What do you think about psychiatry?

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teo123
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What do you think about psychiatry?

Post by teo123 » Sat Aug 10, 2019 9:36 am

So, what do you guys here think about psychiatry?
My mother has been complaining about hearing voices that frighten her, and I am not sure if visiting a psychiatrist if you are mentally ill is a good or a bad idea today. Psychiatry has a terrible track-record of basing itself on science. Its history is basically a history of wrong (if not simply crazy) ideas that costed the patients a lot until they got corrected. You know, from the Freud's idea that cocaine is a cure for many mental illnesses and that most mental illnesses were caused by being a victim of paedophilia, to the ideas that schizophrenia can be cured by destroying the frontal lobe of the brain or the electric shocks.
And, as far I know, there is little evidence that anti-depressants and anti-psychotics work any better than placebo. There is also no scientific explanation of how they are supposed to work. We don't know what causes depression. We also know very little about what happens in our brains when we hear something, and we know basically nothing about what happens in our brains when we hear something that isn't there, and even less about how the anti-psychotics are supposed to work.
Without a doubt, 50 years ago, visiting a psychiatrist was a bad idea. It's hard to tell whether it is a bad idea now. It's certainly not as extremely bad idea as it was 50 years ago, but it could easily still be.
What do you think?

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Jebus
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Post by Jebus » Sun Aug 11, 2019 1:57 am

There is too much to address here. Basically, you need to do a lot more reading about psychiatry until you get a better understanding. I doubt you even know the difference between psychiatry and psychology. You wrote about psychiatry but used Freud (who was completely against psychiatry) as an example.
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teo123
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Post by teo123 » Sun Aug 11, 2019 3:09 am

Jebus wrote:Basically, you need to do a lot more reading about psychiatry until you get a better understanding.
Well, I need to make a decision now, and it might affect the life of my mother and me significantly, for better or worse. I don't have time the time to do a lot more reading.
Jebus wrote:I doubt you even know the difference between psychiatry and psychology.
Well, the right question to ask is what the similarities are. Psychology is a science that primarily studies perception. Illusions, for instance, are a big topic in psychology. It also studies memory, for instance, why people often falsely remember stuff. And, although this is not a major topic, it also studies how to recognize emotions and what causes emotions. Of course, sometimes this borders with sociology and other sciences.
Psychiatry studies how to cure mental illnesses, that is, persistent mood and behaviour disorders, sometimes accompanied by hallucinations, supposedly caused by illnesses of the brain.
Jebus wrote:You wrote about psychiatry but used Freud (who was completely against psychiatry) as an example.
What do you mean Freud was against psychiatry? Sure, he tried to help some patients just by talking to them. But he also tried to cure some patients with cocaine. That is fundamentally no different from what psychiatrists are doing today: giving people drugs that they can't explain how they are supposed to work, for which there is little or no evidence that they actually work, and which have side-effects (though cocaine has much worse side-effects than modern anti-depressants and anti-psychotics do).

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Post by teo123 » Fri Aug 16, 2019 4:57 am

@brimstoneSalad, what do you think about this issue?

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brimstoneSalad
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Post by brimstoneSalad » Fri Aug 16, 2019 4:59 pm

@Jebus is an expert in this field, so I would defer to his judgement here. He knows his stuff here a lot better than I do. My study is mostly limited to the data relevant to philosophy rather than clinical application.

I can comment briefly on this, though:
teo123 wrote:
Sat Aug 10, 2019 9:36 am
And, as far I know, there is little evidence that anti-depressants and anti-psychotics work any better than placebo.
1. Placebo effect is incredibly strong for psychological conditions, at least initially. We're talking about "mind over mind" here rather than "mind over matter". So not working much better than placebo (they do work a little better) isn't really a serious accusation in psychology.

Medication works, placebos work, they both work.
Compare to something like cancer, which is at the opposite end of the spectrum, and doesn't respond to placebo at all.
Whether you get your mother a placebo or medication, both are likely to help a little if she thinks they will.

2. The problem with testing these medications is that the very strong effects some people experience are diluted by the inefficacy that others experience. Most of these medications only work VERY well for a small number of people, so you have to keep switching medications and working with dosages until they work well. Clinical trials don't do this, they focus on specific medications and dosages in a large pool of people and the non-responders mess up the results.

The efficacy of certain medications for certain people is so strong that there's no doubt for practitioners that they work despite the difficulty of proving it clinically. You just have to keep at it. I know that sounds like a leap of faith and it's a difficult thing to contend with, but it's a consequence of how these things work with individual biochemistry and how different that is from person to person.

It's like if you just put a cast on everybody who had leg pain. The people with broken legs would benefit a lot, but people with other problems might just have the side effects of the cast with no benefit. We know that some things work for some people, but we're flying blind when it comes to knowing which medication to give which people so it's a lengthy process of trial and error on an individual level.

There are some people who don't respond to anything at all and suffer with dehabilitating depression, etc.
There's recent evidence building (now that government is finally allowing it to be tested) that very small doses of LSD may be a game changer and successfully treat previously untreatable depression. It looks like it could be a silver bullet. Maybe we'll have something like that some day for psychosis, but today we're stuck with almost blindly trying things until something works well. You likely will reach that point if you keep trying medications as evidenced by the large number of people who are managing their conditions with medication (and get worse when taking the medication away), but it takes real work and dedication to get there. Some combinations may even make things worse temporarily so you have to be vigilant and work with your practitioner.
teo123 wrote:
Sat Aug 10, 2019 9:36 am
There is also no scientific explanation of how they are supposed to work. We don't know what causes depression. We also know very little about what happens in our brains when we hear something, and we know basically nothing about what happens in our brains when we hear something that isn't there, and even less about how the anti-psychotics are supposed to work.
Something is going wrong, and it's kind of like smacking a TV that's not working. Sometimes it helps, and maybe the TV just started working right after you smacked it, but probably not because that would be too much of a coincidence (particularly when it happens multiple times). Or opening it up and randomly pushing on some wires and tightening screws. Sometimes you randomly get it to work and still don't know what was wrong.

Just because we don't know exactly what's wrong doesn't mean we can't determine beyond a reasonable doubt that randomly doing things helped for some unknown reason. The evidence of people relapsing when they stop their medication is a good indication of that (they don't expect to relapse, they think they're better so they stop but then get worse again), it's pretty much a cliche at this point.

It's not a sure thing, but a professional is way more likely to help than hurt.

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