Getting help from mental health professionals is just a way for that individual to foist their opinions onto you. Psychology is a highly subjective field whose studies have startlingly low reproducibility. You’re much better off finding someone in your circle that’s willing to listen to you and shares your values (though not everyone might have this available to them).
I might be the only person on earth that got something out of therapy, and I blame being and staying depressed my entire adult life because I listened to idiots like you. And trust me, I'm restraining myself here. We have a mental health crisis, a broken support system, male suicide at a all-time high, and your opinion is still mainstream. Shut up and listen.
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Advice for the people struggling: don't be afraid to fire your therapist. Going to therapy should feel like having someone to dump your crap and feel they've listened to you with no judgment whatsoever. You should feel you talked to a better, non-opinionated version of your $favorite-relative. If that's not the case, get another one.
AFAIU there's a lot of approaches to therapy. What worked for me was having a person that listen attentively for 99% of the time. In 3 years they have never told me what to do, nor prescribed their vision of the world.
We’re not idiots, just people with communities and appropriate support structures in place that people like you threw out the window on the altar of individualism and shortsightedness. Modern therapists turn around and attack the same ideas that enable people to have and maintain those communities and structures in the first place while leading broken lives and peddling their sorry wares to other broken people they put there in the first place. You really think an institution that has been around for 60 odd years can compare to a stable equilibrium human society settled on for thousands of years? You really think your psychologist who listens to your minutia while “chasing a career” and having her kids raised by some people at a daycare really knows what she’s talking about? She’s just unwittingly making future clients.
This %100. People don't seem to understand how pernicious and subversive the therapy profession is, and how self-replicating. The only point I would correct is the "60 odd years". Its roots go back to the early 1900s and there was an explicit anti-family program from the beginning. Destroy the family, destroy the culture. It's a cultural suicide pill.
I don't want to upset you but, imho, the so-called "mental health crisis" is, in part, caused by therapy culture. Of course there are people who are deeply disordered and those may need medical or institutional help. But, many people believe they need "therapy" who absolutely do not. Consider the possibility that having a good friend, sibling, or spouse might have helped you equally.
This is good advice. Sadly, many on HN are very pro "mental health professionals". I see the opposite advice proffered frequently. These "professionals" make things worse by pathologizing normal life. Their availability to function as ersatz "friends" discourages people from making the real kind, imho.
My family did a few group therapy sessions when my dad died, and it wasn't anything like you suggested.
At no point did the therapist suggest there was anything wrong with us or suggest medication. She just listened and helped us deal with the new situation.
Was it absolutely necessary to talk to a therapist? No it wasn't.
Did it make the situation easier to deal with? Yes it did.
Group therapy is basically like having a mediator in a room to facilitate conversation. It's not quite the same as individual therapy. I'm glad you got some value out of that interaction.
It's just inviting downvotes but I also agree with you.
Therapy is a scam and no doctor can explain how or why anti-depressants work (also why they have people "try" many before finding the "right one for you").
But people are too cool for friends and family now and hearing hard truths so they pay someone to be told they matter and how to run their lives.
I have seen different approaches to therapy being done to different friends and only one friend got better - this tells me it can work for some, but the odds are you're getting a grifter. In this case their therapist told them they didn't need anti-depressants (shocker) and after ~15 sessions said they were fine and didn't need help anymore. Everyone else is medicated and still going every month, presumably til they die.
> Therapy is a scam and no doctor can explain how or why anti-depressants work (also why they have people "try" many before finding the "right one for you").
We also don't know the mechanism behind how anaesthesia works, this doesn't mean anaesthetists are grifters.
Mental health issues are not easily distinguished, "depression" is a cluster of conditions which probably have different treatment responses but all present alike. It's not unusual that some people will respond to SSRIs, others will need beta blockers and a third group will need talk therapy.
I don't remember seeing many studies about anesthesia doubling the risk of going unconscious like anti-depressants and suicide. Or many situations in which someone just doesn't respond to the anesthesia. That's the track record we're talking about here. Not sure it even rises to the status works sometimes.
1) Length of therapy is strongly correlated to school. CBT and it's forks are relatively short and ability-oriented, where psychodynamic is very long with hazy endpoint. And generally CBT should be pushed much more, as it's faster, more goal-oriented, and less prone to, let's say, therapist biases.
