Psychiatry

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#36
The notion that you can help people just by talking to them
In general when bad things happen to someone the victim is blamed for what happened, people will naturally side with authority figures.

If a male cannot get a girlfriend it's assumed that he is doing something wrong, surely the reason must be that he has misogynistic views and that this is the real reason why he is being rejected, "just work on your personality". People are being told to "seek help" and as if talking to some quack therapist would be helpful.

There is also another assumption being made and that is that the reason someone is having a bad life is because of things that can be fixed just by having the individual talk to someone, this is more general than psychotherapy, there is also a very big toxic self-help industry.

It's not only external factors that are largely outside your control but a lot of aspects of yourself are hard to impossible to change to the better. If you are not gifted in mathematics trying to take an advanced math degree will be difficut to impossible even if you try your best, telling people they just need to work harder isn't going to help them.

Often if you ask for advice you will not actually be given good advice, instead you will be given bad advice and be shamed for not following said bad advice and if you then go on to not be successful you will be blamed for not following the bad advice given, if you try to actually follow the advice and fail you will be told you didn't follow it good enough.

Given the very large amount of misinformation it's difficult to navigate unless you have enough brainpower to power through these things, thus even if you give good advice to someone he/she might not actually follow it since other people give him/her contradictory advice.
 

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#37
Psych-quacks fails to treat pedophilia
They tried to treat him, it didn't work.


Had he been smarter he would have lied making them believe he is "making progress" and then proceed to rape young buys.
 
#38
Estrogen treatment is an effective alternative
Related wiki pages
Psychological Effects

I find high estrogen levels of interest from a psychological point of view
  • Depression is very common in the trans community and anything that helps safely alleviate that is valuable.
  • There's people working on high level estrogen for the physical benefits, but I'm not aware of anyone looking into the psychological side.
  • On of the benefits of implants is that its very easy to achieve high and stable estrogen blood levels.
  • When the Sydney endocrinologist Dr Jon Hayes retired there were a small but significant number of trans women who were in serious psychological distress caused by the reduction in blood levels that then followed. These numbers and symptoms seem somewhat similar cis-women suffering PMDD.
Premenstrual Dysphoric Disorder
There's very little research on trans women and a lot of the studies I've looked are related in some way relate to Premenstrual Dysphoric Disorder (PMDD) in cis-gender women. They suffer an extreme form of premenstrual syndrome (PMS), and their their treatment by the medical community reminds me in many ways of transgender women's treatment, only in some ways its even worse.

This SBS article/video describes it well, although I've heard it paints an overly positive view of the actual outcomes


Wikipedia says

Premenstrual dysphoric disorder (PMDD) is a severe and disabling form of premenstrual syndrome affecting 1.8–5.8% of menstruating women. The disorder consists of a variety of affective, behavioral and somatic symptoms that recur monthly during the luteal phase of the menstrual cycle. It affects women from their early teens up until menopause, excluding those with hypothalamic amenorrhea or during pregnancy and breastfeeding. People with PMDD are at higher risk of suicide, with rates of suicidal thoughts 2.8 times higher, history of suicidal planning 4.15 times, and suicide attempts 3.3 times.​
Research
Note that these studies are on cis-women, but its important as depression and suicide risk is prevalent in the trans community. Further, some trans women suffer extreme distress on lower estrogen levels. Implants (and injections) allow very high levels to be easily achieved.

The history of supraphysiological estrogen levels and tachyphylaxis is closely tied to psychological effects of estrogen and depression.

