Two recent books by historians explore the crisis in biological psychiatry

https://bostonreview.net/articles/mental-illness-is-not-in-your-head/

by Caiero • 4 years ago

149 110 4 years ago

nyc1112• 4 years ago

Mental ilness is in your gut. That's where we should be looking at.

How about: Mental illness is a complex thing, that involves multiple parts of the body, and probably also the environment.

marginalia_nu4• 4 years ago

Almost as though the human body is one integrated system, rather than a set of individual components connected through well defined interfaces.

imoverclocked2• 4 years ago

This. I think that people too often overemphasize one factor when it is many that can contribute to mental illness. The gut is definitely an integral part of mental health as has recently been popularized. Being in long-term social isolation or damaging relationships can also lead to mental illness. Having chronic stress (noise/chemical pollution/lack of good sleep/etc) can also lead to mental illness. All of these factors can be combined or work completely on their own.

50• 4 years ago

Not "probably" but certainly. Mental illness not just as a psychological or even chemical problem but also as an ontologically-inflected political one.

yibberish2• 4 years ago

my own mental illness exists in relation to the society I have grown up into.

but you're still right, our own guts are what I had to look at in order to deal with this illness.

zniturah• 4 years ago

Maybe we rely on science here : it is genes + environment + head

marginalia_nu4• 4 years ago

How would you construct an experiment to verify that hypothesis?

sinenomine• 4 years ago

A twin study? https://www.nature.com/articles/ng.3285

The result TLDR: everything we measured about individuals is heritable.

WastingMyTime89• 4 years ago

I don’t know if it’s relying on science. It’s a somewhat tautological statement.

We are physical beings. All the processes happening inside us are mediated through chemicals. Most are assembled according to a building plans encoded in your genes and the building blocks come from your environment. Then obviously as the brain is the command centre of the body, it does involve the head.

Still, it doesn’t tell us much.

For all intents and purposes, we have shockingly little understanding of how the brain actually works. We know some chemicals have unexpected effects but we don’t always understand exactly how that happens. We don’t understand how memories are stored or recalled. We have some understanding of the feedback loops involved in emotion processing but that’s far from perfect. We are starting to realise that the processing happening in other organs like the digestive system have an effect on the brain but it’s not entirely clear which.

I think people generally are not humble enough regarding the level of actual knowledge we have reached in psychology and medicine.

I wouldn’t be surprised if we came to discover we had actually been missing something foundational at some point.

tremon• 4 years ago

That doesn't look like a scientific statement to me. What are its implications? Under what conditions does this hold? How is it falsifiable? What is the relative contribution of each element in that equation?

tkk232• 4 years ago

I agree that most likely genes, environment and the mind itself are an influence. But is science enough to resolve mental problems?

The mind is very close to a computer. Few people use science to develop or debug software. Even if there is a scientific model that explains why somebody feels bad, is that model enough to determine a cure?

jhbadger• 4 years ago

The problem is if you assume a resolution is possible, and it can be shown to work, that is science. When people say "Science can't solve problem X" what they are saying is either "Problem X is unsolvable" or "X isn't really a problem". Science by definition is a a self-updating system that accepts new information based on what works.

yibberish2• 4 years ago

this article reframes the recent trend in psychiatric into psychedelics in a bad light:

Understanding the undulating history of psychiatric hype and crisis is crucial today as the profession builds toward its next trend: psychedelics, already heralded as a “renaissance” and psychiatry’s “next frontier.” These two histories demonstrate that the academic and corporate pursuit of such hype [...] resulting in significant psychological and bodily harm.

this articles ignores the unfounded claim: that the real purpose of the APA was not quite to heal, not after ww2.

We also have not had any significant breakthroughs in treatment.

They even say this, which is as nazi social control as it gets.

psychiatrists in the 1970s who pathologized Black activism as “psychosis.”

oh, and what Bush said in the 90s? I suppose all that went into marketing, and later on (i.e. nowadays) into 'engagement' metrics for online content and so on. so, as I said, they're not trying to heal you, they're trying to make a buck same as everybody else in a capitalist society/marketplace.

now all that scientific progress is being used in an information war. as war crazy as it gets.

mrxd2• 4 years ago

I wondered what is this “community-based” mental health care that the author advocates for, and how is it different from psychiatry. Are psychiatrists not part of the community? It turns out it refers to “dream-work, breathwork, herbalism, and meditation.”

rustmachine• 4 years ago

in what way did it turn out to refer to those things? Community-based health care seems to me like a way of saying that mental health is connected closely to the community you are a part of, and that this community therefore can play a big part of keeping your mind healthy.

