It would have to be extremely stressful, knowing that in some short number of years (since it normally shows up in late teens/early 20s I think) your mind would start to constantly lie to you and you may lose the ability to discern reality from hallucinations.
Imagine if children could get diagnosed, or anyone who had no idea and now has to question their own sanity knowing that if it isn't already affecting them that it's only a matter of time.
Also because our blood can end up in a lot of places. People who may not even be aware it was collected/screened for schizophrenia could end up being targeted by marketers, scammers, or anyone else with an agenda who'll try to feed into their paranoia the same away advertisers target people with biopolar disorder because they know that people in a manic phase tend to buy things/travel more or how scammers use data brokers to buy up lists of people with dementia and those with low IQ/little education
Who needs evidence when there is no real enforceable penalty for doing so? Credit card companies sell our data. Ancestry services probably sell our data. They might put signs in the windows saying "your data is safe with us" but that's pretty much where any amount of trust we place in these companies ends and becomes blind faith.
It's also worth pointing out that a company doesn't have to hold a meeting where they vote to deliberately target and exploit vulnerable members of the public, instead they just use an algorithm that constantly optimizes for making them money and which eventually figures out exploiting people is easy and effective.
Those companies generally know it's happening, and often do set out to make it happen just like they've always targeted ads at young children and teenagers whose brains aren't developed yet, but the algorithm gives them plausible deniability.
I think it would be largely good to know, since being predisposed to schizophrenia doesn't necessarily mean you end up losing your sanity. Schizophrenia is largely genetic and physical markers of schizophrenia (e.g. abnormal thalamus shape) appear in the non-schizophrenic siblings of people suffering from schizophrenia... And if you're predisposed to schizophrenia, there are certain things you should avoid like cannabis consumption that can trigger schizophrenia in people who have the predisposition (and once schizophrenia is triggered, it isn't curable; only manageable with lifelong medication).
If a blood test could tell you that you have the equivalent of a deathly peanut allergy, but to weed (and instead of dying you get a permanent mental health issue that requires medication for the rest of your life), I think it would be better to know that than to not. Even if it's unfortunate and scary to know.
I invite you to read my other postings in this thread and respond to me in your leisure.
It's clear we have a fundamental difference of opinion, and I think a productive discussion could be had between us despite that. I have a very open mind and I'd welcome any knowledge or understanding you wish to convey to me. You can consider me a strong-minded, stubborn but otherwise good faith skeptic.
I apologize in advance if I come off as hostile or otherwise distasteful in this interaction, that is not my intention. This is a subject that I have great passion for, and I truly believe that greed has warped our understanding of care as a society. I especially invite you to look up Soteria Houses (a minimal/no medication way of successfully treating schizophrenia) and the various results of the implementations worldwide before responding.
And to respond directly to your posting:
Can you explain why this thalamus abnormality is associated with schizophrenia? What is the reasoning? Who is to say that such an abnormality has nothing to do with the schizophrenia, but is instead an inherited, but benign condition? Where is the damage/disease? Is the thalamus thought to be central in the cause of schizophrenia?
For example, I have such a rare condition, but with my optic nerve/cup-to-disc ratio. My father has the same condition - we present like we have glaucoma, but it is completely and absolutely benign.
Reading your other posts, I think what you may believe I am proposing is medicating people who do not appear to be schizophrenic on the basis of a blood test. Let me assure you I am not. I think it would be useful to know if you are predisposed to schizophrenia, so that you could avoid substances known to be problematic for people predisposed to schizophrenia, e.g. weed.
Sort of like knowing if you have a peanut allergy allows you to avoid eating peanuts — but we don't mandate people with peanut allergies do anything in particular, we just label foods with "may contain peanuts" if they might contain peanuts. There are already similar labeling laws for cannabis, so a blood test would be useful information for someone to have about whether they should avoid those products.
I'll take a look when I get some time, thanks so much for sharing the link.
And no, I'm so sorry about the misunderstanding and I know you're in good faith, but in my initial comments, I was more or less adding details to what other commenters were suggesting if such a blood test were mandatory or at least common:
Basically, what might happen in such a scenario where psychiatry is used as a blunt instrument to treat an illness that hasn't manifested/possibly won't ever manifest in people that have done nothing wrong - with only a single test and a possibility of illness to justify forced treatment.
Which, unfortunately, isn't too far-fetched given our laws today. Like I said previously, in my state, you just have to argue that somebody could benefit from treatment to take away their freedom. I think theoretically, everyone could benefit from some sort treatment or therapy - and that's all it takes to get whisked away for 20 days or longer, forcibly. Even if you were in bed and you were woken up at 4am by a loud bang, even if nothing is wrong with you, even if you don't want that, even if the evidence actually isn't in evidence. There's not enough due process with involuntary commitment - you should still have a basic set of rights, after all where is the crime or threat to others or self?
I'm suggesting that maybe we are too heavy-handed with anti-psychotics and other pharmaceuticals as the standard treatment methodology of schizophrenia and other mental illness. I think Soteria Houses and other, similar standards of care need to have a closer look as they are absolutely onto something. That disorders in the schizophrenia spectrum, or simply other psychotic disorders or even mental illness at large are primarily a response to trauma and other stress, and/or that there is a measurable, medical issue that we have yet to diagnose or conceive of in these people, or that mental illnesses are perhaps caused or exacerbated by the modern lifestyle being so drastically different from what even our parents lived.
"Environmental" as a cause is a very big umbrella to point to when we have been exposed to so many new chemicals, modes of living, technology, behavior, stimulation, etc. all very, very quickly evolutionarily speaking. I think it's natural with so many variables, stress, and toxins in the products we put on our body or have in the food and water we consume that illness like cancer or other autoimmune diseases are seemingly more common than ever.
