My ADHD diagnosis was useful because it gave me access to stimulants and because it convinced me to cut myself some slack. It was also disruptive because it gave me access to stimulants and convinced me to cut myself some slack. Both of those things are good when you need stimulants and to be less hard on yourself, and bad when you're using stimulants in lieu of sleeping and neglecting your work and the needs of your loved ones.
I also found the community really really unhelpful. There's a serious undercurrent of "nothing is your fault and you're probably trying as hard as you can" which is annoying for two reasons: 1) Actually the path to human happiness is taking responsibility for many things, some of which you will screw up, especially if you have ADHD, and 2) For some reason I don't find the same comfort as others in believing that an unsatisfactory status quo is the best I can accomplish. Maybe I'm just weird like that.
What diagnosis did help with was letting me clearly see "hey, I have these personalty traits, but have set up a life that's fundamentally incompatible with them. Maybe that's bad?" And that's only because I finally found a therapist who listened to my particularized account of ADHD instead of just giving the generic ADHD advice.
Excellent. But I'd also propose that all the reasons you give why it's not useful for YOU to have a diagnosis (and some why it can be, especially related to pharmacotherapy) are great reasons for the suffering person not to have one/insist on one.
I suspect that much of the desire is due to the idea that mental disorders are "just like medical conditions such as diabetes or tb", while driven by very valid motivations, has had a very clear net negative effect, socially/culturally.
I'm not going to repeat all the relevant parts in The Sequences, but, when i started to read the post i expected exploration of the consequences o categorization, for good and for ill.
"I am absolutely not going to ask myself "does this man technically fit criteria for generalized anxiety disorder?" Who cares?"
well, it's telling me bad thing about the category of Generalized Anxiety Disorder. it should pay rent in expectations. i.e, and I'm writing it as someone who have no idea whatsoever about GAD, if someone have GAD i expect it more likely they will have hard time to state their preferences, that even after they did that and it was fine it will take more iterations for their feedback system to grasp that it's fine, that this problem is generalized one and not one-off, so finding workaround just for this is not viable solution - similar problems will rise in other circumstances.
this is what it's mean, for the category GAD to be real category that exist in the world, for me to believe in it. as beliefs should pay rent in expectation.
if what you do with Lonely Alice and Doomist Cedar is totally different, it's mean, in my ontology, that the Clinical Depression category is fake. this is important! the word were there is a thing like Clinical Depression and the one where there isn't are different worlds, and it's important to differentiate between them!
in my model of the world, there is category, that correspond to people who tend to downward spirals of depression, when they need X to be happy, and when they don't do X they tend to stay in bed and cry, and, very important, not do X.
and so, if I believe someone have CD, it's rent-paying belief. for example, if they sad and don't want to do X, I will think that do X is good for them. this is not at all the way that I am, and if someone behave that way toward me that would have been counter-productive and annoying. it's also mean that interrupting the downward spiral is possible.
I don't sure the Psychiatry is even trying to do the Rationalist thing of having categories that actually mean something. but it's so, so weird to read this is post with this "who cares", like you totally ignorant of the possibility that categories may actually have predictive power that hello with treatment!
Like, it's possible that a lot of current categories are fake, and we need to have better ones. but... it doesn't look like you are saying those categories are false and let's find the true ones. It's look like you can't imagine the thing a believe categories are for. and it's so weird!
you keep saying things like "Diagnosis presents the problem as internal to the person" and what i want to say is Your Ontology Is Wrong. this is not what diagnosis is about. it's about predictions. and then you talk about when diagnosis is helpful, and it's look like you do understand.
also, saying that the problem is Poverty can be validating and good the same way saying the problem is Depression can be. we just... don't do that, as society. but we should!)
in conclusion: I am confused. Jasnah Kholin Noticed Her Confusion.
Scott Alexander has some musings on this topic, a three part series on the ontology of psychiatric disorders. If you're interested you could start with the one on taxonomy.🙂
There's a lot of stuff you're bringing up here, but overall I would say that the source of your confusion is that psychiatric diagnoses are significantly fuzzier than you would like them to be and their usefulness depends on context.