2) Although I get the idea that people need friends and family, it's easy to forget that people with severe issues do not look like they have them. And taking care of eating disorder/personality disorder/*PTSD/whatever else treated through therapy, not medication patient is a lot of work to which most people are not equipped, and which drains a lot, to the point of resentment (if they can't run away) or just ghosting. Also, it's not that people do not hear "harsh truths" - it's more about not being able to comprehend them, due to broken thought patterns.
I dislike immensely the idea of CBT and I reckon it's the reason therapy got such a bad rap. Talk therapy is immensely more free form. The goal-oriented approach works great in our modern productivity focused society, it's not a way to just learn to unleash what you actually want to be.
Not sure if there's a branch of talk therapy you are engaged in, but if you look back into the history of the "profession" you might have a good idea of why it got such a bad rap.
Agree that CBT or other behavioral approaches are preferable and that there are some legit disorders that can't be easily helped. Point is that most people don't need or benefit from therapy, and are more likely to be harmed.
I honestly believe that a small amount of people are better off being medicated, keyword being very small (<0.1%). Those that would be a danger to themselves or others in a real way. So I concede some ground.
Most of my friends on them are just bummed out about their life but not enough to change their situation. Perhaps CBT is the answer, my big issue is that the majority of therapists over-prescribes, and that makes me lose trust in the whole thing.
It's like trying to see the good parts of cryptocurrencies, you need to ignore a lot of shit and in the end you wonder if its worth it.
You ignorance on the matter shows. You are probably living in the US where pushing pills is the norm. Honestly, this entire anti-therapy subthread is a shitshow of misinformation.
Let me shed some light: there are psychotherapists, that are not doctor, and can't prescribe anything. Then there's psychiatrists, which are medical doctors, and might approach your depression with the pill du jour. SSRIs just cure the symptom, not the actual bloody problem one has.
You don't need a pill, nor a doctor unless it's an actual curable condition (bipolar, ADHD, etc.). You need someone to talk to.
Some of us are saying that paying a professional because you just "need someone to talk to" is a situation created, enabled, and perpetuated by this talk therapy culture. Some of us are pointing out the history of this profession and its incredible lack of scientific rigor and perverse incentives.
Not a coincidence. It's significantly more common in the profession[0]. They get divorced at a higher rate, and they recommend divorce to their clients. Therapists and psychiatrists are massively responsible for the divorce rates among boomers (the first widespread consumers of these services). Their children apparently learned nothing and are rushing headlong into the same therapy-culture that destroyed so many of their parents' marriages.
It isn't bad if you are in an objectively bad marriage ofc. But if you're in a marriage that "can be worked out" then yeah it's a bad thing, for the kids especially. There is definitely something to be said about making things work because there is no easy "out" called divorce.
In a healthy society, divorce should be difficult, expensive, and rare. Social incentives should be structured to make it less appealing than working on the marriage. Conversely, marriage and children within marriage should be incentivized by law and social programs. It may such policies are unworkable in our present configuration.
There are lots of bad outcomes in a marriage, but many marriages aren't given much of a chance.Anyone who has been successfully married after decades can tell you that it's ups and downs and takes work and there are many moments when you might want to give up. This culture encourages people to cut bait when things aren't fulfilling the spouse. But that's just more of the same individualistic attitudes that Psychodynamics helped create support for. When you enter into a marriage you are less an individual, when you have children, you are even less an individual. It shouldn't be so easy to divorce and there shouldn't be a whole industry that tries to make it easier. This idea that you can detach from your commits to family because you're "unhappy" is insidious and has too many perverse incentives to list here. Predatory industries like therapy are particularly distasteful because they clothe themselves in virtue when they are actually extreme toxic to the culture at large. That culture, if allowed to be healthy, would obviate the perceived need for most therapy (outside of seriously disordered people). Such needs would be supplied by extended family and friends.
IRL, divorce is devastating for everyone involved, especially the children. I believe therapists diagnose divorce and breakups in general so often because it eases their conscience a bit. You can see this same reasoning with abortion and such topics.
A divorced therapist is like a dentist with bad teeth or a tee-totaling drug-dealer. Can't trust any of 'em.
Staying together when you hate each other is much worse. Sometimes divorce is just the best out of several bad options.
(BTW, what is bad about teetotaling for a drug dealer? "Don't get high on your own supply" has allegedly been a credo for them since basically forever)
Hating each offer to the point of violence? Sure. But that’s now his this works IRL. That’s why there is the common movie trope of the wife leaving her husband gif the therapist.
