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It’s actually fairly uncontroversial between psychiatrists that the diagnoses as specified in the DSM are not biologically valid. We use them more as a communi

It’s actually fairly uncontroversial between psychiatrists that the diagnoses as specified in the DSM are not biologically valid. We use them more as a communication tool to give a rough picture of a patient’s symptoms to other providers than as a map onto biology. We simply don’t understand the underlying biology well enough yet to do any better. But there’s a lot of exciting research cracking this area open and we may very well be able to diagnose and prognose based on objective data such as brain imaging, genetics and blood tests. Psych resident

notfashion 7y ago
A lot of people in the psychiatric field believe that mental illness is due to chemical imbalances in the brain. No tests exist which can detect those imbalances. Your faith in "biology" as the ultimate underlying reality of mental illness is discouragingly close to that medical model of mental illness. This idea that mental distress is essentially biological in character has bad consequences because it ignores the fact that each patient is an agent in continuous interaction with his or her social environment. Mental illnesses, in general, don't develop organically from biological defects. They are often the consequence of trauma and adverse life events, as noted by the authors of this research. Sure, some mental illness is purely biological. Some disorders may be influenced by genetics. But the generic, classic phenomenon of somebody "going crazy" is unlikely ever to be attributable purely to physiological processes. These things come about because of profoundly dysfunctional psychosocial environments. As a psychiatric professional, you may find it reassuring to predict the future dominance of an objective medical model of mental illness. It would be braver to admit that the complexity of the mind and of the circumstances that lead to mental illness mean that medical research is a very long way from cracking this problem.
- soup10 7y ago
  Most psychiatrists are well aware that their job is to manage and medicate people that have psychotic episodes, extreme emotional and/or behavioral problems(that deviate from the norm far enough to cause concern with the community but aren't necessarily criminal). Their education is in biology, psychology and clinical medicine, very few know much about computer science or AI approaches to the mind except a few of those involved in research, since it has little relevance in a clinical setting.
- dsego 7y ago
  > No tests exist which can detect those imbalances. Yes, but the drugs actually work, which validates the prediction. > Mental illnesses, in general, don't develop organically from biological defects. In schizophrenic patients there are clear organic changes in the brain, you can see it on brain scans. > These things come about because of profoundly dysfunctional psychosocial environments. Then it would surely be possible to "fix" these issues without pharmacology treatment, which is unmistakably not the case.
- outlace 7y ago
  You’re absolutely right. But the brain is a biological organ, a biological information processor. Experiences shape it’s physical structure and function. Whether mental illness arises from purely environment causes (eg trauma) or purely nature (eg genetics, physical injury), in both cases the phenomena reside in the physical substrate of the brain. When someone has psychosis (eg hearing voices), maybe it was caused by a severe trauma or maybe it was mostly genetic. In either case the person is suffering from psychosis and is unable to normally function in society (if severe enough). In both cases, in principle, we should be able to detect the problem at the level of the brain in structure and function, and should be able to intervene at the level of the brain. The intervention required depends on the nature of the brain change. We can change brain function in many cases by intensive therapy. In some cases sensory inputs alone (via talk therapy) are insufficient to change the brain to rectify an issue. That’s when we have to consider direct intervention on the brain itself either via medications or neuromodulation technology. I don’t think lay people understand how profoundly mentally ill some people are and that they can really have dramatic improvements with treatment. Lay people think of psychiatrists just peddling drugs to mildly depressed patients or people who are mildly oddly behaved. That’s just not the case. I’m working with people who sometimes literally stop eating because they think their food is poisoned, or attempt to kill themselves with minor frustrations, etc. And many patients, mostly not that sick, come in voluntarily because they feel they can’t handle some problem on their own. You’re right that much I mental illness is caused by psychosocial stressors, but some people have just intractably messed up life situations and they’ve just spiraled downward as a result and wouldn’t be able to get on a better path without treatment.
