It is incredible how bad we are, at the end of the first quarter of 21st century, at having a well planned and executed strategy to improve mental health of people.
Compare it to physical health. For instance, everyone is advised to take regular tests (like blood tests). While things can still be improved a lot, this simple proactive measure helps detect many health problems before they cause serious damage.
For mental health, we don't do anything until the person is fed up with their struggles and maybe asks for professional help. Even then, in most cases we do not start with a "Triage" process. It took me a long time to even realize that there should be a mental health questionnaire, and ask my psychologist for it. We leave individuals to learn about mental health and take care of it, while there is not even a clear starting point for anyone who wants to learn.
Mental health problems, like viral infections, can be contagious. Unlike viral infections, one person with one mental health issue infects others with different types of mental health issues than the one they have. It is incredible how much happiness/productivity/economic value is lost to mental health issues that are manageable with our current knowledge.
If our collective goal for the society is to maximize a measure of overall happiness (which I think is a really decent goal), we need to have a better plan. Maybe advances in AI can bring proactive mental health monitoring to more people.
On the flip side: in some cases there are downsides to regular checkups, in particular false positive diagnoses leading to medical operations causing more harm on a population level than if the checkups hadn’t been done in the first place. Unfortunately our medical practices aren’t always good enough yet where doing early checkups at a large scale actually prevent harm.
Combine this with the sometimes shoddy diagnostics processes in mental health, and suddenly it doesn’t seem too weird to me that we avoid poking too much until people complain themselves. I think that if we were to ask people to fill out every mental health questionnaire that exists, most people would likely test positive for some disorders. But if those symptoms are not causing unmanageable harm in people’s lives, and given the current state of treatments (not nearly always effective), I think we should think twice before subjecting everyone to a list of mental health questionnaires.
I think most cultures have beliefs/norms for the suppression of emotion that influence our health more than we may realize. If we want to optimize for happiness, how do we do so without feeling sadness? Or fear? Anger? If I feel very happy with something, I will probably feel very sad if it is gone, afraid it will leave, angry if it gets taken away.
So I think more than physical health, there are hidden cultural forces that interfere with our desire for emotional health. Heck, we even call it mental health more than emotional health probably because of cultural dislike of "emotion." I won't even go into how attitudes in favor of monogamy may contribute lol.
Maybe it's the opposite though? The past century in the west was an age of relinquishing many of the "hidden cultural forces", including in particular "beliefs/norms for the suppression of emotion". Are we better off for it? Could it be the case that those older cultures had some of this stuff figured out right, or at least better than we have today.
> Compare it to physical health. For instance, everyone is advised to take regular tests (like blood tests). While things can still be improved a lot, this simple proactive measure helps detect many health problems before they cause serious damage.
Q: How many people actually take regular blood tests?
Nearly every working person in Japan. It’s mandated by law to get a yearly checkup from your employer, and family is covered too if they don’t have their own.
Part of the (quite extensive) checkup is a blood test.
In the UK, only people on certain treatments or under non-interventional observation that require it or private patients.
Regular blood tests for normal children and adults (other than the elderly perhaps?) on a purely speculative basis are not a thing.
Edit: actually you do get a 5-yearly test after the age of 40 until 65, my mistake. This incudes a finger-prick cholesterol and blood sugar test and may incude a "real" blood test if thought necessary.
A worthy goal We’re not even close to that, though. The various depression questionnaires used in research haven’t been updated in decades and the questions on them have little overlap.
I talk a lot to people who are training to become therapist, to PhD's in psychology, and read a lot of psychology papers. If there is one thing it's time for then it's for academia to get out of their ivory tower and face the real world. As Taleb puts it:
“I will repeat the following until I am hoarse: it is contagion that determines the fate of a theory in social science, not its validity.”
Or as Yarkoni & Westfall put it: "psychology's near-total focus on explaining the causes of behavior has led much of the field to be populated by research programs that provide intricate theories of psychological mechanism but that have little (or unknown) ability to predict future behaviors with any appreciable accuracy." [1]
I personally think it's fair to compare social science research with monks researching a religious text. They can work hard for years without ever coming up with a new idea.
So what's the solution? Somehow dogmatism should be reduced. This will probably happen once the government figures out how to align incentives better. Currently, peer review and grant proposals are largely done by academic peers. These peers can strengthen dogmatic ideas. Somehow, there should be a mechanism introduced that counters this.
> If there is one thing it's time for then it's for academia to get out of their ivory tower and face the real world.
I dont disagree but there is a deeper issue with the academic side of things.
> Currently, peer review and grant proposals are largely done by academic peers. These peers can strengthen dogmatic ideas. Somehow, there should be a mechanism introduced that counters this.
Psych in general is where the whole reproducibility crisis bubble up from. We're paying attention to it everywhere else but the work here is just rotten to the core.
If no one replicates, and especially here, we have major issues because everything is fuzzy.
While indirectly equivalent, I think the far worse side of the coin than "strengthening dogmatic ideas" is shooting down ideas that run contrary to dogma, precisely because they run contrary to dogma.
There are some great examples in science, like relativity, where basically everybody just tossed aside the old and embraced the new. But those are absolutely the exception, rather than the rule. There's a reason no less than Max Planck remarked that, "Science progresses one funeral at a time."
"I personally think it's fair to compare social science research with monks researching a religious text. They can work hard for years without ever coming up with a new idea."
Based on my own experiences, I really don't think this applies to other social sciences very well at all. I'm not particularly familiar with psych papers, which may well be mostly based on text-on-text, but in all the social science disciplines I am familiar with there's a great deal of focus on fieldwork and diving into the messy nitty-gritty of the actual world.
Is psych uniquely constrained from doing this somehow (patient ethics?), or is it a particular culture in the psych departments causing this?
> but in all the social science disciplines I am familiar with there's a great deal of focus on fieldwork and diving into the messy nitty-gritty of the actual world.
Can you give examples?
