Robert Whitaker says that 20th century psychiatric medications take what would have been an episodic condition, and make it chronic [0][1].
There are now vastly more people who need help than capacity to help them. I've recently come to appreciate that we have a bifurcated approach. People who have no one to advocate for them get a catch-and-release treatment, because the holding tanks can only hold people for a few days before they have to be transferred for involuntary evaluation or released to the street. Those with an advocate are given priority.
In my state, the process for helping people who don't realize they need help goes 48-hour hold -> involuntary evaluation (3 days max) -> filing of petition for court-ordered treatment (weeks and weeks).
My friend got the catch-and-release treatment once. She'd escaped from her involuntary treatment program, where her ability to control her alcohol intake (the actual cause of her condition) was not helped by the palliative psychiatric drugs she was forced to take. She did well for a month, then resumed drinking.
After a few weeks of drinking she disappeared. Maybe two days later she called and asked me to pick her up from "big city", but didn't give a specific location. A few days later I got a call from a mental hospital. She said she was being transferred for involuntary evaluation, then she stopped calling. Her father said she'd been released.
I suggested to her father that we should file a missing person report. He concurred. When I called the police, the officer said they'd prefer I come down to the main station or a precinct to file the missing person report in person, so the officer would know I wasn't harassing someone. I was also told it'd help to get her family involved too.
So her father and I went down to the main station. The officer working the desk was skeptical, but after a few minutes he agreed to look up my friend. When he came back and said my friend wasn't missing, because they'd taken her back to the crazy-tank the day before.
Her father had already hired a lawyer. The social worker said they have dozens of petitions for court-ordered evaluation expire every week, on account of not having room to transfer the patients for their evaluations. I think the social worker greased the wheels to make sure my friend wasn't released to the street again.
From the fine article:
> But the problem is that scientific research needs to be sound. We cannot build progress on a rotten foundation.
The 'rotten foundation' in our mental health system is treating people's symptoms without concern for their cause. Scientists have actually figured out most of the causes behind patients' symptoms, so we don't actually have to treat them palliatively anymore. It's just conveniently profitable for the system to play make-believe that our current selection of FDA-approved patent medicines are the best we can do.
[0] https://news.ycombinator.com/item?id=15353109 [1] https://news.ycombinator.com/item?id=12068958
[2] https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor - "New research into MAOIs indicates that much of the concern over their supposed dangerous dietary side effects stems from misconceptions and misinformation, and that it is still underutilized despite demonstrated efficacy. ..."
Is this actually true? If so, how widespread is this knowledge, and is there a mechanism for turning science into practice?
https://www.nice.org.uk/guidance/cg90
The most significant clinical problem with antidepressant use is, as the NICE guidance makes clear, that different patients respond differently (or not at all) to different drugs, probably because depression is a constellation of conditions rather than a single disease. I can't speak to other mental health conditions (because I don't have them and don't follow the science at all carefully) but we're a long way from knowing all the causes of depression, let alone knowing how to treat it reliably in all patients.
I believe the rot is based on a commercial desire to ignore the efficacy of placebo's:
https://www.wired.com/2009/08/ff-placebo-effect/
Nobody wants to be told that the only reason the heavy drugs they are taking are effective, is because they believe that they will be better when they take them - but the evidence is mounting that this is indeed the case.
After that there is literally just one fact that possibly indicates manipulating the original study data, which is allegedly omitting one participant’s experiences which were “positive” (as self-reported decades later).
Even if true, the overall study only included some tiny sample size, and if even only 1-2 had harrowing or abusive experiences, which Rosenhan himself had in his own faked hospital stay, wouldn’t that be enough to prove the general point that abuse was shockingly common and patient treatment in these facilities at that time was seriously troubled?
Meanwhile this article itself is also pushing various book ads for the author’s own book.
My takeaway is that Rosenhan may have selectively excluded data, but the point of his paper was much more qualitative and directional in a direction that turned out to be true and led to a huge overhaul of mental health facilities for the better.
If we can prove Rosenhan manipulated data, we should acknowledge that, and it should not be treated lightly. But it also doesn’t seem to invite sweeping reassessment of the original paper at all.
This piece just seems like somewhat of a publicity grab.
If you need help don’t get spooked by the parent commentator. Help exists.
Your story point to that, but also to Patient compliance, which is a serious issue, not just with CNS disorder, but with everything. There is a stigma associated with needing to take medication, and building a habit is typically tough. It’s less of a problem with pediatric cases, which is why we see more long term compliance and more long term benefits when kids with depression are referred quickly to psychiatrist and therapist.
The scientific literature on SSRI support that they are more efficient and have less side effects.
CNS disorders are a real thing, not just something you can snap out of it. It’s a chemical imbalance that can have profound and lasting effects to the brain.
Saying that scientists know most of the causes, is pure bs. I am one of those and I can assure you that we know next to nothing.
Some people like their SSRI's, some people kill themselves soon after starting that class of drug [0] (presumably due to the serotonin syndrome [1]).
> My life was saved by Lexapro, an SSRI.
My friend told me about how Lexapro seemed to help her. But it also didn't keep her from relapsing on cocaine, a pro-dopamine drug. The MAOIs are much more useful for a cocaine-like boost that doesn't make them crash after 20 minutes than the SSRIs, which take weeks/months before most people notice any benefit, and which help some people by helping them "not care" about their life situation.
20 years ago teh scientists figured out that it's not extra serotonin that helps people, but the SSRI's effects on neurosteroids: https://www.ucsf.edu/news/1999/11/5059/scientists-identify-n...
> If you need help don’t get spooked by the parent commentator. Help exists.
My observation is that some people don't actually get the help they need, and deteriorate from defective prescriptions. My friend needed help getting her drinking under control, but all she got was medically assaulted with anti-dopamine drugs (so-called "antipsychotics").
The tragedy is that we actually know how to help people. Some of the MAOIs are much better drugs to use temporarily while helping people deal with "stress".
[0] https://www.madinamerica.com/2016/10/11-9-million-paxil-suic... - I think the damages were overturned on appeal.
A few years ago I caught a reference to a book originally published in 1956 and updated in the 1970's. My local state university's science library has a copy. It talked about the biochemistry of the organisms' response to stress, and the stress response's role in many "mental" conditions. Selye was the author iirc.
A few years ago some researchers figured out that psychotic patients don't make enough cortisol in the morning [0], as Selye's book might've indicated decades earlier.
20 years ago some scientists figured out the SSRIs help some people by influencing the neurosteroids [1].
The tragedy of our approach to mental health is that many/most patients deteriorate due to the FDA-approved palliative drug cocktails their doctors think are appropriate, instead of getting physiologic interventions. The widespread use of anti-dopamine drugs ("anti-psychotics") is a crime against science.
[0] https://psychcentral.com/news/2016/06/04/low-morning-cortiso...
[1] https://www.ucsf.edu/news/1999/11/5059/scientists-identify-n...
Stress/cortisol adversely affects young people's thinking ability: https://www.scientificamerican.com/article/ldquo-stress-horm...
study on the HPA and psychiatric conditions: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3707958/
a) Much of the brain is not understood. Including why consciousness happens.
b) Even if scientists know the cause of mental health problems, that doesn't mean they can treat those causes. Every human who lives long enough will die of a non-treatable disease. Understanding a problem does not imply treatment is possible.
> Understanding a problem does not imply treatment is possible.
correct. But it seems to me like mental health practitioners artificially limit their diagnosis to conditions which can be treated with an FDA-approved pill, when an old-fashioned quaker asylum [0] would be more appropriate.