People divorce cus they “fall out of love” and, since society today puts self-interest, especially if its related to sex, above all else, and the nuclear family is seen as worthless and “problematic”, people ignore any evidence against their politically correct sheepish opinions.
On your second question, drug dealers often start dealing to support their habit. Only in movies will you get that line. Y’all live such incredibly sheltered lives.
Stay together for the kids. Once they leave the nest, sleep with all the therapists you want. But to pretend like divorce is anything but cringe and pathetic is twice as cringe.
> This is a preview of subscription content, access via your institution.
Unfortunately, since I can't view the article, I can only guess that they evaluated a large number of professions. Since the abstract focused on law enforcement, it seems unlikely that they adjusted their criteria for statistical significance for psychologists in consideration of the number of variables they evaluated.
Looks like my hypothesis is supported by the evidence: On page 4, you can see their regression results. In fact, they don't estimate the statistical significance of any occupation as a factor, not even the law enforcement occupation that they focused on.
The "media and communications equipment workers" category had a reported 0.00% divorce rate! It seems implausible that we should infer causality from this.
There are a few other studies on this. Maybe I'm reading these incorrectly so would appreciate your analysis. As far as I can interpret, the pattern is legit. What is especially counter-intuitive (unless you have a negative view of the profession, as I do) is that so-called professionals in mental health have a higher divorce rate even than respondents who score high on the "anger scale". So what's that all about?
> Survey results from 2008 through 2013 included responses from more than 40,000 physicians; 200,000 other health professionals—dentists, pharmacists, nurses and health care executives; and more than 6 million other adults who reported currently being employed and ever being married. While 24 percent of physician respondents had ever been divorced, the probability of being divorced was 25 percent among dentists, 31 percent among health care executives and 33 percent among nurses. Only pharmacists, at 23 percent, were less likely than physicians to have been divorced. Lawyers had a 27 percent probability of being divorced, and *in all non-health-care occupations, the probability of ever being divorced was 35 percent.*
> A subsequent, larger study of 1118 medical graduates of Johns Hopkins University found cumulative rates of divorce of 29% *with rates higher among psychiatrists (50%)* and surgeons (33%) but was limited by its analysis of physicians from a single institution.
> The choice of specialty was significantly associated (P>0.001) with the risk of divorce (Fig. 1 and Table 2). The cumulative incidence of divorce was highest
for *psychiatrists (50 percent)*, followed by surgeons (33 percent) and “other” physicians (31 percent). Among internists, pediatricians, and pathologists, the incidence of divorce was similar (22 to 24 per-
cent).
> When we examined psychological variables, we found that physicians in the highest quartile for the anger scale had a higher risk of divorce than those
scoring in the lower three quartiles. *Moreover, the cumulative incidence of divorce among the physicians with the highest anger scores was higher than
that of any other subgroup, with the exception of those practicing psychiatry.*
Looking at the "Medical Specialty and the Incidence of Divorce" article, my first thought on reading "Scores on these [psychological characteristic] scales were grouped according to quartiles for analysis" is that the researchers aren't experts in statistical methods, or else are hiding something by bucketing arbitrarily. It's a widespread problem in life sciences. They don't explain (not by this point in the article, at least) why they chose quartiles. I'm skeptical of any analysis that reduces the fidelity of the data without explanation. It smells like p-hacking.
My second thought regarding their model is wondering why they didn't first build a model predicting divorce for the general population. I've heard (received wisdom) that financial stress is the primary cause. It seems unlikely that medical specialty is unrelated to household finances. Ignoring a likely confounding variable is sloppy. It makes the effort seem like a novelty article intended for amusement rather than serious research. It's in the "occasional notes" section of the periodical, which suggests less rigor.
They do little to address the question of causality. They muse that, "One explanation is the longer work hours required in some specialties," but never bothered to analyze the hours worked.
My conclusion: That article is literally a joke, published to give the community something to laugh about over beers after the conference.
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If I were to perform the analysis, I'd first build a model of causes of divorce for the general population. Some candidate variables: household income, household income as a ratio to each person's childhood household income, cost of living where the household lives, frequency of attending religious services, number of children, number of hours worked per week, age when married, etc.
I'm skeptical of psychological characteristic surveys, so I'd spend some time considering alternatives, but I'd want to include some measure of characteristics that might drive the choice of a medical specialty which might also be correlated with divorce. We want to isolate the choice of specialty as the cause as separate from confounders that cause both the choice and divorce.
If medical specialty holds up as a factor after controlling for everything else, then I'd investigate further.