But it's hard to point the finger to any one such chemical or habit besides the obvious ones, because of the sheer volume. I think the EU is much more sane with how they regulate chemicals that could cause harm - they ban them if the burden of proof of safety is not met, and if nothing else, I feel like if the world emulated them, there would be a lot less doubt or uncertainty on what is truly harmful.
Ultimately in responding to you, I'm trying to suggest to you that perhaps schizophrenia is not a lifelong, chronic disease for everyone in part because of my own experience in dealing with hearing voices and other sounds, having delusions, displaying psychotic behavior, and secluding myself for a significant period of my early twenties. I was a victim of some pretty serious crimes that happened in quick succession in my early twenties (assault/head injury from my best friend, and then being raped repeatedly by a younger family member who convinced me that nobody would believe me if I reported him).
I could've (and probably should've) received therapy and in an ideal world psychiatric help during that time, but after a handful of very bad experiences having my anxiety and depression treated in therapy and some nearly deadly medication side effects and I was perfectly content to work through alone all the trauma of my unfortunately very traumatic life, which doesn't start or end with being assaulted or raped, those were just the events leading up to my brea...
No need to apologize! I agree with you — a blood test definitely shouldn't result in anything involuntary being done to someone. I'm sorry to hear about your difficult experiences and am glad you're in a better place now.
Alphabet were investing heavily into this space a while ago, with Thomas Insel leading the research. Their aim was to identify biomarkers of these more serious mental illnesses. Schizophrenia isn't like Huntington where an early predictive diagnosis does little more than inform you of an inevitable debilitating illness. Schizophrenia can be managed, and when it is managed well with early intervention the outcomes can be very good. I oversaw a program that supported sufferers of schizophrenia in the community and we had some staff working with us who were also sufferers. The main difference between those who had positive vs negative outcomes was the way in which the illness was managed at onset (typically between teens to young adulthood). Unfortunately mismanagement during that period could have a massive effect on final outcome, where for example we had 60yo patients suffering PTSD from the way they were treated 40y ago during the onset of their illness.
If there's anything to fear about improved mental health diagnostics it's how this data will be used by insurance companies to exclude customers in countries that lack socialized healthcare (i.e., US).
> If there's anything to fear about improved mental health diagnostics it's how this data will be used by insurance companies to exclude customers in countries that lack socialized healthcare (i.e., US).
Since the Affordable Care Act went into effect in 2014 in USA it's no longer legal to exclude people based on most pre-existing conditions.
"Marketplace plans must cover treatment for pre-existing medical conditions. No insurance participating in the health insurance market place can reject you for coverage, charge more, or refuse to pay for essential health services for any prior medical condition. Moreover, once an individual is enrolled in the marketplace, insurance plans cannot deny coverage or raise rates solely based on your health." [0]
> If there's anything to fear about improved mental health diagnostics it's how this data will be used by insurance companies to exclude customers in countries that lack socialized healthcare (i.e., US).
I dunno, I have a relative who’s sorta a bigwig. The way these guys think is counterintuitive. If anything they’re more likely try to get ‘em early while they’re cheap and then make sure they can dump these patients on their competitors later in life.
A critical factor regarding early detection is whether it is caught while you are a minor.
As a minor, parents can participate in the treatment, make decent decisions and keep their child's life on track. Medication makes a huge difference.
If the patient becomes an adult, treatment is most places becomes the decision of the patient. This can be especially tragic because schizophrenic patients can have anosognosia, which makes them unaware that they have a mental illness.
These kinds of people can go through the system 20 or 30 times before they get treatment, with lots of fallout to all facets of their life.
The outcomes can be pretty horrible as the condition goes untreated for months or years.
Exactly. It's scary to think that a simple screening could dictate how you are treated for the rest of your life effectively.
You're declared a "latent schizophrenic" and people start doubting your credibility, sanity, independence, safety etc. at every change or milestone in your life. You are forced into therapy for your "benefit", because you are preemptively declared "incompetent" because your illness could manifest any time.
You are given "maintenance" doses of major tranquilizers and a cocktail of other poorly understood psychiatric drugs to balance the side effects out; and any spirituality, any epiphanies or sudden changes, any minute delusion is blown out of proportion and is put under a microscope.
This name-calling/magnification of "bad behavior" could happen to anybody, and does every day regardless of such screenings and tests. These psychological disorders are poorly understood, with flimsy and often biased/subjective diagnostic criteria (with no measurable physical damage, only a checklist - even in schizophrenia; those bunk brain scans of people who have been treated long-term with anti-psychotics are evidence of just that - it's not the natural progression of the disease).
"Wellness checks" are one way today where people can effectively send anybody to a mental hospital with no due process. Some states require that you be a threat to yourself or others, which is something that is easy to fabricate/exaggerate if you wish a person harm, or perhaps misunderstand a situation or are misguided and think you know better than the person that you want to "help".
In my state though, if there is "clear and convincing evidence that somebody needs treatment and would benefit from it" during such a check, it basically gives them the right to involuntarily commit you.
Imagine how devastating that could be to somebody who cannot afford to pay for the treatment/duration of stay, even if they were deemed subjectively to need treatment. It's highway robbery how much they charge. And their entire life could be upended in the 3 days they held them, if they did get out in only 3 days. They could lose their job, and it all cascades from there.
Instead of worrying how bad reality can get, or is, we really just need to attack the problem at its core:
Health care needs to be health care, not whatever the hell capitalism has twisted it to be.