Which, I think, sounds very reasonable. If your work environment is toxic, the way to get better is to improve the work community, or find another community to be part of.

newsmonkey5• 4 years ago

Compare to community policing, in which crimes are created and solved by modifying the environment. It is a very good thing.

mrxd2• 4 years ago

I clicked on the “soteria houses” link in the article

jossclimb2• 4 years ago

It is no measure of health to be well adjusted to a profoundly sick society.

Jiddu Krishnamurti

serpix2• 4 years ago

And the way to feel healthy, truly healthy, is to be connected to networks of society or communities that are safe, supportive and which have your back.

Penyngton• 4 years ago

Sadly, that's not something easy to find if you're not born into one...

tsol2• 4 years ago

Which society in human history was not sick? Truth is that's the norm, not the exception

jerojero3• 4 years ago

But how many of the earlier societies had thousands of years of experience to look back to? Wouldn't you say in a society where we're capable of talking to anyone anywhere in the world at any moment we'd be able to at least try and solve these problems?

We've solved so many problems that afflicted humanity for thousands of years in the past 200 years. So why not this one? I guess because, as the article says, to solve this problem we actually need to change society as a whole.

Der_Einzige2• 4 years ago

Northern Europe, right now.

EdwardDiego4• 4 years ago

But being able to fit into society does wonders for your mental health, so maybe don't listen to random philosophers.

1ncorrect• 4 years ago

Contorting myself to fit a mould I find profoundly reprehensible has done wonders for perpetuating my depression and suicidality.

I don’t want to develop my sociopathy to the level required to be mistaken for acceptable in what passes for society today.

concinds2• 4 years ago

This quote is comically misused. It refers to people being called "controversial" or misfits, or being disapproved of for questioning the orthodoxies of deeply immoral societies.

It does not mean that if you're low-functioning in daily life, you get to blame climate change/economic inequality/injustice/whatever. Refusal to take responsibility for one's behavior is always a sign of lack of emotional health.

soledades2• 4 years ago

wow, quite the quote adjudicator, aren't we? where does your krishnamurti lineage come from, may i ask?

have you ever heard of an eastern philosopher who didn't think western civilization was profoundly sick??

it's deeply immoral that we force kids to sit in chairs for hours a day, and then diagnose them with "the ADHDs" when they don't like it. but we could multiple examples endlessly...

ansc• 4 years ago

This quote is comically misused.

It is! I suppose because of its dubious origin. First attribution seems to be from Mark Vonnegut in The Eden Express. Did you read the book, or where did you learn what it _actually_ refers to?

jossclimb2• 4 years ago

It does not mean that if you're low-functioning in daily life, you get to blame climate change/economic inequality/injustice/whatever

Quite an informal fallacy / strawman you have there, whoever said it was?

janef0421• 4 years ago

Refusal to take action to improve your life is unhealthy. Attributing the source of your problems to an external agent via a plausible mechanism is sensible.

Bakary8• 4 years ago

This quote is meaningless because all mental sickness is entirely defined in relation to the target society

carabiner• 4 years ago

The whole article is worth reading. It's a tortured history of the failures of psychiatry, least of which is the DSM and worst of which is mass incarceration of blacks engaged in activism due to "schizophrenia," similar to how homosexuality was once considered mental illness. It ends too early with:

"The fact is, if we didn’t have such a fucked-up society, I’d be out of a job." ... As historian Joanna Radin encouraged me to discuss in my undergraduate course on the History of Drugs, the question is not only, What is the right drug for me?, but also: What would the world have to look like for me not to need drugs at all?

He stops short of really exploring this concept. I'll paraphrase an old comment of mine:

Are you ready for me to diagnose your totally normal reaction to our shitty society as mental illness so I can get you addicted to mind altering drugs for the rest of your life? https://imgur.com/Jb1mJyx

Or as the social critic Dr. Ted Kaczynski said, "Imagine a society that subjects people to conditions that make them terribly unhappy then gives them the drugs to take away their unhappiness. Science fiction? It is already happening to some extent in our own society. Instead of removing the conditions that make people depressed modern society gives them antidepressant drugs. In effect antidepressants are a means of modifying an individual's internal state in such a way as to enable him to tolerate social conditions that he would otherwise find intolerable."

