13 ms·

The links between mental disorders

142 points by BerislavLopac 7y ago

twomoretime 7y ago
I think the main issue is that most mental illnesses are vaguely defined clusters of problems - if you represented a diagnosis as a vector where each index corresponded to severity of a particular symptom, the diagnosis space would not properly aligned with the actual disease basis. This introduces ambiguity - a single disease tends to fall into multiple clusters when your representational domain is misaligned with the actual data axes. The solution is ML. Neural networks with appropriate architectures effectively perform a change of basis, mapping the data basis to an output coordinate system. When properly trained they can automagically orient their internal representation with the true data bases.
- ColanR 7y ago
  I agree with your first paragraph. However, a NN can't explain its reasoning. You start with a set of symptoms, and you end with a vector, and they're two representations of exactly the same thing. The problem is that NNs are representational, not explanatory, so they won't help a doctor get to a root cause any more than just thinking about the collection of symptoms and what they're associated with.
  - dooglius 7y ago
    I think what's implicit in the comment is that the output vector can correspond to things like dosages of drugs or recommended therapeutic treatments.
    - deathgrips 7y ago
      I'm not sure why but I wouldn't feel comfortable letting some tech bros decide what drugs people should take.
      - 9HZZRfNlpR 7y ago
        Psychiatry works as a trial and error of different drugs so it wouldn't be far too off.
        ColanR 7y ago
        Yeah, but at least a malpracticing psychiatrist can lose their license.
    - ColanR 7y ago
      Yes: but what was implicit in mine is that that output vector is no more or less informative than the current method of associating strong symptoms with specific diagnoses which have known drug dosages. Same idea, different representation. The difference is whether the process can be automated, and that is where the problem of the black box comes in. With the current system, we know why the drug was prescribed. With an ML system, we would have no clue.
afarrell 7y ago
One challenge here is that there is that a lot of disorders are diagnosed with reference to moods and life experiences. An ADHDer who repeatedly finds that their distractibility leads to them to fail at obvious tasks and disappoint the people around them can very easily develop symptoms of depression. Would that require having the biological underpinnings of depression?
- DaiPlusPlus 7y ago
  I understand Clinical Depression is more than just feeling down, “depressed”, or demotivated - it’s an actual depression in brain activity (which tends to manifest itself as feelings of sadness, but not necessarily - and people with CD can still laugh, smile, and have a good time... at times). (I wish they’d change the name of CD to something that avoids the layperson’s concept of “depression” - that alone would help the well-meaning but ignorant people who think it’s just a matter of finding a way to cheer oneself up and certainly nothing to do with serotonin...).
  - esotericn 7y ago
    Depression is not sadness, it is emptiness.
  - Ensorceled 7y ago
    Clinical depression is often associated the ADHD exactly as the parent said, so please leave off with the “well actually” explanation. https://www.webmd.com/add-adhd/depression-adhd-link https://www.webmd.com/add-adhd/depression-adhd-link
    - jdudhebee 7y ago
      It seems like you're the one who should be laying off the "well actually" explanations. The example they were responding to, as it was laid out, is not an example of clinical depression. Just because a person in with adhd is depressed due to factors catalyzed by their adhd does not mean they have clinical depression.
afarrell 7y ago
Not a psychiatrist, but I'm pretty skeptical of the approach of trying to sort things according to a few dimensions. I understand the appeal -- There is a reason why memes like sanguine vs melancholic or The Political Spectrum are popular -- but I don't see why it should be likely to cleave reality at its joints. I'd naively think we're more likely to get a useful theory by trying to push a Predictive Processing approach too far for a while and then find a way to incorporate the signaling impact of hormones & ambient levels of neurotransmitters on various feedback loops. I certainly found https://slatestarcodex.com/2017/09/12/toward-a-predictive-theory-of-depression/ https://slatestarcodex.com/2017/09/12/toward-a-predictive-th... useful for overcoming my writing anxiety and issues with motivation.
- Oekeai 7y ago
  Abstraction does not happen at 3D or higher dimensions. Abstraction happens in the second dimension. The Greeks made lifelike marble sculptures during the Hellenistic era (300 B.C.) but it took almost 2,000 more years before artists could make lifelike 2D pictures.
  - mkl 7y ago
    I'm not sure that's true. Marble sculptures last much longer than paintings (case in point: the paint that used to cover the sculptures is gone), and Roman artists were able to paint well not much later. Most Roman paintings are gone too, but some have been uncovered in Pompeii, Herculaneum, etc.