This post presents the situation from the perspective of a life coach, who cannot prescribe pharmaceutical drugs. They can only recommend behavioral interventions, and the behavioral interventions for "depression" and "nonclinical sadness" are effectively identical, likewise for "generalized anxiety disorder" and "having a nervous disposition". From this perspective, psychiatric diagnoses do not pay rent. They recommend no course of action that would not be undertaken otherwise. Sometimes disorders like OCD have specialized procedures for behavioral interventions, which the post notes brings them back into the realm of useful ideas.
To invoke other parts of the Sequences, you might say that psychiatric diagnoses are weak evidence and the specific details of the problem are strong evidence, with the details screening out the broad but less specific implications of the diagnosis. There is a general set of recommendations one would give if they know that a person is "depressed" but nothing else, but once the situation is specified further then your recommendations can in turn become more narrow and useful, to the point where there is little value in using a broader category.
Finally, psychiatric diagnoses are just inherently broad and arbitrary. The breadth of human minds and their problems is vast and trying to draw objective lines between normal and abnormal just isn't possible. Getting diagnosed with depression isn't like getting diagnosed with myeloma or diabetes. There's no blood test, just an inventory asking how sad you are. Psychiatric diagnoses typically just describe clusters of symptoms for the purpose of associating those clusters with treatments that tend to help people meeting that description. The first part of this post gives an example of how this manifests with ADHD diagnoses (https://slatestarcodex.com/2017/12/28/adderall-risks-much-more-than-you-wanted-to-know/).
In summary, you are right that this post implies psychiatric diagnoses are not as useful as people would like them to be.
"the behavioral interventions for "depression" and "nonclinical sadness" are effectively identical"
well, first, as not-depressed person, the interventions when I sad are actually different then those when depressed person is sad, actually! but even if i ignore that - and I think that we shouldn't, I think it's important disagreement - there are still wildly different prediction here. i.e. - if I'm sad and do nothing I will stop being sad with time, not spiral down.
this is real difference in the world. and my inclination to say that this is what depression really mean, even if the clinical criterions sucks.
and we should be able to talk about that. Ozy should be able to tell that the word "depression" point at actual cluster in thingspace, or to say that it's not and productively disagree when someone like me. instead there is this weird sense that we don't know that categories should point to clusters of things.
like, whet is even the point of The Sequences, if not to create public knowledge of that, and having discussions when people can assume that everyone know about clusters and categories?
If some diagnosis are fake, we should be able to say that, not politely say it's not useful. if some of them fake and some not, it's important to know about that, and differentiate between them. saying "not useful" us not a lie, but it's a weird euphemism in that place.
but yet again you say that diagnosis are weak evidence and " to draw objective lines between" and i want to send you to read about The Cluster Structure of Thingspace, because if you think that category should be "objective line" then we talk in a different language, and I think you use words wrong.
It's fine to talk about how categories *should* work, but psychiatric diagnoses were invented by a relatively young field known to be plagued with replication issues that plays host to many internal schools of thought that are less scientific than others.
I probably have butchered some of this explanation and Scott has said it better at many points, but I'm not trying to say that psychiatric diagnoses are useless, just that their use is situational, and that in the situation of life coach their usefulness is low. There is an active conversation among psychologists regarding which diagnoses are good, which are too poorly defined, and which are pathologizing legitimate behaviors so that broader culture can dismiss outsiders as crazy. Some stand on firmer ground than others, but if you point to an entry in the DSM and you can find somebody who will argue that it's just medicalizing the human condition. This is because pretty much all mental illness is an extension of natural human characteristics and the point where normal becomes abnormal is a judgement call. We adopt some standard rules on where the line should be, but those are still just rules of thumb written in an official book.
It's not that there aren't real clusters being pointed to here. There is a real pattern of people who are not just sad, but are resistant to positive stimuli that would improve mood in most people and retain their low mood over a long period of time. But it's not true that everyone prone to depression is completely immune to behavioral interventions. Some of them can get better through exercise, social contact, and fun/constructive activities, but they have to stick to those changes more strictly than most. "Treatment-resistant depression" is real but it's diagnosed by having the person do all the behavior changes and a battery of antidepressants and if they're not better after that then they're treatment-resistant. What I'm trying to say here is that depressed people aren't a clearly distinct carve-out from the rest of humanity, they're the low end of the base mood-level normal curve. How many sigma behind the curve you have to be to count as having a medical problem solved with drugs instead of a "you have a bad life situation and you need to get a better situation" is a judgement call on both an institutional and individual level.
