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. ..."
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.
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/
> 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.