None of the breads listed there I would consider to be of the category "bread" as a German, and what I would be looking for when I wanted one.
Yes, a French baguette-type soft white bread is formally "bread", but it is treated as a different/single category here, as "white bread". With examples of typical bread being, say: https://www.hofpfisterei.de/download/Hofpfisterei-Sortiment-... And I don't think the images really carry across the difference (and variety) in texture and density, to someone who simply never had this kind of "non-soft" bread. You can spread cold butter from the fridge on it without breaking it, maybe that gives away a hint towards the difference. Also note the variety of grain: rye, spelt, wheat, barley, oats, in different compositions and degrees of fineness. And this is just one brand/bakery.
Some more "typical German bread" images. I picked types that maybe convey the difference to "white bread" the best in viewing:
The key used to encrypt traffic is in the URL, everything including path is encrypted from client to the onion service end. What you are saying is true for non-onion HTTP sites, not for onions.
Very sad to see, but I don't expect Israeli kindergardens to be much different in terms of militarization and enemy images, unfortunately. Violence begets violence, and finger-pointing to the other's violence never solved anything.
"Denial" typically refers not to the denial that something bad happened to you, but to not see how you act it out on others (or yourself). It is exactly those in denial that would claim that they "have moved on", and try hard to make it look like they did also to those around them. It then shows up in violent tendencies, lashing out against kids, enemy images, patterns of avoidance, psychosomatic symptoms, burnout, addictions, obesity, sports injuries due to overdoing it, inability to sit still and listen, etc. - not necessarily PTSD symptoms.
"Extrasensory Perception Experiences" -- experiencing it as "extrasensory perception" can be very real, like verbal hallucinations are very real experiences. It's well worth to study people who experience these phenomena.
The definitions of psychological disorders are not exact, the comorbidities are high, all of this is not exact science, like you make it seem. CPTSD is not in the DSM because the symptoms are already covered by DSMs extended PTSD definition. I wonder why it is so important for some people to fight over definitions of what to me mostly look like different maladaptive coping mechanisms with very similar underlying causes and very similar treatment options.
To you, things seem to be either "pseudoscience" (on what grounds?) or "scientific", and what you write sounds very much motivated by your own political beliefs. And, why shouldn't people be motivated by their beliefs? They can still be good scientists too.
You dismiss Freud as "pseudoscientific", where he expressed very clearly that he wants people to challenge his theories and develop them further, and that he doesn't think he owns the truth. He wrote lots of material where he merely documents his interactions with patients and presents his thoughts and theories and experiments, based on what was available to him at the time. Nothing what I read of his extensive study material makes me think it's "pseudoscientific", even if many of his theories have now been challenged and disproven. That doesn't make him a bad scientist. You may want to look at your high horse here. Can you explain why you think Freud didn't do science, back when he did it?
> I wonder why it is so important for some people to fight over definitions
This is the work of most of medicine and science. It's not fighting. But understanding what the correct definitions are is foundational to being able to talk accurately about the phenomena. There's a lot of work that goes into understanding psychological disorders from various different perspectives, including neural anatomy, genetics, behavior etc.
> what to me mostly look like different maladaptive coping mechanisms with very similar underlying causes and very similar treatment options.
The existing disorders these days do a pretty good job of not being too overlapping with respect to cause or symptoms. They are frequently confused with each other either due to incomplete information at the time of diagnosis or due to practitioners not being familiar enough with the latest research. Autism I know is one that gets frequently misdiagnosed as bipolar disorder or anxiety.
There are comorbidities, but those comorbidities are sometimes due to things like misdiagnoses.
> To you, things seem to be either "pseudoscience" (on what grounds?) or "scientific"
I'm not sure what you're driving at here. But science and pseudoscience are different.
> what you write sounds very much motivated by your own political beliefs
The only things I think I've written about my political beliefs on HN are that I'm opposed to political violence, I value democracy, and I value truth and the pursuit of truth. I'm not sure what you are trying to say here.
> And, why shouldn't people be motivated by their beliefs? They can still be good scientists too.