Involuntary treatment should be made illegal, and there should be a much higher bar on what criteria makes somebody incompetent. One psychiatrist and a judge who is wooed by that psychiatrist is not enough. You should be able to direct your care to another psychiatrist or facility if you have any problem whatsoever, but that usually doesn't happen. There are courts specifically called "Mental Health Courts" in the US and I can tell you that "second opinions" and even small changes to your treatment can be hell to fight for.
And finally, suicide should be legal. There should be humane, detailed processes for it, and it should be done in a medical setting. If suicide were legal, then a lot of these frivolous interventions would become regulated. People shouldn't have an express ticket to the mental prison whenever they express wanting to die.
On the other hand, it is arguable that the state has an interest in preventing the collapse of relationships that occur around schizophrenics. That's what the involuntary commitment analysis is for to determine safety/danger. If you don't have rules about this it can get a lot uglier quickly.
Of course, I do think there should be some effort to be made to stabilize individuals in crisis. Just like a typical hospital.
Especially those who may be having medication side-effects, which with psychiatric medication, incidence rates for some fairly severe side effects (such as the potentially irreversible condition called tardive dyskinesia) are fairly high across most commonly encountered drugs.
Add polypharmacy (5 or more drugs at the same time, which is common in illnesses such as schizophrenia, such as antipsychotic polypharmacy being used in 30% of such patients) and a mental hospital is probably the only place that is equipped to help somebody in such a situation. It's irresponsible, dangerous, and unethical what is happening in the current standard of care in my opinion.
I believe consent is the most important thing you need in medical care. Just as you should be able to refuse life-saving care for whatever reason you might have in a regular hospital, you should be able to reject (for example) a long-lasting intramuscular antipsychotic injection, which are usually part of commonly encountered treatment orders.
It's rape if you don't give somebody a choice, and think about what that does to somebody. I am an actual victim of rape, and I can tell you it's no different if a doctor or nurse does it to you. It's something you didn't want, and that should be good enough reason for a doctor to not administer such care. If you have other reasons, such as not liking how it makes you feel, etc. that's more than enough.
And you should be able to make decisions that affect your body especially if you're not a threat to yourself or others. If somebody needs to taper off to safely get off their medication, then have them taper off to get off the medication - but still overwhelm them with support in other ways they approve of if you determine they need it.
BUT there's a pretty valid alternative to scary things like involuntary treatment orders, restraints, locked doors, "Mental Health Courts", and disease-first care.
And that's Soteria Houses. You can read my thoughts on this (in my opinion) revolutionary and successful standard of care in my previous posts: https://news.ycombinator.com/item?id=37140331
The gist is: no locked doors, welcoming supportive environment, no dehumanization or medicalization of their psycho-social issues, minimal psychiatric intervention (mostly for stabilization from what I've read), and they have pretty impressive results treating a supposedly lifelong and chronic disease.
However, it or something like it will never manifest into becoming the dominating model unless we slash the greed out of mental health care and health care at large.
I firmly believe that the medications commonly used in this field today and especially in the past are prescribed irresponsibly, without the long-term testing they need, and side effect/interaction profiles are not studied in the detail they need to be before these drugs are unleashed. This creates a revolving door for these companies to cash out on these people, either through their hospitals or the doctors they brainwash. And boy, do they. You know it's bad when you see an advertisement for XYZ psychiatric drug on the television. It's been bad for however as long as the field has existed. A true horror that we will look back on with great pain as a world.
The fact is that most people probably never have heard about Soteria Houses, and that's by design. It breaks their big illusion. Schizophrenia and other serious mental illness need to be a boogeyman that only a psychiatrist can understand. They say it's a lifelong disease that only they can manage the symptoms of. And this is because they more often than not create the disease in these very, very vulnerable people with the chemicals they claim help more than they hurt.
I think our laws largely in this area (involuntary commitment) reflect how hostile a particular state or geographic location feels towards their homeless population and other undesirables as you suggest.
Psychiatry is used to get these people off the street (for their own benefit of course), and either the state is content to just to disappear them into a hospital (the hospital loves the chance to reap all that money), or is happy to see them in and out, having them experiencing a combination of psychiatric drug withdrawal and side effects.
Perhaps it's not like that everywhere, and these people are provided the medication free of charge through some means, but I know that a pharmacy won't fill your prescription if you don't have money.
Imagine what this dynamic looks like if somebody also has an addiction to feed, or isn't educated properly on the powerful drug(s) they are being prescribed. There's a lot that can go wrong when you give prescription drugs with physical dependence to people who see the opportunity to 1) sell them 2) not take them consistently 3) or administer incorrectly (try to get high). Any of those things can risk withdrawal and other physical side effects, that could only make somebody more unstable, or their behavior even riskier.
Which is tantamount to poisoning these people (why prescribe something with physical dependence if you know they can't reliably get the medication? Where is the "Do no harm"?), and sounds pretty unconstitutional to me on many levels. In general, the homeless have more of their rights stripped than any other population that I'm aware of in the US.
You can't sleep in your car because city/town ordinances, benches are being made to prevent being slept on (hostile architecture in general has become a pretty common), in most areas you can't access or afford housing or property when there's empty housing and property everywhere, the shelters aren't safe, you can't build what you want on your property (e.g. tiny houses not being allowed in some areas), and lastly simply being homeless is enough justification to have all your rights stripped and your freedom taken away. For your own good, because just being homeless is a mental illness in itself for everyone concerned.
This bad stuff won't happen because reason leads us to it. We will come to it because stressful circumstances and/or promises of gain leads us to desiring it. Then we will contrive justification.
Inscrutable medical scientific authority is a great source of justification. It's a scary superpower that way.
? It's a genetic adaptation to hellish circumstances and as we head toward these circumstances somewhat OP.
They really are after you, in Russia, in china, in large parts of Africa and more to come. And there are manmade Tigers in the sky and water.