The problem is, this is the only life most of us have lived, and so we cannot imagine it otherwise, like a fish who cannot conceive of a world without water, or even that water is the medium surrounding it. If our entire society is causing this, then what can we do? Wage slavery, oligarchy, attention theft by tech companies, disintegration of community from various causes. Life for so many people is crawling through glass Monday through Friday, then getting shitfaced on the weekend. Is that happiness?

automatic61312• 4 years ago

It's so easy to call this society "shitty" and "sick". It's much harder to articulate what it should be - and how it should be.

Oh I know you can give a wishlist of things you want society to be; I bet you can't even begin to describe how you achieve it. No one ever does. The only method ever given is "revolution and then New Soviet Man". Every method is a restatement of those six words in longer format.

nyanpasu64• 4 years ago

Ted Kaczynski had an infamous description of his ideal society, and from a quick glance (I didn't fully read) he seems much more of a primitivist than a socialist.

dunnodidntneed• 4 years ago

TO pick only: 'Form on the Day', well doesn't that sound real, realy Mood-controlled ? So IF there are 'high-ends' in 'mood' THAN picking up a receptor-blocker to diddn't let those ('overwhelming' neuro-transmitter) be a part of the unwanted chemistry docking, cos ... hu you know... 'it may be NOT favorable FOR others' -so what's the thing ? That modern psychiatry went from behavior-analysis of criminals, scum and murder to a broader market of salesman... um that maybe is more in touch with the main story behind psychiatrists and 'illness-management'... ?

Sry, non native english speaker... but a broader view... ^^

narrator2• 4 years ago

Yeah, it seems like everything these days is about figuring out how to get everyone motivated to have a revolution. We probably already hit peak civilization at some point over the last 20 years and this revolution stuff is just speeding up the downslope off of that.

throwaway7433• 4 years ago

Universal healthcare and higher education doesn't seem all that much to ask for (US). Offering those seems like a solid start for improving society without unwanted, heavy handed direct action/totalitarianism.

Der_Einzige2• 4 years ago

Read Max Stirner if you want a unique take on how to fix things without resorting to revolutions or to rewiring humans.

Bakary8• 4 years ago

Most of the dystopian decrease we've had has come in the form of added economic surplus. We won't have a revolution and a new man, just a gradual increase in energy production until cruelty and competition is no longer the default state. Or alternatively we'll all choke on our own inventions and shortcomings.

iamevn• 4 years ago

Ted Kaczynski like the Unabomber?

j-bos• 4 years ago

He was a well educated terrorist.

serf• 4 years ago

Or as the social critic Dr. Ted Kaczynski said,

yknow , I agree with your broad points -- I even agree with the sarcastic tone you used to convey the line, but the families of those murdered or injured by Ted Kaczynski would probably prefer the title murderer/arsonist/terrorist.. even inmate.

Most folks would probably prefer that the most infamous title be used when speaking about those that society has deemed to be of ill repute.

'Spiritualist Genghis Khan' sounds weird. So does 'music aficionado and critic Charles Manson'.

It's a grim take, but the condemnation offered by the legal process is one of the things that helps the victims of a crime cope. In other words, the social branding of 'murderer' or 'convict' onto the person charged with the crime is also part of the justice offered to the victims via the legal system -- to ignore that the social title and distinction of the person has been affected by their transition to 'convict' status is to ignore a facet of what the prosecution was attempting to achieve for the sake of the victims.

tsol2• 4 years ago

This is a good explanation of what I felt was off about that wording

dEnigma• 4 years ago

Postcard artist and hobby architect Adolf Hitler

soledades2• 4 years ago

I think that the branding of the UNABOMBER as a "bad guy" is pretty secure at this point.

to ignore that the social title and distinction of the person has been affected by their transition to 'convict' status is to ignore a facet of what the prosecution was attempting to achieve for the sake of the victims.

why on earth should that take precedence over everything else?

