[HN Gopher] Two recent books by historians explore the crisis in...
       ___________________________________________________________________
        
       Two recent books by historians explore the crisis in biological
       psychiatry
        
       Author : Caiero
       Score  : 123 points
       Date   : 2022-10-11 22:47 UTC (3 days ago)
        
 (HTM) web link (bostonreview.net)
 (TXT) w3m dump (bostonreview.net)
        
       | tkk23 wrote:
       | >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.
        
         | slfnflctd wrote:
         | 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 wrote:
           | 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 wrote:
           | 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.
        
             | slfnflctd wrote:
             | I agree in principle, but in the mean time we need triage.
             | The current system has reached a breaking point.
             | 
             | > Do you really think lowering the bar is a good idea?
             | 
             | How much lower can the bar go? The "ethical and self
             | regulation" you describe is all too often nonexistent. If
             | my experiences - and many others I've read about - are any
             | indication, the situation couldn't be much worse. There are
             | certified professionals doing everything from actively
             | pushing religion to making a cynical game out of how fast
             | they can pigeonhole your 'symptoms' into a checklist so
             | they can prescribe the currently most marketed drug for
             | that DSM entry. Then they tell you to report back in two
             | months.
             | 
             | Just having someone to talk your shit out with regularly
             | who doesn't judge too much and has knowledge of practical
             | solutions for common stressors would be a vast improvement
             | over the 'care' all too many are currently receiving. The
             | guidelines for providing simpler care like this can be
             | clear & concise, and we have better tools now for filtering
             | out bad actors. I see more reasons to continue advocating
             | for such an approach than not at this point.
        
         | bergenty wrote:
         | 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.
        
       | eimrine wrote:
       | > 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 wrote:
       | 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 wrote:
         | This looks really helpful, favouriting so I can read it more
         | carefully later.
        
       | lebuffon wrote:
       | 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 wrote:
         | 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.
        
       | zniturah wrote:
       | Maybe we rely on science here : it is genes + environment + head
        
         | WastingMyTime89 wrote:
         | 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.
        
         | marginalia_nu wrote:
         | How would you construct an experiment to verify that
         | hypothesis?
        
         | tkk23 wrote:
         | 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?
        
         | tremon wrote:
         | 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?
        
       | yibberish wrote:
       | 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.
        
       | mrxd wrote:
       | 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 wrote:
         | 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 wrote:
           | Compare to community policing, in which crimes are created
           | and solved by modifying the environment. It is a very good
           | thing.
        
           | mrxd wrote:
           | I clicked on the "soteria houses" link in the article
        
       | nyc111 wrote:
       | Mental ilness is in your gut. That's where we should be looking
       | at.
        
         | BurningPenguin wrote:
         | How about: Mental illness is a complex thing, that involves
         | multiple parts of the body, and probably also the environment.
        
           | marginalia_nu wrote:
           | Almost as though the human body is one integrated system,
           | rather than a set of individual components connected through
           | well defined interfaces.
        
             | serpix wrote:
             | I detect the sarcasm but others may not. As a thought
             | experiment I present that any emotion can always be felt in
             | the body.
             | 
             | If you feel nothing, no emotion or no sensation in the body
             | then that is also a felt emotion in the body as a lack of
             | feeling.
        
               | marginalia_nu wrote:
               | No sarcasm intended. I genuinely don't think you can
               | reduce the human body into parts without simplifying how
               | it works. Humans design machines component-wise that way,
               | but that is a methodology unknown to evolution.
        
           | imoverclocked wrote:
           | 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.
        
             | jvm___ wrote:
             | The human system really has only three inputs your
             | conscious brain has control over (and they're almost all
             | 'loose' controls). Loose controls meaning imagine feeding
             | birds, you don't feed the individual birds you just provide
             | seeds and let them figure it out. Your inputs to your body
             | are rarely localized, you just provide signals and your
             | body figures it out.
             | 
             | So, three inputs.
             | 
             | Energy input as food/drink, how fast you breathe in. Energy
             | output as what you do in the world and how much your
             | muscles exert themselves.
             | 
             | The third input to your body is your stress response as
             | interrupted by your brain. Stress in this case can be pain
             | and discomfort, but also any other input or thought from
             | your senses.
             | 
             | Your body doesn't know that a lion jumping out of the grass
             | is terrifying, it just responds to your brain throwing
             | terror seeds at it.
             | 
             | Your body doesn't know that seeing "23 53 34 78 and bonus
             | number 5" means you just won the Powerball lottery, it's
             | just responds to the your brain throwing happiness seeds at
             | it.
             | 
             | Like you said, mental health can be systemic, but having
             | bad inputs can stress you out as well. If your problem is
             | mainly bad inputs, then you can control your response, just
             | in a loose way rather than a tight way that we humans seem
             | to prefer.
        