- DanBC 7y ago
  > A lot of people in the psychiatric field believe that mental illness is due to chemical imbalances in the brain. No psychiatrist believes this.
cassowary37 7y ago
I'd be curious to hear you define biologically valid. The heritability (variance explained by inherited features) for those diagnoses ranges from 0.3-0.8 - greater than many other medical disorders - and for many of them there are identified genetic variants. Maybe that's some of the 'exciting research' you allude to? I agree that they are used as heuristics - and indeed were developed to be heuristics, dating back to the RDC. Psych attending
- outlace 7y ago
  Perhaps I should have said biologically meaningful. Yes ASD, schizophrenia, bipolar and ADHD are heritable at around 0.8, impressive. But there's also a good amount of research showing that mental illness in any form is correlated and there is a "p factor" that seems to predispose people to mental illness in general. There could be many possible genetic variations that lead to the same DSM diagnosis. Similarly multiple neural derangements can lead to the same set of symptoms. And research based on brain imaging (e.g. https://www.nature.com/articles/s41467-018-05317-y https://www.nature.com/articles/s41467-018-05317-y) suggests that our DSM diagnoses are probably not mapping reliably onto underlying brain dynamics. Plus, if I just randomly throw together a set of symptoms e.g. {back pain, chronic bloating, insomnia}, I wouldn't be surprised if it was heritable at 0.3 or above given that whatever genes are involved are going to get passed down and often genes sit next to each other on the same chromosome etc. The exciting research I care about is more along the lines of < https://www.ncbi.nlm.nih.gov/pubmed/30696271 https://www.ncbi.nlm.nih.gov/pubmed/30696271 > where we observe neural dynamics, hypothesize causality, intervene with TMS or other focal neuromodulatory tech, and see if in fact region A is causally linked to outcome B, or if neural dynamical state A is causally linked to outcome B. I also meant that the DSM is biologically unreliable because it is only symptom clusters, and we cannot intervene at the level of symptoms, you have to intervene at the level of pathology. Symptoms are not pathology. It's the brain that is experiencing some pathology, so we need to ascertain the brain pathology and intervene at that level, and DSM, as noted by brain imaging studies, does not seem to reliably map onto that biology. Aside, are you involved in software engineering? What brings you to HN?
gregfjohnson 7y ago
FWIW, I am an emergentist. It seems that this view comes naturally to computer scientists and software developers. If I understand them correctly, some cognitive neuroscientists such as Michael Gazzaniga are beginning to think seriously about this perspective on the mind-brain problem. Abstraction is as powerful in nature as it is in software. DNA is an amazing abstraction that essentially precludes physics from having a vote in the information content of the genes, and relies instead on an entirely new logic at a higher abstraction level, namely evolution. Grasping for other metaphors, there is a profound complementarity between a great violin and a transcendent performance, but nonetheless Stradivarius and Heifetz were geniuses in different categories. Steinway and Horowitz. Without a piano there is no Horowitz, and everything Horowitz does is translated via the piano and physics to the audience. But, the music is at a qualitatively different abstraction level than the physical piano. So, my current (interested layperson's) view: The human mind and the human brain are complementary yet distinct phenomena. While every mind-event has a physical representation in the brain, and without doubt many physical abnormalities in the brain can manifest in the mind and can therefore be treated by treating the brain, working reductively up from the brain toward the mind as the only acceptable path for treating all mental patients will IMHO eventually run afoul of an abstraction barrier similar to the one physics runs into at the level of DNA.

