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0 pointslutusp12y ago0 comments

> Cool sentiment, but what makes you think other "hackers" have the formal background to reach out and to a depressed person?

Excuse me, but what "formal background" is that? It's not as though psychology is a science, or that psychologists know what causes depression or how to treat it -- public evidence clearly proves they do not.

The field of psychology is such a disaster that the director of the NIMH recently ruled that the DSM (psychology's "bible") may no longer be used as the basis for scientific research proposals, for the simple reason that it has no scientific content. The director said:

Source: http://www.nimh.nih.gov/about/director/2013/transforming-dia...

Quote: "While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity."

"Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment. Patients with mental disorders deserve better. [emphasis added]

As to depression specifically, psychological treatments are notoriously ineffective, but alternative neuroscientific approaches like deep brain stimulation (DBS) are showing great promise. A recent flurry of treatment outcomes that apply deep brain stimulation lead to outcomes in which, by throwing a switch, a brain surgeon can literally turn depression on and off.

Source: http://www.nytimes.com/2006/04/02/magazine/02depression.html...

Quote: '"So we turn it on," Mayberg told me later, "and all of a sudden she says to me, 'It's very strange,' she says, 'I know you've been with me in the operating room this whole time. I know you care about me. But it's not that. I don't know what you just did. But I'm looking at you, and it's like I just feel suddenly more connected to you.' '

"Mayberg, stunned, signaled with her hand to the others, out of Deanna's view, to turn the stimulator off."

'"And they turn it off," Mayberg said, "and she goes: 'God, it's just so odd. You just went away again. I guess it wasn't really anything.'"'

I emphasize this procedure is still experimental and is not yet being offered as a clinical treatment. My point is that people need to get over their reverence for psychology -- it's not scientific, and there's no evidence that it is effective in any scientific sense.

This may come as a surprise to some, but within the mental health field, a revolution is taking place -- a revolution that intends to replace psychological treatments with neuroscientific ones.

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dfraser99212y ago

The DSM is not the "bible" of psychology, but psychiatry. They are two completely different areas of science, and the therapists I've talked to over the years have all, more or less, been very useful for getting a handle on my depression and understanding myself and why I operate like I do. I know a tremendous amount about this topic, having gone through several nasty bouts myself - and having a B.S. in psychology (and computer engineering, as well, which is why I'm on HN)

Psychiatry, however, IMO, is for the most part, useless. Psychiatrists should only stick to dealing with things that have a predominately biological basis, like schizophrenia or bipolar disorder. Garden variety stuff like the "common cold" form of depression should be dealt with using talk therapy. Every psychiatrist I've talked to in an attempt to get a mild antidepressant has resulted in frustration - they are all arrogant SOBs as far as I'm concerned who want to stick you onto the heavy duty addictive crap before trying the easier to deal with drugs - as an engineer, my attitude is try the simpler solution first and only if that doesn't work, rewrite bloody everything (if my brain was a software program...) So I've had to self medicate - I found research indicating the particular subtype of depression I suffer from would be best treated with bupripion, but the last doctor ignored me... so now I am going to pretend I'm a smoker and buy Zyban over the internet to get what I am sure I need. Or I could use nicotine patches as a mild antidepressant (according to the latest research). As a hacker, I see nothing wrong with hacking my body :)

But adding a drug into the system known as "me" isn't going to magically fix everything - I have to change my behavior as well, which is harder and that sort of thing require understanding psychological principles, not psychiatric blather about neurotransmitters being the root of all the problems. It's like people want to fix a software problem by replacing chips on the motherboard! And they aren't even sure exactly what chips!

Scientology is a crock of BS, but they do have a good point about psychiatry being a problematic profession. I would never discard what I've learned through psychotherapy, but drugs... treating mental illness strictly as a medical / mechanical issue is very shortsighted.

