HN Theater @HNTheaterMonth

And from the other side of the aisle, "Why I Quit Being a Therapist":

https://www.youtube.com/watch?v=f0Fi32LbXHA

⬐ Jimpulse

Wow thanks for the opposing perspective. Seems like even as a therapist you're still fighting the system and still only able to treat the symptoms.

⬐ ratling

I can see why they would be good at doing IT.

⬐ rlue

I imagine that OP has done his due diligence, but if it were me, I don't think I'd handle the transition very well. Like any other branch of medicine, psychiatric practice is tightly regulated, and operating outside the standards of the professional community is strictly forbidden. That means that innovation is no longer part of his job description, as that responsibility falls principally to researchers.

In other words, OP has basically left his job as a developer (of software) to be a sysadmin (of humans). Not to disparage the choice, or even remotely suggest that it's the end of the road! Only to say that existential dread can await you no matter what path you choose.

⬐ afterburner

> a sysadmin (of humans)

Lol, that's a terrible way of putting it. A sysadmin has a lot of power over the systems they control. A therapist is like a consultant brought in to evaluate, but with no actual power.

⬐ foxhop

Daniel Mackler is amazing. Although to be fair, his YouTube channel is basically free Therapy sessions for the masses (and himself).

I subscribed a while back and watch all his videos

⬐ julienmarie

Something interesting is making a mental "disorder" a sickness. A mental trait becomes a disorder when this trait no more compatible with social norms ( it breaks the order of things, hence disorder ). Hence the pain. And we assume a pain is a sickness that can be cured, medicated.

Medication do not solve the root of the pain. Our brain is more than a chemical balance. It's a neural network, trained on the training set of our childhood. There is this fundamental age around 6-7 years old where the child creates its identity picture, its definition of self, which becomes the blueprint of its personality trait and evolution. This blueprint causes what psychoanalysts call "neurosis". When digging into it, there are so many things that makes sense in the field of psychoanalysis, and the parallels with neurosciences and even AI are staggering.

Little nuggets I found enlightening in my day to day perception of life :

- We learn language and the meaning of things from others ( our parents usually ). As a consequence, we naturally expect truth and meaning to come from outside. That's why we look for confirmation from others. That's why we expect the people we fall in love with to give our life meaning.

- We create our identities based on our environment. We define ourselves against the others as to define is to draw a boundary, a difference. That's why you'll often see the cliché in family where if the elder's dominant trait/definition is to be good at school, then the second child will take the opposite route.

- Our neurosis is mostly our limiting factor to approach life. This is what we fight against everyday, this is the wall between what we can be and what we are.

I understand this can be seen as a controversial view for many.

I'm no psychiatrist or psychoanalyst, but was raised in a psychiatrist / psychoanalyst family. A weird but enriching experience.

⬐ exolymph

> Medication do not solve the root of the pain.

Contradictory anecdata: Therapy never helped me until after I started taking venlafaxine (generic Effexor) which took away my anhedonia and made it possible to process my trauma productively, rather than continuing to wallow in misery and dysfunction.

⬐ arkades

This, btw, is the standard perspective on medication in the psychiatric community. It's uncommonly the answer in itself, but it puts the person neuropsychiatric state in a mode that is amenable to improvement.

The data tend to support that medication + therapy is significantly better than either alone for mood disorders, which is what gives rise to that conclusion. Spend a week on an inpatient ward with really sick people that were failing on outpatient therapy and meds, and see how quickly they improve in therapy once their meds are appropriately modified. Or look at folks with something like bipolar disorder, where only medication (and only a subset of that) has been shown to decrease the (upsettingly high) rate of completed suicide.

The OP video's assertion that medication is useless is baffling to me; I can only assume that they spent their career with reasonably functional personality/mood disorders in a primarily outpatient setting. Which is another way of saying, if you only ever see the common cold, of course you'd think IV antibiotics are useless overkill.

⬐ copperx

Another Effexor success story here. After spending most of my life suffering through mood changes for no reason (e.g., sometimes I got sad after seeing a color, or the way that something was arranged -- I've called this "emotional synesthesia"), Effexor has made me a normal person again. I've been taking the lowest dose for 7 years now, with no side effects besides dulling of emotions (interestingly, it makes decision making hard -- for me, it now requires me to write a pro/con list when facing a decision because there are few emotions involved, even when buying something that should be slightly exciting, like a new car). As someone who had a great childhood and no major traumas, it makes me wonder if I'm one of the people who have a legitimate "chemical imbalance".

⬐ iamnothere

> (interestingly, it makes decision making hard -- for me, it now requires me to write a pro/con list when facing a decision because there are few emotions involved, even when buying something that should be slightly exciting, like a new car)

This is actually a known phenomenon! Emotions are key to the decision-making process, and when they are impaired for whatever reason then you are more likely to make suboptimal decisions. I recommend Antonio Damasio's book Descartes' Error for a good picture of how this works.