             | nyc111 wrote:
             | I don't agree. Our perception of the world is colored in
             | the gut and served to the conscious mind. When I was living
             | in New York, the jingle of the ice cream truck draw me
             | crazy, it was torture. But for kids, it was happiness
             | because the gut microbes feeding on sugar send a message to
             | the conscsious mind to buy the sugary stuff and they
             | created an irresistible desire for it. This is all done in
             | the guts. Some people can remain cool under any adverse
             | situation because they have a healthy gut.
        
           | 50 wrote:
           | Not "probably" but certainly. Mental illness not just as a
           | psychological or even chemical problem but also as an
           | ontologically-inflected political one.
        
         | yibberish wrote:
         | 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.
        
       | jossclimb wrote:
       | It is no measure of health to be well adjusted to a profoundly
       | sick society.
       | 
       | Jiddu Krishnamurti
        
         | tsol wrote:
         | Which society in human history was not sick? Truth is that's
         | the norm, not the exception
        
           | jerojero wrote:
           | 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.
        
         | concinds wrote:
         | 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.
        
           | soledades wrote:
           | 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...
        
             | [deleted]
        
           | ansc wrote:
           | >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?
        
             | concinds wrote:
             | Good question; I can't read the author's mind since the
             | quote is made up.
             | 
             | But basic logic dictates that the quote (which is
             | apocryphal) means that we cannot deduce that we are healthy
             | simply because we are well-adjusted to society, _if_ that
             | society is sick. It does _not_ say that psychiatric illness
             | is rooted in societal or social problems. And empirically,
             | proponents of the quote (theosophists and Buddhists) also
             | rarely use it to refer to actual psychiatric illness, but
             | rather to moral compasses, values, and overall behavior.
             | 
             | I doubt you'll find many Buddhists parrot the "I'm only
             | depressed because of how messed up society is" line that
             | you often see on the web, since Buddhism explicitly
             | preaches self-transformation.
        
         | serpix wrote:
         | 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 wrote:
           | Sadly, that's not something easy to find if you're not born
           | into one...
        
         | EdwardDiego wrote:
         | But being able to fit into society does wonders for your mental
         | health, so maybe don't listen to random philosophers.
        
           | 1ncorrect wrote:
           | 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.
        
       | narrator wrote:
       | Suicides have been rising since 2000. I think we should go back
       | to tricyclics antidepressants. They worked better than SSRIs.
        
         | jerojero wrote:
         | 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.
        
         | throwaway743 wrote:
         | 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.
        
         | fatneckbeardz wrote:
         | yeah that or 30 hour work week, walkable cities, free
         | healthcare.
        
           | rthomas6 wrote:
           | 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 wrote:
         | Tricyclics are as good as the SSRI, but they aren't first line
         | because of the secondary effects.
        
       | slfnflctd wrote:
       | 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 wrote:
       | "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)
        
       | carabiner wrote:
       | 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?
        
         | automatic6131 wrote:
         | 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.
        
           | narrator wrote:
           | 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.
        
             | feet wrote:
             | To leave a local maximum and find the global maximum, you
             | must traverse the graph downward
        
               | creata wrote:
               | (The singular is "maximum", the plural is "maxima".)
        
               | feet wrote:
               | Thank you for the correction, fixed :)
        
           | throwaway743 wrote:
           | 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.
        
             | automatic6131 wrote:
             | A cause worthwhile advocating for, but do you think you'll
             | get people to stop saying that society is "sick" if you get
             | it?
             | 
             | Hint; Scotland has both universal healthcare and free
             | higher education and also the highest drug deaths per
             | person in Europe - or close to the highest.
        
           | nyanpasu64 wrote:
           | 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 wrote:
           | 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... ^^
        
         | iamevn wrote:
         | Ted Kaczynski like the Unabomber?
        
           | j-bos wrote:
           | He was a well educated terrorist.
        
         | serf wrote:
         | >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.
        
           | tsol wrote:
           | This is a good explanation of what I felt was off about that
           | wording
        
           | soledades wrote:
           | 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?
        
           | dEnigma wrote:
           | Postcard artist and hobby architect Adolf Hitler
        
         | creata wrote:
         | 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.
        
         | EdwardDiego wrote:
         | 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.
        
           | jerojero wrote:
           | 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?
        
       | photochemsyn wrote:
       | 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 wrote:
         | 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.
        
           | photochemsyn wrote:
           | 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.
        
       | jokoon wrote:
       | 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 wrote:
         | 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.
        
           | feet wrote:
           | 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 wrote:
           | 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.
        
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