Thanks. My first reaction is that this one is much better. Larger sample, better methods.
Again, I hate the arbitrary bucketing. There's no benefit to creating age buckets, as if there's some magical change that happens at 40, 50, and 60. I did have an atypically large birthday party, compared to other years, but I don't think that had a dramatic effect on my likelihood to divorce. Maybe some people have such spectacularly intense decade-related birthday parties that it increases divorce incidence for those years? Income doesn't benefit from bucketing, either. Having $199k annual income isn't much different from $201k annual income.
They do a decent job of controlling for confounders. Considering, among other things, that "if the annual rate of divorce was identical across occupations but physicians marry later in life, then at any given time physicians would be less likely to report ever having divorced compared with people in other occupations, simply because they were at risk for less time."
However, their inclusions of state and year fixed effects could have been more considered. These are proxies for other things, like cultural characteristics and neighborhood income levels. I'd like to see some discussion of why they chose to use state and year proxies instead of searching for more specific explanatory variables. Especially state, because some kind of urbanization measure might be more helpful. However, because state medical licensing regulation might affect the choice of occupation, the use of that variable is easily defensible.
Ugh! Bucketing again! Hours worked should be a continuous variable. Inexcusable, unless they feared misreporting. Perhaps they saw some banding at 40, 45, and 50 hours, so they figured it's not really a continuous variable anyway. Again, that needs explanation. Any rationale for bucketing should be thoroughly discussed.
Finally, the effects. First, with this population size, I'd be surprised if these weren't "statistically significant". I'm looking more for practical significance. Check out the estimates for dentists. Dentists appear to have lower incidence of divorce, based on the last year, yet higher prevalence of divorce. Strange. That means that dentists in past years had a higher annual incidence, but the rate has been declining, or declining relative to physicians. Has the practice of dentistry, relative to general medicine, changed that much over those years? This suggests spurious results, at least for the physician vs dentist comparison.
Hispanics were more likely to divorce? Bogus. I'll chalk it up to sampling weirdness. The CI includes 1 anyway, so they're saying it doesn't matter. They should put some asterisks in to highlight the variables we should pay attention to. It looks like they're including Black and Hispanic just to explain what Other means, because Other is the only significant one.
Wow! Income is irrelevant. Weird again. Maybe bucketing at work, turning 1 continuous variable into 4 binary variables, diluting the impact. It should have been log(dollars).
If you work more than 60 hours, you're more likely to get divorced. Makes sense. Again, log(hours) would have been better, though maybe a threshold at 40 hours would have been useful.
I enjoyed the article, but if I were the journal editor, I'd have returned it with some suggestions for improvement rather than publishing it.
Anyway, I hope my commentary was interesting/useful. This article doesn't say anything about psychology, so we've gone off on a bit of a tangent.
Yes, very interesting, thank you for putting in the time. I appreciate the detailed analysis. Were you able to make any inference at all about psychiatry and divorce from these data or no? It's interesting that you are using some background knowledge to evaluate the findings (e.g., hispanic divorce). I'm curious where that comes from and how it fits into our discussion. Is it that you have data about hispanic background divorce rates or is it because you know hispanics are largely Catholic and making a logical inference? As far as dentistry is concerned, it may be a hidden variable, such as makeup of those practicing dentistry. Maybe a change in composition of male/female overall. Or from different cultural or ethnic backgrounds with different background rates of divorce. My overall impression of your analytical tools is that you are willing to hypothesize causes with the caveat that they be subject to further investigation. If you reach such places in analysis and stop, do you just reserve judgment from that point? I would think not. Rather, your priors change and your probabilities change so you can go about life without perfectly constructed and complete statistical evidence, as all of us must.
To return to the topic under discussion, it sounds like you are saying, "there may or may not be a correlation between psychiatry and divorce, but these particular studies can't provide the answer." I assure you I am not basing my opinions about psychiatrists on these studies. Rather, I expect that properly constructed studies that meet your standards would bear out what I know from my own experience and encounters with people in the profession. Others in the thread provided anecdotal data that supports my own. And, I'm not making my judgment based solely on experience. My experience confirms an intellectual analysis based on the history of the profession. Those are my priors and probabilities. I would not be surprised if the data backed me up but I would be surprised if the data refuted my suppositions (and would question the study). It seems that my sort of reasoning doesn't have much place in your toolbox. Is that not the case?