What I've seen is that questionnaires with high "validity" and "reliability" are put out to participants and then statistical tests are conducted to re-confirm significant results. However, these significant results typically do not mean that the results are practically useful. Maybe on average the results are significant, but the effect is too small to really be able to pick out individuals.
Certainly. I'm an anthropologist by training, where extensive fieldwork is the gold standard. Second to this comes a great deal of methodological nerd stuff (IE how to make sure you get good data from all that fieldwork). 'Theory' is mostly subsumed into this, and essentially comes in the form of securing the epistemic quality of the method.
I'm passingly familiar with sociology, area studies, cultural studies and linguistics - all of which seem to me, like they also value real world observations in their respective areas much more highly than it sounds like psych does.
From your description of these questionaires, it sounds like a methodology issue to me. If your baseline is a questionaire, then the questions you would think to ask are going to be informed by your preconceived notions of the issue, and you're forcing the raw data out there to conform to these formats you've set for it. If your chosen method for collecting the data is already distorting the field, then you're injecting a major risk of just confirming your own bias.
I appreciate that psych is trying to get at a different type of knowledge, but from where I'm at this sounds like an "if all you have is a hammer, everything looks like a nail" type of problem. I'm very much not trained to do statistical analysis though, which I believe is part of the toolkit for psych phds - so maybe it actually is the best tool for what they're trying to do.
> If your baseline is a questionaire, then the questions you would think to ask are going to be informed by your preconceived notions of the issue, and you're forcing the raw data out there to conform to these formats you've set for it.
Generally, you'd run a bunch of interviews to develop a question bank, and then run a bunch of pilots to figure out which set of questions work best.
I do agree that there's a big problem in that you base your new measure on how it performs on the old measures, which is problematic if both measures are survey based.
This is a real problem in a bunch of psychology research.
That being said, the actual problem is the culture. You are required to spout out theory if you want to be taken seriously. I only put a theory chapter into my PhD because I was forced to. Like, I think theory can be useful, but it's putting the cart before the horse, given that we're mostly in the stamp collecting phase of psychology as a science.
That's a very interesting perspective, thank you. If you don't mind me asking, do you have a sense of why this feels necessary in psych - is it deference to some preferred school of thought that needs to sign off on your work, or is it more that you need to signal that you know lots of theory? How did you go about it, when they made you put in a theory chapter?
What would happen if you turned in some psych work that was robust in its method, but without explicit references to theory?
> What would happen if you turned in some psych work that was robust in its method, but without explicit references to theory?
It would get rejected. I actually replicated a really interesting negative finding (around optimism and health) multiple times with a good design, and couldn't get it published as I didn't have an explanation for why this happened (i do now, but have been in the private sector for well over a decade at this point).
> it deference to some preferred school of thought that needs to sign off on your work, or is it more that you need to signal that you know lots of theory?
That sounds tough to work in. Do people ever cross-pollinate between theoretical positions and use eachothers data without the competing theory attached, or are they completely siloed off?
I dunno really, it honestly seemed like the theory was the point, which is so ass backwards that I just couldn't handle it.
Note that this all happened before the replication crisis, but I 100% wasn't surprised, having been shocked and appalled by the statistical methods used in "top" papers.
As Andrew Gelman notes, peer review doesn't help if all of your peers are wrong about the same things.
I 100% agree that it is dogma that inhibits the understanding and progression of treating human disorders. Take a look at Alzheimer's for example. They are still droning on and on about plaques as being the cause and despite trial after trial failing. The same is true in mental health. They were treating me with essentially the same medication they treated my mother with 50 years ago. 50 YEARS! No change! And yet every idea I approach them with they dismissed.
Research has shown that there is very little difference between therapeutic protocols, and most of the difference between them can be explained by the degree of engagement of the therapist in the life and challenges of the patient.
Basically, the value of therapy is a sympathetic, grounding person sitting down with you and helping you sort out your life. The therapeutic modalities matter vastly less than the interpersonal skills and "centeredness" of the person you're talking to.
I agree, but on the other hand I don’t think anyone can do anything.
I have a stake in treating ADHD but it’s difficult to even describe what ADHD is to a layperson. Describing the needs is almost impossible as different people have different needs and they often don’t align.
What I’m sure of, though, is that “today” is very hostile to mental health. Some people have been focusing on microplastics, impact of drugs, unhealthy food etc, but it seems that everyone are oblivious to impact of health on the mental health.
We're overworked, stressed, always improving, forced into activities we don’t enjoy (I’ve heard a term “fit-terrorism” to which I don’t agree but seemingly it exists in some circles; there’s ultra parenthood notion etc.), fed with bullshit coming from social networks, and convinced by talking heads that we are in wrongs and should be doing their rights.
We propose that in ADHD, astrocyte function is insufficient, particularly in terms of its formation and supply of lactate. This insufficiency has implications both for performance and development: H1) In rapidly firing neurons there is deficient ATP production, slow restoration of ionic gradients across neuronal membranes and delayed neuronal firing; H2) In oligodendrocytes insufficient lactate supply impairs fatty acid synthesis and myelination of axons during development. These effects occur over vastly different time scales: those due to deficient ATP (H1) occur over milliseconds, whereas those due to deficient myelination (H2) occur over months and years. Collectively the neural outcomes of impaired astrocytic release of lactate manifest behaviourally as inefficient and inconsistent performance (variable response times across the lifespan, especially during activities that require sustained speeded responses and complex information processing).
I think you're only aware of a narrow definition of "supposed to", you're saying the same thing I am.
Edit: to expand a bit. My point is exactly that - if the universe is deterministic. This only applies up to the limit of precision that it can use to calculate its own physics laws but otherwise it should be deterministic. And within a deterministic system all objects are supposed to do certain things, according to the laws that govern them. There's no ulterior moral "supposed to" in the way I'm using the word, which I think is valid usage but I'm not native.