Seems to be misguided notion, out of a nostalgic sense for reality, to want to mis-adapt people to a ever more shrinking raft of stability. This shitty circumstances are normal.. It is what most of the species, spend most of its time in before science gifted us with temporary freedom.
Better in the long run to adapt the surplus scientific society so that it can survive and thrive in shitty circumstances. Let's make chips in Mogadishu the challenge?
Older, longer and more sustainable societies and cultures found places for some of the people we'd call schizophrenic today. I do think it's tragic that we've lost those roles and ideas surrounding those roles in modernity.
However, I've seen with my own two eyes schizophrenia destroy the lives of several people I know. These people are suffering, and not just because of how society treats the neurodivergent. They are trapped in hellish prisons of their own minds, reliving and reinventing traumas no one should have to experience. It's as if their own minds have turned on themselves just to torment them in uniquely personal and unseen hells.
It's utterly tragic, and largely preventable with treatment.
That said, even in the past, where there were roles for those who experienced schizophrenic symptoms, those with extreme symptoms also suffered from expulsion, disownment, imprisonment and death. It's a mistake to romanticize something that torments so many.
It all depends on the strength of the correlation. We all know, that to link behavioral patterns to bio-chemistry is full of false-positive... and the other way around too.
Correlation is not proof, and in biology, due to inherent complexity it is even more questionable.
That looks like some kind of "more research is needed", "give me more money" kind of study.
"Although medication effects, comorbidities, chronic illness, and drug use (licit and illicit) are common in SZ, these factors are difficult to accurately quantify and control, such that caution interpreting these findings is warranted."
Not sure why you're joking, cannabis use absolutely gave me schizoid symptoms like ideas of reference, etc. This is an actual thing that can happen for some people.
Exactly cannabis abuse and schizophrenia often go hand in hand. There is also some evidence that cannabis use can trigger the condition, esp. in people with a predisposition.
I think you might mean schizotypal symptoms. Schizoid personality disorder is considered "on the spectrum" with schizophrenia but has very little similarity to it other than social withdrawal.
Psychiatrists know mental health is mostly subjective and the institution is desperate for physical evidence to add airs of legitimacy. There's a handful of medications that make people less crazy, they prescribe them like candy to anyone for any reason(usually at dosages that are too high). Other than that all they can offer is therapy(which most of them don't want to do because the people that come to them are often heavily traumatized)
ADHD has a half dozen or more effective treatments. Several are rather recent. There’s long term evidence that ADHD medications help those with on a wide variety of measures.
Likewise cognitive behavioral therapy and similar work well for many folks. It helps give people tools to change negative behavioral patterns.
There’s fMRI which can objectively show brain activity differences for various mental illnesses.
What makes fMRI objective proof when the mental illnesses are largely subjective?
One psychiatrist could see a patient completely differently from another. You either have Alzheimer's or you don't. Your arm is broken or it isn't. It's measurable.
With mental illness, the line is blurred. I've never seen compelling evidence for fMRI - just circular reasoning. Psychiatrists who buy into this paradigm posit that the disease exists because in these populations of heavily medicated, subjectively diagnosed (heavily traumatized/stressed) individuals, there are similarities between them in the activity of their brain.
Perhaps it's just their disease-first perspective that I take issue with when it comes to fMRI. You could validly look at these populations completely differently without subjective disease terminology and be logically sound with your findings, such as; people tested who experienced more traumatic events in their lifetime and seeing how their brain lit up vs. people who did not experience traumatic events. Or how people respond in institutionalized situations vs. less formal situations, etc.
The person you are responding to shares the same general thinking that I have: medically, there is no disease if there is no measurable physical damage.
As a doctor when you are arguing that somebody has a disease, especially a disease that is thought to be lifelong or perhaps genetic in nature, it's your job to prove that. A check-list of symptoms isn't enough proof. And by going through these lists you are stereotyping your patient. Studying people diagnosed in this way and forming correlations in these heavily stressed, vulnerable populations proves nothing besides perhaps how stressed they are and the different ways that stress is expressed throughout the population.
But when you factor treatment into the mix, physical study of the brain frankly becomes worthless if you are applying it broadly. It could be that fMRI is more or less finding that people on Lexapro or Lithium (whatever the common prescription for an illness is) respond a certain way. Or that individuals experiencing specific types of heightened states (like mania) respond a certain way.
What we are not saying is that there is not suffering, that symptoms don't exist, that symptom groupings (like ADHD) aren't bad or good, it's the disease terminology and intellectual dishonestly of the psychiatric field that we are pointing out.
I'm not going to touch most of the stuff you brought up here, but I do think it's worth pointing out that the first psychotic episode revealing something like schizophrenia has long term side effects. Not just socially but also in terms of physical differences in brain structure. These severe episodes can actually be closely monitored and prevent for some people. So there is a very real opportunity to do good here
Citation needed. I'm not aware of any studies that highlight differences in brain structure of a "healthy" brain vs. a brain of somebody who has unmedicated first-episode schizophrenia/psychosis.
If somebody took anti-psychotics, especially for a long time, it's known that they affect brain structure and that invalidates any findings that the study has, unless they can account for the changes that the (for example) anti-psychotics produced. Which given our current state of science, and understanding of the brain, is unlikely.
>Initially during the prodrome, a change in brain structure seems to be present in the temporal lobe volume and cingulated. On follow-up in those who have gone onto a psychotic episode, further changes can be seen in the cingulate, temporal lobe, and parahippocampal gyrus.
Structural changes occur before an episode has even occurred.
Thanks so much for that. I appreciate the honesty and clarity of the authors in presenting their findings.
