5 ms·

>Medically speaking a mental illness is no different than a physical illness. I am a proponent of taking time off for mental health, but I have to nitpick here

>Medically speaking a mental illness is no different than a physical illness. I am a proponent of taking time off for mental health, but I have to nitpick here. Medically speaking, physical illness is different from mental illness. One is diagnosed from objective scientific tests (pathology) while the other is not.

dragonwriter 9y ago
> Medically speaking, physical illness is different from mental illness. One is diagnosed from objective scientific tests (pathology) while the other is not. Not all “physical” (the term is not really the correct distinction, since all illness, including mental illness, is physical) illness is diagnosed directly in that manner (not all physical illness can be, because not all is understood well enough to have definitive tests, and it's not always clinical practice to do so even when it is possible in principle.) And, on the other side, some psychiatric conditions have lab tests of the same sort available.
- wu-ikkyu 9y ago
  >some psychiatric conditions have lab tests of the same sort available. Which ones? "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests" -Allen Frances https://en.wikipedia.org/wiki/Allen_Frances https://en.wikipedia.org/wiki/Allen_Frances
  - dragonwriter 9y ago
    Schizophrenia had one on the market briefly, and there is one for bipolar disorder that is (or was, as of last year) in clinical trials. See, e.g., http://www.thedailybeast.com/can-a-blood-test-diagnose-mental-illness http://www.thedailybeast.com/can-a-blood-test-diagnose-menta...
    - wu-ikkyu 9y ago
      Do you have a source for these claims? Because the DSM-5 says otherwise >Diagnosis is based on observed behavior, the person's reported experiences, and reports of others familiar with the person...As of 2013 there is no objective test. [5] https://en.m.wikipedia.org/wiki/Schizophrenia https://en.m.wikipedia.org/wiki/Schizophrenia Edit: the source you edited in simply states the corollary to what I've been saying all along: that scientists are still searching for a biological test for mental illness but as yet still do not have one
TheSpiceIsLife 9y ago
As a counterpoint, there are no objective scientific tests for, say, back pain or neck pain or nausea or menstrual cramps.
- deleted 9y ago
  [deleted]
- wu-ikkyu 9y ago
  That is because pain is not a disease, it is a subjective experience (or symptom) generated by the nervous system.
  - TheSpiceIsLife 9y ago
    Fair point. Counterpoint: in the sense that it is dis-ease (the absence of feeling well and easy going) it may still be a sufficient reason to take a day off work.
    - wu-ikkyu 9y ago
      Agreed. You shouldnt need a diagnosis to take a day off work
  - gpawl 9y ago
    So? A disease (or injury) is what causes the pain. Why the specious distinction?
clfougner 9y ago
Afraid that's not true. Around 60-80% of diagnoses in primary care settings are made purely on the basis of the patient history (followed by a brief clinical examination which usually aims at eliciting subjective responses)[1]. In principle it's true that you could find a pathological explanation for all somatic ("physical") diseases which in practice are diagnosed off patient histories (with the exception of diseases for which the pathogenesis is unknown, f.ex. fibromyalgia, IBS, CFS, etc). However - in principle - the same goes for mental illnesses, although the pathogenesis of mental illnesses are generally poorly understood. If you don't think there's a physical basis for mental illnesses though, skim through the figures in this article[2] for a prime example of the ways modern medicine is disproving that. Diagnoses of both mental and somatic illnesses are heavily based off subjective factors, and both mental and somatic illnesses have very real pathophysiological etiologies. [1] Source: medical school. Not finding a study with exact numbers from a quick search. [2] https://www.nature.com/nm/journal/v23/n1/full/nm.4246.html https://www.nature.com/nm/journal/v23/n1/full/nm.4246.html
- wu-ikkyu 9y ago
  >fibromyalgia, IBS, CFS There are objective tests for all of these pathologies, though those tests are often inconclusive in the face of the symptoms. >If you don't think there's a physical basis for mental illnesses though, skim through the figures in this article[2] for a prime example of the ways modern medicine is disproving that. There are physical symptoms of mental illness, but as yet there is no proof of physical causes, which is why the chairman of the Department of Psychiatry at Duke University School of Medicine and the DSM-4 stated "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests". You'll find no objective biological tests in the DSM. https://en.m.wikipedia.org/wiki/Allen_Frances https://en.m.wikipedia.org/wiki/Allen_Frances
  - clfougner 9y ago