You can't serve two masters. Science is about what is true. If one believes in a sort of "higher truth" that they make science subservient to then they're not really doing science. That goes for whatever they take the "higher truth" to be. Often it's a religious commitment, but it could be other things.
> dismiss Freud as "pseudoscientific", where he expressed very clearly that he wants people to challenge his theories ....
Science isn't about things like having people challenge your theories. It's about making predictions, having on objectively verifiable method for checking the outcome of the predictions, assessing how and why the predictions went wrong, etc. Freud didn't do any of that.
Freud's theories and whether they are scientific or not has been written about a lot. I think it's probably covered in a lot of intro do psychology books. But you can also find web pages about it.
You may disagree, but I'm more in line with publications such as this:
Frank Tallis, We should still pick up the pearls: on the scientific status of Freud, Brain, Volume 147, Issue 4, April 2024, Pages 1115–1117, https://doi.org/10.1093/brain/awad414
"We do not think of Galileo as being a bad scientist because he cast horoscopes. Rather, we consider him to be an excellent one on account of his mathematics. Similarly, our estimate of Freud’s scientific reputation should not be based on what he got wrong—or for that matter, whether his putative affair with his sister-in-law proves that he was a congenital liar—but rather, what he got right. Militant ‘Freud bashing’ has favoured a style of argument that lacks nuance, and sometimes, integrity."
The theories of 100 years of psychoanalysis may not be scientifically proven (nor disproven), but there's plenty of opportunity to do that. There's no need to dismiss any and all ideas coming from that space outright based on some generalization around specific people or their individual-centric approach and reasoning.
"The answer to the question of whether psychoanalysis is ‘scientific’—or not—is less clear than is commonly supposed. Popper’s assertion that psychoanalysis does not meet the falsification criterion, which is often automatically accepted as an incontestable truth, hasn’t prevented ‘scientifically minded’ researchers testing psychoanalytic hypotheses experimentally."
I strongly disagree with your statement that psychological disorders are distinct in terms of etiology. That's just not true, and frankly, unscientific to make up such a claim. To provide some citations:
"The reliability and validity of traditional taxonomies are limited by arbitrary boundaries between psychopathology and normality, often unclear boundaries between disorders, frequent disorder co-occurrence, heterogeneity within disorders, and diagnostic instability."
Kotov, R., Krueger, R. F., Watson, D., Achenbach, T. M., Althoff, R. R., Bagby, R. M., Brown, T. A., Carpenter, W. T., Caspi, A., Clark, L. A., Eaton, N. R., Forbes, M. K., Hyman, S. E., Jonas, K. G., Latzman, R. D., Li, J. J., Nelson, B. D., Regier, D. A., Rodriguez-Seijas, C., Ruggero, C. J., … Wilson, S. (2017). The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, 126(4), 454-477. https://doi.org/10.1037/abn0000258
"Mental disorders traditionally have been viewed as distinct, episodic, and categorical conditions. This view has been challenged by evidence that many disorders are sequentially comorbid, recurrent/chronic, and exist on a continuum."
Caspi, A., Houts, R. M., Belsky, D. W., Goldman-Mellor, S. J., Harrington, H., Israel, S., Meier, M. H., Ramrakha, S., Shalev, I., Poulton, R., & Moffitt, T. E. (2014). The p factor: One general psychopathology factor in the structure of psychiatric disorders? Clinical Psychological Science, 2(2), 119-137. https://doi.org/10.1177/2167702613497473
I think we're coming at this from different point of views and possibly different backgrounds.
My perspective is that ideas need to earn their keep. You have said a few times that I'm "dismissing" ideas, whereas the way science works is that you have to make a case for why your idea should be valued.
Tallis is a clinical psychologist and as I mentioned the clinical (which above I called applied but really I mostly meant clinical) psychologists have been trying to revive Freud for a long time. Tallis is also an author and as even he points out Freud is studied more in literature than in psychology. So yes there is a whole literature of clinical psychologists trying to revive Freud's reputation, and it goes back decades and possibly centuries. I have no problem with you agreeing that literature, but I do want to point out that I already indicated above that it existed.