- throwlaplace 7y ago
  >Not a psychiatrist, but I'm pretty skeptical i don't understand why people do this - if you're not an expert why are you pontificating? if a psychiatrist decided to pronounce on OOP vs FP or raft vs paxos or whatever would you give absolutely any credence to their opinion? this is an article on nature about a nature paper for god's sake - i trust them over my own opinion on the matter let alone your opinion. edit: lest we forget a psychiatrist is an MD plus a 4 year residency. that's a total of 8 years of domain specific education.
rl3 7y ago
Layperson here. Having hit my head quite a few times over the past years, I've dug into cutting-edge mTBI (concussion) research pretty hard. What I learned was that the long-term effects of concussion are now fundamentally thought of as neurometabolic in nature. That is, the loss of metabolic homeostasis within the brain due to an initial trauma. Unless this process arrests, what you're left with is neurodegeneration. How much really depends on the circumstance and patient. The most striking takeaway I had, was that much of the latest research is suggesting that different etiologies lead to the same pathology in many instances. For example, it may be that you can acquire Alzheimer's Disease, or Parkinson's Disease, or even ALS via way of: chronic poor sleep quality (poor glymhpatic performance), history of frequent subconcussive head trauma (CTE), history of concussive or severe head truama (mTBI/TBI), neuroimmune factors, and of course genetic factors. Often times a combination thereof. That example isn't even remotely comprehensive on either the etiology or pathology side. Point being, your brain is like a washing machine. If it goes out of balance, sometimes it will only oscillate further out of balance unless the process is arrested. Psychiatric disorders are much the same way. I suspect it is for this reason that comorbidity is so commonplace. The interesting part about psychiatric disorders however, is to a degree they can self-reinforce in a unique way. Your behavior and thought literally influence your brain's neurochemical state. Likewise, your brain's neurochemical state influences behavior and thought. I suspect this is why behavioral intervention in conjunction with medication generally works better than medication alone in treating psychiatric disorders. Of course, it's not as simple as brain chemistry affecting thought and vice versa. You brain chemistry (and as such your behavior and thought) is still subject to effects of neurodegeneration, neurostructural changes, neuroinflammation, immune activation, and so forth. So what we have is a very, very complex puzzle wherein you have many different factors—often vastly different in mechanism—each affecting the other.
- enchiridion 7y ago
  Is there the implication that a single concussion could cause long-term neurodegeneration?
  - rl3 7y ago
    In most cases probably not, or if so mild. It depends on the hit, and it depends on the person. It's worth noting the second order effects of mTBI (such as sleep disturbance) can in some cases kick off neurodegenerative processes.[0] If it's acute (TBI), then almost certainly yes.[1] It's no longer considered a concussion at that point however. [0] https://www.neuroskills.com/brain-injury/mtbi-and-concussion/does-mtbi-contribute-to-neurodegenerative-disease/ https://www.neuroskills.com/brain-injury/mtbi-and-concussion... [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057689/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057689/
danieltillett 7y ago
I wonder how much of this correlation between disorders is just an artefact of inconsistent classification of patients by psychiatrists? What might be being measured here is not the likelihood of getting a second illness, but the probability that person with illness X get diagnosed with illness Y despite the underlying symptoms not changing. I have always thought that mental disorders are no different to physical disorders. We all know some people who are robustly healthy while others seem to get a bewildering array of different diseases. Illness is not randomly distributed.
- deathgrips 7y ago
  There are plenty of psychiatric disorders that are demonstrably structural in nature, such as schizophrenia (likely genetic, lifelong and incurable), but there are plenty of others that seem to be a disorder in the contents of your brain rather than its structure. An example is depression, where people seem to be able to think themselves into depression and think themselves out of it.
- mirimir 7y ago
  That's been my experience. For decades, I was diagnosed with depression. Eventually, I was prescribed an SSRI. And that became a disaster, over the course of a few years. But then I saw a psychiatrist who inquired about my use of psychoactive drugs. And based on my love of stimulants, he diagnosed me as having bipolar disorder, manifesting primarily as depression. And so he prescribed modafinil, with lamotrigine to reduce the risk of mania. So I wonder if bipolar disorder is actually relatively common. I mean, I was self medicating primarily with caffeine, and for many years used nicotine to take the edge off. Maybe that's fundamentally why coffee, tea, etc are so popular. Edit: typo
  - dillondoyle 7y ago
    Lamotrigine has been a life saver for me! Way more effective than snri, ssri for me at least. I wish more people knew about it. Bonus it's like 5 cents a pill unlike so many patented depression meds
  - ineedasername 7y ago
unexaminedlife 7y ago
Probably 10 or so years ago I had a few episodes that made me think I may be suffering from some form of mental illness (low on the "spectrum", but something nonetheless). Since then I've thought a fair amount about mental illness in general and have a few theories. 1) Diet. Get the right materials into your body so it can do with them what it needs to. Especially early in life while brain is still forming. 2) Exercise. Make sure your body can get sufficient blood / oxygen to all parts of the body so it can function properly. 3) The brain, IMO, should be viewed as a TOOL Sure it is already part of our body but this is why I think it's so overlooked as a perspective. If I decided to do some landscaping and needed an excavator, I would need to learn how to use it, and practice in order to become efficient and effective with my use of it. I think it's same with the brain. New circumstances come up all the time and sometimes the people who experience them have not trained their brains to deal with them in an effective / efficient way. There should be more focus on this sort of perspective / reflection / learning and perform these generally-applicable exercises early in life. Not just math, science, english, etc. -- There is no doubt in my mind there are going to be SOME genetically relevant issues. But I would be surprised if, once this stuff gets fleshed out further, we don't come to realize most of it was preventable.