If I had to describe ADHD to a layperson so they can understand what means to have ADHD... I would describe as to having something in your brain that you don't control that is always conspiring to get you to do nothing, if it fails to have you doing anything but what you want/should be doing; Wherever this is accomplished by making you forget, distracting you, robbing your willpower, making it hard to concentrate, making other things seem more appealing, hyperfocusing you in any random stuff, etc. Doesn't matter to the conspirator as long as they get you to waste time against your will, even when you want to waste time doing something you like, the conspirator will get you to waste time another way, for they are just a prick.
Of course there is no conspirator and I am just personifiying symptoms but that is about it what means to have ADHD on a practical levelm explained in words everyone can understand. There can be other symptoms that are not related to this like forgetting about contacting people you care about or the need to have something in your hands to fidget or not being able to remain sitted but those are secondary and very dependant on the person, the most debilitating aspect that almost every ADHD person has, just manifested slightly different, is that of stopping you from doing what you want/must do, worst is that some of that stuff you can willpower over it, but some you can't, willpower does naught when your brain makes you to temporarily forget that you were doing or you have to do a thing.
Worse stuff is that a lot of individual symptoms of ADHD are things that "happen" to everybody so they judge from their own experiences which is not fair as it is not the same when a non-ADHD person gets distracted or forgets things as when it happens to an ADHD person. Those comparations is like comparing a scratch to a wound that is spilling your guts, one you can shrug off, the other you can't.
This is the first time I've read a description of ADHD, even if it's plastered everywhere on the Web, so consider my reaction genuine and not intended to offend: isn't this just a mix of lack of willpower (potentially subconscious, which could explain the "forgetting" part) and ennui/depression?
In french, we have the word "flemme" that can be approximately translated into "laziness", but it's a bit different, because "flemme" is often construed as an enemy within, something you have to fight, and some people have more than others.
I think it's slightly different than that, in my experience as someone with both ADHD and occasional struggles with depression. For depression, there is this distinct sense of ennui, or that things aren't worth bothering with, that feels present enough emotionally to "identify" with as part of your intent.
But when that's not there, the ADHD ends up manifesting as this sort of detachment of my own thoughts and feelings from my actions. I may be doing something, and there will be in many cases an internal train of thought that's recognizing that there's something else important I should be doing (say, stop engaging with a hobby and go to sleep), and understanding and being alarmed of the consequences of not doing so, but even with that conscience desperately pleading to act on it, for whatever reason, there's a disconnect that makes it not persuasive enough to take action on. And so I stay up late, not wanting that and fully knowing it's a bad idea.
That tends to lead to a lot of mental anguish, and it did unfortunately eventually develop into a sense of futility for me. Because "learning from your mistakes" ends up being ineffective, since you can't use that knowledge to reliably persuade yourself anyway. Before that I instead was just constantly confused and disappointed in myself for not being strong enough to resist it like I was always told I should be able to, if I really believed in it. I'm honestly still not sure which of the two is a better mentality to have, I'd say they both felt catastrophic or occasionally helpful for me at different times in life.
That sounds very tiring. It's almost as though you described the experience of a normal person. I'm fairly sure you are supposed to struggle out of this weak mindset with intention, just like everybody else does.
It’s also incredibly difficult for people with mental health issues to simply get advice to try to “pull themselves up by the bootstraps” by improving their lifestyle when so much of their mind is working against them.
Combine that with the fact that hyper individualism is a big factor for loneliness, (and social media is a poor man’s substitute for socializing) and with loneliness being one of the biggest factors in poor mental health, what we have is not just people with problematic lifestyles (exercise, diet, sleep, social support, financial health, purpose) but also a life structure (overworking, drinking, shopping, doomscrolling, etc.) which makes it all too easy to fall back into old patterns of a poor lifestyle.
What’s crazy is expecting people with poor mental health to just “fix themselves”. Some may be able to, while others will struggle with it their entire lives without proper support and societal guardrails.
> What’s crazy is expecting people with poor mental health to just “fix themselves”. Some may be able to, while others will struggle with it their entire lives without proper support and societal guardrails.
What has helped me is realizing that the only person that can fix me is myself. Nobody is going to do it for you.
I realize that's very sucky advice, though, akin to saying "just don't be depressed"
One thing that has helped me over the last two years is not watching or reading the news (I've haven't done social media in a decade).
I know some people will think it is morally wrong of me to not be interested in the world and society. In fact, I used to think as much too, and thought myself terribly clever because I had an Economist subscription.
The fact is that I _am_ interested in the world and society, but all I found that keeping up with hour-by-hour events did was stress me out. I don't need to hear about plane crashes, or tedious political events.
The only place where I come across news stories now is occasionally on HN, and when talking to other people.
Because I am no longer addicted to the news, I am less stressed, and have more time to do the things that make me calm, happy, and fulfilled, rather than stressed.
I doubt that my "living under a rock" policy will be permanent - in the future I might develop a better capacity to deal with the stress of current affairs - but for now it is definitely helping me.
> I know some people will think it is morally wrong of me to not be interested in the world and society.
Social media and the news are probably the worst way to be “informed” of the world and society.
One could even argue you’re worse off using those because it gives you the illusion of being informed, without much substance.
You’d be far better off picking up a quality history book (not the popular history books which are a step up from the news), but recognized historical books that are globally recognized as authoritative texts.
If you read one book like that a year you would have already exceeded the knowledge from a lifetime of social media and mainstream news.
To clarify, I don't close my ears to everything going on in the outside world. I just don't get my information from news websites or tv stations etc.
I still like to talk to people about what is going on. I find that less stressful, maybe because when talking with friends, family, colleagues, we don't tend to use such alarmist language (at least the people I talk to don't).
As for point b), I can imagine this might not be true, as long as it really was the case that no-one was informed. Hard to plan and orchestrate bad things without information!
> As for point b), I can imagine this might not be true, as long as it really was the case that no-one was informed. Hard to plan and orchestrate bad things without information!
