throw18376

imagine somebody slipped a tiny, barely detectable dose of meth in your morning coffee. barely above placebo. then they slowly start increasing it day by day. by the time it reaches a large dose you are not going to be thinking very clearly. this is more or less how a manic episode progresses.

i'm sure if ChatGPT had tried to convince him it was conscious on day 3, he would not have been convinced. but by the time it happened he was in a state of severe mental impairment.

my inclination when hearing these stories is that these were people who just happened to have a first manic episode (which can strike anyone at any time with or without mental health history). blowing up finances by starting an ill-advised entrepreneurial business, while also destroying a marriage, is very common behavior for someone experiencing a manic state.

in the past such a person might have gotten obsessed with hidden patterns and messages in religious texts, or too involved with an online conspiracy YouTube community. now there is this new opportunity for manic psychosis to manifest via chatbot. it's worse because it's able to create 24/7 novel content, and it's trained to be validating, but doesn't seem to me to be a fundamentally new phenomenon.

what I don't understand is whether just unhealthy interactions with a chatbot can trigger manic psychosis. Other than heavy use late at night disrupting sleep, this seems unlikely to me, but I could be wrong.

i think it's also worth pointing out that mental states of this kind usually come with cognitive impairments, people not only make risky bad decisions, but also become much worse at thinking and reasoning clearly. if you're wondering how a person could be so naive and gullible.

people in states of psychosis often behave in frightening ways out of their control, and do and say hurtful things to those around them. if someone hurts you or does something very frightening, fear and anger are natural emotions.

but it’s not morally wrong to experience psychosis. so how could it be right for me to feel fear and anger towards that person when they haven’t done anything wrong? it is a tough contradiction.

you can resolve the contradiction by just deciding to hate and fear anyone who shows signs of psychosis, treat them as if it is a morally bad trait, which many people do, see discourse about homeless people in NYC.

or you can just try to pretend that psychosis doesn’t exist, which a lot of people do, like when some public figure shows obvious psychotic symptoms but people act like it’s rational behavior.

or you can disavow the fear and anger, but if a person does actually frighten and hurt you, the resulting negative feelings often tend to be expressed in weird and unfair ways. i suspect this author’s employers and doctors probably do a lot of this.

personally I think the least bad solution is to acknowledge that anger towards a person can be justified even if they’ve done nothing morally wrong, just feel anger, and express it only in controlled ways. but this is philosophically confusing, easy to state, hard to really believe deep down.

all kinds of authoritarian regimes and movements certainly do this.

that said... you just have to have a conversation with someone experiencing psychosis. it's a totally altered state of consciousness, they are sensing and understanding the world in a radically different way. it's never just an otherwise normal person with a nonconformist belief.

I think they would say (reasonably accurately, tends to be exaggerated though) that traditional cultures all around the world did have psychedelic practices of one kind or another. a lot of places on earth have some kind of psychedelic plant.

some people should never take psychedelics.

in the last few years' surge of popularity, I found that your typical psychedelic advocate* would never admit this category of people exists. they were committed to the idea that everyone can, should, and must take these drugs.

this attitude is currently on a downturn, which is a good thing. people now admit that these drugs are not for everyone.

however, there's little solid understanding of exactly who should avoid psychedelics. it would be good to have a more solid scientific understanding of this. i imagine psychedelic advocates (which includes many scientists working on the topic) would be wary of such research, because it seems to similar to the history of government-sponsored propaganda "science" finding exaggerated harms of various illegal drugs.

however, scientific knowledge about who most likely will have adverse effects would be useful. that way people at low risk could use psychedelic drugs with the confidence that they are very likely safe. people at high risk can avoid them. this would be a great outcome.

The only problem here would be that if someone chooses not to use psychedelics, this might mark them as having certain traits that most people judge negatively. For example, history of severe trauma, family or personal history of psychotic disorders, and so on.

Given this, I think anyone who wants to normalize psychedelic drug use in their local community, ought to really fight to destigmatize such traits (and most communities won't accept this), or else more practically, promote an extreme commitment to privacy and personal choice.

*: I don't just mean people who do drugs, I mean people who think that doing drugs is mandatory to fix various spiritual/mental problems that prevent you from being a fully ethical being.

this is more or less exactly what i was trying to say. for most people SSRIs are safe, they experience manageable side effects and little health risk. psychedelics and dissociatives seem like they must be really drastic and risky. but actually SSRIs are pretty risky too, there are all these terrible low-probability outcomes.

so it's good we have all options, but ideally we'd have a better way of judging who is safest with which treatment.

i think that "we all want to get high on drugs" situations, like festivals, are actually a lot better. it's about personal choice.

when i talk about psychedelic advocates, i mean the people who think that widespread use of psychedelic drugs would massively improve mental health, make people more productive and happier, etc.

i generally consider myself an enemy of psychedelic advocates, because I think they want to make it effectively socially mandatory to do these drugs, which is really bad.

