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Makes me wonder if you're the Scott Alexander alt because this is clearly a mental health practitioner's opinion. All LLMs go off the rails if you keep talking to them long enough, that's a technical problem to be solved in the next year or two, not a reason that human therapists should have jobs ten years from now. OpenAI has already made it a non-issue by just limiting ChatGPT's context window, you'll see this issue more on models that let you flood the context window until the output quality drops to nothing.
Just FYI, a lot of people would much rather spill their guts to an AI than to another human. Also, one of the most common kinds of stress people face is financial stress, and for these people paying for a therapist will cause more stress than it will ever resolve. Mental health professionals are much more useful to the people that need them most when they are free. Far more people will kill themselves due to not getting expensive human attention than will ever kill themselves because their cybertherapist told them to.
Haha I am a physician but I am not Scott and disagree with him on a large amount of his medical opinions.
I think you make a very fair point about access, and I don't have a good counterargument but it is worth noting that people excessively overweight their ability to manage their own health (including health care professionals who have lots of training in knowing better).
I guess the best argument I have is that these days a lot of mental health problems are caused by socialization adjacent issues and solving that with an advanced form of the problem is unlikely to be an elegant solution.
What do you disagree with him on?
The two things that stick out to me the most are his whole distaste for the FDA and his intense dislike of inpatient psychiatric stays.
The FDA does a lot of good and a lot of bad but the ratio is aligned with what we mostly value.
IP is important, I feel like he probably doesn't have enough ED experience and must have worked with shitty hospitals.
Granted the last time I looked at either of these opinions from him was in like 2017? So not sure if he has updated or I'm misremembering.
Also some boring Pharm stuff I remember reading back in the day but I'm guessing his views have changed a bunch and I haven't read much on the new site, dont want to hold that against him lol.
I'm curious as to which of his opinions you disagree with? I personally can't recall anything I've read being obviously wrong, but I would hardly call myself an expert yet!
I only vaguely remember, this opinion formed back when I first discovered Scott which would have been during Trump's original run when most reputable sources of information died.
Probably anything to do with Insomnia, hypnotics, and especially melatonin. That line of research and guidelines is hideously complicated and in the U.S. at least has no clear consensus.
Any stance is wrong lol.
Hmm.. I actually went into depth on melatonin recently for a journal club presentation, and looked into the papers Scott cited. It seems quite robust to me, at least the core claims that 0.3 mg is the most effective dose, though I don't know how that stacks up with current higher dose but modified release tablets (those are popular in the NHS).
Basically there's a lot of evidence and belief it does nothing at all so that the dose doesn't matter. This is countered by people who believe it works great in at least certain settings (ex: "well for general outpatient management no, but for acute crisis in mental hospital/inpatient ward..."). Some people will also argue that you need spaced dosing for efficacy and that that is more important for dosing.
Fundamentally it is extremely hard to do insomnia research because getting the right population slice is challenging. Pursuant to that, it may also be culturally dependent and a million other annoying things.
Stick with what the research YOU find and YOUR attendings say (with the later being important to wellness lol).
If you look at say Trazodone we have a lot of papers and guidelines in the U.S. saying it doesn't do shit.....but then some newer papers saying it's doing some weird stuff and thats the cause of the subjective improvement in symptoms. It is a mess and you'll see a variety of strong and seemingly evidence based opinions.
Saw your PM will reply when I get a chance, I think that needs more attention.
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ED = eating disorder, in this context?
Emergency Department, that's often where the absolute worst psychiatric crisis happen - people who are high as fuck (and eventually calm down before they get to Psych) or incredibly decompensated (and get snowed with medication before they get to psych).
Outpatient Psych types in particular often forget just how bad things can get because the kind of patients who really need inpatient management end up being too disorganized to be seen outpatient and get disposed first to the ED, prison, or state level hospitals. .
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I just can’t get excited for AI therapy because honestly, unless you have literally nobody in your life to talk through things with, there’s no value to therapy. I just don’t see people with long-standing issues get better because they had therapy. In fact, some people have therapy for multiple years without ever getting to the point of not needing therapy anymore.
I’m very much of the Stoic/CBT/Jordan Peterson school of therapy. Over focus on feelings and overthinking problems not only does not work, but quite often makes your original issues much worse. The key to getting better (barring something organically wrong with your brain — and that’s fairly rare) is to get out of your own head and get into taking productive actions to make your life better. Feeling bad about yourself is much better treated by becoming a better person than by sitting around trying to convince yourself that just because you haven’t ever done anything useful doesn’t mean that you’re useless. Get out there and start building, fixing or cleaning things. You’ll get over feeling worthless because you’ll know you did something useful.
Maybe your sample just isn’t representative? I don’t know anyone who claims their life turned around after confession, either, but that doesn’t mean it can’t happen.
I mean, I don’t know anyone who claims they decided to turn their life around after confession either. The usual claim is deciding to go to confession after making up one’s mind to turn their life around.
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Confession is not the same as a long conversation with a pastor or priest about serious life issue or worries. I tend to think that people who know you well will give better advice than someone whose paycheck depends on telling you things that will make you happy.
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Uh, isn't the evidence that therapy- or at least forms of therapy- is genuinely helpful to people with actual mental health issues- or at least some subset thereof, eg PTSD- pretty ironclad?
Thankfully I do have my effortpost/AAQC on the topic handy:
https://www.themotte.org/post/983/culture-war-roundup-for-the-week/209218?context=8#context
(In short, yes)
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