I used to think much the same thing.
I have, however, had the wonderful experience of being treated (for ADHD) by two very science oriented psychiatrists.
They know the research articles cold, suggest approaches based on actual research, can explain the best scientific understanding of why something should work, and when it doesn't, why that theory may be wrong, etc.
Now, as for " What needs to happen first is that we need to attain a much deeper understanding of how the brain works on the low and high levels, mechanically and abstractly."
I couldn't more strongly disagree. What you say could be applied to every area of medicine. We have been very wrong in very many fields about very many causes of very many diseases.
We only gain understand through trying and failing, and trying and succeeding.
Sitting around waiting for scientific knowledge to magically increase through some unspecified process will do nothing.
If you want to argue psychiatrists are overconfident and usually wrong, that's one thing.
If you want to argue that the diagnosis criteria are essentially vague bullshit that reads like the stuff they used to use to convict people of being witches, i'm right there with you.
But you seem to be arguing we should stop trying with medications until we understand things better.
If we did that, we should stop roughly all modern medication, because in large part, we only know it works, not why or how, at any real level. We irradiate cells to try to solve cancer. This is basically at the level of using leeches.
We have theories. People are trying these theories out on real live people through making test medications, performing trials and treatments. Sometimes they pan out, sometimes they don't.
Sitting around doing MRI imaging studies (and any other kind of study you can think of) of the brains of various mentally ill people has been done, and the results analyzed. It has not helped.
So let's start simple:
What exact process would you use to increase knowledge to the point you suggest?
Past that, if your real argument is that more conservative approaches should be favored over medication first, well, the problem there is simple at it's core:
Nobody is willing to pay for it.
Insurance companies are happy to cover a pill at 10 bucks a month for months.
Most people can't get outpatient CBT/DBT except at significant out of pocket cost.
So the fact that you have plenty of psychiatrists willing to sit around and prescribe med after med is partially an artifact of "that is what they can do for their patients".
> I used to think much the same thing. I have, however, had the wonderful experience of being treated (for ADHD) by two very science oriented psychiatrists.
First, you're very lucky! From what I understand, those psychiatrists are not only expensive (usually they are not on insurance plans), but also hard even to schedule (as they are rare, and in high demand)
Slightly OT, but were you diagnosed as a child or as an adult? If the former, did your treatments change as you grew older? If the latter, what was your impetus in getting diagnosed/treated?
It is true my psychiatrists are not on insurance plans. This is a larger problem with how mental illness treatment is funded/supported.
I was diagnosed as a child about 27 years ago (IE well before the current "popularity").
My treatments did change. I learned to cope with some aspects, the medications I used changed (I am on a non-stimulant now, Straterra, that works as well as my stimulants did).
Besides being able to be more introspective and self-aware as I got older, I also chose a path that would set me up for success.
I have a job that has multiple roles, and essentially requires me to pay short amounts of attention to a large number of things at once, which is somewhat ideal for my ADHD.
The things that require longer amounts of focus tend to be lower priority.
> I am on a non-stimulant now, Straterra, that works as well as my stimulants did
That's interesting - thanks for sharing. IIRC Strattera is relatively new; I wonder if the drugs themselves are getting more effective, or if the most effective drug for a person changes over time based on physiological changes or external factors.
I don't have any personal experience to compare it with, but of my friends who have been treated for ADHD for more than 15 years, it seems all have had to switch medications multiple times.
I don't see your email address on your profile, but mine is my username at gmail - mind dropping me a line?
"That's interesting - thanks for sharing. IIRC Strattera is relatively new; I wonder if the drugs themselves are getting more effective, or if the most effective drug for a person changes over time based on physiological changes or external factors."
Yes, Straterra is relatively new. I became immune to ritalin (well, roughly) after taking it for so many years, and Adderall, even in the XR version, started becoming less and less effective for me. This is apparently normal, and medication switching is common over long term treatment.
My doctor said she could up the dosage, but that she'd rather try Stratterra first, given the advantages of that vs high-dose stimulants
Note that 20 years ago, the common viewpoint was that adult adhd did not exist, that it simply "wore off" as you got older.
Straterra has worked fine for years so far, and i have not seen any of the gradual reduction effect that was completely obvious in all the stimulants over time.
Nice to see someone who has noticed that a good doctor actually bases his opinions of science. You could be fooled by the massive disdain for medicine in this thread, or at the very least be led to believe that no one here has ever talked to a doctor.
They know the research articles cold, suggest approaches based on actual research, can explain the best scientific understanding of why something should work, and when it doesn't, why that theory may be wrong, etc.
Now, as for " What needs to happen first is that we need to attain a much deeper understanding of how the brain works on the low and high levels, mechanically and abstractly."
I couldn't more strongly disagree. What you say could be applied to every area of medicine. We have been very wrong in very many fields about very many causes of very many diseases.
We only gain understand through trying and failing, and trying and succeeding. Sitting around waiting for scientific knowledge to magically increase through some unspecified process will do nothing.
If you want to argue psychiatrists are overconfident and usually wrong, that's one thing. If you want to argue that the diagnosis criteria are essentially vague bullshit that reads like the stuff they used to use to convict people of being witches, i'm right there with you. But you seem to be arguing we should stop trying with medications until we understand things better.
If we did that, we should stop roughly all modern medication, because in large part, we only know it works, not why or how, at any real level. We irradiate cells to try to solve cancer. This is basically at the level of using leeches.
We have theories. People are trying these theories out on real live people through making test medications, performing trials and treatments. Sometimes they pan out, sometimes they don't.
Sitting around doing MRI imaging studies (and any other kind of study you can think of) of the brains of various mentally ill people has been done, and the results analyzed. It has not helped.
So let's start simple: What exact process would you use to increase knowledge to the point you suggest?
Past that, if your real argument is that more conservative approaches should be favored over medication first, well, the problem there is simple at it's core:
Nobody is willing to pay for it.
Insurance companies are happy to cover a pill at 10 bucks a month for months.
Most people can't get outpatient CBT/DBT except at significant out of pocket cost.
So the fact that you have plenty of psychiatrists willing to sit around and prescribe med after med is partially an artifact of "that is what they can do for their patients".