("sure, it's your choice what you put in your body, but a really enlightened person wouldn't be so frightened and closed-minded that they don't want to see what psychedelics can show them...")

of course ketamine for depression has this giant downside risk of adverse effects and psychosis, and we should talk about it more, not just sell it as a safe miracle drug.

however... safe, neutral, bland, boring well-tolerated SSRIs, also have a massive downside risk, in that they can trigger a manic episode, which in severe cases also involves psychosis.

so i find myself in the position of being glad there are different depression treatments for different people, including psychedelics and dissociatives, and hopefully we can find a way to make sure people get sorted to the treatments where they are least exposed to the tail risk side effects.

it's pretty hard to establish causality for something like this, but you have:

1) very solid evidence of correlation at a population level

2) a lot of clinical experience from doctors that patients with psychotic disorder diagnoses who use cannabis tend to do worse. and, similar stories from family members of people with psychotic symptoms who aren't in treatment.

so unfortunately I think there is something real here, it's not just people having transient bad reactions to weed and going to the ER and getting a diagnosis.

I support the legality of cannabis and alcohol.

However, on an individual level, I think people need to know about the psychosis risks. It undoubtedly can trigger schizophrenia and make it much worse once it exists.

I know more than a few people who have severe alcoholism problems in their families, and just chose to never drink alcohol. I think a similar choice may be wise for cannabis if there is a history of psychosis.

On a public health level there was a theory that people would substitute cannabis for alcohol. But unfortunately, this doesn't seem to be bearing out.

cannabis is pretty safe for the average person, even heavy users. it's not good for you, but i think most of the effects like this are explained by selection effects. unhappy people use it to self-medicate.

however, using cannabis comes with a very big tail risk. if you are susceptible to psychosis, cannabis can cause it or make it much more severe. this is undoubtedly causal.

people take all kinds of worse risks in life which everyone agrees should be acceptable, so I think cannabis should be legal. but I also think that if people clearly understood this risk, most would choose to avoid cannabis.

i think if the main thing is “hearing voices” this kind of thing is probably a good strategy, but there are lots of other probably worse symptoms of psychosis.

this and other alternative schizophrenia treatments a very good thing when they work, which is relatively rare.

as we can see from the comments here already, many people choose to believe these alternative treatments always work and there is never any need for antipsychotics.

it completely makes sense that some people who suffer from the horrible side effects of antipsychotics would have some wishful thinking of this kind.

what i don’t get is why random people with no skin in the game, are often so emotionally invested in the idea that antipsychotics don’t work or are unnecessary. but it’s very common.

in northeast urban areas, if someone uses y’all it means they are probably a left-wing/social justice oriented person. use is correlated with “folks”/“folx”. no idea why, maybe to replace gendered “you guys”. weird but true.

people with lots of good things to do in their lives have less time to post.

on platforms like twitter, this means that the posts are disproportionately made by people with unhappy and limited lives, who have too much invested in their status and image on social media, because that's who has time to post. this makes for an unpleasant environment and is also fertile ground for mobs, bullying etc.

after this most recent wave of migration, bluesky feels fairly pleasant, but that's not stable. lots of normal people just moved their accounts over and are still engaging. but they will become less active soon leaving only the "power users" who will make the site unpleasant again.

probably bluesky will once again become just as bad as pre-Elon Twitter was at its worst. however this would still be much better than the current situation on X, where at some point you will be exposed to people advocating rape and people celebrating the Holocaust, or other such horrible things, so I don't think people will move back to X the way they did last year.

the reality is the vast majority of students have no interest in seeing the beauty of any mathematical or technical field.

they want the professor to tell them the passwords they need to memorize. then on the exam they repeat the passwords and get an A. this is understandable though because they are under a lot of pressure and these days nobody can afford to fail.

if the teaching style deviates from this they become annoyed, leave poor course reviews, and that professor has a hard time.

the professor could overcome this by being "good" -- when the students say a professor is "good" they mean it is easy to get an A.

sometimes the obvious advice is the most important to hear. thanks for posting.

unfortunately the nature of some health problems that require a caregiver, makes both the sufferer and caregiver into social pariahs. in that case asking for help is unlikely to work well. but even in such cases the other advice is very sound.

i think we would agree a lot about the brutality and incompetence of the current system of psychiatric institutions.

however, the reality is, psychosis frequently prevents people from recognizing their own impairment. it's just true that this is very common, and maybe shouldn't be so surprising, since in many other cases (alcohol, drugs, dementia, brain injury) people also are prone to underestimate how impaired they are.

well, okay, then we can say that a lot of people diagnosed with schizophrenia now, even if the concept of schizophrenia is not viable, do have biological disease(s) that cause psychosis alongside what we now call the negative symptoms of schizophrenia. I'm fine with that claim.