In Ganger 1989 when supraphysiological were found, and for which there was no known harm, their treatment consisted of

Optimal management in the cases described here is not known. There are no data to indicate that supraphysiological oestradiol concentrations cause harm. We suspect, however, that further implantation relieves symptoms for ever shortening periods. Our approach has been to withhold all forms of oestradiol until the plasma oestradiol concentration has returned to less that 200 pmol/l. This may take many months during which the patients suffer intense vasomotor and psychological symptoms, are miserable, and need much support. We then start giving them oestrogens in a form that does not cause accumulation.​

Garnett 1990 rightly says of this approach

Complete withdrawl of oestrogen therapy as suggested by Ganger et al. (1989), to alow levels to return to 200 pmol/l is wrong and in severely depressed patients may be dangerous.​
Supraphysiological oestradiol levels are an uncommon consequence of oestradiol implants occurring most frequently in women with a history of depression or surgical castration. These high serum oestradiol levels were not associated with any deleterious effects and may be necessary for the control of symptoms in specific women.​

Garnett 1990 argues that supraphysiological levels found in the study are not tachyphylaxis

It is the increasing frequency of implantation which causes plasma oestradiol levels to rise but for selected women with severe depression or PMS these levels may be a therapeutic requirement. This is not true tachyphylaxis as these women require high oestradiol levels in order to remain symptom-free.​

Garnett 1990 suggests that supraphysiological oestradiol levels may control depression. These days doctors generally won't allow supraphysiological estrogen levels, but will hand out anti-depressants like jelly beans (as if they are safer).

Summary. The serum oestradiol levels of 1388 women treated with hormone implants at a menopause clinic were reviewed in 1988. Thirty eight (3%) were found to be above 1750 pmol/l. Of these 38 women with supraphysiological oestradiol levels 23 had started therapy for menopausal symptoms and 15 for the premenstrual syndrome (PMS). Of the 23 women treated for menopausal symptoms 11 had a history of psychiatric referral for depression and nine had undergone a surgical menopause. Nine of the 15 women with PMS had a history of psychiatric referral for depressive symptoms. We conclude that the women who attain supraphysiological levels of oestradiol on implant therapy have a high frequency of psychopathology or surgical menopause and may require higher oestradiol levels for adequate control of symptoms.

Studd 1993 (page 219) says

Supraphysiological concentrations of oestradiol are probably necessary for the relief of psychological symptoms in some women, and it is reassuring that there is no evidence that such levels are dangerous.​

The authors of Garnett 1990 follow up their previous paper in a response to Ganger 1991

Although we reported two women with high oestradiol levels after receiving 50 mg at their last implant, both had been treated for 8 years with regular larger doses (never more than 100 mg) for their depression. Both had been able to discontinue antidepressants for the first time after 10 years of previous use.​

Gordon 2019 indicates this may be related to physical differences in women's brains

...one postmortem study observing that women with major depressive disorder at the time of their deaths had lower estradiol receptor α expression in the frontal cortex and hippocampus...​

John Studd says on his website in 2020 of in relation to high levels and tachyphylaxis

... There would rarely be an indication for repeat implant if the oestradiol levels are above 1000 pmol but sometimes women with convincing oestrogen responsive depression need even higher oestradiol levels and a repeat implant should not, after very careful consideration, be prohibited. It is wrong to deny women further oestrogen therapy thus making them suffer many months or years of symptoms, particularly depression, anxiety and loss of energy.

Klaiber 1979 is an early study on the effects of estrogen using very high doses of Premarin. Note that Premarin is far more dangerous than modern bio-identical estrogens and has not been recommended for transition for many years due to the significant risks it carries.