Sorry, yes. My assumption was that the bad guys will still stay informed, just like the bad guys don't put down their guns because I would prefer us all to be pacifists.
> b) If everybody did this, a) would quickly no longer be true…
Maybe the spiral goes in the other direction: Because no one does, a) is not true. I.e. because many people are "keeping up with hour-by-hour events", your house may explode tomorrow. If everyone was living under a rock, your house would be safe.
Maybe there are two equilibriums. One equilibrium where everyone needs to know about current events because their houses may explode, and another equilibrium where everyone lives under a rock because their houses are save.
I appreciate this. Suggesting that mental health is "just" a chemical imbalance is maybe addressing a very complicated system with a narrow fix.
That said, I'm likely biased to be predisposed to believe that mental health is a complex system based on other beliefs I hold or experiences I have (e.g. having suffered depression myself, having experienced homelessness, believing in the theory of alienation.)
But also, I don't know what you do to address systems that doesn't require radical or even revolutionary change. We're a far cry from even applying the mental health practices we do have to everyone who wants them today. To say nothing of the massive social stigmas associated with therapy, depression, and medications.
Perhaps "mental health" is such a broad diagnosis that talking about remedies for "mental health" may be unhelpful. The remedies for a paranoid schizophrenic may be very different to depression which may be very different to say ADHD.
Treating as a disease with a chemical cure does in part remove some of the stigma. But it's really only helpful if it addresses the root cause of the problem.
Much of the root of "modern" mental health is "feeling good" as in "I had to step back to protect my mental health" and that's more a social, and view-of-self issue that's best addressed with therapy.
So perhaps the categorization of "mental health" is as varied as "physical health" and we can accept that no one solution is going to fix everything.
ADHD isn't even a good diagnosis. We throw these words as if we know what the disease even is and all we need is to figure out the cure, when these diseases have dozens of variations "my ADHD is more like this", the definitions of the disease and classification change all the time. ADHD when I was a kid is very different from ADHD today.
So to me the article shouldn't even be "we need to take a wider approach to the cures", it should be "we don't know jack shit about mental health and need way more research".
> psychiatric models in the 20th century, centered on the notion of disease... ..mental health conditions are to a large extent, a social construct produced by lifestyles
Is the problem medicalization of psychiatry, or is it "sciensification?"
How much progres have we actually made in the last 100 years? Medicine, particularly "wellness" is difficult to map onto an experimental framework. Even theoretically testable, Popper-esque theories are hard to formulate. For psychology/psychiatry... pretty much impossible.
To the extent that treatment is ever actually science-based... "Science" means a pharmacalogical framework, a drug testing framework. You can substitute exercise, talk therapy or whatnot for drugs but... that approach is going to lead you to conclude "drugs."
IRL, practitioners are either entirely nonscientific or extremely narrow... or both. There isn't really a "model of the mind" that's both expansive and scientific. We're dealing with that middle ground of science, philosophy and practical need that tends not to produce knowledge.
Without being disparaging, how much actual knowledge has psychiatry gained over the last 100 years?
> how much actual knowledge has psychiatry gained over the last 100 years?
Some
Plus you are conflating psychiatry with theraputic approaches, so that muddies the water.
Overall there have been massive advances in pharmacology which have given us an arsenal of drugs
In some cases they can be very helpful.
However these have been massively over prescribed, especially in the USA
There is good empirical evidence that many cases of mental illness have roots in e.g. childhood abuse.
There have been a lot of empirical studies that show increased rates of mental illness in childhood abuse survivors, combat veterans and rape victims.
There is good empirical evidence that some theraputic approaches can improve outcomes for some people. There does not appear to be any one approach that works for everyone.
Many therapists believe in those cases where there is an identifiable cause it is better to keep drugs as a last resort and try to find a therapy that improves things.
Certain conditions e.g. schizophrenia, appear to only really respond to a pharmaceutical approach and even then, again, not for all cases.
> Even theoretically testable, Popper-esque theories are hard to formulate. For psychology/psychiatry... pretty much impossible.
There are models of the mind, of development, of response to trauma.
It is possible to test outcomes of therapies without needing a full "model of the mind"
Granted, much of the research is of dubious value but some overall trends appear to be solid. I've tried to base this answer on that
> To the extent that treatment is ever actually science-based... "Science" means a pharmacalogical framework, a drug testing framework. You can substitute exercise, talk therapy or whatnot for drugs but... that approach is going to lead you to conclude "drugs."
I don't think any of that paragraph is well founded
Yes, I'm very serious here. Apart from crooks, fanatics and other vocal minorities, the religious people I met have several advantages. One, more mundane, is a sense of community which works best in smaller groups. Second, a sense of purpose in life and a kind of reference point. Third, when a darker period comes, a source of strength to go through it.
Religion is a payday loan against reality. As someone that grew up in a religious household, I am certain that no matter how well-intentioned people are, someone is going to have to foot the bill.
It is very unfortunate that religion associated itself with miracles a lot, which are perfectly incompatible with science.
It turns out to be pretty hard to come up with a religion that has your listed advantages, and which does not break down under the critical views of science. Ironically, the “God” concept is in the clear, but the bible needs a serious overhaul to be trustworthy again.
> It is very unfortunate that religion associated itself with miracles a lot, which are perfectly incompatible with science.
And yet, there are religious scientists. Just like you can separate your work and personal life, you can separate your religious/spiritual/mental beliefs from your rest of self. You don't need to "prove" the religion to be true for it to be useful.
You know what they say about models and their correctness?
None of the advantages you list require belief in the supernatural, or the absolute truth of some sacred thousand-year old text. It's only due to deep cultural conditioning that people assume religion is necessary for community, a sense of purpose or resilience. However, the world is filled with religious people who lack these qualities and non-religious people who possess them.
The absolute last thing we need for mental health care is a paradigm that considers demon possession or the wrath of an angry God to be legitimate concerns.
