[algesten]

> 3. modern clinical psychiatry is an evidenced-based, research-driven field which treats and forms diagnoses on the basis of decades of research into any particular condition. It isnt the 1950s.

But isn't modern clinical psychiatry marred by the same problems social or economic sciences are? Ultimately you are studying/interpreting human behaviour, which doesn't lend itself well to quantisation or categorising.

[mjburgess]

The most reasonable thing to think about any mental health disorder is whatever the consensus in clinical psychiatry is.

That is the point. It is so overwhelmingly well-researched, that even if its conclusions are wrong, no lay person is going to be in a position to have "an argument" that hasn't already been considered and researched and folded into the consensus.

This isnt the case with social sciences, and it isnt the case with macroeconomic policy. Both of these are about groups of humans, not individual humans, and are fundamentally about behaviour in the face of cultural/economic/social changes. That kind of analysis is purely speculative and historically accidental in the way that giving people adderall and measuring their cognitive performance isn't.

A man on the street may well have good reasons to speculate differently about the evolution of his society that those speculations produced in some university in a foreign country.

A man on the street can have no good reason to act against the consensus of research-based medicine. To do so is to fly blindly into an area of profound research depth and consideration.

We have a problem today of these domains being equivocated. About people believing they are experts because the "Experts" they see are really political speculators and commentators of macro-cultural changes. And so everyone thinks everything is speculation.

This is profoundly not the case for, let's say, what the best treatment plan for bipolar disorder, adhd, autism, clincial depression, psychosis, etc. etc. etc. is.

...which has folded in lifetimes of research on the way the brain works, the way that drugs work, CBT, social therapies, counselling, etc. etc. etc. ...

An opinion on what "should be done" about a family member with bipolar disorder may as well be an opinion about what should be done about their thyroid problem, carpal fracture, lymphoma, etc.

[xapata]

Sounds like you're not familiar with sociology nor macroeconomics literature.

[mjburgess]

My concern was to defend the topic at hand. Trying to distinguish between different forms of economics and sociology would muddy the waters a great deal.

For sure, no doubt, there is highly defensible macroeconomic and sociological work done.

There does seem to be a boundary where sociology meets macroeconomics meets english literature meets arsty-psychology wherein a huge amount of highly speculative work is done. Work which seems, as far as its truth apt, mostly false.

I don't think this work properly belongs to any of those subjects and is really a kind of speculative blogging that certain academics like to do that happens to get published somewhere. However that also tends to get seen more often than their detailed work on interest rates in the 1970s.

[whatshisface]

Macroeconomists often can't run experiments, and some kinds of "macro-sociological" theories can't be tested either. That puts them in a fundamentally different epistemological class.

[Grieverheart]

Most recent studies in psychiatry and social sciences that I have read, even those published in Nature, use sample sizes of around 50 people, which should be considered insufficient. Instead they use various cooked up formulas for correcting for gender/ethnicity etc. Instead, sample sizes should be much bigger. Of course this is not practical or even perhaps impossible. I find this to be a poor excuse, though.

The matter of fact is, we know very little about how the brain works. We certainly have some big picture on how the brain functions, but we are very far from grasping the chemistry.

[mjburgess]

psychiatry =/= psychology =/= social psychology

This is more "everything is the same" anti-expertism.

Clinical psychiatry is not about p-hacking groups of 50.

The treatment of bipolar disorder hasnt been decided on the basis of what happened to the last dozen undergrad students.

>The matter of fact is, we know very little about how the brain works.

Profoundly untrue. Even if it were truth, its very truth would preclude your ability to make this assertion. If we knew nothing, how are you estimating the nothing we know?

It is no mystery what happens when you give a person lithium. Nor some speculative game to know what the effect of MDMA on PTSD patients is. Nor hocus pocus to identify the effects of repeated trauma.

How are you deciding what percentage of "how the brain works" we need to know in order to do psychiatry in a reasonably well-informed way?

Suppose, even, we know now 0.1% of the entire story. Is this sufficient for an evidence-based treatment of psychosis?

It clearly seems to be. Since the treatment of schizophrenia is overwhelmingly more effective than anything based on a study of 50 people.

Your comment may very well apply to "journalistic science" ie., the increasingly prevent, "ive just had an idea, lets get 50 undergrads and a seminar room!".

That is a tiny percentage of science, even if it is the most commonly popularized.

[Grieverheart]

I had a look at this review on bipolar disorder, https://doi.org/10.1136/bmj.e8508 . According to a study referenced in it, 68 randomized trials where used to determine the effect of different drugs compared to placebo. Again the sample size is low and the statistical significance is also small, unless I'm missing something.

You are correct in saying that we don't actually know how much we know about the brain. But the brain is s much more complex than e.g. planets orbiting the sun. There are many components that can get affected by chemical compounds in the short term, but more importantly in the long term. I agree though that only through testing can we get a better understanding. It is just the way it's currently done that I disagree. I would gladly read some research you think is good and does not have the shortcomings I describe.

[dsacco]

> Most recent studies in psychiatry and social sciences that I have read, even those published in Nature, use sample sizes of around 50 people, which should be considered insufficient.

I disagree with your reasoning even if your conclusion is correct about the validity of those studies. Small sample sizes are not intrinsically bad and there’s no magic number to make sample sizes valid. It’s a sliding scale with statistical significance - with a large enough p value a relatively small sample size doesn’t mean the observed phenomenon isn’t there. In that case I would be more concerned about p value hacking or the researchers “presuming the conclusion from the outset” than the sample size.

[always_good]

You can't condemn sample size without also condemning the statistical methodology of an experiment.

"Small sample size thus irrelevant" does not make sense despite often being the top comment on Reddit.

[Grieverheart]

This is correct. Sample size should be dependent on the strength of the effect. As a rule of thumb though, a sample of 50 people is very little. If physics used these kind of sample sizes and confidence levels, we would have discovered multitudes of new particles.