⬐ copperx

Thanks for the book suggestion. I'm now wondering whether an overactive emotion circuitry makes one an even better decision maker or does it impair it? Perhaps the book will provide some insight.

⬐ PavlovsCat

> As a consequence, we naturally expect truth and meaning to come from outside. That's why we look for confirmation from others.

Yes, we look for confirmation, just like we give it, but that's not all, we also decide how to weigh opinions based on our opinion of the people holding that opinion. I mean, how can others give you confirmation, if they in turn get their truth and meaning from the outside? That'd just be pointers going in a loop. By the same token "the outside" can tell you anything, you can tell "it" anything.

⬐ smhost

That comes later. Our world would be nothing but confusion and trauma if we all came into the world as aware as we are now.

⬐ PavlovsCat

For some it never comes, that's the problem. edit: apart from "being aware" being kinda unrelated to anything I wrote, since you can still be unaware or aware as "your own person" or as someone who "gets meaning and truth from the outside".

> that's why we expect the people we fall in love with to give our life meaning

Surely that doesn't describe infants.

In that comment I just see things about either getting meaning from others, or trying to be different from others, which is claimed to be our main "limiting factor in life". "Imitating someone" and "trying to be different from someone" are two sides of the same coin, and while necessary for early development, not all there is. Come to think of it:

> The emergence of the stranger and his externalization stands in direct relationship to the degree of impairment of that which is most personal - namely, a person's identity. But how can inner development take place in children if everything that makes up their individuality is rejected and made foreign? Then identity is reduced to adaptation to those external circumstances that insure a child's psychic survival. Children do everything to fulfil their parents' expectations, and the way they do this is to identify with their parents, but then the child's individuality is replaced by a foreign element. That is why the 18th Century English poet Edward Young wrote: "We are born as originals, die as copies".

> An identity that develops in this manner is not oriented to its own needs but to the will of an authority.

[..]

> I want to emphasize that the "stranger" in us is bred by a culture that won't accept the spontaneous expression of children's aliveness and vitality. This aspect of a culture gives rise to violent behavior and is responsible for the development of deficient identities. Personalities formed by the processes producing the inner stranger were never able to develop trust as an underlying component of their personality. Instead, they take on a "false identity" that makes them idealize repressive authorities in the hope that they will be rescued by the very people who are their tormentors.

-- Arno Gruen, "The Need to Punish - The Political Consequences of Identifying with the Aggressor"

And that's what I hear when I read that "we" expect people we fall in love with to give our meaning life, as if it relieves us from the pain of pointlessly seeking to be different, which just limits us. As if uniqueness, unpredictability, wasn't what makes us human, but what keeps us from reaching our full potential.

I would never ever put that sort of onus on someone, much less someone I loved. I would not want to be with someone whose life had no meaning if I was run over by a bus, either.

⬐ smhost

i ultimately agree with your politics, but i don't think it's a matter of simply deciding to be somehow self-contained. you can decide to give yourself whatever meaning you want about yourself, but so long as society doesn't recognize your meaning and see you as you see yourself, that meaning has no meaning outside yourself. and there's also another problem with denouncing the other, which is that you close them off to the possibility of realizing themselves through you, and so they can never be a part of whatever society you decide to create for yourself.

⬐ PavlovsCat

> i don't think it's a matter of simply deciding to be somehow self-contained

Neither I nor Gruen said anything like that. I read the comment I responded to as claiming it's all from the outside, all from society, and I simply ask what IS society, when they all just get it from the outside. And I say there's not just the outside -- and the only way that can get heard is as me claiming "there's only the inside"? That's frustrating. It may may be "politics" to others, but to me it's simply a question of awareness, and Socrates-style question that are intended to be answered, not to make a point first and foremost..

You said making your own decisions "comes later", which as I pointed out doesn't fit the comment I replied to, since that was also talking about getting your meaning from others as an adult, e.g. falling in love. Also, Gruen and others mention the individuality of infants being suppressed -- so is there something to suppress, or does that "come later"?

What's the youngest age a human can approach or retract from a stimulus? I'd say then at the latest it becomes a two-way street, but it's probably one from the first cell division. If anything, that's what I'm arguing.

> so long as society doesn't recognize your meaning and see you as you see yourself, that meaning has no meaning outside yourself.

"Society" cannot do that anyway, since it's not an individual human being. We can use society as a shorthand for actually existing humans, but "society" as such is an abstraction, it doesn't really act or think or feel or understand or mean anything, like any group.

And yes, the meaning we have in life is for us only, but how is that a problem? What's the alternative? A "common" delusion, or people saying the same words as if that makes them the same inside?

> there's also another problem with denouncing the other, which is that you close them off to the possibility of realizing themselves through you, and so they can never be a part of whatever society you decide to create for yourself.