    > There are objective tests for all of these pathologies, though those tests are often inconclusive in the face of the symptoms. No, objective tests are in these cases used to exclude other causes to the symptoms, not to diagnose the mentioned illnesses. These are diagnoses of exclusion[1]. > There are physical symptoms of mental illness, but as yet there is no proof of physical causes, which is why the chairman of the Department of Psychiatry at Duke University School of Medicine and the DSM-4 stated "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests". You'll find no objective biological tests in the DSM. I'm not disputing the fact that it's not possible to do pathophysiological tests for mental illnesses in current clinical practice, but you're creating a false equivalence by implying that being unable to test for a pathophysiological factor is the same as that factor not existing. There are plenty of pathophysiological changes that occur in mental illnesses [2-4], but for obvious reasons it's not feasible to haphazardly take biopsies of the brain to test for them, especially when the patient history and subjective examinations suffice to make a diagnosis in most cases. Conversely, my point still stands that the vast majority of somatic illnesses are diagnosed off subjective symptoms - doctors don't bother doing objective lab tests for a cold or a sprained ankle when the diagnosis is glaringly obvious based off subjective symptoms. [1] https://en.wikipedia.org/wiki/Diagnosis_of_exclusion [2] https://en.wikipedia.org/wiki/Mechanisms_of_schizophrenia#Pathophysiology [3] https://en.wikipedia.org/wiki/Biology_of_depression [4] https://en.wikipedia.org/wiki/Causes_of_schizophrenia
calafrax 9y ago
A doctor administered evaluation or a patient self-survey is just as objective as any other test. These tests take a measurement and based on peer-reviewed statistical studies make a determination as to whether or not the measurement falls into a pathological range. This is exactly the same as measuring blood pressure or cholesterol. You read a number and decide if there is a statistically valid correlation between that number and an identified disease.
- wu-ikkyu 9y ago
  >patient self-survey is just as objective as any other test. Subjective: based on or influenced by personal feelings, tastes, or opinions. Objective: (of a person or their judgment) not influenced by personal feelings or opinions in considering and representing facts.
  - calafrax 9y ago
    What is the difference between being depressed and "feeling" depressed? What is the difference between being schizophrenic and having the "opinion" that Satan speaks to you through your neighbor's cat? Mental illness is defined by what a person feels and believes. What you feel and believe is subjective but you can objectively establish that a particular cluster of subjective feelings and beliefs is abnormal vis-a-vis a populate. Then when you ask people the same questions and their cluster of responses fits the abnormal definition you can objectively say that they have a mental illness. The objectivity does not come from the doctor observations or patient self-survey, it comes from the study that created the questions and proved that a certain score or cluster of responses is statistically abnormal.
    - alasdair_ 9y ago
      > >What is the difference between being depressed and "feeling" depressed? >What is the difference between being schizophrenic and having the "opinion" that Satan speaks to you through your neighbor's cat? >Mental illness is defined by what a person feels and believes. Honestly, a lot of the time it comes down to observable impact. If a patient comes to a doctor and says that they feel depressed, that's one thing, if they have lost their third job this year because they can't do anything but lie in bed and seem to not care about their own lives (especially if they used to not be like this in the past) that's something else.
rifung 9y ago
> Medically speaking, physical illness is different from mental illness. One is diagnosed from objective scientific tests (pathology) while the other is not. Isn't this just because we don't actually understand medical illnesses nearly as well as we understand physical ones in general? I don't we actually know that there is anything innate about mental illness that makes it different from physical illness in this sense. That being the case, mental illnesses are just like those physical illnesses that we have yet to understand as well no? Please correct me if I'm misinformed as this is a topic that I am very interested in.
cbtacy 9y ago
wow. ummm... yeah, that's straight mythology. you should read up on brain scans before spreading old falsehoods.
- wu-ikkyu 9y ago
  >Given how much we've learned about the role of the brain in mental illness, many people are surprised to learn that we can't know what psychiatric diagnosis a person has—or even if the person has any diagnosis—by examining that person's brain. https://www.scientificamerican.com/article/can-brain-scans-diagnose-mental-illness/ https://www.scientificamerican.com/article/can-brain-scans-d...

