throw18376

imagine somebody slipped a tiny, barely detectable dose of meth in your morning coffee. barely above placebo. then they slowly start increasing it day by day. by the time it reaches a large dose you are not going to be thinking very clearly. this is more or less how a manic episode progresses.

i'm sure if ChatGPT had tried to convince him it was conscious on day 3, he would not have been convinced. but by the time it happened he was in a state of severe mental impairment.

my inclination when hearing these stories is that these were people who just happened to have a first manic episode (which can strike anyone at any time with or without mental health history). blowing up finances by starting an ill-advised entrepreneurial business, while also destroying a marriage, is very common behavior for someone experiencing a manic state.

in the past such a person might have gotten obsessed with hidden patterns and messages in religious texts, or too involved with an online conspiracy YouTube community. now there is this new opportunity for manic psychosis to manifest via chatbot. it's worse because it's able to create 24/7 novel content, and it's trained to be validating, but doesn't seem to me to be a fundamentally new phenomenon.

what I don't understand is whether just unhealthy interactions with a chatbot can trigger manic psychosis. Other than heavy use late at night disrupting sleep, this seems unlikely to me, but I could be wrong.

i think it's also worth pointing out that mental states of this kind usually come with cognitive impairments, people not only make risky bad decisions, but also become much worse at thinking and reasoning clearly. if you're wondering how a person could be so naive and gullible.

people in states of psychosis often behave in frightening ways out of their control, and do and say hurtful things to those around them. if someone hurts you or does something very frightening, fear and anger are natural emotions.

but it’s not morally wrong to experience psychosis. so how could it be right for me to feel fear and anger towards that person when they haven’t done anything wrong? it is a tough contradiction.

you can resolve the contradiction by just deciding to hate and fear anyone who shows signs of psychosis, treat them as if it is a morally bad trait, which many people do, see discourse about homeless people in NYC.

or you can just try to pretend that psychosis doesn’t exist, which a lot of people do, like when some public figure shows obvious psychotic symptoms but people act like it’s rational behavior.

or you can disavow the fear and anger, but if a person does actually frighten and hurt you, the resulting negative feelings often tend to be expressed in weird and unfair ways. i suspect this author’s employers and doctors probably do a lot of this.

personally I think the least bad solution is to acknowledge that anger towards a person can be justified even if they’ve done nothing morally wrong, just feel anger, and express it only in controlled ways. but this is philosophically confusing, easy to state, hard to really believe deep down.

all kinds of authoritarian regimes and movements certainly do this.

that said... you just have to have a conversation with someone experiencing psychosis. it's a totally altered state of consciousness, they are sensing and understanding the world in a radically different way. it's never just an otherwise normal person with a nonconformist belief.

I think they would say (reasonably accurately, tends to be exaggerated though) that traditional cultures all around the world did have psychedelic practices of one kind or another. a lot of places on earth have some kind of psychedelic plant.

some people should never take psychedelics.

in the last few years' surge of popularity, I found that your typical psychedelic advocate* would never admit this category of people exists. they were committed to the idea that everyone can, should, and must take these drugs.

this attitude is currently on a downturn, which is a good thing. people now admit that these drugs are not for everyone.

however, there's little solid understanding of exactly who should avoid psychedelics. it would be good to have a more solid scientific understanding of this. i imagine psychedelic advocates (which includes many scientists working on the topic) would be wary of such research, because it seems to similar to the history of government-sponsored propaganda "science" finding exaggerated harms of various illegal drugs.

however, scientific knowledge about who most likely will have adverse effects would be useful. that way people at low risk could use psychedelic drugs with the confidence that they are very likely safe. people at high risk can avoid them. this would be a great outcome.

The only problem here would be that if someone chooses not to use psychedelics, this might mark them as having certain traits that most people judge negatively. For example, history of severe trauma, family or personal history of psychotic disorders, and so on.

Given this, I think anyone who wants to normalize psychedelic drug use in their local community, ought to really fight to destigmatize such traits (and most communities won't accept this), or else more practically, promote an extreme commitment to privacy and personal choice.

*: I don't just mean people who do drugs, I mean people who think that doing drugs is mandatory to fix various spiritual/mental problems that prevent you from being a fully ethical being.

this is more or less exactly what i was trying to say. for most people SSRIs are safe, they experience manageable side effects and little health risk. psychedelics and dissociatives seem like they must be really drastic and risky. but actually SSRIs are pretty risky too, there are all these terrible low-probability outcomes.

so it's good we have all options, but ideally we'd have a better way of judging who is safest with which treatment.

i think that "we all want to get high on drugs" situations, like festivals, are actually a lot better. it's about personal choice.

when i talk about psychedelic advocates, i mean the people who think that widespread use of psychedelic drugs would massively improve mental health, make people more productive and happier, etc.

i generally consider myself an enemy of psychedelic advocates, because I think they want to make it effectively socially mandatory to do these drugs, which is really bad.

("sure, it's your choice what you put in your body, but a really enlightened person wouldn't be so frightened and closed-minded that they don't want to see what psychedelics can show them...")

of course ketamine for depression has this giant downside risk of adverse effects and psychosis, and we should talk about it more, not just sell it as a safe miracle drug.

however... safe, neutral, bland, boring well-tolerated SSRIs, also have a massive downside risk, in that they can trigger a manic episode, which in severe cases also involves psychosis.

so i find myself in the position of being glad there are different depression treatments for different people, including psychedelics and dissociatives, and hopefully we can find a way to make sure people get sorted to the treatments where they are least exposed to the tail risk side effects.

it's pretty hard to establish causality for something like this, but you have:

1) very solid evidence of correlation at a population level

2) a lot of clinical experience from doctors that patients with psychotic disorder diagnoses who use cannabis tend to do worse. and, similar stories from family members of people with psychotic symptoms who aren't in treatment.

so unfortunately I think there is something real here, it's not just people having transient bad reactions to weed and going to the ER and getting a diagnosis.

I support the legality of cannabis and alcohol.

However, on an individual level, I think people need to know about the psychosis risks. It undoubtedly can trigger schizophrenia and make it much worse once it exists.

I know more than a few people who have severe alcoholism problems in their families, and just chose to never drink alcohol. I think a similar choice may be wise for cannabis if there is a history of psychosis.

On a public health level there was a theory that people would substitute cannabis for alcohol. But unfortunately, this doesn't seem to be bearing out.

cannabis is pretty safe for the average person, even heavy users. it's not good for you, but i think most of the effects like this are explained by selection effects. unhappy people use it to self-medicate.

however, using cannabis comes with a very big tail risk. if you are susceptible to psychosis, cannabis can cause it or make it much more severe. this is undoubtedly causal.

people take all kinds of worse risks in life which everyone agrees should be acceptable, so I think cannabis should be legal. but I also think that if people clearly understood this risk, most would choose to avoid cannabis.

i think if the main thing is “hearing voices” this kind of thing is probably a good strategy, but there are lots of other probably worse symptoms of psychosis.

this and other alternative schizophrenia treatments a very good thing when they work, which is relatively rare.

as we can see from the comments here already, many people choose to believe these alternative treatments always work and there is never any need for antipsychotics.

it completely makes sense that some people who suffer from the horrible side effects of antipsychotics would have some wishful thinking of this kind.

what i don’t get is why random people with no skin in the game, are often so emotionally invested in the idea that antipsychotics don’t work or are unnecessary. but it’s very common.

in northeast urban areas, if someone uses y’all it means they are probably a left-wing/social justice oriented person. use is correlated with “folks”/“folx”. no idea why, maybe to replace gendered “you guys”. weird but true.