Bakary8• 4 years ago

Why can't we just skip the virtue signaling and just discuss the ideas presented? Absolutely none of the discussion we have here is going to affect the societal process of justice as described.

creata2• 4 years ago

Do most people even take psychiatric medication for "the rest of their life"? I thought that most people who take psychiatric medications take them for a few years, but I don't have the stats on that.

Or as the social critic Dr. Ted Kaczynski

Whose doctorate is in mathematics.

EdwardDiego4• 4 years ago

Well, Ted Kaczynski is certainly someone we should emulate right? Go live in a cabin in the woods, and send bombs in the mail to people, sounds like the epitome of great mental health.

jerojero3• 4 years ago

Someone might have a good analysis of the problem but being incapable of coming up with an appropriate solution to it. These are definitely two different skillsets.

Imo a lot of what Kaczynski says is actually very well thought out and there are multiple other philosophers and thinkers that have come to similar conclusions or have pointed similar problems with society.

If you had read that statement without reading who it was that said it, what would you have thought about it?

jokoon• 4 years ago

Even a diagnosed bipolar woman started telling me my depression should not really affect my work.

I'm tired of people.

I feel the antiwork movement is starting to become the shelter of people with depression who are not being treated like they have a handicap.

I'm glad I don't have a career, because my health would have crashed of I had one.

tovej• 4 years ago

I don't think it helps that working a lot of jobs it feels like I've had a negative contribution to human well-being and ecology. I cannot think of a large successful private company that is a net positive to society.

feet3• 4 years ago

This is one of the primary reasons I'm disgusted with private industry. It's BS, pointless at best and harmful at worst purely to make a couple people rich on the backs of others

PicassoCTs• 4 years ago

Honestly, if you travel around a bit as consultant, you don't even need to dig to know a "companys crimes". Just sit in the canteen and talk with some. The employee neurosis tells you all about it.

Lots of vegan activism - grows animals on farms or trades in that sector.

Pro-Peace and cultural sector activism. Produces weapons.

Greenpeace? Usually chemical dumps or other environment damage.

Virulent Patriotism? Usually exploits cheap labor & conditions abroad.

List goes on.

The more desperate the cooperate souls peddling their convictions to "outside strangers", the more morally rotten the business usually is.

Just a observation.

narrator2• 4 years ago

Suicides have been rising since 2000. I think we should go back to tricyclics antidepressants. They worked better than SSRIs.

throwaway7433• 4 years ago

Years ago my doctor switched me to an SSRI as a one time trial to see if it would better help/could be tolerated... yeah never again. That shit straight up induced mania and suicidal thoughts. I cut that trial off real quick right after noticing.

Everyone's different, but SSRIs are a hard no for me.

jerojero3• 4 years ago

Sorry but, did you even read the article?

The crisis is societal argues the author, it's not really about the drugs. The drugs might be effective (and a lot of evidence suggests they're not really all that effective) but in our society even if they were. They would probably be behind paywalls and only accessible to rich people.

I've recently immigrated to Australia, trying to seek mental health help here has been a huge struggle and it's funny because you'd think for people with mental health problems to find a solution should be really easy. Imagine you have an accident and one of your legs stops working and the only way to get to the doctor is by walking; that's how it feels. To my australian native friends the situation has not been much easier, recently a friend was in the hospital on a suicide attempt and not only they were discharged fairly quickly but the only support they got was with a completely apathetic doctor.

Mental health is a big business and there is no interest in solving it, because as it says in the article, the biggest crisis in psychiatry is that there is no crisis in psychiatry.

fatneckbeardz• 4 years ago

yeah that or 30 hour work week, walkable cities, free healthcare.

rthomas63• 4 years ago

That's testable. That's already the case in some places, or close to it. Do those places also have rising suicide rates?

alvarezbjm-hn• 4 years ago

Tricyclics are as good as the SSRI, but they aren't first line because of the secondary effects.

LatteLazy• 4 years ago

Neither really work well enough to be used. We should seriously examine society...

eimrine• 4 years ago

The real crisis in academic psychiatry is that there is no crisis.

I so love this words, especially I love to read that in the middle of my reading of Kuhn's "Structure of scientific revolutions" book because that book lets me clearly visualize of what crisis in psychiatry is being waited for.

FailMore• 4 years ago

I started writing a long comment in response to this article (more to respond to the original catchy headline this topic first went live with "Mental Illness Is Not in Your Head").