There's a poem I like, but I don't quite remember it, something about being "alone like a tree, and brotherly like a forest". I think true friendship, love, and/or a society of adult citizens, "achieves its full flower" with individuals who stand on firm inner ground, so to speak.

The closest two eggs can get is when their shells touch -- if you make omelette, they're no longer eggs in that sense, and to me that's not two eggs coming really close, but two eggs disappearing and being replaced by something that's less than each of them.

⬐ smhost

you're making a domain error when you conflate the forces of physical chemistry during first mitosis with higher level cognitive phenomenon of self-perception and identity. i hope you recognize that.

and you're entirely wrong about society being a fiction and therefore it not being real enough to matter. try telling black americans during the civil right era that society is just a fiction anyway and they just need to find meaning within themselves. it's a profane asymmetric insult for you to enjoy all the benefits of being recognized by the dominant fictions of society in the form of powerful institutions at every level of society, and then to deny that same recognition to people who are not you. meaning within fiction matters, "common delusion" matters, and it matters more and in more powerful ways than any individual can provide themselves.

⬐ PavlovsCat

> you're making a domain error when you conflate the forces of physical chemistry during first mitosis with higher level cognitive phenomenon of self-perception and identity. i hope you recognize that.

No, I'm using a figure of speech, and you're responding to nothing, certainly not the strongest possible interpretation.

> and you're entirely wrong about society being a fiction and therefore it not being real enough to matter.

You simply don't understand a word of what I say, as I say it.

The very first words of my first comment in this thread were

> Yes, we look for confirmation, just like we give it

Which makes it clear I don't "denounce others" or say "the outside is an illusion", or any of those plump distortions of my words, laced with big words, you offer. Apart from "I agree with your politics" which is like saying "I think it's fine you're beating your dog". I'm not beating my dog, I wasn't proposing politics, I disagreed with something. Initially by asking a question, to let the other person maybe elaborate on something I got wrong, etc. Well so much for that, I guess that boat sailed. Yet you are not OP and cannot answer my questions to them. As it turns out, you can't even give your own answers, because you distort what I say or ask before you even interact with it.

Simply because I disagree with one extreme, you put words about another extreme into my mouth. As far as I'm concerned, you haven't actually addressed any of what I said, and I'm done wasting my time.

⬐ smhost

you're complaining about how i'm not understanding your beliefs in exactly the way that you want to be interpreted, so the only recourse you have is to turn away and act as if my interpretations ultimately don't matter, which is exactly in line with your stated belief that meaning is internal. i won't see you the way you see yourself, so now i'm wasting your time and making extreme statements, and there's nothing you can do about it except close yourself off.

⬐ delian66

Well, I agree with PavlovsCat and disagree with you. So in our little mini society of at least 3 people in this thread, a society which is not fiction (as you said), there is nothing you can do about it, except to take the feedback we give you, I guess.

⬐ smhost

that's not true. since i believe that meaning is external, the correct thing for me to do is either continue to try to convince you, or kill you both if you don't compromise a meaningful way forward.

⬐ usgroup

Agrippa's trilemma, used as a reductio in your argument. Unfortunately, it applies to pretty much all claim to knowledge not just the case you're using it in.

⬐ PavlovsCat

I'm not "using" anything, I asked something.

> how can others give you confirmation, if they in turn get their truth and meaning from the outside?

When someone says something like "we get truth and meaning from the outside", I think it's a fair question.

⬐ thomasfedb

> A mental trait becomes a disorder when this trait no more compatible with social norms (it breaks the order of things, hence disorder).

Your definition is close, but not quite in keeping with the medical world.

Broadly, something would become a disorder if it results in a) distress, or b) dysfunction.

Distress is usually self-reported, dysfunction can also be observed (e.g. unable to eat, sleep, care for self).

I'm a student doctor, currently on rotation in psychiatry.

⬐ wpietri

Sure, but I think their point here is that many things are called a disorder when the the problem is a trait combined with social norms. Yes, the person is distressed or unable to function, but that determination is made on the basis of the person's experience in a highly constructed environment.

For example, look at the way gay and lesbian people were treated. Now we understand that there's nothing wrong with them; it's a natural human variation. But for quite a while it was treated as both a social and a medical problem. [1] And some of the evidence used to medicalize the issue came from the way society mistreated those they saw as deviant.

You can see the same dynamic playing out today with trans people. The trans suicide rate is absurdly high, and there's all sorts of comorbidity. Anti-trans campaigners will use that to suggest that trans-ness is the problem. Trans people themselves will tell you that the problem is society's relentless and often vicious gender policing, where trans people are forced into societal roles that don't suit them.