Patients were admitted to the study only if they had an extended history (at least two years) of unsuccessful treatment by a variety of conventional therapies, eg, electroshock, antidepressant medications, psychotherapy. ... Entrance into this experimental research project was frequently viewed by the patients as a last chance to get well, after all else had failed.​
... Estrogen therapy in the treated patients was begun at the dose level of 5 mg daily. The daily dosage of estrogen was increased in 5-mg steps each week that the patient failed to show improvement in the Hamilton ratings. The maximum dosage of estrogen was arbitrarily set at 25 mg daily.​
... The above results indicate that high doses of oral conjugated estrogen provided significant alleviation of symptoms for a group of severely depressed women who had not responded to conventional antidepressant therapies.​
... On balance, we regard this study as providing ample justification for further research into the therapeutic effects of estrogen on depression. It is important to determine now how therapeutically effective estrogen is in populations of women who are less severely ill and less resistant to therapy than the patients in our study. It is also important to know why, physiologically, some depressed women responded so much more favorably to treatment than others.​
... In assessing the risk-benefit ratio of estrogen therapy with these patients, we considered several factors. Twenty five of the 40 patients (62.5%) had made serious suicide attempts prior to inclusion in the program. All of our patients expressed suicidal thoughts ranging from mild to severe during the time of the study, and a number of suicides were attempted. In addition to the suicide risk, these women faced an extremely high risk of life-long debilitation from a severe chronic depressive state. In comparison, the risks of endometrial carcinoma or thromboembolic disease seem considerably less. Thus, we feel that the risk-benefit ratio, which must be considered in the use of all drugs, is well met by this estrogen therapy.​

Unfortunately following Klaiber 1979 there was no further research. Even now, 40 years later and when safe bioidentical forms of estrogen exist, high level estrogen carries the same stigma regardless of its benefits. It's as if these fears have become institutional memory and can no longer be questioned. Studd 2004 refers to Klaiber 1979 saying

The clue to the use of estrogens came with the important and somewhat eccentric paper by Klaiber and colleagues who performed a placebo controlled study of very high-dose estrogens in patients with chronic relapsing depression. They had various diagnoses and were both premenopausal and postmenopausal. They were given Premarin 5 mg daily with an increase in dose of 5 mg each week until a maximum of 30 mg/day was used. There was a huge improvement in depression on these high doses, but this work has not been repeated because of anxiety over giving high-dose estrogens.
It is estimated that up to 95% of women have some form of PMS, but, in about 5% of women of reproductive age, they will be severely affected with disruption of their daily activities. Considering these figures, it is disturbing that many of the consultations at our specialist PMS clinics start with women saying that, for many years, they have been told that there are no treatments available and that they should simply ‘live with it’.​
... In spite of this clear clinical history of a woman who will probably respond to estrogens, most psychiatrists believe that such patients are ideal for the use of antidepressants.​

Despite the apparent evidence that high estrogen levels protect against depression, Panay 1997 is an example of what happens instead. This women's depression worsened and without effective help from doctors she started self-medicating with estradiol gel. By the end of the study her only effective treatment was self-medication to high estrogen levels and yet the authors refuse to consider any possibility of that being the appropriate treatment. Also note the use of the words "claiming that her symptoms had returned", phrased in such as way as to dismiss her credibility.

A 46-year-old woman, with a past history of depression and alcoholism, was referred by her family physician complaining of severe premenstrual symptoms.​
... She was maintained with 75-mg estradiol implants for 1 year. However, after the third implant posthysterectomy, she returned only 2 months later for a repeat implant, claiming that her symptoms had returned. She was not given a repeat implant at this stage because her estradiol levels were adequate at 170 pg/L.​
... Despite adequate estradiol levels from unopposed estrogen, her depression and anxiety symptoms deteriorated, and she began taking haloperidol, procyclidine, and nitrazepam as prescribed by her family physician. After a while, anxiety and panic attacks became prominent and she was unable to leave the house because of agoraphobia. This was thought to be caused by side effects of the nitrazepam, which was reduced in dose.​
... When she was next seen in June 1995, she stated that she had been self-medicating with estradiol gel and the day before had used half a tube. This had produced an estradiol level of 5,555 pg/L. She claimed she needed the extra estrogen because she only obtained relief of her symptoms of lack of energy, hot flushes, palpitations, and joint pains when her estrogen was "at the right level for me."​
.. In December 1995, she claimed to be using eight strips of estradiol gel per day as well as her 6-monthly 50-mg implants, and her levels had declined to 634 pg/L. She felt well but was still taking antidepressants at her last visit.

References

Antidepressants
There's a lot more to be added here. I'd like to explore the potential risks of high estrogen levels vs the actual risks of antidepressants.