I decided I'd turn it into a blog post and have posted it for discussion here: https://news.ycombinator.com/item?id=33201781

Here's it is as a comment:

This is a response to an article currently being discussed on Hacker News [Two recent books by historians explore the crisis in biological psychiatry, originally titled Mental Illness Is Not in Your Head]. I believe that the, now replaced, catchy headline of the article is not correct. I believe mental health is in your head, but this does not mean that mental health is controllable through altering neurotransmitters (or in fact altering any specific biological process).

~All mental health issues use the same biological structures[1]. A structure which interprets the emotional dynamic of the situation you are currently in. Another structure which reactivates the emotional memory you have associated with that dynamic.

Most likely the same mechanism is used for both happy and unhappy paths:

# Happy paths:

If you grew up with a loving (but not overwhelmingly loving) and calm family, your unconscious association between the emotional dynamic of a situation you are in, and the emotional memory associated with it are positive. These could range from: "Everyone is having fun right now, I can relax and have fun too!", to "That person did something that made me uncomfortable, I know it's safe to express my needs and feelings, so I can communicate calmly to the person who upset me how I their behaviour made me feel".

# Unhappy paths:

If you grew up with caregivers who were stressed by certain situations, your unconscious association between the emotional dynamic of a situation you are in, and the emotional memory/requirements associated with it will contain protective responses. These could range from: "Everyone seems to having fun right now... but everyone got so stressed out when I was anything other than calm and happy when I was young, I better keep all my stressed feelings hidden inside, and be act like I'm happy and having fun too - even if something is going on for me which means deep down I'm not feeling good", to "That person did something that made me uncomfortable. Everyone go angry so quickly when I was little, that I’m sure this person will get really angry too if I say anything to them. I will just pretend that I’m ok with what they did.” This list goes on and on, and will depend on the subtle dynamics of the relationships you were raised in.

You will notice that in the happy paths there is not a separation between your external world and your internal worlds, whereas in the unhappy paths there is this split. This split is uncomfortable and it is lonely. It requires a tense form of control that the person on the happy path doesn’t need to apply to themselves.

# Things get worse […before they get better?]

I’m sure a bit of you related to the unhappy paths that I described. That is because we all have them. One of the biological survival mechanisms we have as highly dependent infants is to bend our emotional responses into ones which mean we get what we need from our caregivers.

This is such a common requirement for making it through infancy that the human is built to shed these leant emotional shackles. I am in a controversial minority within psychotherapy that believes that the precise diagnosis of these emotional shackles is the function of dreaming (https://psyarxiv.com/k6trz).

Getting rid of an emotional shackle is not complicated when it is clearly visible. It is not particularly pleasant, but you simply have to unlearn the fear by facing up to it. If you notice you keep your stressed feelings inside, you’ll need to find the courage to start opening up. If you are not setting boundaries when you feel yours are getting trodden on, you need to find the courage to start having those (initially) awkward conversations. The same is true for whatever unuseful emotional conditioning you are trying to get free from.

The mechanism behind this approach is very simple. We are extremely scared of facing these learnt fears (the type and level of fear we typically[2] only know in infancy). When we repeatedly face these fears and survive they are very quickly unlearned from the brain. It is highly inefficient for the brain to keep a fear in place that we now know (at an experiential, not only cognitive, level) to be superfluous, and the brain does not seem to want to do this.

But what happens if no one is there to help you work our your emotional shackles and you are left to suffer their isolating consequences on your own? Again, I am in a bit of a controversial minority of the mental health community, but I believe it is the useful response that mental health symptoms should worsen.

If things worsen both you and others begin to notice that something is wrong. If they notice something is wrong, there is an increased likelihood that you will get the emotional care that might lead you to successfully removing your emotional shackles; reducing your stress and isolation. Many people start treating their mental health because things have gotten bad, but the treatment (the process of discovering and facing up to unconscious fears) doesn’t need to stop when you return to your base level.

In summary, I think there is a strong component of mental illness that is very much within our own heads. Because the happy and unhappy paths of mental illness use the same structural processes we cannot force a change at the biological level. Instead we have to explore, challenge and ultimately change the underlying emotional memories that are elicited in the structural processes. From my personal experience, this causes the greatest improvement to our mental health/reduces our “mental illness”.