The same applies to people who aren't neurotypical. The tech industry has been a haven for me. I grew up as the nerd, the weird kid, the eternal outsider. When I first turned up in San Francisco 20 years ago, it was a fucking relief. Early on I spent most of 3 days at our colo on a big project, and I still remember seeing all my fellow sysadmins come in and out. They talked like me, they looked like me, they dressed like me. It was such a huge relief: I had finally come to a place where I didn't stick out all the time. Instead of people wanting to medicate me for my ADD, etc, I got to join an industry where the unusual way I thought was a positive.

So although in theory your distinction is correct, it's not so neat in the real world. Being incompatible with social norms is a huge mental burden, causing distress and dysfunction. Does that mean the trait is a disorder? Your colleagues have often declared it so. Note how in the 30s and 40s left-handedness was seen by prominent psychiatrists as a serious condition in need of correction. They have come around on that, and on some GLBT issues. But I see no reason to think that we have eliminated the class of problem. I think medicalization of deviance is still an ongoing issue.

[1] http://digitalhistory.hsp.org/anonymous-no-more/essay/medica...

⬐ throwaway2018-2

One of the things that really scares me about working with a therapist is that I have suicidal thoughts a lot. Like, I don't deserve to be alive or that I want to die. I'm still pretty productive, make a good salary, was recently promoted. I'm scared that if I were really open about these feelings, something bad would happen, that I could be hospitalized. Which feels like a real step backwards to me. A step towards not actually getting better.

⬐ jakegarelick

If it makes you feel better, I seriously doubt a (certified) one will do that. The smart ones realize that hospitalization can really derail your life and make you an even higher suicide risk.

Additionally, there is a big difference (in my opinion) between suicidal thoughts and actually acting on those thoughts.

Just from reading your post it doesn’t sound like you have much to worry about.

⬐ baselined

Suicidal ideation is different than having a plan and access to the method to follow through.

It’s when ideation proceeds to having a timeline and decision to die by suicide is when hospitalization is absolutely necessary. At the end of the day, if I a person wants to die by suicide, there is very little anyone can do about it.

⬐ gcb0

I doubt a bad therapist would not report ideation and risk it in the US. Specially a not very good therapist, as seem to be norm in a country where their effectiveness is diminished everywhere in favour of promoting the unrealistic benefits of psychologist and drugs (which they will prescribe in day one)

⬐ julienmarie

I agree with jakegarelick, a good therapist will not hospitalize you.

What matters is for you to talk.

Why would anybody not deserve to be alive? Life is fundamentally nonsensical, and our struggle / cross ( depending on how you see it ) is to put meaning into it. This is why life is at the same time a tragedy and a liberating experience.

We are ephemeral, and not this important at the individual level. Only thing that matters is not harming others, eventually doing good to others if we are lucky, and finding joy in little things ( intellectual endeavours, earthly pleasures, art, sunsets, you name it ).

If it can help, a reading that helped me when I was deep in depression in my 20's was the The Gay Science, by Nietzsche. Don't read it in one go. Keep it with you, and read a few aphorisms every day. Some three liners aphorisms from Nietzsche made more impact in my life than everything else I read combined. This book literally saved my life.

⬐ masonic

  a good therapist will not hospitalize you

In the USA, anyway, a therapist is legally required to intervene if s/he sees the patient as a threat to harm himself or others.

⬐ exolymph

It's more of an imminent threat thing than "I want to die sometimes"; the latter is very common for therapists to encounter and help their patients work through. (Ideally — not all suicidal feelings can be worked through.)

⬐ viraptor

You can find therapists who has remote sessions over internet. If you're worried about someone acting against your will, you can have a Skype session without revealing your real name. Even with someone in another country - if your primary language is English, you have lots of options.

You can't get things prescribed this way. But it doesn't sound like that's an issue here.

⬐ anonuser123456

To be considered suicidal, I believe you need to have formulated a plan. Feeling worthless or not wanting to be alive is not the same, that's just bread and butter depression.

⬐ DanBC

This is incorrect.

People can be suicidal - can have suicidal ideation - without having an active plan.

Thoughts of "I feel trapped", "I feel hopeless" are red flag signs even if the person doesn't have a plan at that moment.

It's probably a good idea to remember that bad advice about suicide can cause death.

⬐ DanBC

You didn't say what country you're in.

If you're in England you can write an advance directive saying that detaining you under the act would be harmful, and you can work out who your "nearest relative" is and make sure they say to the AMHP "I object to the section". These don't make it impossible to hospitalise you, but they do make it much harder.

But, importantly, you deserve help. And you don't need to disclose suicidality. You can just say that you feel very low, that you feel desperate.

There's good evidence that cognitive behaviour therapy is effective for about 60% of the people who use it. You may want to think about combining it with medication.

⬐ DubiousPusher

I was hoping for something insightful but really got more of the same antiestablishment alt-med ranting you'll find elsewhere on the web.

Dude even cites his anecdotal experience to claim psych meds don't work while at the same time claiming mental healthcare is full of psuedoscience and vaguely endorsing something that sounds an aweful lot like Freudian psychoanalysis. So that was pretty rich.

