They didn't disappear at the same time. I was on antidepressants for a year and my time on antidepressants was pretty much independent of the degree to which my sleep problems were fixed. I probably was slightly less anxious while on the antidepressants, but this was far overwhelmed by the fact that I get/got anxious & depressed after the nights my sleep was poor and I don't/didn't whenever I sleep well. I was able to narrow it down to this specific direction of causality (bad sleep -> anxious the next day) through the fact that my sleep was often affected by exogenous physical factors.
I apologize for not going into too much identifying detail on a pseudonymous account, but I solved it by completely ignoring the medical establishment, reading voraciously about the problem, and experimenting on myself until I got myself to an 85% solution that at least allowed me to get back to work. This happened at a far, far slower and more grinding pace than the counterfactual in which I had any competent doctors around me (or rather, if competency wasn't ludicrously uncommon within medicine), since 1) I was sick, 2) I was employed until I quit to focus on the issue, and 3) I don't have an educational background in medicine the way that a doctor (ostensibly) would.
I'm far, far, far more comfortable reading papers in noisy epistemological environments than most people; I can't even imagine how horrible and expensive and drawn-out this process would have been had I not been had the confidence or ability to take this route and had to rely on the medical establishment.
After getting most of the way there myself, I still have issues sleeping once every week or two, and I decided to visit the relevant specialist to use them as a reference to expedite my path to a 100% solution[1]. It's a criminal indictment of our medical system that the only recourse for patients with complex, multi-factor health problems is to themselves navigate both medical knowledge and the medical system until they've narrowed it down to a fairly well-defined, simple solution. To the extent that the system's abdication of responsibility is driven by individuals' decisions, they should be ashamed of themselves (though again, I will reiterate once again that I think that the problem is systemic; I think most people of average intelligence would behave similarly in the situations that doctors find themselves in and I haven't seen any evidence that leads me to believe that most doctors are particularly extra-bright).
[1] At which point regulatory BS popped up again and I was legally required to have a perfunctory appt (at the cost of several hundred dollars, of course) with a doctor to request a referral to this type of specialist
> This happened at a far, far slower and more grinding pace than the counterfactual in which I had any competent doctors around me […]
I know the details are scarce, but why do you say that a competent doctor would have been able to diagnose and treat your condition quickly? Issues related to mental health and sleep are exceptionally difficult. Literally everyone I know, including myself, with mental health or sleep issues has gone through that same slow, grinding pace that you describe. Issues range from anxiety disorders, to bipolar disorder, or idiopathic hypersomnia (where “idiopathic” just means “we don’t know why”).
The etiology of these diseases ranges from completely unknown to “a mix of psychological, environmental, and biological factors”. These diseases are frequently not curable, and the best we can do is manage side effects. Going to a doctor as a legal impediment to getting prescription drugs is damn useful because the drugs carry risks of liver damage to chemical dependency and everything between.
Having been through this process myself, and witnessed close friends and family go through it, I can understand why anyone would be frustrated but it’s not clear what the alternative is. As a society we don’t have the medical knowledge to solve these issues quickly and effectively, and we only have so many brilliant minds to go around. In the meantime, therapy and/or prescription drugs make the difference between functioning member of society and being unable to work or even leave the house, at least for several people I know, including myself.
I wouldn’t be so quick to indict an entire profession, especially given your admitted use of anecdotes.
> I wouldn’t be so quick to indict an entire profession, especially given your admitted use of anecdotes.
This point is very well-taken, despite what my earlier comments may have sounded like, as is your point that I may be misunderstanding the scope of the problem as deficiencies in the solution process. Believe it or not, I am sensitive to these possibilities and didn't arrive at my current conclusion hastily or lightly. I didn't lazily interpret the system failing to solve my problem instantly as an indictment of the system, particularly given my small firsthand sample size. As I said, I've also talked to a lot of doctors who I'm acquainted with, and the only facts I'm working off of are fairly uncontroversial among them. I'm talking about specific failures like irrational institutional biases against some types of specialists (that both the doctors and the specialists that I've spoken to in a non-patient context admit exist).
When I say that a competent doctor would have been able to solve my problem _more_ quickly, it's because of the multiple challenges that required retreading the steps that a doctor is ostensibly trained in. The economy is built around paying people to do jobs that you are capable of but haven't spent the time to specialize in: it would be considered a failure of each industry if I needed to become a domain expert to get my cable fixed, or have my shirts tailored, or fly on an airplane. I get that medicine is devilishly more complicated than any of the above, but again, I'm talking about specific problems with either the ability or the will to take the time to apply that medical training through critical thinking. Since those with training abdicated their opportunity to do think critically, I had to bring (a very narrow form of that training) to the only person willing to think critically about the patient: me.
I don't think it's a very controversial statement that the healthcare system has lots of issues: the doctors I've spoken to about the way the system works and has worked for me pretty much all agree with me once they get over their defensiveness and realize that I'm not interested in putting most of the blame on individual doctors and their behavior within a difficult system. Slapdash, cookie-cutter engagement with patients is IMO a lot more reflective of the constraints that doctors operate under wrt time and the average patient[1] than it is a commentary on individual doctor's level of intelligence or something like that.
[1] hell, I don't even judge doctors with the all-too-common undercurrent of almost-contempt for their patients, given the average patient they probably have to deal with
They didn't disappear at the same time. I was on antidepressants for a year and my time on antidepressants was pretty much independent of the degree to which my sleep problems were fixed. I probably was slightly less anxious while on the antidepressants, but this was far overwhelmed by the fact that I get/got anxious & depressed after the nights my sleep was poor and I don't/didn't whenever I sleep well. I was able to narrow it down to this specific direction of causality (bad sleep -> anxious the next day) through the fact that my sleep was often affected by exogenous physical factors.
I apologize for not going into too much identifying detail on a pseudonymous account, but I solved it by completely ignoring the medical establishment, reading voraciously about the problem, and experimenting on myself until I got myself to an 85% solution that at least allowed me to get back to work. This happened at a far, far slower and more grinding pace than the counterfactual in which I had any competent doctors around me (or rather, if competency wasn't ludicrously uncommon within medicine), since 1) I was sick, 2) I was employed until I quit to focus on the issue, and 3) I don't have an educational background in medicine the way that a doctor (ostensibly) would.
I'm far, far, far more comfortable reading papers in noisy epistemological environments than most people; I can't even imagine how horrible and expensive and drawn-out this process would have been had I not been had the confidence or ability to take this route and had to rely on the medical establishment.
After getting most of the way there myself, I still have issues sleeping once every week or two, and I decided to visit the relevant specialist to use them as a reference to expedite my path to a 100% solution[1]. It's a criminal indictment of our medical system that the only recourse for patients with complex, multi-factor health problems is to themselves navigate both medical knowledge and the medical system until they've narrowed it down to a fairly well-defined, simple solution. To the extent that the system's abdication of responsibility is driven by individuals' decisions, they should be ashamed of themselves (though again, I will reiterate once again that I think that the problem is systemic; I think most people of average intelligence would behave similarly in the situations that doctors find themselves in and I haven't seen any evidence that leads me to believe that most doctors are particularly extra-bright).
[1] At which point regulatory BS popped up again and I was legally required to have a perfunctory appt (at the cost of several hundred dollars, of course) with a doctor to request a referral to this type of specialist