Upon a very, very brief read it still seems difficult for them (in my opinion) to find that schizophrenia is primarily genetic in nature when there still could be potential causative agents that only siblings share (the same house, the same food and water, the same household/generational chemical/drug use/exposure, etc.) which may yet explain the changes/differences. I will take a closer look when I have the time and look at the wealth of references they included (they do have some pretty large studies referenced that support their findings). Thanks again.
I just want to say that while I may seemingly appear to be particularly hostile to the physical causative angle or the genetic (or predictive) angle of mental illness, I just want to clarify that this is mostly because of the fears I have about the current/near-future clinical/societal implications of this being established, in my opinion, prematurely.
There's unarguably a lot of good that research can do in this area, however, I just hope that more understanding in these areas are reflected clinically by a massive diversity of treatments. Especially, laser-focused treatments that cause minimal side effects.
I don't think there's any arguing from me that if we were able to stop the progression of schizophrenia before first-episode psychosis (especially without using anti-psychotics long-term or at all) that it wouldn't be a good thing.
Or as other commenters pointed out, to stop these people who share these markers from doing things that might worsen/manifest their illness, like cannabis. Or researchers finding out how the endocannabinoid system is involved in the illness, including potential therapies (like tackling the systemic inflammation that is common in serious mental illness).
It's just a slippery slope if we go about this in the wrong way. Like forced treatment. Or applying treatments to other differences that may not cause distress to the individuals or inhibit their functioning or participation in society (like forcibly treating high functioning individuals who are on the autism spectrum).
Or incorrectly diagnosing schizophrenia/psychosis in one person and inappropriately treating them, when in reality there were two or three distinct diseases causing a similar illness or set of symptoms. Who knows, there is a distinct lack of knowing still in this field. I just know that the profit-motive needs to disappear before true progress and medicine can happen.
Nobody with clinical experience or even an educational background in psychopharmacology/medicine would make a comment like this. Antipsychotics are given with great caution as many have extrapyramidal effects and a few even require REMS programs.
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[ 3.6 ms ] story [ 132 ms ] threadAlso because our blood can end up in a lot of places. People who may not even be aware it was collected/screened for schizophrenia could end up being targeted by marketers, scammers, or anyone else with an agenda who'll try to feed into their paranoia the same away advertisers target people with biopolar disorder because they know that people in a manic phase tend to buy things/travel more or how scammers use data brokers to buy up lists of people with dementia and those with low IQ/little education
Just had an interview where there was no correct answer.
Remembered the equivalent leetcode problem, and my solution worked. Could not pass their test cases though.
https://www.congress.gov/bill/118th-congress/senate-bill/212... (S.2121 - DELETE Act)
CFPB is trying to rein them in. Call your congressional reps, ask them to support the DELETE Act.
>advertisers target people with biopolar disorder because they know that people in a manic phase tend to buy things
I've assumed this is probably true, but do you have any evidence that this is actively practiced?
https://gizmodo.com/depression-anxiety-brokers-sell-mental-h...
The study: https://techpolicy.sanford.duke.edu/data-brokers-and-the-sal...
https://www.healthyads.com/targeting/medical-conditions-targ...
https://mobilemarketingmagazine.com/psychological-targeting-...
It's also worth pointing out that a company doesn't have to hold a meeting where they vote to deliberately target and exploit vulnerable members of the public, instead they just use an algorithm that constantly optimizes for making them money and which eventually figures out exploiting people is easy and effective.
Those companies generally know it's happening, and often do set out to make it happen just like they've always targeted ads at young children and teenagers whose brains aren't developed yet, but the algorithm gives them plausible deniability.
If a blood test could tell you that you have the equivalent of a deathly peanut allergy, but to weed (and instead of dying you get a permanent mental health issue that requires medication for the rest of your life), I think it would be better to know that than to not. Even if it's unfortunate and scary to know.
It's clear we have a fundamental difference of opinion, and I think a productive discussion could be had between us despite that. I have a very open mind and I'd welcome any knowledge or understanding you wish to convey to me. You can consider me a strong-minded, stubborn but otherwise good faith skeptic.
I apologize in advance if I come off as hostile or otherwise distasteful in this interaction, that is not my intention. This is a subject that I have great passion for, and I truly believe that greed has warped our understanding of care as a society. I especially invite you to look up Soteria Houses (a minimal/no medication way of successfully treating schizophrenia) and the various results of the implementations worldwide before responding.
And to respond directly to your posting:
Can you explain why this thalamus abnormality is associated with schizophrenia? What is the reasoning? Who is to say that such an abnormality has nothing to do with the schizophrenia, but is instead an inherited, but benign condition? Where is the damage/disease? Is the thalamus thought to be central in the cause of schizophrenia?
For example, I have such a rare condition, but with my optic nerve/cup-to-disc ratio. My father has the same condition - we present like we have glaucoma, but it is completely and absolutely benign.
Reading your other posts, I think what you may believe I am proposing is medicating people who do not appear to be schizophrenic on the basis of a blood test. Let me assure you I am not. I think it would be useful to know if you are predisposed to schizophrenia, so that you could avoid substances known to be problematic for people predisposed to schizophrenia, e.g. weed.
Sort of like knowing if you have a peanut allergy allows you to avoid eating peanuts — but we don't mandate people with peanut allergies do anything in particular, we just label foods with "may contain peanuts" if they might contain peanuts. There are already similar labeling laws for cannabis, so a blood test would be useful information for someone to have about whether they should avoid those products.
And no, I'm so sorry about the misunderstanding and I know you're in good faith, but in my initial comments, I was more or less adding details to what other commenters were suggesting if such a blood test were mandatory or at least common:
Basically, what might happen in such a scenario where psychiatry is used as a blunt instrument to treat an illness that hasn't manifested/possibly won't ever manifest in people that have done nothing wrong - with only a single test and a possibility of illness to justify forced treatment.