Well, if we're comparing anecdotes, my experience is that when a certain relative of mine was on lithium, she didn't try to stab me in the bathtub with a steak knife to keep the demons from getting me and when she wasn't on her lithium, she did.

⬐ noetic_techy

I wouldn't call experience handling hundreds of patients in in a major metro area such as NY City "anecdotal".

None of this smelled of alt-med ranting. It's the true accounts of a therapist who saw the deficiencies of the system from the inside.

⬐ DubiousPusher

It is exactly anecdotal evidence.

https://en.m.wikipedia.org/wiki/Anecdotal_evidence

This person is using their one personal experience as a general indictment of the field rather than using any kind of controlled method to consider outcomes which is the only way to determine if a field of medicine is doing more good than harm or vice versa.

⬐ hutzlibu

Well, if someone is only peaceful while on meds, I would not feel at peace at all with that person around. People forget their meds/choose not to take them. And then all that was supressed comes out. So does your anecdote sounds. So maybe if she would have had a real therapy which does not rely on meds so much, she would know how to handle her demons better when beeing without drugs.

⬐ thomasfedb

The drugs do actually work. We have long acting forms (e.g. four injections per year) of some medications which help when people truely are dangerous to themselves or others.

⬐ andrewvc

Psych meds for something like schizophrenia or acute psychosis are very different than for things like ADD, Depression, etc. Additionally, it is objectively true that these disorders are overdiagnosed (there are many studies backing this up).

Some psychiatric issues fit much more closely with the disease model of medicine (like psychosis), and others are in a huge gray area.

Most of psychiatric work is in that gray area and does a poor job of it.

Even a former DSM chair thinks so. I highly recommend reading "saving normal" for more info.

⬐ withdavidli

It's a profession that's mentally and emotionally draining. My education background is in psychology, worked at a mental institution for a few months as a mental health assistant. Never met a psychologist that was actively encouraging students to go the therapist route, in fact the opposite. It's something to think long and hard about. One memorable encounter was an aunt of my friend literally grabbed me by the arm when she found out I was planning to be a psychologist and advised against it. Thought "who is this crazy lady", she was head psychologist of several institutions for the district...

⬐ chippy

> Thought "who is this crazy lady"

Did you become a psychologist?

⬐ withdavidli

Nope. The mental health assistant job knocked it out of me. Nothing like being in an environment where you have to be on guard for your safety to really want an office job (friends had teeth knocked out, another head-butted ended with concussion and I believe migraines for rest of her life, I almost had a finger bitten off, and other coworkers got stabbed with utensils).

⬐ kopo

>> in fact the opposite

What are you telling them to do? I have a psychiatrist friend who consults at the medical center, in a college town. She is getting called in so much she wants to move to a different town.

⬐ withdavidli

To know what they're getting into. It's mostly a thankless job. One of the OP's video talks about how most therapist just wants the easy clients and refer all their hard ones to the YouTuber. So it will vary greatly depending on who your clients are. Imagine the difference between being a therapist for silicon valley tech employees vs a mental hospital, prison, or juvenile detention center.

If they do their own practice, it's much like any other business, picking the right clients goes a long way in making your job easier and how much money you can make.

Psychiatrist are different than psychologist. The former goes to medical school and can prescribe drugs.

⬐ d33

Autogenerated transcript for those who don't want to sit at the video for half an hour: https://pastebin.com/XCe5Kctr

⬐ biophysboy

I wish he had gone into more detail about the specific issues with anti-depressants.

Most anti-depressants target serotonin or norepinephrine because the medical industry is still more or less following the "monoamine hypothesis". The hypothesis goes like this: monoamine neurotransmitters are crucial in the human brain, depressed people have depleted levels of them, therefore we should give them a drug that prevents their reuptake.

But there are issues. SSRIs take roughly 5 hours to become bioavailable, but the positive effects of antidepressants take weeks. Why? If the core issue was depleted serotonin levels, shouldn't the person be happier same-day?

Perhaps I'm building a strawman (I doubt med professionals believe the mono-amine hypothesis either), but antidepressants are being prescribed at record rates, and they are being increasingly trusted by the public. Why? The science is trial and questionnaire, the drug efficacy is low, and the side effects are many.

⬐ outlace

Most SSRI’s are prescribed by general practitioners and often with fairly low thresholds. I’ve seen interactions like this: Patient comes in to follow up high blood pressure. Doctor: Have you been feeling depressed lately? Patient: Well, yeah I have actually. Doctor: Do you want to start a medication for that? Patient: Uh, ok.

Most psychiatrists would not do that. And I think psychiatrists at academic centers would not pretend to know exactly how SSRIs work at this point.

Nonetheless, SSRIs have a modest effect on average but for some patients they’re life changing. Recently met someone who was so depressed she could barely get out of bed in the morning. Started on the right Med (after a first failed trial) and she’s been happy ever since (more than a decade).

