Comment by logicchop | Hacker News Reader

Comment by logicchop | Hacker News Reader

The author's point is well-taken; but I don't think the problem is simply that psychological problems have become "de-personalized," and I think the move to "chemical" explanations is largely because the "chemical" treatments have been wildly successful (especially in comparison to, what? psychotherapy? talking about it?).

I think the actual crisis is a lack of good judgment in the scientific arena. There are obvious cases we can imagine where a "chemical" explanation is simply bone-headed. Joe's dog dies, his house burns down, he is laid off from his work. His resultant emotional distress surely involves chemistry; he's a person, after all. But it is depersonalizing, naive, and a bit creepy, to suggest that his distress is "just chemical" and should be treated with a drug. That's just gross, and I take it the author's point.

But consider another example. Terry has great friends, rewarding job, engaging hobbies, etc., but spontaneous and overwhelming anxiety over the possibility of being hit by a meteorite. This is now entering the territory of an irrational psychological reason, and it isn't "de-personalizing" or naive for a doctor to suggest that there might be a purely chemical explanation. We seek the chemical explanation when there just isn't any other sufficiently motivating factor.

There's a time for both approaches.

I think you're overstating the success of chemical treatment. I'm not extremely well versed in the subject, but I've read a number of books and articles that seriously call into question that idea.

It would seem that "talking about it" is actually more effective than medication in many circumstances (e.g. the research on cognitive behavioral therapy versus medication).

The consensus at this point seems to be that we do not have any real causal theory for most mental illnesses, including depression.

You might have an Aristotelian sense of "success" in mind here (meaning that it covers something like the long-term overarching benefit of the person), but I don't. I just mean success as in, anxiety medication actually improves anxiety; depression medication actually improves depression; attention deficit medication actually improves attention. Whether there are better ways for us to achieve long-term outcomes is a different issue.

Except sadly that's not true. Anxiety medication usually does not improve anxiety. Same with the rest. But sometimes they do, and when it works it's enormously valuable to people.

Medication and talk therapies (including CBT) are more or less tied, from what I've heard.

Antidepressants are not much more effective than placebo, which is a problem if you're a drug researcher, but as a patient it doesn't really matter that your relief actually comes from placebo effect.

> I think the move to "chemical" explanations is largely because the "chemical" treatments have been wildly successful

This. The fact that "the mechanism of action remains a mystery" doesn't mean we shouldn't do anything about it. Those drugs work, and AFAIK they are pretty safe. The same can be said about many other disorders that we don't know the mechanisms of action, but we still use drugs that seem to be successful (schizophrenia, OCD, Tourette, etc.). Depression and anxiety seem to be much more stigmatized when drugs are involved. I agree the diagnostics are all over the place, though. You can be sad and not be depressed, and you can be stressed without having an anxiety disorder. Doctors should be more rigorous and not default to antidepressants for every patient they see.

Some people cannot break a million years of evolution baggage and have a job or friends - it is unnatural. What we think is normal these days hardly even resembles conditions we evolved to thrive in.

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