Which, unfortunately, isn't too far-fetched given our laws today. Like I said previously, in my state, you just have to argue that somebody could benefit from treatment to take away their freedom. I think theoretically, everyone could benefit from some sort treatment or therapy - and that's all it takes to get whisked away for 20 days or longer, forcibly. Even if you were in bed and you were woken up at 4am by a loud bang, even if nothing is wrong with you, even if you don't want that, even if the evidence actually isn't in evidence. There's not enough due process with involuntary commitment - you should still have a basic set of rights, after all where is the crime or threat to others or self?
I'm suggesting that maybe we are too heavy-handed with anti-psychotics and other pharmaceuticals as the standard treatment methodology of schizophrenia and other mental illness. I think Soteria Houses and other, similar standards of care need to have a closer look as they are absolutely onto something. That disorders in the schizophrenia spectrum, or simply other psychotic disorders or even mental illness at large are primarily a response to trauma and other stress, and/or that there is a measurable, medical issue that we have yet to diagnose or conceive of in these people, or that mental illnesses are perhaps caused or exacerbated by the modern lifestyle being so drastically different from what even our parents lived.
"Environmental" as a cause is a very big umbrella to point to when we have been exposed to so many new chemicals, modes of living, technology, behavior, stimulation, etc. all very, very quickly evolutionarily speaking. I think it's natural with so many variables, stress, and toxins in the products we put on our body or have in the food and water we consume that illness like cancer or other autoimmune diseases are seemingly more common than ever.
But it's hard to point the finger to any one such chemical or habit besides the obvious ones, because of the sheer volume. I think the EU is much more sane with how they regulate chemicals that could cause harm - they ban them if the burden of proof of safety is not met, and if nothing else, I feel like if the world emulated them, there would be a lot less doubt or uncertainty on what is truly harmful.
Ultimately in responding to you, I'm trying to suggest to you that perhaps schizophrenia is not a lifelong, chronic disease for everyone in part because of my own experience in dealing with hearing voices and other sounds, having delusions, displaying psychotic behavior, and secluding myself for a significant period of my early twenties. I was a victim of some pretty serious crimes that happened in quick succession in my early twenties (assault/head injury from my best friend, and then being raped repeatedly by a younger family member who convinced me that nobody would believe me if I reported him).
I could've (and probably should've) received therapy and in an ideal world psychiatric help during that time, but after a handful of very bad experiences having my anxiety and depression treated in therapy and some nearly deadly medication side effects and I was perfectly content to work through alone all the trauma of my unfortunately very traumatic life, which doesn't start or end with being assaulted or raped, those were just the events leading up to my brea...
If there's anything to fear about improved mental health diagnostics it's how this data will be used by insurance companies to exclude customers in countries that lack socialized healthcare (i.e., US).
Since the Affordable Care Act went into effect in 2014 in USA it's no longer legal to exclude people based on most pre-existing conditions.
"Marketplace plans must cover treatment for pre-existing medical conditions. No insurance participating in the health insurance market place can reject you for coverage, charge more, or refuse to pay for essential health services for any prior medical condition. Moreover, once an individual is enrolled in the marketplace, insurance plans cannot deny coverage or raise rates solely based on your health." [0]
0: https://en.wikipedia.org/wiki/Pre-existing_Condition_Insuran...
Unfortunately, all the marketplace plans suck.
I dunno, I have a relative who’s sorta a bigwig. The way these guys think is counterintuitive. If anything they’re more likely try to get ‘em early while they’re cheap and then make sure they can dump these patients on their competitors later in life.
As a minor, parents can participate in the treatment, make decent decisions and keep their child's life on track. Medication makes a huge difference.
If the patient becomes an adult, treatment is most places becomes the decision of the patient. This can be especially tragic because schizophrenic patients can have anosognosia, which makes them unaware that they have a mental illness.
These kinds of people can go through the system 20 or 30 times before they get treatment, with lots of fallout to all facets of their life.
The outcomes can be pretty horrible as the condition goes untreated for months or years.
The person might never recover a normal life.
https://en.wikipedia.org/wiki/Anosognosia
2. Blood test.
3. Help the unfortunate person with large doses of mandatory etc.
People need to be judged on their behaviour, not their blood. Nothing more, nothing less.
You're declared a "latent schizophrenic" and people start doubting your credibility, sanity, independence, safety etc. at every change or milestone in your life. You are forced into therapy for your "benefit", because you are preemptively declared "incompetent" because your illness could manifest any time.
You are given "maintenance" doses of major tranquilizers and a cocktail of other poorly understood psychiatric drugs to balance the side effects out; and any spirituality, any epiphanies or sudden changes, any minute delusion is blown out of proportion and is put under a microscope.
This name-calling/magnification of "bad behavior" could happen to anybody, and does every day regardless of such screenings and tests. These psychological disorders are poorly understood, with flimsy and often biased/subjective diagnostic criteria (with no measurable physical damage, only a checklist - even in schizophrenia; those bunk brain scans of people who have been treated long-term with anti-psychotics are evidence of just that - it's not the natural progression of the disease).
"Wellness checks" are one way today where people can effectively send anybody to a mental hospital with no due process. Some states require that you be a threat to yourself or others, which is something that is easy to fabricate/exaggerate if you wish a person harm, or perhaps misunderstand a situation or are misguided and think you know better than the person that you want to "help".
In my state though, if there is "clear and convincing evidence that somebody needs treatment and would benefit from it" during such a check, it basically gives them the right to involuntarily commit you.
