nickbarnwell

What I most frequently heard was "There are two solutions: the deprecated one, and the one that doesn't work yet."

As do 99% of bicycle manufacturers producing CF frames - the expertise and manufacturing base are primarily in Taiwan, and everyone from Trek to Canyon are sourcing from the same few people. There are some boutique brands still doing lugged carbon builds that may be assembled in the USA with the AL components manufacturer here as well, but they'll be more expensive and worse performing models for the crowd who hasn't moved on from their "steel is real" phase.

Incredibly bearish. To summarise a few decades of common factors research poorly, our understanding of therapy's mechanism of action is limited, and it's not clear that any given technique or modality has superior curative power compared to another. The most important component is pantheoretical, the strength of the relationship between client and therapist. Alexa, Siri, et al. can not reliably determine whether I want the lights switched off in my bedroom or the living room, and we are seemingly decades away from the sort of strong AI required to hold meaningful conversations about the purpose of life or the nature of our interpersonal relationships. The Heart & Sould of Change is an approachable text on the topic if you're curious.

That's not to write it off completely; there have been adaptions of CBT and DBT into text and electronically-mediated forms that show promise among subclinical populations or as an adjunct to conventional therapy, but by and large a human is going to be necessary for a long, long time.

For anyone debating whether to pick up the book discussed in the article, I'm about halfway through right now and would highly recommend it. Harrington's a clearly talented writer and has done an amazing job weaving together the separate threads of thought and history to produce our modern conception of psychiatry. If you're familiar with Sarah Bakewell's writing, this is similarly compelling.

Though much improved since the early days, both the 3 and the S have considerably worse fit and finish and material quality than competitively priced vehicles. Whether for weight, cost, or complexity savings, they also eschew a lot of sound deadening material.

A $50,000 C class or A4 has a far nicer cabin than anything Tesla has produced, and when you start moving up into E or F segment vehicles the difference is even more pronounced. My 2010 B8 wagon with 115k on it has fewer creaks and rattles than a coworker's 2016 S with a third of that.

Infotainment wise, I find Audi's Virtual Cockpit to be incredibly well done and quite like MMI as a whole. I've not used the latest BMW or MB product that's just been released recently, but both seem to be garnering quite good reviews.

The least expensive Model 3 in Germany is 57.900 EUR with 540km (wltp cycle) of range – part of this is that they've only been exporting the high margin long-range AWD models. The more expensive "First Edition" id.3 will have approx 425km of range for 35.000 > x < 40.000EUR. Even taking the top end of that range, it seems the $:km ratio is in favour of the VW. If the First Edition battery is equal in size to the yet-to-be-released 58kWh battery, it seems the efficiency is at least comparable to the M3 as well.

Plus, you probably get a better interior. Certainly a better built one…

> reading self-help books…is similarly effective to in-person psychotherapy

That was not the outcome of the CPR paper, and even the authors' statement in the abstract is considerably more hedged than you imply here.

iCBT and bibliotherapy have both demonstrated the greatest efficact in subclinical or extremely high functioning populations; their utility in more severe cases or those where there are comorbid psychiatric or bio-social issues is less clear.

I absolutely believe in using telehealth to broaden access to behavioural health services and think they're an excellent first line treatment, but stating there's nothing to suggest that they're a fungible good with equivalent value to human-delivered psychotherapy risks dissuading people who're already struggling and fail to improve with self-guided resources from seeking out more comprehensive services.

Teletherapy outcomes have yet to be thoroughly researched, but anecdotally most clinicians report a strong preference for face-to-face sessions. Part of the discomfort stems from legal concerns – how do you handle a patient who reports intense suicidal ideation with a plan being one of the big ones – but also the limitations of teleconferencing. Neither the typical therapist nor their patient is like to have access to a fancy $$$ teleconferencing setup; both are likely stuck using whatever $0.50 on the BOM selfie camera Apple chose for their latest iDevice. Seeing only the face, and a 720p at that, denies the clinician a lot of valuable information about the client's internal state, their physiological responses, and their body language. Not to mention connection issues. Imagine being someone who's kept a secret about their sexuality or childhood abuse and finally developed enough trust and worked up the courage to discuss it to your therapist only to be met with a "Connection lost…" or frozen image of their face.

