The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:
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Requests for advice and / or encouragement. On basically any topic and for any scale of problem.
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I’ve started seeing a therapist. If you had told me 6 months ago that I would be in this position today, I would have called you insane.
I’m still fiercely critical of the “medical model” of mental health, and find much in contemporary “therapy culture” that is deeply disagreeable to me. You can’t manufacture human subjectivity on an assembly line. But, the fact that I’m seeing a classically trained Lacanian psychoanalyst rather than a more “mainstream” therapist is part of what allowed me to reconceptualize the enterprise enough that it became palatable.
I don’t have much of a point in posting this besides: if you feel like you’re stuck in a rut and things will never change, you can have hope. Sometimes radical change can happen very fast if you just give yourself a little push.
Keep in mind that tens of thousands of experts in a variety of fields over multiple decades and many paradigm shifts are actually thinking about this and working on epistemic certainty.
Not every therapist is academically minded (and many types of degrees don't engage with this at all) but despite anti-psychiatry people the field is more scientifically minded then you might imagine but it rarely comes out in frustrated opinions by people who are mad that things aren't going the way they them to.
For instance for nearly a hundred years, there was a pipeline from Psychiatry to neurology. Once medicine understood the disorder better (for example, Alzheimer disease) it moved fields. This means that Psychiatry is naturally left with the less understood stuff.
However diagnostic entities like Schizophrenia are pretty well understood with clear medical shit (such as direct identification of neurotransmitters and pathways).
The more common and less severe things (such as simple anxiety and depression) are less understood but you better bet that experts in the field have a decent enough understanding of what's a severe biochemically mediated depression and what's more likely to be SLS (shit life syndrome).
These conversations and investigations happen they just don't make it to you.
How sure are you about that? Skimming recent reviews, I'm seeing a whole lot of
The literature overall does seem extremely long on "medical shit" in the sense of suggestive genetic associations, claimed biochemical correlations and grand hypotheses, but still very short on clarity and well-verified soup-to-nuts pathways. It has the patina of science! that you'd get if you hit literally any biological thing with a bunch of GWASs, but what would be your cite for this being clear and well understood actually?
Yes I'm sure. Your linked quote is just filler words in an abstract, we know plenty about the pathophysiology of Schizophrenia with specific gene targets (although it is not fully understood), asking a question about the nigrostriatal pathway is a med student level question. It's likely appropriate to say that we have a better understanding of Schizophrenia than Parkinson's, and it's 100 percent appropriate to say we have better treatments. We understand Schizophrenia more than most of the dementia types (including the billions of dollars in research for Alzheimer’s). We understand Schizophrenia infinitely better than depression, which is why depression is a common topic when complaining about this.
Now do we understand it enough? No. We can reduce the risk of conversion from genetic risk to illness (ex: avoid weed) but not stop it, which would be the goal. But we can't also do that with Type 1 Diabetes or MS, and while we have an elevator pitch for what causes those now it's by no means a solved problem.
Schizophrenia in particular is unique in that the vast majority of cases are essentially a lifestyle disease problem - reducing morbidity and mortality is a matter of social solutions and ethics, the treatments are what we need already.
Right, yes, I hear that you are asserting this. However, in skimming the literature I'm seeing lots of suggestive findings about genetic and environmental risk factors plus some very partial/local mechanisms, portions of which are being built into assorted models and hypotheses, all of which seem to be discussed with considerably more awareness of limitations than you use. The condition appears incredibly complex with neurodevelopmental, metabolic, immune involvement and I'm not immediately seeing anything that looks like a clear etiology that's supported by solid fieldwide consensus. However, I would certainly be very interested to learn about this if it exists.
Thus, could you help me understand what's going on, by providing the references you were thinking of when you initially said that schizophrenia was "well understood"?
My understanding is that the field believes that the majority of cases stem from a classic "2 hit" model. You have genetic load (with some of these genes being explicitly known) and secondary insult (with some of these insults being explicitly known, such as synthetic marijuana). Some of the details of what translates that into illness are less clear, but we can point to specific brain pathways and impacts on neurotransmitters, and this is extremely clear because of how clearly "traditional" antipsychotics work and how questionable most of the other treatments are (ex: Cobenfy).
Additionally we are talking about concerns about the medical model of mental health, with the implication being that the medical model doesn't have much to add or has some inaccuracy issues, but Schizophrenia is a good example of a disease that we know as much or more about than some "strictly medical" diseases - examples I gave were Parkinson's, Alzheimers, MS, DM1 (and sure in many ways DM2).
The existence of knowledge gaps doesn't mean we know nothing or that the models we do have have no utility, which is often the complaint.
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