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 breakdown.

Changing my environment to one where abuse could never happen (or conceivably happen) was the most helpful thing for me in managing my illness (no medication period). This environment change included people in my life that showered me with an incredible amount of kindness, understanding, and support. Something I had a great lack of prior. Sort of like a Soteria House. Basically, I stopped hearing voices when I was finally safe. Feeling safe took a while, though. I stopped having irrational fears and beliefs that I never had prior to my illness - I became myself again, minus whatever deficits I received from the head injury.

But an anecdote is just that. I am aware that schizophrenia and other serious mental illness can manifest with no apparent psychological or environmental cause, and in those cases, it's perfectly rational to assume or speculate that there may be a deeper, less obvious cause, such as a genetic cause.

I just think, given my history, that things like involuntary commitment, or forced treatment, or even being told you are going to be ill for the rest of your life and have to take medication is incredibly damaging. I know I wouldn't have been able to get better if I kept that mentality alive at any point during my illness.

But I'm not arguing that a no or minimal medication path is right for every person suffering, just that choice and consent is very important. You should have the choice to go to a Soteria House, for example, when you refuse medication in a hospital setting. But instead you just get a forced treatment order and effectively raped.

Thanks so much for you response and time and I hope you have a good holiday, and I'm sorry to bring the holiday down with such a serious subject. I just desperately want to shed light on an issue that I feel needs a lot of serious attention.

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.

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.

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.

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 do, especially when it comes to the care of schizophrenia and other mood disorders. We can do better, we are way too primitive to be messing with an organ in ways we don't fully understand with definite greater health implications, especially so in people that may not be able to fully comprehend and communicate what is happening to their bodies.

Overall, I think this is a great, affordable first step for redefining primary care - one that makes sense for doctors and patients, but is not a replacement for specialties like Functional Medicine.

I largely think that doctors, especially primary care doctors, are being limited/held hostage by the insurance companies and the health care corporations that they work for.

They are not reaping the profits from the care they give, and can't focus because of patient loads being way too high. As it was explained to me by my doctor, this is because of how insurance companies pay out (per visit, no matter the duration) and the places that employ doctors usually expect that they see a certain volume of patients. Most doctors have a large amount of student loan debt, and usually feel helpless to fight against it - starting a new practice is very costly.

Once you really look into how oppressive/restrictive the system is to our doctors, the issue with our health care becomes pretty clear. People can't get timely, accurate care -- they have to wait for most prescriptions (because as long as doctors take insurance, they cannot fill medications), and they are always guessing (fearing might be more apt) how much a particular medication, test, or scan will eventually cost, causing hesitancy to seek out care. And most importantly, no longer do patients (or their doctor) have to worry if their insurance company will cover XYZ medication or treatment under this model of care.

My doctor negotiated with a local lab company, and that company offers my doctor's patients pretty much any test at-cost - this is another business dealing that is restricted by insurance companies.

DPC takes all the mystery out (I pay $45 a month for this service, all visits are free): all common procedures/lab/scan/medication costs are up on the website (they are very reasonable/wholesale/at-cost), and I don't have to fight to get that information; I don't have to fight to get an appointment, I can text/email/etc. my doctor whenever and get a prompt response. Because he limits the amount of patients he sees this is possible.

I think if primary care was overall something like this model, but perhaps a bit more accessible (more doctors practicing this way); not only would a lot of illness be treated before it is chronic, people would be less afraid to seek care out, and hospitals and specialists would be less overloaded.

We have the technology and means to do better than we ever have before in every area; and at least here in the US, we're ripe to have this infrastructure put in place. We need a true Green New Deal, not a watered-down bill that allocates funding to the few to accomplish nothing or something small-scale and localized.

If we added thorough, accessible high speed rail infrastructure for transportation AND freight here in the US, we could reduce our fossil fuel emissions and dependence by a pretty large factor. And make travel more dignified and safe. It's absolutely ridiculous how we ship and receive goods - and it's absolutely ridiculous that the best means of travel from any place more than a few hours away is essentially just air. The roads are laughably bad, and they are clogged to the brim with tractor-trailers. It's time to stop.

The real, measurable cost of continuing fossil fuel dependence is higher than we know or predict most likely, and justifying continuing this solely because doing better is "expensive" or "problematic" just shows the lack of leadership we have and the massive tumors that we need to excise. The amount of jobs that a national infrastructure deal would create are staggering, and the new, more sustainable economies of scale that would develop around it are priceless.

There is so much low hanging fruit in the US its not even funny. If you want to invest money and get people in rail, start with proper S-Bahns and combine that with the historic rail network outside of the cities.

Add trams to your cities and proper bus service with priority lines and priority signaling.

And of course the absolutely brain dead land use and zoning policies in the US are the real issue even if you build public transit.

Worry about those things before dreaming up schemes of high speed trains.

That said the Great Lakes region high speed rail, combined with Canada would make a huge amount of sense.

Be it high speed rail, car, bus, e-bike, e-scooter, etc. As long as what you are doing is safe, and you're not harming yourself or other people, you should be able to use whatever the hell kind of gadget you want to in order to get to the places you need to go. You shouldn't have police coming up to you telling you what you can and cannot put on the road because the laws are ancient and stagnant - and only get changed if there is a profit incentive.

You shouldn't have to worry about getting run off the road/sidewalk/crosswalk because the people who planned/make the roads think it's a good thing to build thin, one-lane on each side, roads, with no bike lane, with no shoulder or a very small shoulder, with poorly-maintained sidewalks, etc.

We really need to rethink how roads should work, how traffic lights should work, suggest speeds instead of set limits, and update our infrastructure. And standardize, standardize, standardize.

And specifically, here in the US, we need to change to the metric system, like the rest of the world. But that probably will never happen.

At least in the US, laws seem to be just made to control/monitor/limit the masses in increasingly more insidious ways. Besides basic gestures like gay marriage, I haven't personally witnessed or felt anything that impacted my life in a meaningful, positive way.

There is no universal bill of rights for humans - right to life, right to thrive, right to speech, right to be free/not a slave (such as proper work conditions) etc.

What is considered appropriate behavior is subjective, varies from person to person - from institution to institution - country to country, and too often laws often just end up being made as a reaction to maintain control. I'm not aware of many countries where I think democracy is a truly active process for everybody involved/affected and there are many countries that are hostile to some of the ideas I espouse.

And companies basically make all the standards on the web/computer. Although, thanks to players like Mozilla and OSS as a whole (and the good companies that truly embrace the OSS philosophy), there is resistance to this. Because of that, I'll hold out hope that we can figure out how to free the computer and web. IMO we are still at the drawing board phase for realizing computers/operating systems/a web that works for everybody, after all these years.

The only way any of this happens is if we 1) work on bettering diplomacy with other countries to even get to the starting point to realizing this - 2) encourage organized, civilized debate, denoted by tolerance and good faith, between many countries and individuals to determine what constitutes a minimum expected standard of living/draft a universal bill of rights for each and every citizen (this isn't the middle ages, we can do this) - 3) work on making all levels of education accessible, open, and free to every person willing to learn - imagine billions of people involved in problems and working towards solutions that work for society/their communities.

But, I will say to hell with worrying about "market costs of maintaining parts of the Internet". We need to heavily incorporate decentralization, open-source/free software, etc. into every facet of the computing ecosystem.

The average person shouldn't have to worry about backdoors - not knowing what every part of their computer is doing because of proprietary software/firmware, they should not have to be bombarded by advertisements and other attention/time-consuming dark patterns, and they shouldn't have to worry about the impersonal, but organized stalking/data collection of their every move they make using technology by those who are driven by greed, paranoia, and control.