dragonwriter 9y ago

> Medically speaking, physical illness is different from mental illness. One is diagnosed from objective scientific tests (pathology) while the other is not. Not all “physical” (the term is not really the correct distinction, since all illness, including mental illness, is physical) illness is diagnosed directly in that manner (not all physical illness can be, because not all is understood well enough to have definitive tests, and it's not always clinical practice to do so even when it is possible in principle.) And, on the other side, some psychiatric conditions have lab tests of the same sort available.

wu-ikkyu 9y ago
>some psychiatric conditions have lab tests of the same sort available. Which ones? "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests" -Allen Frances https://en.wikipedia.org/wiki/Allen_Frances https://en.wikipedia.org/wiki/Allen_Frances
- dragonwriter 9y ago
  Schizophrenia had one on the market briefly, and there is one for bipolar disorder that is (or was, as of last year) in clinical trials. See, e.g., http://www.thedailybeast.com/can-a-blood-test-diagnose-mental-illness http://www.thedailybeast.com/can-a-blood-test-diagnose-menta...
  - wu-ikkyu 9y ago
    Do you have a source for these claims? Because the DSM-5 says otherwise >Diagnosis is based on observed behavior, the person's reported experiences, and reports of others familiar with the person...As of 2013 there is no objective test. [5] https://en.m.wikipedia.org/wiki/Schizophrenia https://en.m.wikipedia.org/wiki/Schizophrenia Edit: the source you edited in simply states the corollary to what I've been saying all along: that scientists are still searching for a biological test for mental illness but as yet still do not have one

TheSpiceIsLife 9y ago

As a counterpoint, there are no objective scientific tests for, say, back pain or neck pain or nausea or menstrual cramps.

deleted 9y ago
[deleted]
wu-ikkyu 9y ago
That is because pain is not a disease, it is a subjective experience (or symptom) generated by the nervous system.
- TheSpiceIsLife 9y ago
  Fair point. Counterpoint: in the sense that it is dis-ease (the absence of feeling well and easy going) it may still be a sufficient reason to take a day off work.
  - wu-ikkyu 9y ago
    Agreed. You shouldnt need a diagnosis to take a day off work
- gpawl 9y ago
  So? A disease (or injury) is what causes the pain. Why the specious distinction?

clfougner 9y ago

Afraid that's not true. Around 60-80% of diagnoses in primary care settings are made purely on the basis of the patient history (followed by a brief clinical examination which usually aims at eliciting subjective responses)[1]. In principle it's true that you could find a pathological explanation for all somatic ("physical") diseases which in practice are diagnosed off patient histories (with the exception of diseases for which the pathogenesis is unknown, f.ex. fibromyalgia, IBS, CFS, etc). However - in principle - the same goes for mental illnesses, although the pathogenesis of mental illnesses are generally poorly understood. If you don't think there's a physical basis for mental illnesses though, skim through the figures in this article[2] for a prime example of the ways modern medicine is disproving that. Diagnoses of both mental and somatic illnesses are heavily based off subjective factors, and both mental and somatic illnesses have very real pathophysiological etiologies. [1] Source: medical school. Not finding a study with exact numbers from a quick search. [2] https://www.nature.com/nm/journal/v23/n1/full/nm.4246.html https://www.nature.com/nm/journal/v23/n1/full/nm.4246.html