notfashion 7y ago

A lot of people in the psychiatric field believe that mental illness is due to chemical imbalances in the brain. No tests exist which can detect those imbalances. Your faith in "biology" as the ultimate underlying reality of mental illness is discouragingly close to that medical model of mental illness. This idea that mental distress is essentially biological in character has bad consequences because it ignores the fact that each patient is an agent in continuous interaction with his or her social environment. Mental illnesses, in general, don't develop organically from biological defects. They are often the consequence of trauma and adverse life events, as noted by the authors of this research. Sure, some mental illness is purely biological. Some disorders may be influenced by genetics. But the generic, classic phenomenon of somebody "going crazy" is unlikely ever to be attributable purely to physiological processes. These things come about because of profoundly dysfunctional psychosocial environments. As a psychiatric professional, you may find it reassuring to predict the future dominance of an objective medical model of mental illness. It would be braver to admit that the complexity of the mind and of the circumstances that lead to mental illness mean that medical research is a very long way from cracking this problem.

soup10 7y ago
Most psychiatrists are well aware that their job is to manage and medicate people that have psychotic episodes, extreme emotional and/or behavioral problems(that deviate from the norm far enough to cause concern with the community but aren't necessarily criminal). Their education is in biology, psychology and clinical medicine, very few know much about computer science or AI approaches to the mind except a few of those involved in research, since it has little relevance in a clinical setting.
dsego 7y ago
> No tests exist which can detect those imbalances. Yes, but the drugs actually work, which validates the prediction. > Mental illnesses, in general, don't develop organically from biological defects. In schizophrenic patients there are clear organic changes in the brain, you can see it on brain scans. > These things come about because of profoundly dysfunctional psychosocial environments. Then it would surely be possible to "fix" these issues without pharmacology treatment, which is unmistakably not the case.
outlace 7y ago
You’re absolutely right. But the brain is a biological organ, a biological information processor. Experiences shape it’s physical structure and function. Whether mental illness arises from purely environment causes (eg trauma) or purely nature (eg genetics, physical injury), in both cases the phenomena reside in the physical substrate of the brain. When someone has psychosis (eg hearing voices), maybe it was caused by a severe trauma or maybe it was mostly genetic. In either case the person is suffering from psychosis and is unable to normally function in society (if severe enough). In both cases, in principle, we should be able to detect the problem at the level of the brain in structure and function, and should be able to intervene at the level of the brain. The intervention required depends on the nature of the brain change. We can change brain function in many cases by intensive therapy. In some cases sensory inputs alone (via talk therapy) are insufficient to change the brain to rectify an issue. That’s when we have to consider direct intervention on the brain itself either via medications or neuromodulation technology. I don’t think lay people understand how profoundly mentally ill some people are and that they can really have dramatic improvements with treatment. Lay people think of psychiatrists just peddling drugs to mildly depressed patients or people who are mildly oddly behaved. That’s just not the case. I’m working with people who sometimes literally stop eating because they think their food is poisoned, or attempt to kill themselves with minor frustrations, etc. And many patients, mostly not that sick, come in voluntarily because they feel they can’t handle some problem on their own. You’re right that much I mental illness is caused by psychosocial stressors, but some people have just intractably messed up life situations and they’ve just spiraled downward as a result and wouldn’t be able to get on a better path without treatment.
DanBC 7y ago
> A lot of people in the psychiatric field believe that mental illness is due to chemical imbalances in the brain. No psychiatrist believes this.

cassowary37 7y ago

I'd be curious to hear you define biologically valid. The heritability (variance explained by inherited features) for those diagnoses ranges from 0.3-0.8 - greater than many other medical disorders - and for many of them there are identified genetic variants. Maybe that's some of the 'exciting research' you allude to? I agree that they are used as heuristics - and indeed were developed to be heuristics, dating back to the RDC. Psych attending

outlace 7y ago
Perhaps I should have said biologically meaningful. Yes ASD, schizophrenia, bipolar and ADHD are heritable at around 0.8, impressive. But there's also a good amount of research showing that mental illness in any form is correlated and there is a "p factor" that seems to predispose people to mental illness in general. There could be many possible genetic variations that lead to the same DSM diagnosis. Similarly multiple neural derangements can lead to the same set of symptoms. And research based on brain imaging (e.g. https://www.nature.com/articles/s41467-018-05317-y https://www.nature.com/articles/s41467-018-05317-y) suggests that our DSM diagnoses are probably not mapping reliably onto underlying brain dynamics. Plus, if I just randomly throw together a set of symptoms e.g. {back pain, chronic bloating, insomnia}, I wouldn't be surprised if it was heritable at 0.3 or above given that whatever genes are involved are going to get passed down and often genes sit next to each other on the same chromosome etc. The exciting research I care about is more along the lines of < https://www.ncbi.nlm.nih.gov/pubmed/30696271 https://www.ncbi.nlm.nih.gov/pubmed/30696271 > where we observe neural dynamics, hypothesize causality, intervene with TMS or other focal neuromodulatory tech, and see if in fact region A is causally linked to outcome B, or if neural dynamical state A is causally linked to outcome B. I also meant that the DSM is biologically unreliable because it is only symptom clusters, and we cannot intervene at the level of symptoms, you have to intervene at the level of pathology. Symptoms are not pathology. It's the brain that is experiencing some pathology, so we need to ascertain the brain pathology and intervene at that level, and DSM, as noted by brain imaging studies, does not seem to reliably map onto that biology. Aside, are you involved in software engineering? What brings you to HN?

gregfjohnson 7y ago

FWIW, I am an emergentist. It seems that this view comes naturally to computer scientists and software developers. If I understand them correctly, some cognitive neuroscientists such as Michael Gazzaniga are beginning to think seriously about this perspective on the mind-brain problem. Abstraction is as powerful in nature as it is in software. DNA is an amazing abstraction that essentially precludes physics from having a vote in the information content of the genes, and relies instead on an entirely new logic at a higher abstraction level, namely evolution. Grasping for other metaphors, there is a profound complementarity between a great violin and a transcendent performance, but nonetheless Stradivarius and Heifetz were geniuses in different categories. Steinway and Horowitz. Without a piano there is no Horowitz, and everything Horowitz does is translated via the piano and physics to the audience. But, the music is at a qualitatively different abstraction level than the physical piano. So, my current (interested layperson's) view: The human mind and the human brain are complementary yet distinct phenomena. While every mind-event has a physical representation in the brain, and without doubt many physical abnormalities in the brain can manifest in the mind and can therefore be treated by treating the brain, working reductively up from the brain toward the mind as the only acceptable path for treating all mental patients will IMHO eventually run afoul of an abstraction barrier similar to the one physics runs into at the level of DNA.