[1] I'm aware that I am talking with one of two layers of abstraction. I'm not talking about the specific parts of the brain, but these processes are consistent in all of us.

[2] Stressful situations we experience as adults that cause PTSD are ones where our emotional processing of the situation we are going through mimics our childlike experience. The experience is overwhelming.

lordgrenville• 4 years ago

This looks really helpful, favouriting so I can read it more carefully later.

tkk232• 4 years ago

Others engage in therapy with an artificially intelligent (and usually feminized) chatbot. Disturbingly, these digital apps are largely unregulated and have questionable standards of care.

What alternatives are there? Therapists don't scale. If half of society could improve their life with therapy, and a therapist can treat 30 people per month over 10 years, then 1% of society have to become therapists. More therapists than teachers would be needed.

I believe that this is a huge opportunity. Like medicine, people will be willing to pay anything to be happy. The biggest problem apart from developing a cure will be getting heard. The market will be flooded with enticing apps and a most likely bitter medicine will be a tough sell.

slfnflctd3• 4 years ago

This has become much more clear in the last couple years. Demand shot way up and is far outstripping supply. Then you get into the issue of how so many patients aren't a good match for the first therapist they try, so they have to jump through all the hoops and fill out all the forms to try another one, which also may not be a good match (all while potentially on the edge of some kind of breakdown)... I went through at least five before I found one I felt was effective for me, and my experience is not uncommon.

Personally, I think we need to lower the barrier of entry for people to become therapists, and streamline the whole patient intake process. It's not like the quality is all that great with existing barriers, there are PhDs out there actively harming patients-- one kept trying to push Jesus on me when part of what I was dealing with was childhood religious trauma and the difficulties of restructuring my world view as a nonbeliever, an absolute breach of ethics.

We need to make it easier for people to try out multiple therapists until they find one that's a good match for them, and part of that is increasing the supply of therapists. Unfortunately I'm not sure a chatbot is ever going to quite do it except for in the simplest & most clear cut cases, the mental tangles we can get into really require general intelligence to grapple with.

BeFlatXIII• 4 years ago

Not to mention that the dating game of filling out all the paperwork for the third time may be what pushes someone from on-edge but stable for the day into a breakdown.

mola• 4 years ago

Therapist have a huge amount of influence and power over their patients. Do you really think lowering the bar is a good idea? Try and imagine the end result. Maybe it's me, but I shudder thinking of it.

The real problem, IMHO, is we've built an inhumane economic system that causes tremendous stress over the psyche of the individual. Instead of optimizing for wellbeing,we optimize for GDP, this is a pretty poor proxy. A more humane and tolerant society, with less hyper stimulating culture could reduce the need for more therapists. But of course this is an ideal, I don't know how to get there, but it seems to me unleashing therapists into the wild, while streamlining out the ethical and self regulation that come with the guild structure is a terrible idea.

bergenty2• 4 years ago

Therapists just play the role close family fulfill in most of East and South Asia. That scales very well but requires a societal monoculture that I’m not sure the west is capable of.

scaramanga• 4 years ago

Mental health is terrible in east asia (at least in Korea), where mental health issues are highly stigmatized, mental healthcare is not covered under insurance (it's all in your head), familial and cultural narcissism is rife, the suicide rates are staggeringly high (especially among children and the elderly), and highly disordered behaviour (drug abuse, eating disorders) are considered as part of the culture, so I'm not sure these are good examples?

chongli• 4 years ago

No they don’t. East and South Asian family relationships can be quite fraught. People don’t talk about their feelings. Parents put tremendous pressure on their children to study in school. Then they pressure them to quickly get married and have kids right after school. I have met plenty of people from both India and China who have expressed a lot of alienation from their families.

It’s all economic pressure in the end.

imoverclocked2• 4 years ago

Instead of scaling therapy/drugs up, maybe we improve community instead. Humans often just need to vent and otherwise connect with each other. OTOH, work is often considered a dangerous place to do that and we spend most (or at least a significant portion) of our waking lives there. This means we need to build community outside of work. Among other things, that in turn negates at least one of long commutes or long hours.

Bakary8• 4 years ago

We already have therapist alternatives in the form of parasocial relationships and pseudo-personalized entertainment. There's even one prominent livestreamer who acts as a collective psychiatrist and does public sessions with other streamers, which is the most 2022 thing I've heard of in the last few weeks.