Check out the PHQ-9, the most common inventory for screening for depression in the world. It's just nine questions asking how sad you are. The more sad you said you were, the more sad points you get and the higher your depression severity is estimated. Not useless, but you can see how this isn't like taking a nasal swab to be told exactly which viruses you have and being given drugs tailored exactly to that virus?
Diagnoses are good at matching general symptom clusters to general intervention plans, but the plan for "depression" is only separated from the plan for "nondescript persistent bad mood" in that the former can involve medical interventions that a life coach can't prescribe. So for a life coach, a depression diagnosis isn't a rent-paying idea. It can be in other contexts, just not here.
Again, I think Scott covered these issues in the first section of the adderall post I linked much better than I did. The Lorien Psychiatry post linked by another responder is also good.
no, i don't describe how categories should work. I'm describing how they are ACTUALLY work. things cluster. or they don't. people can have wrong maps, but the territory remains the territory.
psychiatric diagnosis could be wrong. there are historical examples for that. but I'm trying to talk about the territory, and i get reactions that feel to me as if the people i talk to just don't get that the map is not the territory, that it's possible to talk about the territory and not about the map. to say not only if some map is useful, but if it reflect the territory. and if it not, it's false.
but if some category does not cut reality by the joints, it doesn't mean there is no reality there, and it's possible to talk about that reality. it's possible both say the the diagnosis of Autism does not cut reality by the joints, and that it's pointing to real cluster in peoplespace, and then talk about that real cluster.
this is the natural and obvious thing to do in rationalist space. to build maps that reflect the territory. expect, it's look like this idea, that looks so obvious to me, is something unthinkable to some people. and it's so, so weird!
I honestly don't know what to answer to someone who wrote a whole paragraph about usefulness and medicalization, and human condition and didn't even mention true and maps the reflect the territory and allow to make predictions.
like, I already linked to the relevant posts. I already wrote about clusters and predictions. I can translate, yet again, to another language. notice that things can cluster or not, and thing don't have to be illness to cluster. men and women are two clusters.
but I don't expect it to work. there are epsilon worlds when it didn't work on the first try but will work on the second, so I predict.
so I can go on and answer to thing like " But it's not true that everyone prone to depression is completely immune to behavioral interventions." and explain why it's not a valid counter argument. that it miss the point.
but instead I will point that it look like a lack of basic prerequisites, and be sad about the rationalist project.
I think you would probably benefit more from reading the posts by Scott Alexander I and the other reply linked to if you haven't already, he probably communicates this better. I've read the posts you link to, but I am clearly still failing to bridge some inferential distance.
But to put it another way, I think psychiatric diagnoses of the DSM map the territory of working as a psychiatrist. It allows you to look at patient symptoms and make good predictions about actions that a psychiatrist should take that would improve their situation. Working as a life coach is a different territory and it requires different maps. Because individual peoples' specific problems are so fine-grained but also small in size, it is often better to just put down the maps entirely and go directly to the house you want to know about.
I plan to read the post sometimes, but i did read quit a lot of Scot's posts, and I predict that reading the post will not change my opinion about... working as life coach is NOT different territory, and this statement is... i don't even know what to say in response. there is only one territory. people may prefer to have different kind of maps for different circumstances, but there is only one territory. and saying there is different territory is strong evidence for basic misunderstanding.
You make some great points! Clients can appreciate diagnoses for the reasons you mentioned, but descriptive diagnoses as they are, often give insufficient guidance to the clinicians who are trying to figure out how to help.
You write: "If you have OCD, you should seek exposure and response prevention therapy from a qualified therapist; if you don’t have OCD, exposure and response prevention won’t help you. If you have depression, you should try doing rewarding activities, figuring out whether your thoughts are rational, and improving your relationships with others—all of which are also useful if you are nonclinically kind of sad. From my perspective, it is useless to distinguish depression and nonclinical sadness."
I agree that OCD benefits from ERP (as well as ACT). But with depression, it's much less straightforward. There isn't just one kind of (clinical or nonclinical) depression which is automatically helped by the three types of treatment you mention (Behavioral Activation, CBT, and IPT). Further, even though those treatments can help relieve some types of depression, they don't necessarily get to the root of what is causing the depression in the first place. For example, depression caused by early attachment wounds are hardly healed by Behavioral Activation or CBT. And a trauma triggered nervous system shutdown depression is not healed by any of these.