wu-ikkyu 9y ago
>fibromyalgia, IBS, CFS There are objective tests for all of these pathologies, though those tests are often inconclusive in the face of the symptoms. >If you don't think there's a physical basis for mental illnesses though, skim through the figures in this article[2] for a prime example of the ways modern medicine is disproving that. There are physical symptoms of mental illness, but as yet there is no proof of physical causes, which is why the chairman of the Department of Psychiatry at Duke University School of Medicine and the DSM-4 stated "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests". You'll find no objective biological tests in the DSM. https://en.m.wikipedia.org/wiki/Allen_Frances https://en.m.wikipedia.org/wiki/Allen_Frances
- clfougner 9y ago
  > There are objective tests for all of these pathologies, though those tests are often inconclusive in the face of the symptoms. No, objective tests are in these cases used to exclude other causes to the symptoms, not to diagnose the mentioned illnesses. These are diagnoses of exclusion[1]. > There are physical symptoms of mental illness, but as yet there is no proof of physical causes, which is why the chairman of the Department of Psychiatry at Duke University School of Medicine and the DSM-4 stated "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests". You'll find no objective biological tests in the DSM. I'm not disputing the fact that it's not possible to do pathophysiological tests for mental illnesses in current clinical practice, but you're creating a false equivalence by implying that being unable to test for a pathophysiological factor is the same as that factor not existing. There are plenty of pathophysiological changes that occur in mental illnesses [2-4], but for obvious reasons it's not feasible to haphazardly take biopsies of the brain to test for them, especially when the patient history and subjective examinations suffice to make a diagnosis in most cases. Conversely, my point still stands that the vast majority of somatic illnesses are diagnosed off subjective symptoms - doctors don't bother doing objective lab tests for a cold or a sprained ankle when the diagnosis is glaringly obvious based off subjective symptoms. [1] https://en.wikipedia.org/wiki/Diagnosis_of_exclusion [2] https://en.wikipedia.org/wiki/Mechanisms_of_schizophrenia#Pathophysiology [3] https://en.wikipedia.org/wiki/Biology_of_depression [4] https://en.wikipedia.org/wiki/Causes_of_schizophrenia

calafrax 9y ago

A doctor administered evaluation or a patient self-survey is just as objective as any other test. These tests take a measurement and based on peer-reviewed statistical studies make a determination as to whether or not the measurement falls into a pathological range. This is exactly the same as measuring blood pressure or cholesterol. You read a number and decide if there is a statistically valid correlation between that number and an identified disease.

wu-ikkyu 9y ago
>patient self-survey is just as objective as any other test. Subjective: based on or influenced by personal feelings, tastes, or opinions. Objective: (of a person or their judgment) not influenced by personal feelings or opinions in considering and representing facts.
- calafrax 9y ago
  What is the difference between being depressed and "feeling" depressed? What is the difference between being schizophrenic and having the "opinion" that Satan speaks to you through your neighbor's cat? Mental illness is defined by what a person feels and believes. What you feel and believe is subjective but you can objectively establish that a particular cluster of subjective feelings and beliefs is abnormal vis-a-vis a populate. Then when you ask people the same questions and their cluster of responses fits the abnormal definition you can objectively say that they have a mental illness. The objectivity does not come from the doctor observations or patient self-survey, it comes from the study that created the questions and proved that a certain score or cluster of responses is statistically abnormal.
  - alasdair_ 9y ago
    > >What is the difference between being depressed and "feeling" depressed? >What is the difference between being schizophrenic and having the "opinion" that Satan speaks to you through your neighbor's cat? >Mental illness is defined by what a person feels and believes. Honestly, a lot of the time it comes down to observable impact. If a patient comes to a doctor and says that they feel depressed, that's one thing, if they have lost their third job this year because they can't do anything but lie in bed and seem to not care about their own lives (especially if they used to not be like this in the past) that's something else.

rifung 9y ago

> Medically speaking, physical illness is different from mental illness. One is diagnosed from objective scientific tests (pathology) while the other is not. Isn't this just because we don't actually understand medical illnesses nearly as well as we understand physical ones in general? I don't we actually know that there is anything innate about mental illness that makes it different from physical illness in this sense. That being the case, mental illnesses are just like those physical illnesses that we have yet to understand as well no? Please correct me if I'm misinformed as this is a topic that I am very interested in.

cbtacy 9y ago

wow. ummm... yeah, that's straight mythology. you should read up on brain scans before spreading old falsehoods.

wu-ikkyu 9y ago
>Given how much we've learned about the role of the brain in mental illness, many people are surprised to learn that we can't know what psychiatric diagnosis a person has—or even if the person has any diagnosis—by examining that person's brain. https://www.scientificamerican.com/article/can-brain-scans-diagnose-mental-illness/ https://www.scientificamerican.com/article/can-brain-scans-d...