AI chatbots are just the natural conclusion.

lebuffon• 4 years ago

My thought experiment question around Psychiatry is: How would pre-electricity age people explain the operations of a digital computer? They would probably invent some theories that bore no resemblance to the actual underlying technology. They might be close and even create some relevant metaphors but the theory would never be "correct", I suspect. Is this analogous to Psychiatry?

An old engineering axiom is: "If you can't build it, you don't really understand it"

This leads me to ask, will we only understand the human mind after we learn how to build one or two?

Notwithstanding the question, can a network with X neurons fully comprehend a network with X neurons?

dmarchand90• 4 years ago

The mechanistic view of the universe is ancient and thinking of things as a set of motion induced cause/ effect dates back at least to Democritus. The ancient Greeks had mechanical computers for astronomy. And mechanical automata have been around for a long time.

Depends on the definition of understand. If you mean complete and faithful reproduction then maybe not. At least in one mind. Definitely a set of N minds with X-1 neurons can together understand the whole of X neurons if each simulates under given conditions or subsets of the whole.

The mind also probably has a degree of fractal self similarity in its structure and understanding a part gives a representation of the whole.

IIAOPSW• 4 years ago

A Turing machine can simulate the operation of any other Turing machine, so maybe there's hope for a ball of X neurons.

Bakary8• 4 years ago

We don't need to understand all of the workings of the human brain. We need to provide a way for patients to be able to deal with their psychological burdens and establish mental self-sufficience.

photochemsyn2• 4 years ago

I think this section is worth emphasizing - mental disorders are as unlikely to be due primarily to underlying genetic issues as getting an infectious disease is:

"The oft-cited claim, for example, that schizophrenia has a genetic basis has failed to pass scientific muster. As Scull discusses, after failing to find a Mendelian set of genes that could explain schizophrenia, researchers in the 2000s pinned their hopes on new genome-wide association studies (GWAS) that could investigate hundreds of thousands of base pairs in the search for genetic linkages to psychiatric disorders. But GWAS studies have not revealed a clear genetic basis for schizophrenia (or bipolar disorder, for that matter). While combining hundreds of genetic sites can help explain, at best, 8 percent of the observed variance of schizophrenia, it is still possible for an individual to have many of these genetic variations without developing the disease."

There might be some influence - for example, someone born with genetic immunological defects is likely to be more susceptible to various infectious diseases, and there might be some kind of brain development issue that means that some people are less able to cope with high levels of stress, disappointment, trauma and so on - but the claim that this outcome is somehow ordained at birth is nonsensical.

All in all, the science of mental disorders today could be compared to the science of infectious disease in say, 1890 - they didn't have much in the way of understanding of core mechanisms, even if some approaches (surgical sterilization, rigorous post-operative hygiene, etc.) were being shown to reduce mortality.

Probably the most promising tools in this regard are the use of psychedelics under controlled settings to improve outcomes, but even here, the research is basically in its infancy due to the socio-governmental paranoia over these substances.

derbOac• 4 years ago

I do research in this area, and that paragraph is misleading. GWAS was a mistake from the beginning -- it was overhyped and ridiculously oversimplified from an analytic-design perspective. No one should have expected genes of major effect to emerge, and everyone generally agrees with this now. To me it's fine to point to GWAS as a major failure, but it's a major failure with academic systems and how research foci and funding occur, not with the idea of genetics in psychiatric phenomena in general.

What's more realistic to me -- and what I tried to get colleagues to do for years -- is a focus on polygenic risk, where numerous genes have small effect. This research has been more fruitful, but again, it's overhyped and oversimplified (the article mentions this too, briefly). The problem isn't with the idea of genetic influences on mental illness, especially severe mental illness, it's the way that academic research occurs in general.

The truth is, the most likely genetic explanation (which will only be a small part of the pie) -- the one that's been the case all along -- is some combination of polygenic influence, involving some complex cascade of genetic effects, along with very rare mutations occurring within single individuals or families. There's also probably lots about genetics and genetic expression we are totally wrong about in general.

I'm deeply sympathetic with the articles' arguments. Modern psychiatry has really lost its way and has neglected more psychosocial, systems-level explanations, along with things like chemical and microbiological exposures. I myself have written critiques of popular psychiatric genetic positions.