Imagine how devastating that could be to somebody who cannot afford to pay for the treatment/duration of stay, even if they were deemed subjectively to need treatment. It's highway robbery how much they charge. And their entire life could be upended in the 3 days they held them, if they did get out in only 3 days. They could lose their job, and it all cascades from there.
Instead of worrying how bad reality can get, or is, we really just need to attack the problem at its core:
Health care needs to be health care, not whatever the hell capitalism has twisted it to be.
Involuntary treatment should be made illegal, and there should be a much higher bar on what criteria makes somebody incompetent. One psychiatrist and a judge who is wooed by that psychiatrist is not enough. You should be able to direct your care to another psychiatrist or facility if you have any problem whatsoever, but that usually doesn't happen. There are courts specifically called "Mental Health Courts" in the US and I can tell you that "second opinions" and even small changes to your treatment can be hell to fight for.
And finally, suicide should be legal. There should be humane, detailed processes for it, and it should be done in a medical setting. If suicide were legal, then a lot of these frivolous interventions would become regulated. People shouldn't have an express ticket to the mental prison whenever they express wanting to die.
Especially those who may be having medication side-effects, which with psychiatric medication, incidence rates for some fairly severe side effects (such as the potentially irreversible condition called tardive dyskinesia) are fairly high across most commonly encountered drugs.
Add polypharmacy (5 or more drugs at the same time, which is common in illnesses such as schizophrenia, such as antipsychotic polypharmacy being used in 30% of such patients) and a mental hospital is probably the only place that is equipped to help somebody in such a situation. It's irresponsible, dangerous, and unethical what is happening in the current standard of care in my opinion.
I believe consent is the most important thing you need in medical care. Just as you should be able to refuse life-saving care for whatever reason you might have in a regular hospital, you should be able to reject (for example) a long-lasting intramuscular antipsychotic injection, which are usually part of commonly encountered treatment orders.
It's rape if you don't give somebody a choice, and think about what that does to somebody. I am an actual victim of rape, and I can tell you it's no different if a doctor or nurse does it to you. It's something you didn't want, and that should be good enough reason for a doctor to not administer such care. If you have other reasons, such as not liking how it makes you feel, etc. that's more than enough.
And you should be able to make decisions that affect your body especially if you're not a threat to yourself or others. If somebody needs to taper off to safely get off their medication, then have them taper off to get off the medication - but still overwhelm them with support in other ways they approve of if you determine they need it.
BUT there's a pretty valid alternative to scary things like involuntary treatment orders, restraints, locked doors, "Mental Health Courts", and disease-first care.
And that's Soteria Houses. You can read my thoughts on this (in my opinion) revolutionary and successful standard of care in my previous posts: https://news.ycombinator.com/item?id=37140331
The gist is: no locked doors, welcoming supportive environment, no dehumanization or medicalization of their psycho-social issues, minimal psychiatric intervention (mostly for stabilization from what I've read), and they have pretty impressive results treating a supposedly lifelong and chronic disease.
However, it or something like it will never manifest into becoming the dominating model unless we slash the greed out of mental health care and health care at large.
I firmly believe that the medications commonly used in this field today and especially in the past are prescribed irresponsibly, without the long-term testing they need, and side effect/interaction profiles are not studied in the detail they need to be before these drugs are unleashed. This creates a revolving door for these companies to cash out on these people, either through their hospitals or the doctors they brainwash. And boy, do they. You know it's bad when you see an advertisement for XYZ psychiatric drug on the television. It's been bad for however as long as the field has existed. A true horror that we will look back on with great pain as a world.
The fact is that most people probably never have heard about Soteria Houses, and that's by design. It breaks their big illusion. Schizophrenia and other serious mental illness need to be a boogeyman that only a psychiatrist can understand. They say it's a lifelong disease that only they can manage the symptoms of. And this is because they more often than not create the disease in these very, very vulnerable people with the chemicals they claim help more than they hurt.
I disagree that this is the best we can...
I think they just want to separate the sheep from the goats. And then dispose of the goats.
Psychiatry is used to get these people off the street (for their own benefit of course), and either the state is content to just to disappear them into a hospital (the hospital loves the chance to reap all that money), or is happy to see them in and out, having them experiencing a combination of psychiatric drug withdrawal and side effects.
Perhaps it's not like that everywhere, and these people are provided the medication free of charge through some means, but I know that a pharmacy won't fill your prescription if you don't have money.
Imagine what this dynamic looks like if somebody also has an addiction to feed, or isn't educated properly on the powerful drug(s) they are being prescribed. There's a lot that can go wrong when you give prescription drugs with physical dependence to people who see the opportunity to 1) sell them 2) not take them consistently 3) or administer incorrectly (try to get high). Any of those things can risk withdrawal and other physical side effects, that could only make somebody more unstable, or their behavior even riskier.
Which is tantamount to poisoning these people (why prescribe something with physical dependence if you know they can't reliably get the medication? Where is the "Do no harm"?), and sounds pretty unconstitutional to me on many levels. In general, the homeless have more of their rights stripped than any other population that I'm aware of in the US.
You can't sleep in your car because city/town ordinances, benches are being made to prevent being slept on (hostile architecture in general has become a pretty common), in most areas you can't access or afford housing or property when there's empty housing and property everywhere, the shelters aren't safe, you can't build what you want on your property (e.g. tiny houses not being allowed in some areas), and lastly simply being homeless is enough justification to have all your rights stripped and your freedom taken away. For your own good, because just being homeless is a mental illness in itself for everyone concerned.
Inscrutable medical scientific authority is a great source of justification. It's a scary superpower that way.
They really are after you, in Russia, in china, in large parts of Africa and more to come. And there are manmade Tigers in the sky and water.
