TO LEO - Mental Health

[docs20]

Hey Leo, as a psychiatry resident in Europe and fan of your work, I just wanted to give you props for your recent posts and interest on the mental pathology domain 

Keep it up! 


In case you ever feel the need for some exchange of views on this topic, feel free to dm me

[Leo Gura]

Howdy!

What kind of conditions do you study/work with?

[Davidess]

@Leo GuraI'm a medical student (3rd year) aspiring to be a psychiatrist one day and your work enormously helps me to develop epistemological and metaphysical background for my future work, your work is invaluable to me, thank you 🥹

[Yimpa]

Are there any discussions about psychedelics floating around in your field? How do those discussions tend to go? 

[docs20]

3 hours ago, Leo Gura said:

Howdy!

What kind of conditions do you study/work with?

Up until now, I've worked during my residency mostly with acute patients-emergency psychiatry (suicidal attempts, suicidal ideation, acute schizophrenia, mania, depression, behavioural disorders), then also with more day-to-day clinic setting conditions like adhd, depression, old age cognitive impairment, mood disorders and personality disorders

[Davino]

It's very important that psychiatrist have a grasp of consciousness as existence itself to properly cognise mental disorders.

Consciousness is working in unexpected ways and science tries to square it all down in an objective material world independent of the subject, which leads to misconceptions. The Sovereign Mind of the individual I is generating reality and it's not consistent with the fabrications of the other individual Is. What is literally happening is that the bedrock imagination faculty of existence is happening in a distinct way for those people. I'm struggling to explain this without mentioning solipsism but it's important to understand the Absolutism of Consciousness and Experience to make sense of mental disorders. It's another reality, we share reality in so much as there is consistency among us. How does a snake experience the world? Is a snake crazy? What if I'm a snake?

[docs20]

Even severe conditions like bipolar 2 disorder and schizophrenia are more common than we think (thank God in Europe at least the toll of the opioid crisis is nowhere as near as the prevalence in the US).

Depending on diagnostic criteria the prevalence of schizophrenia can rise up until 1,2%!

Diagnostic criteria are quite an epistemic trouble in psychiatry - no other medical field in 2025 has the quite as much an epistemic problem - you don't see endocrinologists fighting about what diabetes really is or internal medicine doctors fighting about the definition of pneumonia, but you can find psychiatrists in the same hospital not fully agreeing even on what something as common as depression really is
 

[Yimpa]

31 minutes ago, Davino said:

It's very important that psychiatrist have a grasp of consciousness as existence itself to properly cognise mental disorders.

The more woke psychiatrists become the more they’ll openly advocate for psychedelics 

[Davino]

22 minutes ago, Yimpa said:

The more woke psychiatrists become the more they’ll openly advocate for psychedelics 

I don't know how much psychedelics can help cure mental disorders, with the exception of depression, usually makes it much worse.
Imagine giving a schizo LSD and make his/her reality even loser, moreover infusing consciousness with a thousand fold more imaginative powers, it can backfire. There's certainly potential to help but it's a very sophistacated and complex terrain. Maybe the @docs20 can give his views on the topic, who surely understands better this topic.

[Yimpa]

Our world simply isn't ready to go insane.

We are collectively attempting to prevent Insanity.

[Yimpa]

1 hour ago, docs20 said:

Diagnostic criteria are quite an epistemic trouble in psychiatry - no other medical field in 2025 has the quite as much an epistemic problem - you don't see endocrinologists fighting about what diabetes really is or internal medicine doctors fighting about the definition of pneumonia, but you can find psychiatrists in the same hospital not fully agreeing even on what something as common as depression really is

Facts.

5 minutes ago, Vynce said:

But then again: which makes this field even more interesting is that EVERYBODY has different experiences with mental issues and their respective medications.

 

[Leo Gura]

4 hours ago, Davidess said:

@Leo GuraI'm a medical student (3rd year) aspiring to be a psychiatrist one day and your work enormously helps me to develop epistemological and metaphysical background for my future work, your work is invaluable to me, thank you 🥹

Nice! Thanks.

Best of luck in your studies.

2 hours ago, docs20 said:

Up until now, I've worked during my residency mostly with acute patients-emergency psychiatry (suicidal attempts, suicidal ideation, acute schizophrenia, mania, depression, behavioural disorders), then also with more day-to-day clinic setting conditions like adhd, depression, old age cognitive impairment, mood disorders and personality disorders

You're doing important and difficult work.

What made you passionate about that?

Edited April 9 by Leo Gura

[Leo Gura]

2 hours ago, docs20 said:

Depending on diagnostic criteria the prevalence of schizophrenia can rise up until 1,2%!

Diagnostic criteria are quite an epistemic trouble in psychiatry - no other medical field in 2025 has the quite as much an epistemic problem - you don't see endocrinologists fighting about what diabetes really is or internal medicine doctors fighting about the definition of pneumonia, but you can find psychiatrists in the same hospital not fully agreeing even on what something as common as depression really is

That's because the mind is such a tricky beast! There are so many different kinds of states of Consciousness and complex ways for mind to misbehave.

Even a category like "schizophrenia" is far too simplistic to capture all the neuro-diversity involved.

Ken Wilber's AQAL 4 Quadrants model is very important I think for researchers and clinicians to understand and apply for sense-making of mental disorders.

Edited April 9 by Leo Gura

[docs20]

On 09/04/2025 at 10:59 PM, Leo Gura said:

That's because the mind is such a tricky beast! There are so many different kinds of states of Consciousness and complex ways for mind to misbehave.

Even a category like "schizophrenia" is far too simplistic to capture all the neuro-diversity involved.