it's very different than the common anti-psychiatry claim that the schizophrenia diagnosis is a social construction that gets applied to healthy people who violate social norms.

i'm getting very argumentative on the internet today (under a pseudonymous account because as you might guess from my incessant posting, this issue is personal for me)

trauma (at any time), drug use, other experiences -- all can make schizophrenia more likely in those susceptible. absolutely true.

but it is a biological disease, and healing trauma won't stop its progression. as your source notes, the trauma causes differences in brain development, and once that's done its done.

i don't think coming up with a new drug, the main advantage of which is it doesn't numb you the horrible way existing antipychotics do, is a bad thing.

this is basically a drug that was only created to improve the QoL of people with schizophrenia. if society just wanted to numb them, we already have drugs for that and could just be much more aggressive in violently coercing treatment.

investing in these drugs isn't "looking away", it's putting in a huge investment of many billions of dollars to help the victims live better lives.

this is completely true, but they take up a very disproportionate amount of time and energy from social service providers, people who work in shelters, etc, and make all spaces for homeless people much more chaotic.

the crisis would look very different if it was just a mix of people dealing with drug addiction (but basically lucid and rational) and with poverty.

look, if someone has actually have a new drug that works like antipsychotics but doesn't have the nightmare side effects, i am very happy for that person to get filthy rich.

if this pans out the way they hope, by all means give the lead guy a couple yachts or whatever he wants. space tourism, gold statue of himself, whatever. big bonuses all the way down the org chart.

there's the potential to reduce an absolutely staggering amount of human misery here. frankly (again if this pans out) our homelessness crisis would look very different if this drug had existed 20 years ago, when the mechanism of action was discovered.

the people who cared enough and took a huge concentrated risk to do this should just get rich, if in fact it pans out.

i'm curious what is the longest conversation you've ever had with an untreated schizophrenic person?

it's so obviously a "real disease" even if we don't fully understand the biological basis. it's subjective but honestly, there are just a ton of completely obvious cases.

abuses of the psychiatric system are very bad, but schizophrenia is so so clearly real.

this is a good point about stock characters. a very lively and thriving art form can rely on these (as theater, movies, novels have at various times).

that’s not all of what bothers me though. if you look at Frieren, every main character is going through some kind of lonely attachment thing, even the ones that follow other stock character archetypes. it’s the whole show. It’s also the main drama in Spy x Family (another show that’s good on the merits).

I recently watched the first episode of “Wind Breakers”. They set you up for 5 minutes to think it will be about a strong guy fighting his way to the top. Surprise! It’s actually about belonging and finding friends who care about you.

Fine to have works of art about lonely people coming together and finding belonging. But it really is weird how much of a dominant theme this is, seemingly in the majority of new anime and manga.

“Chainsaw Man” is interesting because it sets up and subverts this at every possible turn, over and over.

outside of the actual pornography, more and more of anime is just emotional pornography for people with attachment troubles.

it can be a great art form. even some of the emotional pornography can have artistic merit (recently: Frieren). but increasingly, despite diversity in genre and visual presentation, all anime just tries to push the same emotional buttons of loneliness, belonging, connection, in a very heavy-handed way that is more about provoking the emotions in the body than about artistic expression.

not everyone has those buttons, which is why anime fans are a devoted minority, and why it seems like lonely, traumatized, and marginalized people are drawn to it.

concern for the plight of boys and men is more fashionable than you might think in progressive spaces, especially in the past few years.

for example, Barack Obama's summer reading list just came out. I think being on this list indicates being fashionable among progressive elites.

https://x.com/BarackObama/status/1823082706462253510

one of the books he lists this year is "Of Boys and Men: Why the Modern Male is Struggling, Why It Matters, and What to Do About it" by Richard Reeves. It's about exactly what you say.

at the very least, they can induce manic episodes for some susceptible people. that alone proves these are real psychoactive drugs that have powerful effects on the brain.

there is still a question of whether they are really an overall good treatment for depression. i think the answer is "yes", but certainly people could disagree in good faith.

my problem is the most common anti-SSRI argument is that they are just placebos that do nothing at all, which is ridiculous.

very, very early on in Signal, back when it was still called TextSecure, they did actually federate with other servers, in particular with servers run by CyanogenMod (predecessor of LineageOS, briefly a commercial startup, now defunct).

https://signal.org/blog/cyanogen-integration/

It seems like this was a very bad experience for Open Whisper Systems which is why they don't like decentralization.

Maybe the arguments for and against have changed since then.

But it's not like they just refuse to try it for no reason.

my theory is that schizophrenia is so difficult that most people prefer not to think about it. People seem to have a mental block or resistance about the fact that some people have the disease of schizophrenia, and about what its symptoms and prognosis look like.

if true, maybe that’s why it’s usually not mentioned in discussions about the politics of mental health, and why people don’t even consider “schizophrenia” when they see someone behaving strangely.