But clinical psychologists are not trained in research, which is the branch of psychology that conducts the science. So they usually don't have the background to understand whether his contributions count as scientific research. The article also makes at least one factual mistake -- Koller discovered the anesthetic properties of cocaine, Freud did not suggest them. It doesn't seem to make a case for any science Freud did.
Galileo is a good scientist because he did science. We don't include his horoscopes as science. Same with Newton and his alchemy. Freud has just the horoscopes and alchemy so he hasn't achieved the same status.
Most of what people typically say they value in Freud predates him by thinkers whose reputation is stronger. The idea that the mind does a great deal of unconscious work goes back to the 1700s with people like Kant and Hume in philosophy. William James started writing about the unconscious mind in 1890, a few years before Freud. Ramón y Cajal was doing his neuroscience work around the same time as Freud. We sometimes think of Freud as one of the first psychologists and as inventing some famous concepts like the unconscious. But that's not actually true. There were other psychologists who predated him or were working at the same time who are considered today to have made lasting empirical contributions in a way that Freud hasn't. So it's not about his being early it's about the way he chose to go about things.
> their individual-centric approach and reasoning
I'm not sure what you mean here, but if by individual-centric approach you mean case studies, then yes this is very relevant. An individual experience is an anecdote or one datum. You need to systematically study lots of data. Freud dealt in case reports, so units of individual anecdotes. There's not enough information and not enough systematization to extract useful signal from the noise.
> I strongly disagree with your statement that psychological disorders are distinct in terms of etiology. That's just not true, and frankly, unscientific to make up such a claim.
Under your view, how would you explain why the disorders have different rates of heritability, different genetic markers, different fMRI patterns, and different treatments?
> Under your view, how would you explain why the disorders have different rates of heritability, different genetic markers, different fMRI patterns, and different treatments?
"Heritability" is a misnomer. "Heritability" via twin studies cannot account for the prenatal phase, so by definition anything that results from early developmental influences is included in "heritability", where it would be more precise to regard is as environmental. Wouldn't it be weird to claim the first 9 months of plant growth is "hereditary" and has nothing to do with its environment in that phase? Epigenetics play a role in the modification of genetic markers. There is a growing body of research around cell memory and "early consciousness". Anything you can measure from a biological lense provides data for correlation, not causation. You can stop on that level, sure, and then claim that is "etiology", or you can theorize about common causes elsewhere.
Explaining "different treatments" makes it sound like there is an agreement on how to treat, say, CPTSD vs bipolar disorder vs schizophrenia vs BPD vs DID vs GAD, where in practice there is a lot of experimentation and overlap. Of course if you "treat" on the level of say, receptors, and try to influence the system that way, you need to use different drugs, depending on what effect the original cause already had. The same cause may result in different adaptations of the body for different people. If you work on the level of the psyche, you might find that what your patients have in common is a history of violence, towards self and others; the symptoms may disappear either from a continous stream of your carefully tuned drugs, or from removing the ongoing violence. Unfortunately you cannot easily measure that from the outside, and people will not necessarily give you accurate data to work with in your surveys; if you even bother to gather that. Psychotherapy is attempting to remove internalized violence against self/other.
Let me try an analogy here: You are tasked to fix broken houses. The symptom that is described is that the floors are wet and it is cold inside. You arrive at the house and see that, yes, the floor is wet, and the windows are broken; the heating works. It is not false to claim that the broken windows are the "cause" of the wet floor. You put in new windows. Case closed.
You get called to another house, with the same symptom. You find that the roof needs fixing. You create a new category in your diagnostic manual of house disorders.
You try to approach it scientifically: You take the symptoms of 100.000 houses, and categorize measurable problems inside the house and correlate them to what needs to be fixed. You may in fact not be interested in why the windows are broken: You make a living from these repairs. You do sometimes wonder why you get called to the same houses periodically to find the same windows broken, but you don't see anything particularly wrong with the house after you fix it up each time so you move on. It's not your job to identify a group of youngsters that walk around throwing rocks into people's windows and dismantling roofs.