Ken Wilber's AQAL 4 Quadrants model is very important I think for researchers and clinicians to understand and apply for sense-making of mental disorders.

Totally agree to what you are stating

As far as what I've seen Ken Wilber's work is really genius, I will delve more into the AQAL if you think it is going to help me making sense more deeply of what I see every day in my work.

 

[docs20]

On 09/04/2025 at 10:55 PM, Leo Gura said:

Nice! Thanks.

Best of luck in your studies.

You're doing important and difficult work.

What made you passionate about that?

When I finished high school I was more interested in scientific subjects and to the more typical ones of the medical field and it seemed a career where you could make a good living and also help other people. In the second year of uni I had also started delving into the world of Game and self-improvement-psychology, I saw a psychiatrist myself for OCD-depression-panic attacks who helped a lot. Then actually in the last few years of my medical studies I started finding boring some of the subjects like cardiology, surgery, endocrinology, etc (basically the ones that are typical medical core curriculum) and I liked studying psychiatry for the exam, then I also got in contact with one of my professors and also thanks to him I managed to do some forensic psychiatry internship which I liked and I started going just as a student to help in the emergency psychiatry department. 
Then when I had to choose my residency my score was pretty decent and I was a bit uncertain whether to actually choose psychiatry, cause I also got passionate about emergency medicine and anesthesia-intensive care. 

In the end since I liked more the kind of work-life balance of psychiatry + I really like the fact that you could help and impact people in the domain of their mind problems + the fact that it's a subject that is very much related to philosophy, spirituality, sociology, then I made to choice to start officially start the career in psychiatry.
I am taking an extra university class which will also allow me to work in a forensic setting.

[Jacko]

@Leo Gura Can you recommend any other insightful books on Schizophrenia? 

[Leo Gura]

21 hours ago, Jacko said:

@Leo Gura Can you recommend any other insightful books on Schizophrenia? 

There will be several when I update my book list.

[Leo Gura]

On 4/13/2025 at 11:53 AM, docs20 said:

When I finished high school I was more interested in scientific subjects and to the more typical ones of the medical field and it seemed a career where you could make a good living and also help other people. In the second year of uni I had also started delving into the world of Game and self-improvement-psychology, I saw a psychiatrist myself for OCD-depression-panic attacks who helped a lot. Then actually in the last few years of my medical studies I started finding boring some of the subjects like cardiology, surgery, endocrinology, etc (basically the ones that are typical medical core curriculum) and I liked studying psychiatry for the exam, then I also got in contact with one of my professors and also thanks to him I managed to do some forensic psychiatry internship which I liked and I started going just as a student to help in the emergency psychiatry department. 
Then when I had to choose my residency my score was pretty decent and I was a bit uncertain whether to actually choose psychiatry, cause I also got passionate about emergency medicine and anesthesia-intensive care. 

In the end since I liked more the kind of work-life balance of psychiatry + I really like the fact that you could help and impact people in the domain of their mind problems + the fact that it's a subject that is very much related to philosophy, spirituality, sociology, then I made to choice to start officially start the career in psychiatry.
I am taking an extra university class which will also allow me to work in a forensic setting.

Very nice. Good luck.

[Carl-Richard]

On 9.4.2025 at 8:13 PM, docs20 said:

Even severe conditions like bipolar 2 disorder and schizophrenia are more common than we think (thank God in Europe at least the toll of the opioid crisis is nowhere as near as the prevalence in the US).

Depending on diagnostic criteria the prevalence of schizophrenia can rise up until 1,2%!

Diagnostic criteria are quite an epistemic trouble in psychiatry - no other medical field in 2025 has the quite as much an epistemic problem - you don't see endocrinologists fighting about what diabetes really is or internal medicine doctors fighting about the definition of pneumonia, but you can find psychiatrists in the same hospital not fully agreeing even on what something as common as depression really is

Over time, I've been convinced by the idea that "mental disorder" (as opposed to "disorders") is a more unitary phenonema that can be put on a general spectrum of "well" to "unwell". And when you are pushed to the side of "unwell" (be it by environment, genes, stress, life situations), general symptoms of disease pop up; in the beginning of the spectrum maybe milder symptoms of ADHD, OCD, neuroticism, rumination, while later down the spectrum, symptoms of schizophrenia, bipolar disorder, depression (and the aforementioned beginning symptoms in more extreme forms).

In other words, it's not that suddenly at some point in your life, you start manifesting a clear cut phenotype of say "schizophrenic", but usually it's that you experience general disease; anxiety, panic attacks, social maladjustment, maladaptive coping strategies; and some people tend to get very ill and lean more in one direction (e.g. schizophrenic psychotic symptoms) while some more in another direction (e.g. bipolar psychotic symptoms). And often you can experience symptoms somewhere in-between these two (and we even have a "category" for this: "schizoaffective disorder"). You don't necessarily fall into one category (in fact, you virtually never do).

At the same time, you do get the sense that some illnesses are more "hardwired" and unitary than others. For example, many people with bipolar disorder type 1 seem to be able to live quite functional lives at times when they are not psychotic, and that when the psychosis starts, it's like they are being taken over by something. But still, the times they do become psychotic, you can very often point to some situation in their life, some challenges and some maladaptive coping strategies that makes them spiral into that state. And it's just an extreme form of general unstability which you can see in many people, maybe even yourself, that when you e.g. become very overwhelmed by things that you need to do, pressure, deadlines, etc., you can enter this elevated and restless state. Bipolar disorder is just this taken to the extreme (and some are more prone to escalate to that extreme than others).

Edited April 16 by Carl-Richard

[The Crocodile]

@Carl-Richard Yes, the old model of just "madness" is actually closer to truth than all these hyper-specific symptomatically based psychiatric labels.