It's easy to forget that science has found many conditions that affect the brain that, because science can easily treat or prevent them, we no longer consider to be mental health conditions. Off the top of my head, hookworm, syphilis, lead poisoning, various vitamin deficiencies, various prion diseases, thyroid diseases, sleep apnea, ergot poisoning, fetal alcohol syndrome...
Sure, there are almost certainly many cases of anxiety, depression, and ADHD that are not amenable to "You have a chemical imbalance, here is a pill to fix it, get on your way." However, society has reaped enormous rewards from the idea common mental issues may have simple and understandable causes that can be treated or prevented in unfeeling, cookie-cutter fashion.
That's interesting. It kinda reminds me of the AI effect [0] in the sense that the goalpost for mental disorders is moved based on the physical causes we discover, and how we might consider the goalpost will be further shifted (in a good way) as our understanding increases.
Concerning NHS I'd be extatic if they listened to my specific and narrow problem before writing paperwork that they do not read later and I have to tell again someone else in that 15 minutes they allocate for me, that would be a first step in my view towards the dreamland of holistic approaches.
You took the words out of my mouth. Mental health on the NHS has more or less collapsed under its own weight. All this time limitation, ignoring what you say, forgetting to note important details, pretending at each appointment that there is no history etc is just systemic refusal/inability to offer treatment at the end of the day (not just mental health).
My increasing feeling is that the patients' purpose is to provide input for paperwork that gives exuse to write payslips. The patients are for the system, not the other way around. The patients are wrapped around (bounced around, jumped through hoops, etc) the system's needs, not the system is formed around the needs of the patients. All is organized so the system's resources can be used the most optimal way (all hail the St. Key Performance Indicator!). Meanwhile if some curing happens, that's an acceptable byproduct.
I can definitely appreciate that conclusion. We are told to fill in forms, answer questionnaires, attend appointments, wait for callbacks, sign up for waiting lists, read websites, phone these numbers, search for alternative private options... just keeping you busy and distracted. They loved using COVID as an excuse to abolish the concept of face-to-face anything, to keep you even more arms length.
I literally said one of my issues is isolation, lack of connections etc and they said "ok we can offer you a phone appointment only". I know it's due to shortages but it was the complete lack of acknowledgement of the situation.
A lot of people are definitely getting paid just to manage applications and lists and callbacks and note typing etc without any care being delivered. Just enough to CYA if a relative blames them for anything that happens
> How can this situation be changed? First, psychiatry must reduce medicalization as a commitment to doing no harm, by engaging in the multidimensional construction of alternatives to the conventional paradigm, which despite being dominant, is ineffective in the face of the complex challenges that involve mental care, such as stigma, social exclusion, and violation of rights.
I don't want to be flippant, especially not when discussing mental health. Still, how can you look at this sentence and think "yep, that's a good way to communicate my message"?
It does seem sort of obvious that many mental health conditions are tied up in a person’s wider life and lifestyle, not just in brain chemistry. But is this really a revolution in our understanding? Hasn’t psychiatry always taken a broad view of potential causes? People sitting on a couch talking about what’s going on in their lives and somehow being helped by conversing with the psychiatrist?
Or is this about non-psychiatrist doctors rushing people onto drugs instead of referring them to psychiatric treatment?
You're confusing psychiatry, which is a branch of medicine, with psychoanalysis. This article is about the former.
Psychiatry has become heavily focused on prescribing drugs for diagnoses based on the DSM, where only the presenting symptoms are taken into account and interaction with the patient after the initial diagnosis is minimal.
I think the bigger issue currently is we understand so little about the brain. For something like Schizophrenia there is very obviously biological origins - not that environment doesn't have an impact as well, but you're not solving that with behavioral therapy alone. However I think biological psychiatry has sorta thrown the baby out with the bathwater in the way it tries to study these disorders, lumping everyone with psychotic disorders into one basket and doing some one dimensional studies on that.
Since we don't really have a foundational understanding of the brain and these are complex (probably multiple distinct under 1 umbrella) diseases, it's difficult to draw many real conclusions. Unfortunately on the flip side it is rare to see professionals that focus on the human side of things think much about biology. So you get a weird gap where people with fancy biology tools are studying very ill-defined phenomena, and people who work on unpacking the psychological phenomena are entirely ignoring the critical underlying biology. Maybe one day the fields will be better bridged, but research that is currently done isn't really abstracted in a way where it's feasible for the two sides to meaningfully inform each other. Plus there are cultural barriers in place.
According to your comment, it is also extremely overrated.
Diet is very complex, and the behaviours associated with it are very complex as well. It is very hard to tell causality from correlation in this context. If someone’s temporary mental problems are clearing up, there may be more room to improve eating habits, and if someone is riding a negative spiral, there might be just a little comfort in eating junk food.
Of course we should study the relation between food and mental health more, but I sincerely doubt that reducing sugar intake will cure depression.
I find that I have to repeat myself. You seem to be using a kind of reasoning that I don't think is very productive. Are you aware of this?
I could spend some time explaining where I think you go off the rails, but I'm afraid you prefer trolling over learning. Please let me know if I'm mistaken, and I'd be happy to continue the conversation.
Why are real world examples "counterproductive"? Do you not see that some people are healed by this?
What is hard to understand about real world people healing?
So because in a study of eg 200 people 170 don't improve at all but 30 do this now obviously means that on average the thing studied doesn't work: so the study concludes "X doesn't work" even thought 30 people got completely cured.
So you'd now prefer for no-one to get cured because "on average" treatment X doesn't work. Perhaps your reasoning is not productive?
It's really simple: these things work for SOME people: should they not have tried this and instead remain ill?
A human life is not the average + confidence interval in a study: humans are different, an individual is a VERY REAL N=1, not "the average study participant".
I’m responding to you here because they flagged another post that you made a comment on. It was about the autoimmune diseases. I have no idea why they flagged that post are there than I wrote the article and I posted it as well.
It was interesting to read the feedback with one person saying that because I am not a doctor. I can’t learn anything.