However, I think the underlying problems stem from wanting to shoehorn behavioral science into to some model where it doesn't fit. Typically this is physics or chemistry, or molecular biology. It's not that. It's kind of like that, but not the same. It's also kinda like economics, and kind of like infectious disease science, and kinda like computer science, but not quite like any of those things. But people want to oversimplify it nonetheless, and it becomes this all-or-nothing argument, between the "brainless" and "mindless", and you're not allowed to take some integrative position. Then you get into people in say, physics, complaining that because it's not that it's not scientific, which is also not true. There's just a lot of politics and pendulums swinging back and forth.

Combine this with academic fad-chasing and the funding nonsense that fuels that fire, and you have a recipe for disaster. It's like layers of people wanting to oversimplify things for attention, combined with some kind of narcissistic vulnerability with people wanting to prove they're "real scientists" or "real physicians" and in the end people with problems just end up becoming pawns in this political back-and-forth.

I'm happy to see these articles, but also a little frustrated because although their underlying arguments are on-point, they kind of end up perpetuating the same problems. Yes, part of the problem is that genes just aren't the end-all-be-all explanation for behavior. But part of the problem is we just don't know very much right now. So what will happen is the biopsychiatrists will retort with some new method or R-squared that refutes the specific points, but not the underlying message. And the process will just go round and round.

Some of this is maybe true of academics in general -- oversimplfying things to get attention -- but some of it is made worse by the field not having some consensual agreement that behavior is really complex and not likely to be reducible to anything simple.

photochemsyn2• 4 years ago

I'd compare and contrast the state of the field to something like how modern molecular biology can produce an unambiguous diagnosis of drug-resistant tuberculosis in a patient and prescribe an effective course of treatment, relative to diagnosis and treatment of schizophrenia.

There's no unambiguous physical test for schizophrenia that I've ever heard of, it's just things like patients having auditory hallucinations and so on. There's no known mechanistic pathway (i.e. there's no known defective proteins that the genes express that somehow mess up the auditory pathway in the brain causing such hallucinations). It really sounds more like a mis-wiring-of-neurons type of thing that develops over time in the person, due to external pressures that they're unable to cope with.

Now with infectious disease, there is a great mystery still - out of a thousand people exposed to the same level of the same pathogen, some get sick and some don't. Some of this is explained by previous immunological exposure, but a lot isn't. Some of it is probably genetic in that one's in-born complement of immunological genes likely results in increased resistance or sensitivity to viral and bacterial proteins used to target cells.

What I'd guess here is that people just don't want to admit that mental illness is more of a social problem than a biological one, due to things like mass homelessness (which could cause schizophrenic breaks), poor parenting (which parents would rather blame on 'bad genes' rather than their own personal failures), etc. Of course, the same can be said of the prevalence of infectious disease due to poor public health regimes, contaminated food supplies, etc.

slfnflctd3• 4 years ago

Yes, it's kind of a long article. It's also one of the best analyses I've ever read of our current mental health treatment situation, whether you agree with the final paragraph or not. Save it for later if you don't have time now.

I was particularly drawn in by the idea of the Soteria approach [https://en.wikipedia.org/wiki/Soteria_(psychiatric_treatment...].

boxmonster• 4 years ago

"Before you diagnose yourself with depression or low self esteem, first make sure you are not, in fact, just surrounded by assholes."

@debihope (Boosted by William Gibson)

chatterhead• 4 years ago

Humpty Dumpty sat on a wall,

Humpty Dumpty had a great fall.

All the king’s horses and all the king’s men

Couldn’t put Humpty together again.

Not even with drugs. That's how the mind works. Build something new in your head; don't try to reclaim what's lost with chemical glue.

UniverseHacker• 4 years ago

Interesting how the two most promising "new" therapies are CBT (basically ancient Greek Stoicism) and psychedelics (which predates our species most likely)

rapjr9• 4 years ago

The article linked here seems like a big clue that at least some psychological disorders have a biological basis:

https://news.ycombinator.com/item?id=33186046

as does the fact that some drugs show benefit. That Big Pharma perverted the research goals does not mean this is no longer a good avenue to explore.

Two recent books by historians explore the crisis in biological psychiatry

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