong' for a given definition of wrong. Until then we have to hack away around the problem.

I do agree, however, that skepticism is vital in this area as in every other.

atsaloli• 15 years ago

More quotes from psychiatrists on the subjectiveness and ineffectiveness of the DSM:

http://www.cchr.org/sites/default/files/education/appendix/0...

http://www.cchr.org/quick-facts/disorders-voted-into-existen...

Produce2• 15 years ago

A complete disregard for using psychedelics to treat psychological disorders is the reason I can't take modern psychiatry seriously. We have compounds which are capable of producing deep, lasting changes yet the field is so political in nature that we simply brush them off to the side. Just as there were serious consequences stemming from the influence of the church on society a couple of hundred years ago, so it is with business today.

singular2• 15 years ago

You have to be careful with psychedelics - they can potentially cause very serious problems as well as (allegedly) improve things.

A close family relation and a number of his friends took relatively small amounts of LSD and as a result experienced very serious mental health issues, anecdotal but I think not unrelated, also I believe this is backed by studies.

Produce2• 15 years ago

Psychedelics are tools, albeit very sharp ones. I could use my knife to kill myself or chop some vegetables for a healthy salad. I think that the risks are greatly diminished when psych's are used the in right setting, for the right purpose. Failing those safeguards, I imagine that the psychiatrist would have some anti-psychotics and benzodiazapines to pull the patient back out. Also, I imagine that in a therapeutic setting the patient would be evaluated to determine their risk of developing schizophrenia or other mental illnesses, and cut off if said risk is too high.

The Illusions of Psychiatry

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