I appreciate your reply and explanation. However, I think we'll probably be speaking at cross-purposes because your description of the kind of variables you would choose for your own model strike me as (necessarily) limited and reflective of the data requirements of your preferred methods (McNamara fallacy?). (I don't actually believe you live your life via models generally, but maybe you do.)
My opinion is there is no room in such models for all the many things that are part of the rich fabric of psychological experience, without which all you get is a kind of significant/not-significant binary according to available imperfect data. I mean, yes, it preserves the null hypothesis, but it feels sterile to me to attribute so much to randomness when the model itself is so obviously curated to work with available data. Or even to hidden variables that will require further study, at some point, in the future, maybe... Not to mention the cases where the null hypothesis was subsequently rejected (smoking, ulcers,...). Yes, Maybe you believe these variables are the principal components of the theoretical complete data? The don't appear orthogonal to me.
Meanwhile, life has to be lived and if you've encountered "types" of people in the world but won't allow yourself to acknowledge their existence unless one can build a rigorous predictive model to verify the existence of those types and to be sure they are not noise or sample bias or whatever, then you are enjoying a life that I would find almost barren. There are so many locked doors in this way of seeing the world. You have problems with datasets, which you have to decide whether to trust. Will you apply statistics or heuristics to those problems? Absent trustworthy data will you just decide to defer judgment? It's a form of not trusting oneself as well, which I reject on principle, and of making oneself unbiased to the point of being inconsequential. In other words, a form of nihilism (perhaps nullism is the appropriate term).
No, I don't think I can make any inferences about psychiatry from those articles. My Bayesian update is the opposite of yours: because the evidence presented was weak, I'm more skeptical of any relationship between psychiatry and divorce. I was quite ready to believe it, and was disappointed to see such weak studies. It suggests to me that it's difficult to find positive results with stronger analysis.
You seem to be suggesting I'm philosophically a Frequentist. Somewhat true, but I am, like basically everyone, a Bayesian when it comes to practical decisions. Also, I have no fear of logical deduction when statistical inference is infeasible.
Nullism is a good term. I'm of the opinion that most things are random and that humans' imaginations frequently mislead us. Absent better evidence, I'm unlikely to believe any link between psychiatry and divorce.
If they are performing according to the profession's own standards, then they spend their working days involved in other people's problems, delusions, traumas, grievances, morbidities, obsessions, suicides, etc, (not to mention various mental disorders). This probably accounts for high rates of burnout among them. But, ask yourself, what about the ones who don't burn out? What is it about them that allows them to do this sort of thing day after day? Is it the $300/h? Is it a strange fascination? Is it some mental disease of their own? Questions worth asking.
By the same token, avoid seeing oncologists, EMTs, many kinds of surgeons. These people see death every day, ask yourself why: they must have a sick fascination with it. Or they stopped caring. Is that something you want in someone caring for you?
Well, those specialties at least have the benefit of medical science behind them but even so I wouldn't go to any of those specialists for mental health advice. Why are surgeons stereotypically arrogant and lacking in bedside manner? Is it, as you say, because they see death and disease every day? Do they cope by dehumanizing people? Or are the naturally that way and so well-suited to the profession? Worth asking.
> I wouldn't go to any of those specialists for mental health advice.
Or medical advice! Only damaged people would chose those professions. They are surrounded by death and injury. Are they killers? Will they kill you? These are questions you should ask yourself if you notice a skin abnormality.
It can be as simple as them having found coping mechanisms or support systems that work for them. No need to invoke weird conspiracies about them being mentally ill.
I'm not invoking conspiracies about them being mentally ill. I'm suggesting it as characteristic of the type that they are messed up. That's not a conspiracy, any more than saying that people drawn to fighting forest fires are brave or parachute instructors have a high risk tolerance.
People drawn to fighting fires are stereotypically brave, but they are also stereotypically arsonists themselves. The worst people to call when you notice a fire is the fire brigade. They'll just spread more fire! Evidence: they're admitting to burning undergrowth to stop wildfires. "Fighting fire with fire", these people are nuts!
Plus - firefighters: stereotypically buff and desirable. You'll lose your house and your partner.
The right person to call is a poet. Not otherwise associated with fire, handles a lot of paper. They hate fire!
Undoubtedly. Software engineering is a niche activity that takes a certain aptitude for abstract reasoning. Right away you eliminate a lot of people from the candidate pool. What's your argument?
Anecdotal: but all of the psychology students i've met were far from being stable and had serious issues of their own. But its just my own experience and a stereotype i have now
