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Thomas Reilly's avatar

Let me have a go at 3) and 6).

3)

Firstly, there are no clear distinct boundaries between one psychiatric disorder and another, with big grey areas of overlap. Psychiatric diagnoses are based on a clinician's interpretation of symptoms and the same symptoms can be present in different disorders (e.g. anxiety can be part of a depressive disorder or an anxiety disorder but can also be secondary to difficulties in communication/social interaction in the context of autism). So naturally different clinicians can interpret symptoms differently and consequently come to a different conclusion about the correct diagnosis.

Secondly, being diagnosed with one psychiatric disorder makes a person much more likely to subsequently be diagnosed with a further psychiatric disorder (generally referred to as co-morbidity) - https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2720421

There could be a few reasons behind this. The kinds of environmental risk factors that make a person more likely to develop depression, for example, may also put them at risk of developing a substance misuse disorder. Some disorders, like schizophrenia and bipolar disorder probably share some underlying mechanisms - https://pubmed.ncbi.nlm.nih.gov/29049482/

Furthermore, there is substantial shared genetic vulnerabilities between mental disorders - for an example, this paper looking at variation shared between ADHD and depression https://www.nature.com/articles/s41598-021-86802-1#Sec11

6)

I think it's worth saying that psychoanalysis never had the same hold over British psychiatry as it did in the states, where many head of psychiatry departments were analysts. This changed with the reemergence of biological psychiatry and massive swing towards psychopharmacology.

In terms of evidence-base, as a field psychoanalysis has historically not engaged with (or has actively resisted) trials of its effectiveness. My feeling is that psychoanalysis in general is not particularly interested in the scientific method or testing its theories. There are some notable exceptions to this rule, Peter Fonagy at UCL springs to my mind - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592654/

Additionally, compared with modalities like CBT or DBT, psychoanalytic psychotherapy is more difficult to evaluate. Therapy tends to be more open-ended, more long-term, less focussed on the reduction of symptoms, less able to be operationalised or standardised. It's also much more expensive for a person to be in therapy for years than to have say 12 sessions of CBT.

Despite not having a strong evidence base, I think most UK-based psychiatrists do see a role for psychoanalytic-based therapies, though the cost is more of a difficult one to argue in terms of the NHS, so it is reserved for a small number of patients.

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Jay Vandermer's avatar

7) Here's an old study that establishes the existence of lookism: https://www.researchgate.net/publication/223673076_Pretty_pleases_The_effects_of_physical_attractiveness_race_and_sex_on_receiving_help

6) "Therapeutic alliance" will be a useful bit of vocabulary in your search. My understanding is that most of the time therapeutic alliance matters more than the therapy modality. I don't think this is universally true (for example, CBT for insomnia).

4) I've had these thoughts too. I want electoral reform but I know that a different system would have tradeoffs and unintended consequences. It would be nice to know in advance what those might be.

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