Soon enough we’ll be able to specifically identify which patients are likely to be good responders and who won’t.

⬐ johnchristopher

> But there are issues. SSRIs take roughly 5 hours to become bioavailable, but the positive effects of antidepressants take weeks. Why? If the core issue was depleted serotonin levels, shouldn't the person be happier same-day?

Also we don't see negative effects on non-depressed people that take drugs to reduce serotonin levels (or so I was told).

⬐ omosubi

What are good countries/societies that have good mental health systems? What does that even look like? Is this a uniquely American problem?

⬐ mjevans

At least in the US:

    * Health-care is a cost center.
    * Denying Health-care is a profit center.
    * The populace has been conned in to believing it's an "insurance"
    * vvv

The population also mostly doesn't realize, at a logical level, that those without coverage still factor in to costs.

    * Increased suffering
    * Increased crime
    * Decreased GDP (both from less able workers and more broken windows)
    * Actual costs of care are passed along as inflated prices.

I would really like, and as long as there weren't other blockers would vote, for candidates that supported at least /basic/ healthcare for all. Profits to be had in line cutting during non-triage critical moments.

⬐ hiker512

Germany, Sweden, Norway, Finnland, Austria, Switzerland, France, Netherlands. Not sure about the other countries in Europe.

But honestly, every time I hear anything about the American healthcare system, I'm not sure if I should laugh or cry.

⬐ intralizee

Canada is better than United States from my experience of living in both countries.

I sought help with gender dysphoria in the United States. Ended up being drugged with antipsychotics, while stuck in a hospital for two months against my will and when I just wanted to start HRT. Doctor wrote untrue statements on my medical records and I couldn't find anyway to sue since I was a poor university student at the time. Almost resulted in suicide. Insurance was billed approximately $55,000

Now I'm in Canada and I'm suicidal from the past events in life but I can see a psychiatrist once a week. She doesn't recommend drugs and mostly just wants to talk with trying to improve my outlook. I'm trying to get death with dignity in Switzerland and got a positive evaluation from her after several months. Everything in Canada is covered since I was born in Canada (citizenship). I'm in Montréal and from what I've seen most doctors don't push prescription drugs compared to what I saw in United States (Michigan). Canada also has a phone number (similar to 911) but is a direct line to speak to a nurse or social worker for help. People here actually can get help concerning their health right away and not fear having to pay anything.

edit: I think the cost of the healthcare in the USA is why people that don't get help, end up mass shooting and mental health stigma is a result of people not being able to afford it; trying to rationalize it's for people really messed up (not them).

⬐ cheez

Geez, sounds tough. You seem like a smart person, I think you'd be worth knowing.

⬐ nowarninglabel

Thanks for documenting your story, appreciated reading through one of your blog posts and would recommend others to take a look.

⬐ muglug

I think the cost of healthcare has something to do with it, but surely the culprit is the gun culture that's everywhere you look the moment you leave big coastal cities. The culture that says - "feel threatened? Reach for your gun!"

Also, second what other people are saying - I'm so sorry you were hurt for so long. I hope that you stick around a while, continuing to advocate online for the trans community.

⬐ OpenBSD-reich

Oh please. Guns are no more the root of gun violence than BitTorrent is the root of digital piracy. Gun control is the cheap easy path to kudos and biscuits, where improving the mental health system is the long tiring hardwork nobody wants to do. Muslim examples in Europe have shown vehicles and knives to be just as effective.

Last but not least, if you vote away my hobby/toy, don't whine like a little piggy when I rally others to vote away your hobby/toy. Government is force which should be used sparingly and responsibly.

⬐ pjc50

> Muslim examples

As you've almost spotted, the problem is one of radicalisation rather than either gun ownership per se or mental health. Other countries have guns. Other countries have people with depression or PTSD. Mass shootings in other countries are generally correctly labelled as terrorism. But people are unwilling to realise that the American mass shooting problem is one of terrorism.

⬐ cheez

Do you think the people driving trucks into people have no mental health issues?

⬐ pjc50

Some of them, probably. But not necessarily all of them, and I don't think it's a necessary precondition. I've certainly not heard of very many suicide bombers or mass shooters that had diagnosed but unmanaged mental health conditions.

Is someone having political beliefs that they're willing to die/kill for a sign of mental illness?

⬐ cheez

> Is someone having political beliefs that they're willing to die/kill for a sign of mental illness?

I think you're making an assumption that this is what is happening. What do unsuccessful, captured suicide bombers say?

⬐ pjc50

There are a few of these: http://www.spiegel.de/international/world/a-conversation-wit...

https://www.huffingtonpost.com/raza-rumi/an-interview-with-a...

⬐ cheez

Thanks! The first one isn't very relevant because it is the leader, who can say what he likes to indoctrinate anyone.

