mental health, psychiatry, and friends 💊 🩺

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

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 in

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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 f... 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

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

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.

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Some people, especially those who are autistic, dohave a flat emotional affect, do rely on scripts and do have a clear-cut sense of justice which leads them to cut off those who transgress it. When we talk about these traits as inhuman and robotic, what are we implying about the people who display them? The impulse to be unapologetic about emotiona... See more

Also, psychedelics have a fundamental discordance with allopathic research which can never be overcome. The placebo problem is unsolvable. And these medicines are customarily adjacent to non-directive therapy, and ongoing integration. We'll never be able to quantify those things in a trial format the same we we can for a blood pressure pill. Finall... See more

With that investigative spirit, Halsted had embarked on experiments with cocaine—then touted as a wonder drug—with a group of colleagues in 1884. Submitting themselves as test subjects, they explored the drug's pain-numbing abilities by injecting it into their peripheral nerves. In doing so, they would advance the concept of local anesthetic, a cri... See more