Seems to be misguided notion, out of a nostalgic sense for reality, to want to mis-adapt people to a ever more shrinking raft of stability. This shitty circumstances are normal.. It is what most of the species, spend most of its time in before science gifted us with temporary freedom.
Better in the long run to adapt the surplus scientific society so that it can survive and thrive in shitty circumstances. Let's make chips in Mogadishu the challenge?
However, I've seen with my own two eyes schizophrenia destroy the lives of several people I know. These people are suffering, and not just because of how society treats the neurodivergent. They are trapped in hellish prisons of their own minds, reliving and reinventing traumas no one should have to experience. It's as if their own minds have turned on themselves just to torment them in uniquely personal and unseen hells.
It's utterly tragic, and largely preventable with treatment.
That said, even in the past, where there were roles for those who experienced schizophrenic symptoms, those with extreme symptoms also suffered from expulsion, disownment, imprisonment and death. It's a mistake to romanticize something that torments so many.
Correlation is not proof, and in biology, due to inherent complexity it is even more questionable.
That looks like some kind of "more research is needed", "give me more money" kind of study.
https://doi.org/10.1126/sciadv.adi4386
"miRNA cargo in circulating vesicles from neurons is altered in individuals with schizophrenia and associated with severe disease"
— Uncensored lyrics of Green Day’s Basket Case.
Now let's say those voice correspond to people making these publications, what does that mean?
Likewise cognitive behavioral therapy and similar work well for many folks. It helps give people tools to change negative behavioral patterns.
There’s fMRI which can objectively show brain activity differences for various mental illnesses.
One psychiatrist could see a patient completely differently from another. You either have Alzheimer's or you don't. Your arm is broken or it isn't. It's measurable.
With mental illness, the line is blurred. I've never seen compelling evidence for fMRI - just circular reasoning. Psychiatrists who buy into this paradigm posit that the disease exists because in these populations of heavily medicated, subjectively diagnosed (heavily traumatized/stressed) individuals, there are similarities between them in the activity of their brain.
Perhaps it's just their disease-first perspective that I take issue with when it comes to fMRI. You could validly look at these populations completely differently without subjective disease terminology and be logically sound with your findings, such as; people tested who experienced more traumatic events in their lifetime and seeing how their brain lit up vs. people who did not experience traumatic events. Or how people respond in institutionalized situations vs. less formal situations, etc.
The person you are responding to shares the same general thinking that I have: medically, there is no disease if there is no measurable physical damage.
As a doctor when you are arguing that somebody has a disease, especially a disease that is thought to be lifelong or perhaps genetic in nature, it's your job to prove that. A check-list of symptoms isn't enough proof. And by going through these lists you are stereotyping your patient. Studying people diagnosed in this way and forming correlations in these heavily stressed, vulnerable populations proves nothing besides perhaps how stressed they are and the different ways that stress is expressed throughout the population.
But when you factor treatment into the mix, physical study of the brain frankly becomes worthless if you are applying it broadly. It could be that fMRI is more or less finding that people on Lexapro or Lithium (whatever the common prescription for an illness is) respond a certain way. Or that individuals experiencing specific types of heightened states (like mania) respond a certain way.
What we are not saying is that there is not suffering, that symptoms don't exist, that symptom groupings (like ADHD) aren't bad or good, it's the disease terminology and intellectual dishonestly of the psychiatric field that we are pointing out.
If somebody took anti-psychotics, especially for a long time, it's known that they affect brain structure and that invalidates any findings that the study has, unless they can account for the changes that the (for example) anti-psychotics produced. Which given our current state of science, and understanding of the brain, is unlikely.
>Initially during the prodrome, a change in brain structure seems to be present in the temporal lobe volume and cingulated. On follow-up in those who have gone onto a psychotic episode, further changes can be seen in the cingulate, temporal lobe, and parahippocampal gyrus.
Structural changes occur before an episode has even occurred.
Upon a very, very brief read it still seems difficult for them (in my opinion) to find that schizophrenia is primarily genetic in nature when there still could be potential causative agents that only siblings share (the same house, the same food and water, the same household/generational chemical/drug use/exposure, etc.) which may yet explain the changes/differences. I will take a closer look when I have the time and look at the wealth of references they included (they do have some pretty large studies referenced that support their findings). Thanks again.
I just want to say that while I may seemingly appear to be particularly hostile to the physical causative angle or the genetic (or predictive) angle of mental illness, I just want to clarify that this is mostly because of the fears I have about the current/near-future clinical/societal implications of this being established, in my opinion, prematurely.
There's unarguably a lot of good that research can do in this area, however, I just hope that more understanding in these areas are reflected clinically by a massive diversity of treatments. Especially, laser-focused treatments that cause minimal side effects.
I don't think there's any arguing from me that if we were able to stop the progression of schizophrenia before first-episode psychosis (especially without using anti-psychotics long-term or at all) that it wouldn't be a good thing.
Or as other commenters pointed out, to stop these people who share these markers from doing things that might worsen/manifest their illness, like cannabis. Or researchers finding out how the endocannabinoid system is involved in the illness, including potential therapies (like tackling the systemic inflammation that is common in serious mental illness).
It's just a slippery slope if we go about this in the wrong way. Like forced treatment. Or applying treatments to other differences that may not cause distress to the individuals or inhibit their functioning or participation in society (like forcibly treating high functioning individuals who are on the autism spectrum).
Or incorrectly diagnosing schizophrenia/psychosis in one person and inappropriately treating them, when in reality there were two or three distinct diseases causing a similar illness or set of symptoms. Who knows, there is a distinct lack of knowing still in this field. I just know that the profit-motive needs to disappear before true progress and medicine can happen.