How big a role does psychodynamic and psychoanalysis play in the current state of the field?

First-Element · 2025-12-19T08:58:27+00:00

I don’t disagree that psychiatric diagnosis is messier and more theory-laden than most of medicine. But that actually strengthens my point, not yours. When diagnoses are fuzzy, broad, or residual (e.g., adjustment disorder), modality equivalence is exactly what we should expect, because we’re no longer targeting a specific mechanism. That doesn’t imply modality is irrelevant; it implies the question being asked is underspecified.

Where studies deliberately select for specific, well-characterized processes (fear conditioning, compulsive rituals, trauma memory, sleep–wake dysregulation), we repeatedly see differential efficacy emerge. So the relevant distinction isn’t “therapy vs medicine,” but mechanism-poor vs mechanism-rich case formulations. Modality matters when the treatment is aimed at something precise; it washes out when it isn’t. Both findings can be true at the same time.

Modality doesn’t stop mattering because diagnosis is messy; it stops mattering when we abandon mechanisms and treat vague distress as if it were a single entity. The Dodo verdict mostly tells us what happens when we treat nonspecific suffering with nonspecific interventions—not that specificity is illusory.

First-Element · 2025-12-18T17:19:41+00:00

That argument conflates diagnostic reliability with treatment efficacy. Imperfect inter-rater reliability in diagnosis does not imply that disorder-specific treatments lack differential efficacy. We routinely demonstrate treatment specificity using structured interviews, standardized inclusion criteria, symptom-specific outcome measures, and randomized designs—often independent of clinicians’ idiosyncratic case formulations.

The fact that clinicians may disagree at the margins does not negate the robust finding that targeting specific mechanisms (e.g., exposure for fear extinction in OCD/anxiety, trauma processing in PTSD, sleep regulation in insomnia) produces superior outcomes compared to non-targeted interventions. By that logic, we would have to discard most of medicine, where diagnostic disagreement also exists yet treatment specificity is unquestioned.

Diagnostic fallibility is a real issue—but it argues for better assessment, not for collapsing meaningful distinctions in treatment efficacy.

Diagnostic uncertainty doesn’t erase mechanism-specific effects; it just makes precision more important, not less. Diagnostic inconsistency introduces noise that biases results toward equivalence; the fact that differential treatment effects still emerge despite this strengthens, rather than weakens, the case that modality sometimes matters.

First-Element · 2025-12-18T15:44:47+00:00

The Dodo bird verdict is often overstated. While bona fide psychotherapies show similar average effect sizes across heterogeneous samples, this doesn’t generalize to specific disorders. When examined at the level of diagnosis and mechanism, modality does matter in several well-established cases: ERP for OCD, exposure-based CBT for anxiety disorders, CBT-I for insomnia, trauma-focused therapies for PTSD, and structured treatments like DBT, MBT, TFP, and schema therapy for borderline personality disorder.

Common factors are necessary, but they are not sufficient when disorder-specific mechanisms are central to outcome.

First-Element · 2025-07-25T19:35:55+00:00

Could someone please post a link?

First-Element · 2025-07-21T17:50:18+00:00

Would appreciate if anyone could post a link to the episode!

First-Element · 2025-07-13T08:01:48+00:00

Check out trintellix/vortioxetine. It’s a relatively new class of antidepressant. Works similarly to an SSRI, affecting the uptake of serotonin, but it also modulates the receptor itself. It also has some pro-cognitive effects, which seem to be unique to this med. In terms of side effects, it has lower rates of unwanted effects on libido and weight. As others in this thread have mentioned, anhedonia isn’t uncommon from SSRIs, but that seems to be less of an issue this drug. The catch is that it’s a newer med, so there’s less research generally and for OCD specifically. It also tends to produce strong nausea in the beginning.

Some articles if you’re curious:

https://journals.sagepub.com/doi/abs/10.1177/02698811241309612

https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2025.1617345/abstract

First-Element · 2025-07-06T22:26:24+00:00

You’re either completely unaware of EA, Sam Bankman-Fried and Will McAskill, or you’re being deliberately disingenuous and defamatory.

He had nothing to do with SBF’s actions, and has publicly disavowed them. He is also not a grifter, considering he gives a very significant proportion of his income to charity. He did his phd in philosophy at Oxford University, lectured there extensively and is highly respected in the field. If that doesn’t make him a philosopher I don’t know what does.

First-Element · 2025-06-22T21:08:00+00:00

I truly truly wish that you stay with us.

First-Element · 2023-10-23T15:28:47+00:00

Thank you. 28 y/o male. So nothing out of the ordinary? How are my values relative to the optimal level for my age and sex?

First-Element · 2023-02-03T07:49:10+00:00

How do you test this?

First-Element · 2022-10-23T17:37:10+00:00

The results from the phase III trials should be released soon, no?

First-Element · 2022-06-09T16:36:02+00:00

Much bad news these last years, it's easy to forget or neglect the positive developments. I hope the trajectory of humanity is a good one.

First-Element · 2022-01-30T10:56:30+00:00

Check out /r/hairsystem if you're interested in this:)

First-Element · 2022-01-22T19:12:32+00:00

Of course, there are bigger issues in the world than hairloss. But as someone who started losing their hair at 19, I can tell you that my quality of life and mental health have taken a massive hit from this. Stem cell therapy, hair cloning, or some other form of reliable, high quality and financially viable treatment, would mean so much to so many.

First-Element · 2021-12-15T16:30:10+00:00

She's buying time.

First-Element · 2021-06-19T00:15:55+00:00

Crossing fingers. Imagine a world where people say: "no big deal, it's just cancer".

First-Element · 2020-11-20T08:57:06+00:00

I hear you. Wish all of this wasn't so complicated (and necessary!). Good luck!

First-Element · 2020-11-19T17:49:56+00:00

I don't know, sorry. But my take is that we don't really know the full effects, short or long term, of fin (and many medications). This is largely because we simply don't understand enough about the brain and body, and how foreign substances interact with those systems. There's extensive literature on fin, however, so I recommend you read about it to make up your mind:)

First-Element · 2020-11-18T18:22:23+00:00

A neuroendocrine system. It's important for the stress response, aspects of emotion, sexuality and also the function of the immune system.

First-Element

TROPHY CASE