McIntyre 2005 shows how estrogen acts as an antidepressant. The 2002 publication refers to a large study, the Women's Health Initiative (WHI), which found that synthetic HRT was dangerous.

With the publication in July 2002 of results indicating potential harmful effects of HRT (estrogen monotherapy), there was a dramatic reduction in HRT prescriptions.​
We found that a significant decrease in the number of HRT prescriptions was associated with a statistically significant increase in prescriptions of serotonergic antidepressants. Others have noted associations between changes in HRT and antidepressant prescription patterns.​

Unfortunately, doctors will freely give out antidepressants, which have well known risks, rather than higher levels of estrogen for which there's no clear evidence of risk (or safety).

These articles are relatively easy to read and reference the original research papers. They discuss the risks and harms of antidepressants, and commercial biases in reporting and approval.

Scientific American
  • The Hidden Harm of Antidepressants in 2016 - “My view is that we really don't have good enough evidence that antidepressants are effective and we have increasing evidence that they can be harmful,” Moncrieff says. “So we need to go into reverse and stop this increasing trend of prescribing [them].”

Articles on antidepressant risks in Psychology Today (wikipedia entry)

References
 

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#39
The psychiatry industry benefit from mental illness
One obvious issue with the psychiatry industry is that the more mentally ill people are the more these people will profit, thus its against their interest to actually help people and in their interests to give people permanent brain-damage.

This perfectly explain the history of psychiatry, they seem to very much gravitate to treatments that are harmful
  • Lobotomy
  • ECT
  • drugs that schrink the brain
  • drugs that cause permanent sexual dysfunction
  • physically restraining people traumatizing them
  • peoples pets die as they are locked in a psych ward
  • billing people for 'help' they didn't want.
  • providing harmful talk-therapy so people keep coming back (giving harmful advice).
But it goes further, its also in the interest of psychiatry that people live bad lives so they seek 'help' in the first place. It's also in the interests of psychiatrists to oppose any actual effective treatment like medical transition from male to female or paying a sex-worker.
 

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#40
How to better handle people in danger to themselves or others
There are many people who clearly cannot just be left alone or they will be likely to harm themselves or other people.

There are a lot of people who are not criminals (at least not yet) while still being likely to harm others. For example some parents might be a clear danger to their children, some people are suicidal, etc.

Currently the way these things are dealt with is to just lock people up often without any conviction of a crime. Psych-ward can hold people for 72 hours without court-approval and people can be held even longer than that even if they have not violated any law, i shouldn't even have to explain why that's a bad idea.

https://www.youtube.com/watch?v=iTQ4t7RmyfM

They way we (should) deal with people who have not yet committed any serious crime is to monitor them to make sure they do not harm themselves while still allow them basic freedoms like going to work or going outside. They can be observed by people from the government or by people who are close to them.

This is actually cheaper than confining people to psych wards:

The average cost to deliver care was highest for Medicare and lowest for the uninsured: schizophrenia treatment, $8,509 for 11.1 days and $5,707 for 7.4 days, respectively; bipolar disorder treatment, $7,593 for 9.4 days and $4,356 for 5.5 days; depression treatment, $6,990 for 8.4 days and $3,616 for 4.4 days; drug use disorder treatment, $4,591 for 5.2 days and $3,422 for 3.7 days; and alcohol use disorder treatment, $5,908 for 6.2 days and $4,147 for 3.8 days.

https://pubmed.ncbi.nlm.nih.gov/22588167/

This is before you put the price-tag on violating peoples basic rights and people no longer being able to work due to being confined in a ward in addition to the productivity-loss due to the trauma from the psychiatric rape.

This can also be used if we are afraid some parents are going to harm their children, we have someone with them to support them and ensure their kids will remain fine.
 

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#41
The mythical good psychiatrist
The mental-health laws are so bad you as a psychiatrist cannot be good to people without constantly breaking the law (you would probably lose your job quickly) thus you end up with people who constantly harm their patients and violate them in all sorts of ways.

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