Is it wrong to claim that fixing the windows is the correct treatment at the "origin", and that it wouldn't help if the roof needs fixing? No. Does it say anything about the "root cause"? No.
DSM Disorders Disappear in Statistical Clustering of Psychiatric Symptoms (2024)
I don't see where you've addressed the genetic and fMRI data etc. Could you be concrete and choose, say, two specific disorders. Walk through the fMRI and connectivity differences and the genetic differences as currently understood in the medical literature and then describe how those these differences come from a common cause in this case. And specifically what studies establish that common cause? That will help ground the conversation in specifics.
> Walk through the fMRI and connectivity differences and the genetic differences as currently understood in the medical literature
"Medicine" can not say anything about kids throwing rocks, it can only talk about broken windows and roofs, because all it measures is houses. I did not argue against measuring and fixing houses. I did not claim there are no visible differences in fMRI, nor did I claim there were, nor did I claim there are no genetic differences, or that there were. Straw man. It makes no difference for what I was arguing about, which you decided to ignore and not engage with.
"The high degree of genetic correlation among many of the psychiatric disorders adds further evidence that their current clinical boundaries do not reflect distinct underlying pathogenic processes, at least on the genetic level."
The Brainstorm Consortium; Anttila, V., Bulik-Sullivan, B., Finucane, H. K., Walters, R. K., Bras, J., … (2018). Analysis of shared heritability in common disorders of the brain. Science, 360(6395), eaap8757. https://doi.org/10.1126/science.aap8757
"This empirical evidence of *shared* genetic etiology for psychiatric disorders can inform nosology and encourages the investigation of common pathophysiologies for related disorders."
Lee, S. H., Ripke, S., Neale, B. M., Faraone, S. V., Purcell, S., Perlis, R. H., … Wray, N. R. (2013). Genetic relationship between five psychiatric disorders estimated from genome-wide SNPs. Nature Genetics, 45(9), 984-994. https://doi.org/10.1038/ng.2711
"evidence accumulated over decades of family and twin studies have shown that familial and heritable components commonly overlap between disorders. […] Genetic influences on psychiatric disorders also share genetic determinants with dimensional psychological and neurocognitive traits that transcend diagnostic boundaries."
Lee, P. H., Feng, Y. A., & Smoller, J. W. (2021). Pleiotropy and Cross-Disorder Genetics Among Psychiatric Disorders. Biological psychiatry, 89(1), 20–31. https://doi.org/10.1016/j.biopsych.2020.09.026
"We are so embedded in this structure. We have spent so much time diagnosing mental disorders that we actually believe they are real. But there's no reality. These are just constructs. There's no reality to schizophrenia or depression. We might have to stop using terms like depression and schizophrenia, because they are getting in our way, confusing things." (Thomas R Insel MD, NIMH director 2005-2015)
"In the last 2 decades, it has become obvious that child
abuse, urbanization, migration, and adverse life events contribute to the etiology of schizophrenia and other psychoses. […] I expect to see the end of the concept of schizophrenia soon." (Murray, R. M. (2016). Mistakes I Have Made in My Research Career. Schizophrenia Bulletin, sbw165. doi:10.1093/schbul/sbw165)
"Clinically, the evidence that symptoms cut across disorders — or that people frequently have more than one disorder — has only grown stronger. […] Even seemingly separate disorders are linked. In 2008, geneticist Angelica Ronald, then at King’s College London Institute of Psychiatry, and her colleagues found that autism and attention deficit hyperactivity disorder (ADHD) overlapped."
"I would say [biomarkers] are potentially highly useful but conceptually and practically incomplete"
Freckelton I., QC (2018). Overdiagnosis in Psychiatry: How Modern Psychiatry Lost Its Way While Creating a Diagnosis for Almost All of Life's Misfortunes, by Paris Joel: Oxford University Press, 2015, xi-xix and 1-181 pp., Psychiatry, Psychology, and Law, 25(2), 325–327. https://doi.org/10.1080/13218719.2018.1463588
Evidence of correlation in genetic studies doesn't answer the questions you were asking. The claim you made was that you don't believe psychological disorders have different causes.