Additionally, licensure for mental health professionals is handled on a state-by-state basis, making CoL arbitrage difficult.

Even at the top end of that range it's less than what a competitive internships annualised compensation would be. Are you really able to hire people at those rates?

There is a both a large and strong evidence base for the usage of ECT in cases of severe, treatment resistant depression. Many aspects of modern medicine can be made to sound barbaric with the right framing; those who disparage ECT are not so quick to characterise chemotherapy as “poison by any other name” or dialysis a “vampiric ball and chain”.

By the time ECT is on the table, every other option is exhausted and the sufferer has been through multiple acute hospitalisations for suicidal ideation, if not unsuccessful attempts.

It is certainly fair to say the effect is not always permanent, that maintenance courses are a burden, and that their long-term efficacy does not justify the risks of the procedure itself or the anaesthesia it requires. Nonetheless, for someone who has been depressed for many years, plagued by crippling ennui and a nihilistic view of existence not even Schopenhauer’s grimmest passages can match, any respite is welcome. To deny them that option, with full knowledge of the risks, is to deny them agency.

I can't speak to Amazon, but at Microsoft the equivalents to the Google offering are going to have the same OSS competitors. Having worked on services there, the only thing I really miss is Kusto; it's now available as an Azure service, but I'm at a company all in on AWS :(

All three have talk therapy within their scope of practice, and "the talking cure" originated with 19th century German doctors. Until the middle of the 20th century it was exclusively the domain of MDs.

In modernity, insurance reimbursement policies incentivize psychiatrists to focus on medication management, but there are still many of the old guard (and cash-only practices that set their own rates) who will perform psychotherapy. Additionally, in certain states, Licensed Psychologists (PhDs and PsyDs) who have completed additional training in psychopharmacology are allowed to prescribed a limited set of psychotropic medications in collaboration with a fully licensed MD (not necessarily a psychiatrist). Also in the prescribing realm are PMHNPs, mid-level providers trained in the nursing model who focus on psychiatric care. As with psychiatrists, they tend to focus on medication management, but are able to provide talk therapy as well.

Psychologists (PhDs and PsyDs) are Doctoral level providers trained in research, talk therapy, and administering psychological assessments such as personality inventories, IQ tests, and capacity determinations for forensic purposes.

Licensed Clinical Social Workers, Counselors, and Marriage & Family Therapists are all Masters-level providers trained to provide talk therapy. There are different histories and underpinnings that have created these distinctions and is reflected somewhat in the specifics of their graduate studies, but it's largely irrelevant to you as a client; much like engineering, therapy is as much art as science, and most of the "real" training comes once you have graduated and begun working in the field.

The current trend in outcomes research indicate that the license and professional background is not a significant factor in the efficacy of psychotherapy. To quote Irvin Yalom, a giant in the field of talk therapy (and a psychiatrist by training), "it is the relationship that heals".

It is harsh, but where's the fun in the comment section of an HN post on psychology without a little hyperbole?

My disdain comes from seeing people I'm close to repeatedly pushed towards those treatments by practitioners who, when asked to provide references supporting their endorsement supply anecdotes about past or current patients rather than DOIs. There are specific TMS protocols that appear to have some growing amount of evidence behind them, but ketamine still seems to be a wildly variable cash grab that requires further data before anything can be said about its efficacy.

I am referring to traditional agents, not ketamine. There is insufficient evidence to draw conclusions about Ketamine's usefulness as a rapidly acting agent for treatment of depression.

I lack training in psychopharmacology or neuroscience and thus my interpretation of the research is that of a layperson, but my understanding from talking with psychiatrists on the matter is that it is unlikely that ketamine will become a frontline treatment but its mechanism of action will be explored and lead to the development of new drugs that activate the same pathways in the brain but lack or have lessened anesthetic effect.