Finally, don't forget that sadness is not generally a cause of depression. Sadness is an emotion that we all need to feel when we experience loss. It's actually the cutting off of feeling that is more likely to cause a logjam-type depression. Sadness itself is not depression.
Yup, therapists love to diagnose OCD! Half the treatment is just "yes you have this illness, no you are not a monster, no these thoughts don't mean anything, yes you have OCD". Patients are usually so relieved and happy upon getting the diagnosis.
I once had a therapist try to diagnose me with ocd in the first 10 minutes after meeting them, which seemed a bit extreme. (The next 15 minutes were spent trying to convince me that I needed to be on an SSRI, even though the previous three SSRIs didn’t work. I did not schedule a second session.)
Yeah I already had a med setup I was happy with when I talked to the guy! But apparently the meds I’m on ~don’t address ocd directly~ so obviously SSRIs are the answer and screw your “previous experience” with them “causing suicidal ideation and panic attacks and possibly a hypomanic episode that one time”.
Genuinely not sure what his deal was - it’s hardly unusual go to therapy because you want non-med coping skills.
(To be fair to the guy I do have Tourette’s and some imo subclinical ocd symptoms. But that wasn’t the reason I wanted therapy and it was extremely annoying that the guy derailed the whole session for this.)
Indeed. I suspect the magic words to say to someone like that is would be something like "I'm already seeing a psychiatrist for medication management, so I'll tell them your opinion. Now can we get back to [whatever you originally wanted to talk about]." And if that doesn't shut them up, leave. :P
That would probably have been the better move, yeah. On the other hand, playing it out gave me good information about whether I wanted to ever see that therapist again (emphatically no), so maybe it worked out.
My ADHD diagnosis was useful because it gave me access to stimulants and because it convinced me to cut myself some slack. It was also disruptive because it gave me access to stimulants and convinced me to cut myself some slack. Both of those things are good when you need stimulants and to be less hard on yourself, and bad when you're using stimulants in lieu of sleeping and neglecting your work and the needs of your loved ones.
I also found the community really really unhelpful. There's a serious undercurrent of "nothing is your fault and you're probably trying as hard as you can" which is annoying for two reasons: 1) Actually the path to human happiness is taking responsibility for many things, some of which you will screw up, especially if you have ADHD, and 2) For some reason I don't find the same comfort as others in believing that an unsatisfactory status quo is the best I can accomplish. Maybe I'm just weird like that.
What diagnosis did help with was letting me clearly see "hey, I have these personalty traits, but have set up a life that's fundamentally incompatible with them. Maybe that's bad?" And that's only because I finally found a therapist who listened to my particularized account of ADHD instead of just giving the generic ADHD advice.
Excellent. But I'd also propose that all the reasons you give why it's not useful for YOU to have a diagnosis (and some why it can be, especially related to pharmacotherapy) are great reasons for the suffering person not to have one/insist on one.
I suspect that much of the desire is due to the idea that mental disorders are "just like medical conditions such as diabetes or tb", while driven by very valid motivations, has had a very clear net negative effect, socially/culturally.
nonbinary treeboys REPRESENT
(Hello again this is Cedar from LessOnline!)
"because descriptive diagnoses are just saying your experiences back at you with a Serious Doctor Voice"
"just" is one of those words that should rise alert every time it used. it'
Categorizing Has Consequences!
aka: https://www.lesswrong.com/posts/veN86cBhoe7mBxXLk/categorizing-has-consequences
I'm not going to repeat all the relevant parts in The Sequences, but, when i started to read the post i expected exploration of the consequences o categorization, for good and for ill.
"I am absolutely not going to ask myself "does this man technically fit criteria for generalized anxiety disorder?" Who cares?"
well, it's telling me bad thing about the category of Generalized Anxiety Disorder. it should pay rent in expectations. i.e, and I'm writing it as someone who have no idea whatsoever about GAD, if someone have GAD i expect it more likely they will have hard time to state their preferences, that even after they did that and it was fine it will take more iterations for their feedback system to grasp that it's fine, that this problem is generalized one and not one-off, so finding workaround just for this is not viable solution - similar problems will rise in other circumstances.
this is what it's mean, for the category GAD to be real category that exist in the world, for me to believe in it. as beliefs should pay rent in expectation.
if what you do with Lonely Alice and Doomist Cedar is totally different, it's mean, in my ontology, that the Clinical Depression category is fake. this is important! the word were there is a thing like Clinical Depression and the one where there isn't are different worlds, and it's important to differentiate between them!
in my model of the world, there is category, that correspond to people who tend to downward spirals of depression, when they need X to be happy, and when they don't do X they tend to stay in bed and cry, and, very important, not do X.
and so, if I believe someone have CD, it's rent-paying belief. for example, if they sad and don't want to do X, I will think that do X is good for them. this is not at all the way that I am, and if someone behave that way toward me that would have been counter-productive and annoying. it's also mean that interrupting the downward spiral is possible.