The second is incredibly interesting and seems very much like a brainwashing. I can see how an otherwise normal person can end up this way.

⬐ None

None

⬐ DanBC

> Muslim examples in Europe have shown vehicles and knives to be just as effective

No they haven't. This is a bizarre misrepresentation of the scale of gun violence in the US, and obviously access to guns causes gun violence.

⬐ vSanjo

You don't know me, and I don't know you, but I hope the words of a real person from a different country behind a keyboard help you at least get through your day, week, month or year.

Best of luck to you, friend. Whatever your endeavours, however you -truly- want things to be, I hope it goes the direction you plan.

⬐ analyst74

The field of psychiatry is actually undergoing a lot of changes and improvements. With progress in understanding how our brain works at chemical level, and newer drugs to balance the chemicals when they are out of balance. Many of the previously untreatable mental problems are now treatable with medicine.

That is unfortunately only available to psychiatrists, who has medical designation.

source: a psychiatrist friend

⬐ zaroth

At a macro level (population surveys of mental health) I think we can safely say your friend is biased, and that the field is basically stumbling around in the dark ages and generally unable to offer much help.

Didn’t the latest DSM get basically outright rejected by the NIH?

⬐ patcon

> With progress in understanding [...] and newer drugs to balance the chemicals [...] Many [...] mental problems are now treatable with medicine.

The catch here is that those deciding what "progress" is, are the same therapists and health professionals of the sort speaking in the video. And as they said, they are under immense pressure of their own. The alternative to "medication" is social support, of which they themselves are often primary sources. They are overburdened themselves and often under-supported by gov, so they're under stress (therapists for well-off people excluded).

tl;dr - they have a huge incentive (for preservation of their own sanity) to see "medication" as progress, because it relieves their own burden (which is structural to system).

I'm not saying this is malevolent or judging anyone to be bad, but it's something to be wary of

Disclaimer/source: sibling is community social worker

⬐ carapace

reading this is like taking a time-machine back to the dark ages. It's like the "Bring out yer dead!" scene in Monty Python's "Holy Grail", only not funny.

For the love of God, use Neuro-linguistic Programming.

The "vicarious traumatization" wouldn't be a problem if you used techniques that don't require reliving the trauma! It would be healthier for both the therapist and the client.

There are repeatable algorithms for dealing with e.g. early life trauma. You can actually "go back in time" and relive a different life and have it massively and permanently affect your real-world present-day life.

One of the strangest and saddest things about psychology is the disconnect between practitioners and researchers on the one hand, and the cutting-edge state-of-the-art techniques and "schools" on the other. (The NLP wikipedia page is all about how it's a pseudo-science. Sheesh!)

⬐ None

None

⬐ intralizee

Key points from the video:

1) People mostly benefit from having someone to talk to about their problems. Drugs apparently aren't much help.

2) People with the most trauma are the ones that have the least finances to pay for treatments.

3) Most trauma is from early life.

4) The therapist has no support from colleagues and cannot talk openly. When someone mentions suicide its recommended to send the person straight to the hospital and to be medicated (Video author does not agree).

5) The responsibility is too much, hearing the horrors and being on the minds of the harmed person.

⬐ nothrabannosir

In addition: there is a constant pressure to “upsell” the clients medication, i.e. refer them to psychiatrists. He felt frustrated at the institutionalised proclivity for medication, and had to fight hard when going against it.

(And one bit that struck me hard: he mentions suffering from vicarious trauma so much that at some point he was crying with patients every day. Makes the video worth watching, imo. It makes you think about the kind of therapist you’d hope to find yourself in a room with, if necessary, one day.)

⬐ phkahler

>> he mentions suffering from vicarious trauma so much that at some point he was crying with patients every day.

Actually experiencing someones emotions is one of the most helpful things you can do for them. I say actually because it seems therapists train to pretend to understand. They train to hide their own feelings or let a client try to support them. It's ironic that they want people to become their authentic selves, but that's the one behavior they won't model. I have no doubt the guy in this video did wonders for his patients.

⬐ clarkevans

Regarding point #3 -- In the 80's, clinicians at Kaiser Permanente recognized that success in a weight-loss program was correlated to stresses experienced during childhood. This lead to the Adverse Childhood Experiences study, using a measure which scores people on a scale of 0-10. Those with scores of >3 (factors such as separated parents, child abuse, sexual abuse, food insecurity) have significantly worse outcomes in later life. https://en.wikipedia.org/wiki/Adverse_Childhood_Experiences_...

⬐ phnofive

Thanks for the summary, as it’s the only way I’d have heard this person’s view. 1) paints a broad and inaccurate view unless there is more specificity about what kind of medication is being discussed. 4) & 5) are well taken, though; where do professionals with confidentiality restrictions get help, each other?