And I appreciate what you’re saying here about mental illness because what you’re saying is true. If you go to my Substack, I’m going to talk more about how I use my genetics to discover the cause of my mental illness and how I’m using food to cure it as well as all the other disorders that came along with my mental illness.
People have a hard time with creative intelligence and unlearning dogma that’s been taught to them for years. I was hoping in hacker news people would be more open-minded but now I’m seeing that’s not the case.
>> I was hoping in hacker news people would be more open-minded but now I’m seeing that’s not the case.
Yes this was a bitter pill to swallow for me also: hackers would be open minded right? It's exactly the opposite: many comments that I do like this get downvoted very often heh...more like Sheep News than Hacker News :)
But I'm totaly used to it now, though my opinion that "programmers are be smart and wise people" now doesn't have the "wise" part in it anymore...
I am the OP. First, I am glad this post has gotten so much attention and traction.
But what if I told you I cured my mental illness at 58 years old, a serious case of Bipolar Disorder Schizoaffective Type that had me on Disability and in and out of psychiatric hospitals since I was in my early 30's?
What if I told you it was more than holistic but it was holistic thinking that helped me cure my disorder.
Will you all listen to me or write me off by saying that nothing I say is true because I had a mental illness? Will you be like my doctors who do not believe I am better? That I have no more mental illness along with all the neurological issues that came with it?
And what if I told you what I have discovered in myself can be applied not only to mental illness but to everything from Cancer to Alzheimer's to ME/CFS and Long COVID?
If there is one person here who will take the time and have a creative mind to understand what I am saying I will explain it?
My disorder was caused by too much ATP in the mitochondria and too little in the cytosol. I have a Partial PNP Deficiency[1].
The higher ATP and GTP in my mitochondria causes higher sensitivity to all the G Protein Coupled Receptors[2], this includes the serotonin and dopamine receptors. So any increases in serotonin was exaggerated leading to psychosis and delusions much like someone would have on psilocybin.
This was cured by a low calorie, high seafood diet, a lot of walking, and limiting exposure to oxidative stressors like air pollution.
Most people however have the opposite problem; too little ATP in the mitochondria and too much in the cytosol. This leads to low energy receptor function. So when that person is exposed to dopamine there is very little reaction so they keep seeking dopamine. Hence we have depression and addiction.
In short, changes in the Purinergic pathway cause mood disorders. And this is not even a radical statement, it is just not well known[3].
So you can see why things like SSRIs will work, but stop working after a while. Since nothing is being done to correct the low mitochondrial ATP.
> during the 2017 Psychedelic Science meeting in Oakland
I'm personally really interested in studies with psychedelics. E.g. https://episode-study.de for germany.
I feel like they could really help in a lot of mental conditions, especially in a controlled setting with a therapist.
Therapy with psychedelics could be like speedrunning therapy! That's what many people claim after their experience at least.
I do also think widespread use of such substances could drastically change our society, which is also good for mental health, presumably.
> Mental health conditions are often caused by physiological imbalance that is socially constructed. Deficits in sleep, nutrition, exercise, introspection, and other pillars of good mental health do not occur in the vacuum, they are produced by how we live.
Yes. Asking someone to "exercise" or "eat better" is just addressing the symptoms. The underlying issue is stress (which is not always "socially constructed").
They were preaching the same about obesity for years, which achieved absolutely nothing, and then GLP-1s came along. Turns out that yes, there is indeed a hormone which can reliably be increased to cause weight loss.
They have on label use as weight loss medicine. It might be discovered first as a side effect, but it's genuinely considered a primary desirable effect these days.
I think parent's point was primarily that its not "hormone causes weight loss", its "hormone causes changes to innate drive, which change behavior, which causes weight loss". If you did the same things off the drugs that you did on, you would lose similar weight.
Given that, the rational of the original comment makes less sense. A hormone that changed your behavior such that the resulting behavior changes made you happier is far more of an obfuscated ask of modern pharmacology, as there is no behavior change that will reliably fix the problem the same way there is for weight loss (eat less).
You don't need drugs to grown muscle, just an active lifestyle; which is also highly beneficial to mental health. Many of peoples physical and mental problems are a result of their sedentary lifestyle.
Testosterone and human growth hormone were the the main ones I had in mind, but I think there is much more a specialist could so that would be safe and effective
I strongly believe we don't have "mental health problems", yet we have a global style of living in "modern society" that is inherently incompatible with the way we evolved: e.g. office-based daily tasks instead of walking and hunting, foods fabricated to stimulate us instead of what we could find in nature, high buildings and cities with sound/light/air pollution instead of a calm, clean nature, always trying to "optimize for time/money" instead of slow living etc. all eventually end us up in a mentally and physically depleted state. The problem is that none of those factors alone have a direct visible effect, but they accumulate together over years, so it's hard to quantify a specific factor in an isolated manner.
As long as we don't change out lifestyle to something simpler fundamentally, I doubt we can really solve problems with any kind of drugs or medical tests etc.
I hope a holistic approach will take us back to who we really are, which would gradually solve our both mental and physical health problems.
100% agree. You need to cook your food. You need to exert energy to move (walk, run, or cycle instead of car.) You need to communicate face-to-face, instead of with a screen. Swimming is such a great feeling that I've never seen someone worry about an email while doing it.
If you drive your car to a desk job where you sit in a zoom meeting all day and then stuff your face with food you bought, you're going to crash and burn. If your "hobbies" involve "Netflix", you've got a problem.
Take for example a diet that causes gut problems, which then causes anxiety to manifest physically, which result in anti-depressant medication, which you guessed it, cause gut problems.
However, when a raise in mental-health issues correlate with a an inequality crisis, de-funding of mental health services, and lowering of national food standards ( UK, Brexit, Austerity ), maybe it's not so much that we can't sit in offices, but rather balance has simply been stripped for profit.