I don't sure the Psychiatry is even trying to do the Rationalist thing of having categories that actually mean something. but it's so, so weird to read this is post with this "who cares", like you totally ignorant of the possibility that categories may actually have predictive power that hello with treatment!
Like, it's possible that a lot of current categories are fake, and we need to have better ones. but... it doesn't look like you are saying those categories are false and let's find the true ones. It's look like you can't imagine the thing a believe categories are for. and it's so weird!
you keep saying things like "Diagnosis presents the problem as internal to the person" and what i want to say is Your Ontology Is Wrong. this is not what diagnosis is about. it's about predictions. and then you talk about when diagnosis is helpful, and it's look like you do understand.
also, saying that the problem is Poverty can be validating and good the same way saying the problem is Depression can be. we just... don't do that, as society. but we should!)
in conclusion: I am confused. Jasnah Kholin Noticed Her Confusion.
What's going on?
Scott Alexander has some musings on this topic, a three part series on the ontology of psychiatric disorders. If you're interested you could start with the one on taxonomy.🙂
https://lorienpsych.com/2020/10/30/ontology-of-psychiatric-conditions-taxometrics/
Edit: typo
There's a lot of stuff you're bringing up here, but overall I would say that the source of your confusion is that psychiatric diagnoses are significantly fuzzier than you would like them to be and their usefulness depends on context.
This post presents the situation from the perspective of a life coach, who cannot prescribe pharmaceutical drugs. They can only recommend behavioral interventions, and the behavioral interventions for "depression" and "nonclinical sadness" are effectively identical, likewise for "generalized anxiety disorder" and "having a nervous disposition". From this perspective, psychiatric diagnoses do not pay rent. They recommend no course of action that would not be undertaken otherwise. Sometimes disorders like OCD have specialized procedures for behavioral interventions, which the post notes brings them back into the realm of useful ideas.
To invoke other parts of the Sequences, you might say that psychiatric diagnoses are weak evidence and the specific details of the problem are strong evidence, with the details screening out the broad but less specific implications of the diagnosis. There is a general set of recommendations one would give if they know that a person is "depressed" but nothing else, but once the situation is specified further then your recommendations can in turn become more narrow and useful, to the point where there is little value in using a broader category.
Finally, psychiatric diagnoses are just inherently broad and arbitrary. The breadth of human minds and their problems is vast and trying to draw objective lines between normal and abnormal just isn't possible. Getting diagnosed with depression isn't like getting diagnosed with myeloma or diabetes. There's no blood test, just an inventory asking how sad you are. Psychiatric diagnoses typically just describe clusters of symptoms for the purpose of associating those clusters with treatments that tend to help people meeting that description. The first part of this post gives an example of how this manifests with ADHD diagnoses (https://slatestarcodex.com/2017/12/28/adderall-risks-much-more-than-you-wanted-to-know/).
In summary, you are right that this post implies psychiatric diagnoses are not as useful as people would like them to be.
"the behavioral interventions for "depression" and "nonclinical sadness" are effectively identical"
well, first, as not-depressed person, the interventions when I sad are actually different then those when depressed person is sad, actually! but even if i ignore that - and I think that we shouldn't, I think it's important disagreement - there are still wildly different prediction here. i.e. - if I'm sad and do nothing I will stop being sad with time, not spiral down.
this is real difference in the world. and my inclination to say that this is what depression really mean, even if the clinical criterions sucks.
and we should be able to talk about that. Ozy should be able to tell that the word "depression" point at actual cluster in thingspace, or to say that it's not and productively disagree when someone like me. instead there is this weird sense that we don't know that categories should point to clusters of things.
like, whet is even the point of The Sequences, if not to create public knowledge of that, and having discussions when people can assume that everyone know about clusters and categories?
