mental health, psychiatry, and friends 💊 🩺

There is only so much powerlessness, so much indignity in the mounting pressure that people can tolerate, and God, family values, or appeals to a mythical utopian past quite frankly are not going to change a single concrete thing for them. Resorting to the dopamine rush of endless scrolling, or to the sticking-plaster medical intervention of SSRIs,... See more

The search for root causes often means a life event that has triggered the mental disorder. When I hear people talk about root causes, it usually means they are not happy with a biological explanation and want something more psychological, more meaningful, more profound.

In clinical practice, this is tricky though - we can rarely, if ever, put our... See more

The same is true for any assumption that holds the mind or its pathologies to be inexplicable in some fundamental sense: it can only lead to extremely bad explanations. We have no choice but to treat mental illness as unknown but knowable .

We psychiatrists tend to start our first sessions with some variant of the question: “What would you like to change?” People often list negative goals: to be less depressed, stop using drugs, feel less anxious, etc. It’s a start, but we often need more. There is a helpful reframing found in Acceptance and Commitment Therapy: no dead person’s goals.... See more

1. Some therapists have an overly reductive understanding of psychiatric diagnosis. They seem to think a diagnosis of mental disorder necessarily implies there is some intrinsic brain abnormality. They think if someone’s symptoms can be explained with reference to a history of abuse or trauma, then a diagnosis doesn’t apply to them. The logic is so

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Many scientific theories assume constructs that are not directly observable (muons, genetic drift) but whose existence is inferred. In mental health research, psychiatric diagnoses play such a role. We assume that constructs, such as schizophrenia or alcohol use disorder, exist but we can only observe the signs, symptoms, and course of illness that... See more

Philosophy of science has had a long-running debate about the status of such postulated entities. Two major positions have evolved: scientific realism and instrumentalism. Advocates of the former argue that these constructs truly exist. Instrumentalists are more modest and argue that such constructs should be treated as tools and evaluated on their... See more

People who are miserable are ugly and unapproachable and have a “victim mindset” because they can’t accept that it is all their own fault, and therefore they are bad. People who are happy must be strong and living virtuous lives full of beauty and tradition. People who are not must therefore be weak and moral failures. This framework of logic makes... See more

Studies have shown promise in treating Alzheimer’s and Parkinson’s with GLP-1 drugs, perhaps by regulating insulin levels and reducing inflammation, and the drugs may yet prove useful in treating many other conditions made worse by chronic inflammation. Some studies have found large decreases in the risk of depression and anxiety; others found... See more