I feel like inequality is often used as a sort of scape goat in topics like this. The reason is that though we obviously have inequality that's in raw numbers substantially greater than ever before, it's also a very different form than in the past. In the past being poor meant you were probably living in makeshift housing, had no 'privileges' like plumbing or clean water, and could easily slip into genuine starvation if things got even slightly worse.
In modern times, obesity is one of the biggest health issues among the poor. The poor of times past would think we're living in a utopia. And in terms of "stuff" we probably are, but it doesn't feel like a utopia because it obviously isn't. Current times are probably the best evidence imaginable that all of the things we relatively ignore in terms of quality of life (family, nature, philosophy/purpose, and so on) are, at the minimum, no less important than the things we obsess over like income, education, and sexuality.
I understand your perspective, but I believe it's important to recognize the complex role inequality plays in modern society.
While it's true that overall living conditions have improved, with more access to amenities like plumbing and clean water, this doesn't mean inequality has lost its relevance. Inequality still has a profound impact on mental health, social cohesion, and overall well-being.
Many people in developed countries live in makeshift housing without basic necessities like electricity, plumbing, and clean water. This indicates that not everyone benefits equally from societal advancements, and calling these amenities "privileges" overlooks their fundamental importance.
Furthermore, while obesity is indeed a prevalent issue among the poor today, it often results from limited access to healthy food options, which is another manifestation of inequality. You also mentioned that inequality contributes to obesity, so dismissing it as a scapegoat contradicts this observation.
The poor of the past might view our access to "stuff" as utopian, but they wouldn't likely see the lives of today's poor in the same light. Improved material conditions don't necessarily translate to improved quality of life, especially when disparities in wealth and opportunity persist. Quality of life involves more than just material wealth; it encompasses family, community, purpose, and other non-material aspects. Inequality affects all these dimensions, making it a crucial issue to address.
Merely 20 minutes ago a colleague was complaining to me that his smart watch popped up a distressing notification while he was swimming. I was telling him to turn off all notifications and toss that watch.
This. In the past few decades we changed completely how we are supposed to live. Our bodies and brains evolved and adapted through thousands and thousands of years. With plenty of outdoor activity, sunlight, bonding in close communities, quiet time to exercise creativity and arts, and specially, the lack of continuous stimuli and artificially induced anxiety and stress of modern world.
> In the past few decades we changed completely how we are supposed to live... outdoor activity, sunlight, bonding in close communities, quiet time
It's more like 100 years for this division.
> continuous stimuli and artificially induced anxiety and stress of modern world
Is anxiety artificial?
400k years ago, humanity emerges. 40k years ago we finish raping and murdering the last of our close ancestors off the face of the earth (Neandertals and Densovians). It's not like we settled down after that. What are the founding stories for Rome: one brother kills another then go one town over a kidnap some wives (rape of the sabine women).
I picked Rome because the Pax Romana was 200 years of peace. ON the back of mass professionalized violence (the Legion). It wasnt exactly a time of ease and abundance out side the select few.
The last dual in America was less than 200 years ago.
2 generations ago you were lucky to make it out of a major war... the ones we have had since have been mild and voluntary.
We live in a time of abundance, ease, and calm in comparison to history.
No bears are going to eat us. No one is going to come in and burn the village down. We're not worried about starving. Or war... the "plague" was a bit upsetting but in the grand scheme of things it didn't kill a lot of us.
Are we supposed to be anxious and stressed for real reasons, are we programed to be that way, and are now freaking out over minor things because we have gotten rid of all the major ones?
Good point! I even think if the anxiety of being observed by a feral animal is the same, psychological and physiological speaking, of being summoned to the director office or waiting for the result of an exam. We live in a much better world today. Maybe our bears, lions and bandits look different now.
> 2 generations ago you were lucky to make it out of a major war... the ones we have had since have been mild and voluntary.
That's only true if you're talking specifically about US-involved wars, from the US side of things. For a lot of people, the Iraq War (for instance) was neither mild nor voluntary.
Strong point I should have made the US/western nature of my comment far more clear.
To expand on what you're saying I think many of people who have lived through those wars would look at our "western" complaints of stress and anxiety as abject nonsense. And thats not to be dismissive of what people "feel" were built in to be hyper on guard based on history.
I have a corollary to this: a lot of people in tech, who are great at their shitty office job, they all have some terrible job in their path that they will happily tell you they never want to go back to.
Someone once told me something thought provoking - we as a species have never spent so much time away from touching the ground, it's almost as if it is lava.
We spend 1/3 of the day sleeping in beds, raised off the floor, sometimes in apartments 10s of metres away from the ground.
We spend 1/3 of the day working in artificial offices, sat on chairs, 10s of metres away from the ground.
The other 1/3 of the day we may be sat in cars/ other transport raised from the ground, sat at tables, sat on our sofas, in our flats doing chores etc. Even if we are walking from A to B, if you are a city dweller, you're probably still walking on tarmac separated with the rubber soles on your shoes.
He then asked when the last time I touched grass or soil with the soles of my feet (or even with my hands). At the time it was about April in London, so just coming out of winter. I think the last time I had honestly walked barefoot on grass/soil was possibly September - and I LOVE the outdoors, go running/ hiking often, very active lifestyle etc.
We have grown so far away from how we evolved, so quickly, and most of us are completely unaware of it. So yes, I ditto your comment - modern society, its stimulus and it's constant FOMO orientation, is absolutely causing our issues today.
I couldn't afford to buy a property in London with a garden to address this issue, so subsequently moved up to North Leeds. I now ensure I am outside in my bare feet at least once or twice a week regardless of the weather. This morning I spent five minutes walking through a stream barefoot to the base of a local waterfall, listening to the birds, playing with my dog, feeling the nature, and wow do I feel happy and focused today as a result. Megacity life if killing us.
You appreciate "calm, clean nature" from the perspective of a technological civilization with most of the basic needs met. On its own it can just be a lot of boring nothingness with or without back-breaking labor.
Perhaps "optimizing for time/money" is as much who we really are as slow living and you're just ignoring the other half.