If some diagnosis are fake, we should be able to say that, not politely say it's not useful. if some of them fake and some not, it's important to know about that, and differentiate between them. saying "not useful" us not a lie, but it's a weird euphemism in that place.
but yet again you say that diagnosis are weak evidence and " to draw objective lines between" and i want to send you to read about The Cluster Structure of Thingspace, because if you think that category should be "objective line" then we talk in a different language, and I think you use words wrong.
https://www.lesswrong.com/s/SGB7Y5WERh4skwtnb/p/WBw8dDkAWohFjWQSk
It's fine to talk about how categories *should* work, but psychiatric diagnoses were invented by a relatively young field known to be plagued with replication issues that plays host to many internal schools of thought that are less scientific than others.
I probably have butchered some of this explanation and Scott has said it better at many points, but I'm not trying to say that psychiatric diagnoses are useless, just that their use is situational, and that in the situation of life coach their usefulness is low. There is an active conversation among psychologists regarding which diagnoses are good, which are too poorly defined, and which are pathologizing legitimate behaviors so that broader culture can dismiss outsiders as crazy. Some stand on firmer ground than others, but if you point to an entry in the DSM and you can find somebody who will argue that it's just medicalizing the human condition. This is because pretty much all mental illness is an extension of natural human characteristics and the point where normal becomes abnormal is a judgement call. We adopt some standard rules on where the line should be, but those are still just rules of thumb written in an official book.
It's not that there aren't real clusters being pointed to here. There is a real pattern of people who are not just sad, but are resistant to positive stimuli that would improve mood in most people and retain their low mood over a long period of time. But it's not true that everyone prone to depression is completely immune to behavioral interventions. Some of them can get better through exercise, social contact, and fun/constructive activities, but they have to stick to those changes more strictly than most. "Treatment-resistant depression" is real but it's diagnosed by having the person do all the behavior changes and a battery of antidepressants and if they're not better after that then they're treatment-resistant. What I'm trying to say here is that depressed people aren't a clearly distinct carve-out from the rest of humanity, they're the low end of the base mood-level normal curve. How many sigma behind the curve you have to be to count as having a medical problem solved with drugs instead of a "you have a bad life situation and you need to get a better situation" is a judgement call on both an institutional and individual level.
Check out the PHQ-9, the most common inventory for screening for depression in the world. It's just nine questions asking how sad you are. The more sad you said you were, the more sad points you get and the higher your depression severity is estimated. Not useless, but you can see how this isn't like taking a nasal swab to be told exactly which viruses you have and being given drugs tailored exactly to that virus?
Diagnoses are good at matching general symptom clusters to general intervention plans, but the plan for "depression" is only separated from the plan for "nondescript persistent bad mood" in that the former can involve medical interventions that a life coach can't prescribe. So for a life coach, a depression diagnosis isn't a rent-paying idea. It can be in other contexts, just not here.
Again, I think Scott covered these issues in the first section of the adderall post I linked much better than I did. The Lorien Psychiatry post linked by another responder is also good.
no, i don't describe how categories should work. I'm describing how they are ACTUALLY work. things cluster. or they don't. people can have wrong maps, but the territory remains the territory.
psychiatric diagnosis could be wrong. there are historical examples for that. but I'm trying to talk about the territory, and i get reactions that feel to me as if the people i talk to just don't get that the map is not the territory, that it's possible to talk about the territory and not about the map. to say not only if some map is useful, but if it reflect the territory. and if it not, it's false.
but if some category does not cut reality by the joints, it doesn't mean there is no reality there, and it's possible to talk about that reality. it's possible both say the the diagnosis of Autism does not cut reality by the joints, and that it's pointing to real cluster in peoplespace, and then talk about that real cluster.
this is the natural and obvious thing to do in rationalist space. to build maps that reflect the territory. expect, it's look like this idea, that looks so obvious to me, is something unthinkable to some people. and it's so, so weird!
I honestly don't know what to answer to someone who wrote a whole paragraph about usefulness and medicalization, and human condition and didn't even mention true and maps the reflect the territory and allow to make predictions.
like, I already linked to the relevant posts. I already wrote about clusters and predictions. I can translate, yet again, to another language. notice that things can cluster or not, and thing don't have to be illness to cluster. men and women are two clusters.
but I don't expect it to work. there are epsilon worlds when it didn't work on the first try but will work on the second, so I predict.
so I can go on and answer to thing like " But it's not true that everyone prone to depression is completely immune to behavioral interventions." and explain why it's not a valid counter argument. that it miss the point.
but instead I will point that it look like a lack of basic prerequisites, and be sad about the rationalist project.