⬐ jefurii

A have a family member who is a marriage and family therapist (MFT). She and most of her peers themselves see therapists. This is partly because people who become (good) therapists have themselves had to struggle with issues in their lives and dealt with it by experiencing therapy.

It's also a way to be able to talk to someone else about their cases. The person they go to is themselves bound by confidentiality restrictions so they can talk about whatever they need to without worrying that patients' communications will be leaked.

⬐ bshimmin

Addressing your last point, at least in the UK, therapists usually/often have supervisors. I think it's a fairly peer-to-peer system, rather than hierarchical, once you get to a certain point of seniority.

⬐ thomasfedb

In Australia it's a registration requirement for a psychologist to have another psychologist who supervises then in respect to the personal impact of caring for their patients.

⬐ gcb0

the talk is from the US, where the american dream forces doctors into individual practice being the norm.

⬐ palimpsests

Therapists and psychologists in the U.S. are required to have supervisors in the latter stages of their training (2-5 years). Many of them continue to have a supervisor afterwards. Most therapists and psychologists are not doctors.

⬐ DanBC

For people with so-called personality disorder (and that seems to be the group they're talking about: need for therapy; adverse childhood events) medication isn't recommended and treatment should be a long form talking therapy. "Meeting the Challenge, Making a Difference" has some useful information. https://www.crisiscareconcordat.org.uk/inspiration/meeting-t...

That's an important point because this group of people often find themselves medicated with a range of different drugs - valproate, quetiapine, lamotrigine, topiramate, carbamazepine, lithium, benzos, z drugs, SSRIs, etc etc, but there's little evidence that these meds provide any benefit for this group of people.

(I'm not anti-medication.)

⬐ phnofive

I agree, that does seem to be what he is obliquely referencing.

I hope I don’t need to be on a stimulants forever, but at least the effect is quantifiable.

⬐ intralizee

He didn't really discuss what kind of medication.

My interpretation is he feels medication is pushed too much and rarely solves the problem. He mentioned how people wanted to taper off and eventually stop taking prescription medication. He didn't like how he isn't allowed to help with that area.

Also he voiced how the cost difference for someone staying in the hospital as an impatient is very high compared to seeing him. Insurance will try to prevent patients from seeing him 3 days per week and only want once a week (even if 3 days is helpful). Insurance companies have every detail about a patient and demand it without respecting privacy.

⬐ withdavidli

Happy to see you clarified your take on point one. While summaries are helpful, it's playing the telephone game on interpretation. It's better to view the source material whenever possible.

⬐ reledi

I wish all comment threads started with a summary. Thanks!

⬐ panchicore3

he also mentions that there are alternatives ways of dealing with the problems that only with medications, is he referring to psychedelics as one of them I am afraid, where you manage to lower your defenses in order to pain came out?

⬐ AltruisticGap

I didn't watch the video yet but pt 2 and 3 is 100% correct.

I am in EU. We're supposed to have "amazing healthcare". Yeah, well, maybe if your face is in a ditch or you're dying alcohol poisoning? If you're one of those who managed somehow to function with insane levels of anxiety... you when you finally find the strength to reach out and heal.. you find out that you get a pityful 200 EUR a YEAR for psychotherapy (that's what my healthcare in Belgium pays).

Anyone healing significant trauma is going to do one year of therapy, probably more. At the very minimum twice a month, otherwise you lose the rhythm. Realistically, 5 times a month tapering down to 3-4 times a month, for a year or two or more. It's exhausting too. To heal and make real progress, you go to therapy like a beaten dog, keeping your heart open all the time, accepting to feel vulnerable all the time. You don't get to hold a mask, you have to undress and put it all out, every session... takes a lot of determination and courage. But who gives a shit. Here's 200 EUR for your troubles, good luck.

On top of that, in my case I have a 7 year gap in my career in IT. Doesn't help getting back into employment! Often times with trauma from early life, you don't grow in an environment surrounded by sane people. You're surrounded by dissociated parents / siblings. At school nobody gives a fuck or has the sensibility to ask questions. So in all likelyhood if you managed to function in adult life and hold a decent job, you're starting therapy much later, when it takes longer. So hopefully you got some savings otherwise well eat shit son.

I guess I have to be truly grateful that here in Belgium our "unemployment benefit" system is lax enough, that it allowed me to take the time to heal. But don't you go tell them that! I can only imagine what it was like for my parents, when they didn't have that kind of support.. because even with the unemployment benefits, I've had to fork out THOUSANDS of euros for my therapy.

Anyways just need to rant I guess.

Yes, I predominately mean psychotherapy. The links I've listed mostly just provide hints of excessive psychologizing and quackery, but it is indeed awkward when >90% of psychotherapy methods do not perform better than placebo. There seems to be quackery in the medical side of psychiatry as well, but to a lesser extent.

Here it is straight from the horse's mouth:

https://www.youtube.com/watch?v=f0Fi32LbXHA