Contemporary systems are an organism to themselves. Guided by natural "artificial" selection. Corporations are like aliens trying to terraform the social landscape so they can survive. I can't image what it will be like when they become even more autonomous.
In fact, the original concept of a corporation was that they were created for a specific purpose and then dissolved once completed. In a way, the fact that modern corporations don't do that is analogous to how cancer is mutated cells that don't stop growing, even to the detriment of the host.
> In fact, the original concept of a corporation was that they were created for a specific purpose and then dissolved once completed
You're wrong there. One of the original corporations grew to become the sovereign power over a whole sub continent and eventually got nationalized into a colonial administration. Another original corporation had a para military mandate and conducted large scale open ended naval warfare in three different continents.
I’ve always found it interesting how the word corporation is traced back to the Latin for body, corpus. As in Corpus Christi, the body of Christ, or the word corpse. There is something very organic about the word’s etymology which becomes even more compelling considering the role of corporations in the future of life on this planet.
You may be over-romanticizing the hunter-gatherer times. It wasnt all just a nice summer evening where people did a nice walk in the forest after chilling at the beach. Life was rough, often it was cold and rainy, people were hungry and every little injury could easily mean a horrible death. Constantly worrying how to fill your stomach without getting killed by wolves or a tiger (or a rival tribe) or breaking your foot, or some deity being unhappy with you and sending a thunderstorm. Can't just pop a pill when you have pains or can't sleep.
True, mental health likely wasn't much of an issue. But the other issues you got in exchange...
Of course. I never meant that it was all fun and chill, perhaps life was much harder, and perhaps our brains evolved to cope with that and when there are no natural threats it errs.
I've always felt this way, and while I never thought I was alone exactly (the documentary, Koyaanisqatsi, literally translated as "life out of balance" suggests that some have come to this realization before I was even born), but I thought that perhaps others were better able to deal with modernity than I. That is probably true to some extent, but increasingly I think that most people are affected but aren't as conscious of the reasons for their malaise. Also, a lot of people still seem to be able to believe in religion (I'm sadly not one of them) which seems to help them.
It's a result of societal competition. The people most able to survive and breed in these hostile harsh conditions will sadly inherit the Earth. You can't slow down or the Red Queen bulldozes you.
I’m quite sure that there is (at least some) truth in this. I’ve been travelling in Italy for a month now. Around and below Napoli, there is something which I cannot grasp, which seemed very calming. It’s slower somehow, and way more enjoyable, than north Italy. Even parts of north Italy which are very “chill”, and where “nothing really happens”. One for sure: south Italy lifestyle is definitely closer to slow living than any “slow living” part of the north. Even Napoli on some level.
This is an important part of the story and I agree that it accounts for most mental illness but certainly not all. Illnesses such as schizophrenia and autism exist and while society can make them worse, there are obviously strong biological components.
> a holistic approach will take us back to who we really are
Epistemology - stuff we know about knowledge - never really moved into
the psychological and political.
Study some and you'll hear all about "justified true beliefs" and so
on. A lot of what we call science is built on this foundation. But
there are things we know, and can prove, but cannot say. John Bowlby
wrote on "knowing what you are not supposed to know and feeling what
you are not supposed to feel" [0]
Therefore science built on partial epistemology must also remain
partial. All science is inherently political; medicine and digital
technologies are shining examples.
This blockage, where we spend our energy in modernity pretending,
avoiding, finding reasons to believe in things we know are abhorrent,
defending our ego against insecurity... means we get overworked with
moral labour. It's exhausting just to doom-scroll with one finger and
get out of bed to work for some shitty company that's ruining the
planet.
Many people start to feel better when they have some sort of epiphany,
breakdown, break-through and just start being more honest. More
honest with themselves. More honest with others. You lose friends, but
you gain new ones [1]. You lose a job, but you get a better one, for
you. Rather than meeting resistance and disagreement, you find that
"everybody knows" [2]. I think that honesty is the key to mental
health.
Is there any evidence indicating that mental health issues have increased during this period? Or that there is higher incidence in more developed nations?
Changing your environment is one of the best things you can do and this has been shown countless times.
For example, it is paramount for an alcoholic to get rid of any trace of alcohol in his home and any other frequented places. Do you perhaps believe that instead he should just "get his act together" and through "sheer will" ignore the temptation of alcohol even if he is surrounded by it 24/7?
It may well take humanity a few more decades before they, en masse, come to terms with the fact that, in the end, it is the human condition itself (not the environment) that needs to change. The environment is fine ... more than fine in fact, would anyone really want to go back to "the old times" if they were to be honest?
> When disagreeing, please reply to the argument instead of calling names. "That is idiotic; 1 + 1 is 2, not 3" can be shortened to "1 + 1 is 2, not 3."
Also,
> Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith.
Are you really going to shit on people for failing because we've turned society to "hard mode"? Imagine it's suddenly the zombie apocalypse - are you gonna victim blame people for not having a bunker, years of saved food and an arsenal of anti-zombie arms ready to go?
Compare it to physical health. For instance, everyone is advised to take regular tests (like blood tests). While things can still be improved a lot, this simple proactive measure helps detect many health problems before they cause serious damage.
For mental health, we don't do anything until the person is fed up with their struggles and maybe asks for professional help. Even then, in most cases we do not start with a "Triage" process. It took me a long time to even realize that there should be a mental health questionnaire, and ask my psychologist for it. We leave individuals to learn about mental health and take care of it, while there is not even a clear starting point for anyone who wants to learn.
Mental health problems, like viral infections, can be contagious. Unlike viral infections, one person with one mental health issue infects others with different types of mental health issues than the one they have. It is incredible how much happiness/productivity/economic value is lost to mental health issues that are manageable with our current knowledge.
If our collective goal for the society is to maximize a measure of overall happiness (which I think is a really decent goal), we need to have a better plan. Maybe advances in AI can bring proactive mental health monitoring to more people.