I think you would probably benefit more from reading the posts by Scott Alexander I and the other reply linked to if you haven't already, he probably communicates this better. I've read the posts you link to, but I am clearly still failing to bridge some inferential distance.
But to put it another way, I think psychiatric diagnoses of the DSM map the territory of working as a psychiatrist. It allows you to look at patient symptoms and make good predictions about actions that a psychiatrist should take that would improve their situation. Working as a life coach is a different territory and it requires different maps. Because individual peoples' specific problems are so fine-grained but also small in size, it is often better to just put down the maps entirely and go directly to the house you want to know about.
I plan to read the post sometimes, but i did read quit a lot of Scot's posts, and I predict that reading the post will not change my opinion about... working as life coach is NOT different territory, and this statement is... i don't even know what to say in response. there is only one territory. people may prefer to have different kind of maps for different circumstances, but there is only one territory. and saying there is different territory is strong evidence for basic misunderstanding.
Now I'm thinking about a sitcom how a former? crime boss therapist actually solves the underlying problems using fake documents, violence and bribery.
You make some great points! Clients can appreciate diagnoses for the reasons you mentioned, but descriptive diagnoses as they are, often give insufficient guidance to the clinicians who are trying to figure out how to help.
You write: "If you have OCD, you should seek exposure and response prevention therapy from a qualified therapist; if you don’t have OCD, exposure and response prevention won’t help you. If you have depression, you should try doing rewarding activities, figuring out whether your thoughts are rational, and improving your relationships with others—all of which are also useful if you are nonclinically kind of sad. From my perspective, it is useless to distinguish depression and nonclinical sadness."
I agree that OCD benefits from ERP (as well as ACT). But with depression, it's much less straightforward. There isn't just one kind of (clinical or nonclinical) depression which is automatically helped by the three types of treatment you mention (Behavioral Activation, CBT, and IPT). Further, even though those treatments can help relieve some types of depression, they don't necessarily get to the root of what is causing the depression in the first place. For example, depression caused by early attachment wounds are hardly healed by Behavioral Activation or CBT. And a trauma triggered nervous system shutdown depression is not healed by any of these.
Finally, don't forget that sadness is not generally a cause of depression. Sadness is an emotion that we all need to feel when we experience loss. It's actually the cutting off of feeling that is more likely to cause a logjam-type depression. Sadness itself is not depression.
I wrote an essay in response, arguing that diagnoses aren’t just for clients. They’re essential for treatment, too: https://thehumanconditionrevisited.substack.com/p/why-therapists-do-and-should-give
Yup, therapists love to diagnose OCD! Half the treatment is just "yes you have this illness, no you are not a monster, no these thoughts don't mean anything, yes you have OCD". Patients are usually so relieved and happy upon getting the diagnosis.
I once had a therapist try to diagnose me with ocd in the first 10 minutes after meeting them, which seemed a bit extreme. (The next 15 minutes were spent trying to convince me that I needed to be on an SSRI, even though the previous three SSRIs didn’t work. I did not schedule a second session.)
Did you eventually end up on a different class of drug for whatever problem the SSRI was intended to treat?
Yeah I already had a med setup I was happy with when I talked to the guy! But apparently the meds I’m on ~don’t address ocd directly~ so obviously SSRIs are the answer and screw your “previous experience” with them “causing suicidal ideation and panic attacks and possibly a hypomanic episode that one time”.
Genuinely not sure what his deal was - it’s hardly unusual go to therapy because you want non-med coping skills.
(To be fair to the guy I do have Tourette’s and some imo subclinical ocd symptoms. But that wasn’t the reason I wanted therapy and it was extremely annoying that the guy derailed the whole session for this.)
Indeed. I suspect the magic words to say to someone like that is would be something like "I'm already seeing a psychiatrist for medication management, so I'll tell them your opinion. Now can we get back to [whatever you originally wanted to talk about]." And if that doesn't shut them up, leave. :P
That would probably have been the better move, yeah. On the other hand, playing it out gave me good information about whether I wanted to ever see that therapist again (emphatically no), so maybe it worked out.
The highlight of my morning was watching that diagnosis musical sketch. Thank you! 😂