The trend over the past few decades has been an increasing emphasis on the biological aspects of 'mental illness' - when you examine the history of the two fields, you can see a swing between the two extremes - e.g. when Freud's theories started getting attention, an increased emphasis on the psychological aspects of mental issues became prominent in society and it become fashionable to be seeing a psychoanalyst.

But psychoanalysis, like that promoted by Freud, isn't that helpful for the most part in solving problems, so the trend started swinging back to biological especially after research etc started uncovering the biological aspects of mental illness (serotonin, LSD research, etc). Thus the 'magic bullets' became drugs and since they are cheaper and more profitable than talk therapy (and "easier" for the patient as well) that became the emphasis.

For some reason, viewing the whole issue as the interaction between psychological issues and biological factors isn't viewed as important - as an engineer who understand this stuff better than the usual layperson (though I'm not an expert) it is frustrating because it is so obviously just good engineering to view a person as a system - biology matters but so does environmental issues (family history, current life of the patient...) Drugs are cheaper and more profitable...

But yes, the DSM has gone quite downhill over the years in its usefulness. So if you change, in your post, "psychology" with "psychiatry" I won't down vote you.

And if one's depression is caused by environmental issues, like work related stress, or family, or "meaning of one's life" - they are not going to go away once you start taking the right drug or zapping the depression away. And thus it'll only come back eventually.

Another big problem is that "depression" is such a fuzzy label - there are many subtypes and each need to be dealt with in a specific way. I came across a book a few years ago that correlated what was known about different areas of the brain and their function and how different drugs affected each differently - i.e. something leading to theories on what type of antidepressant would be best for a patient given the symptoms they were exhibiting. Thus my theory on why bupripion would be better for me than Paxil (which was useless). But like with the low fat vs low carb controversy of dieting, medicine is afflicted with fads and trends - just like IT (are all problems solved with NoSQL? of course not, but lots of people seem to think that. same with the virus known as Agile)

lutuspOP12y ago

> The DSM is not the "bible" of psychology, but psychiatry. They are two completely different areas of science ...

First, mental health professionals disagree with you -- the DSM is the standard guide for all mental health diagnosis in the U.S. and to some extent elsewhere, in both psychiatry and psychology.

Second, neither psychiatry nor psychology are scientific enterprises, as you have just proven.

What do I mean? Let's look at a real science -- physics. Within physics there are any number of specialties -- let's look at two: cosmology and particle physics. Cosmologists study nature at the largest scale -- the entire universe. Particle physicists study nature at the smallest scale -- below the size of atoms.

But, notwithstanding this apparent difference in focus, cosmologists and particle physicists recognize their respective fields as both grounded in physics, and they productively attend each other's conferences. These two specialties are united by (a) science, and (b) a common desire to understand nature.

Psychiatrists and psychologists, although apparently specialties in the same field (human psychology), insist (as you now insist) that they're not related. And they're right -- the reason they're not related is because human psychology offers no central corpus of scientific theory to join them together, in the way that the standard model joins cosmology and particle physics, and in the way that the theories of evolution, natural selection and cell biology unite biology and medicine.

If human psychology were a science, psychiatrists and psychologists would endeavor to explain what they are satisfied to describe, these fields would be joined by reliable scientific results and theories, and the DSM would not be rejected by thinking people everywhere, including the director of the NIMH, who recently ruled that the DSM may no longer be accepted as the basis of scientific research proposals, for the simple reason that it has no scientific content.

> I know a tremendous amount about this topic ...

All except the single most important thing to know -- psychiatry and psychology are not sciences -- they're primarily steered by anecdote and belief.

> Psychiatry, however, IMO, is for the most part, useless.

How typical. Need I tell you that psychiatrists say the same thing about psychologists?

> Another big problem is that "depression" is such a fuzzy label ...

This is why the world is moving on from psychiatry and psychology, toward neuroscience, where (among other things) deep brain stimulation is showing very promising results where psychological treatments have failed.

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