Humans share 98.8% of genetics with chimpanzees. That doesn't tell you humans and chimpanzees are the same. It tells you where to look for the differences between humans and chimpanzees. A similar study to the GWAS study you cite shows that arthritis and type 1 diabetes have significant genetic overlap (https://pmc.ncbi.nlm.nih.gov/articles/PMC10291128/). That makes sense they're both autoimmune disorders where inflamation plays a major role. But arthritis and type 1 diabetes are not the same disorder.
The GWAS studies narrow down the search for genetic markers. They don't establish some sort of continuum for disorders all controlled by a single cause. They don't mean the difference between mental disorders is environmental. They don't mean that medicine or psychological disorders are social constructs or that there is "no reality to them".
The question of whether two things are distinct is determined by any one difference. 1 and 2 are distinct despite differing by only 1. You can list thousands of ways they are similar (both integers, both positive, both less than 500, both written with marks on a page). But those similarities do not make them identical.
That's why I'm saying once again that if you want to focus the conversation we need to talk about the genetic differences, fMRI differences etc between disorders and then you would need to make the case that those differences have the same cause. At any rate, I don't feel like pursuing this any further, but I wish you well.
P.S. I noticed in one of your earlier comments you said something about psychotherapy. Just in case it's not clear, psychotherapy is very different from psychoanalysis, which is what Freud was doing. Freud has a bad reputation as someone whose theories haven't held up well and who engaged in deliberate fraud. Psychotherapy is an evidence-based branch of medicine and is rightfully well regarded. You'll find that I've several times on this site and elsewhere recommended everyone use psychotherapy just like everyone should have a dentist. I just wanted to clarify that in case you were under the impression that my statements about Freud applied to psychotherapy. However, psychotherapy doesn't have anything to do with "attempting to remove internalized violence against self/other."
I get the feeling we're completely talking past each other. I never claimed that psychological disorders cannot have different causes. They may mostly be variants of a living organism's spectrum of maladaptive reactions to various adverse circumstances, yes.
You seem to read what I write, then make assumptions what I might be saying, and then reply to your assumptions, and ignore most of what I write (e.g. about your claims of "heritability"), which makes this a very weird interaction overall.
I agree with your idea of just letting this be, as I don't find it a very productive exchange.
I don't know why you keep coming back to fMRI and genetic markers, because, again, nothing of what I was trying to say has anything to do with whether there are measurable differences on that level or not. You seem to think that "symptoms" are described in the disorder definitions, and anything you measure is the "cause". Again: To me, it is similarly possible that both are symptoms. You can use that for diagnosis if you feel like you need to make this discrimination, but that doesn't say anything about treatment or etiology.
> psychotherapy doesn't have anything to do with "attempting to remove internalized violence against self/other."
I take it you do not consider the EMDR protocol, ACT, CBT, IFS, ego state, Schema, CFT, EFT, SE, DBT, MBSR, DBT, IPT, systemic therapy, gestalt, to be "psychotherapy" then. All of them work with and address internalized violence against self ("inner critic", self-worth, other negative thinking patterns; chronic often suppressed feelings of shame, anger, grief).
That is quite false, especially if you mean "out of the box". And it's likely a temporary situation - there's no guarantee whatsoever that people will maintain x86 and some specific Nvidia Pixel Shader emulation support 50 years from now.
This has already happened, PC Gaming Wiki has entries for lots of games where support for various old methods of doing things no longer work, on real hardware on windows, and you need to use a variety of workarounds like dgvoodoo or a fix by a random third party modder to get the game to operate correctly. And that's before you consider defunct copy protection or trying to add improvements.
Given the amount of work emulator authors go to supporting consoles like the Neo Geo CD, with 8 not very good games (they had to do serious work, over many years, breaking the encryption), and the amazing cycle accurate emulators for consoles like NES and SNES, I’m confident we will continue to have good emulators in the future for any system anyone cares about.
nVidia has dropped 32-bit PhysX support in 50-series cards, significantly impacting some older-but-not-old games, and there’s no real solution yet except to own an older card.
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