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Comment by tokenadult | Hacker News Reader

What does he propose to do to demonstrate that some new way of treatment has greater safety and effectiveness than the way he desires to replace?

For historical perspective, the author of the opinion piece kindly submitted here has been practicing medicine for about as long as I have been an adult. At the beginning of his practice, the Freudian paradigm of "treatment" was just beginning its long decline into the ash heap of history, after decades of not working for patients. The current use of antipsychotic drugs to treat schizophrenia is imperfect, to be sure, but it is much better than what came before.

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How reflexive a dismissal this is can be seen in how you pooh-pooh the author's 30 years of experience, yet don't pay enough attention to read her name.

Edit: I'm afraid the "historical perspective" you supply is not very historical. The decline of Freudianism began long before the 1980s, and pharmaceutical psychiatry has a much longer history than you imply. The antipsychotics that Steingard writes about were discovered about 60 years ago—something you might have learned from the fifth paragraph of her article. It is highly unlikely that she was trained as a Freudian; she says she spent 20 years routinely prescribing antipsychotics.

I am past my edit window, so I can neither delete the post above or edit it, but the replies that suggested I read the article kindly submitted here too hurriedly are correct. Sorry about that. On second reading, I think the doctor who wrote this article is trying to assimilate the latest research on long-term effects of antipsychotic drugs. The headline writer indeed didn't do her argument justice. I should have looked past the framing of the argument from the headline and dug more into the details before replying. I agree with her that it is a good idea to have a direct conversation with patients and ask, "Now that you've been on your medications for a while, and you are aware of the difference between your thought processes when you weren't treated, and your thought processes now, do you dare to reduce your medication dose, or stop it entirely, in view of the side effects from the medication you are experiencing?" That is a reasonable question for a physician to ask, and doesn't presuppose an answer from the patient.

Thanks to the participants here who openly disagreed with me and prompted me to read the article a second time when I didn't have an appointment rushing me out the door.

Are you commenting purely from the headline? It doesn't seem like you read the article.

> Half remained on drugs continuously; the others stopped taking drugs when they became well but restarted them if symptoms emerged. After seven years, the researchers found that those who were not continuously on drugs had a much greater likelihood of getting a job and resuming their regular life activities than those who remained on medications. Remember that people who stop drugs have a higher rate of relapse? It turns out that over the seven years, those who remained on the drugs relapsed as often as the others.

"What does he propose to do to demonstrate that some new way of treatment has greater safety and effectiveness than the way he desires to replace?"

His point is that they are evidently not safe.

There's good old fashioned self-discipline available for most people. I mean, just because you're having mental issues doesn't necessarily mean you can't step outside yourself and understand and assert self control.

This is a bizarre post.

How exactly does someone who is having auditory or visual hallucinations exert self-discipline?

I'd certainly agree that some people know the voices they hear are hallucinations, and that some of those people live happily with those voices and don't need meds. Is that what you're trying to say?

Because it sounds like you're saying "pull yourself together", or "try harder" or similar.

Someone who has a severely broken leg needs to have a cast and needs to do the physiotherapy, and both of those need some self discipline. But after that discipline isn't going to make the bone knit faster.

Many people with "mental issues" can't just think themselves better.

Judging from the downvotes, looks like I've run into an institutional dogma here.

To a large degree and for many people, mental health issues are something the individual can deal with on his own. To the extent that one can he should be urged to do so, not be put on drugs which we simply do not know all the unintended consequences of.

I know that is an unpopular sentiment in our culture but it's the truth.

To be more specific: often it's bad ideas and habits that lead to most mental health problems. E.g. if you sit around all day watching TV that's not good for your mental health. Everyone can choose to not do that, on their own, without drugs.

It's really bizarre, and telling, that in this culture you're not permitted to suggest that mental health problems can be caused -- and therefore, remedied -- by personal choices.

It's not only bizarre, it's perverse and sick. No wonder mental issues are running rampant.

> just because you're having mental issues doesn't necessarily mean you can't step outside yourself and understand and assert self control.

is this sarcasm?

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