- james_s_tayler 7y ago
  Im sort of half surprised at the down votes and not surprised at the same time. I think you're probably right to a large degree. To paraphrase you're basically saying yes, there for sure is a very real genetic and environmental component, however if we simulate a reality where everyone runs their bodies and minds in an optimal manner we'd be far less likely to see all forms of disease including mental illness/psychiatric disorders. The takeaway is if you're struggling with it, they are both important components that ought to be a part of a wholistic treatment plan. I was watching something on Health Theory the other day and she psychiatrist being interviewed said they start with an elimination diet and the nutritionists have more success than the psychiatrists. Food for thought.
  - DanBC 7y ago
    > Im sort of half surprised at the down votes and not surprised at the same time. Reducing the complexity of the bio-psycho-social model down to "exercise" and "eat better" isn't great.
deleted 7y ago
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lidHanteyk 7y ago
It is interesting how powerful the meme is which prevents discussion of psychology and psychiatry amongst the laity. Multiple threads started and died on the theme of being a layperson and not an expert, despite the fact that any science should be examinable on its premises, observations, models, and theories. Meanwhile, the Dodo Bird theory [0] has yet to be disproven, and there are good reasons to suspect that humans are merely smart mammals, rather than special animals who have no peers throughout the rest of the kingdom, which means that psychology and psychiatry are only the tip of a much bigger comparative discipline which handles humanity as a special case rather than as the main system of study. [0] https://en.wikipedia.org/wiki/Dodo_bird_verdict https://en.wikipedia.org/wiki/Dodo_bird_verdict
- dodobirdlord 7y ago
  The Dodo Bird theory may, as it states, be relevant to therapy, but it holds no water for psychiatric treatment. Some mental disorders are known to respond radically differently to certain psychoactive medications. SSRIs are a canonical example. They are an effective treatment for major depression, but in bipolar disorder they cause rapid cycling and increase suicide risk.
  - lidHanteyk 7y ago
    Assuming mental disorders exist, sure. But there is also evidence that a sufficiently technocratic government will use psychoactive drugs indiscriminately on its population in order to coerce and control them [0][1][2][3]. We must demonstrate somehow that mental disorders not only exist, but that their classification is due to science, and not due to bigotry and a lack of understanding [4][5]. Your example of SSRIs is an especially poor one, as SSRIs are well-understood to have been developed by the pharmaceutical industry as part of a panpsychic wellness package which is meant to be sold pill-by-pill to the public [6][7]. SSRIs today are like sugar in the past [8], with a corporate army of compensated scientists ready to study the noise and find useful results from harmful chemicals. [0] https://en.wikipedia.org/wiki/Project_MKUltra https://en.wikipedia.org/wiki/Project_MKUltra [1] https://en.wikipedia.org/wiki/Edgewood_Arsenal_human_experiments https://en.wikipedia.org/wiki/Edgewood_Arsenal_human_experim... [2] https://en.wikipedia.org/wiki/Crack_epidemic_in_the_United_States https://en.wikipedia.org/wiki/Crack_epidemic_in_the_United_S... [3] https://en.wikipedia.org/wiki/CIA_involvement_in_Contra_cocaine_trafficking https://en.wikipedia.org/wiki/CIA_involvement_in_Contra_coca... [4] https://en.wikipedia.org/wiki/Homosexuality_and_psychology https://en.wikipedia.org/wiki/Homosexuality_and_psychology [5] https://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders#DSM-5_critiques https://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Man... [6] https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor#Controversy https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_i... [7] https://twitter.com/jcbonthedl/status/1159823784242753537 https://twitter.com/jcbonthedl/status/1159823784242753537 [8] https://en.wikipedia.org/wiki/Sugar_marketing#Influence_on_health_information_and_guidelines https://en.wikipedia.org/wiki/Sugar_marketing#Influence_on_h...
ThrustVectoring 7y ago
There's a couple related shared factors that cause correlation between diagnosis of various mental disorders. 1. People who are doing okay don't seek out diagnosis. One big example is Bill Gross, the "Bond King" who manages mutual funds - he happened to read the description of Asperger's and realize he had it in his seventies. Psychologists do not see a representative sample of society. If diagnosis A and B are both mild enough to cause some people with it to not seek treatment, but everyone with both to do so, you'll see a correlation between A and B. 2. All mental health diagnostic criteria share a clause that sounds like "and these symptoms cause a significant amount of distress or ill-functioning to the patient." This is similar to the first factor, but happens after people seek treatment; if you tell a psychologist that you aren't having any problems in your life, they do not diagnose you with depression, anxiety, ADHD, etc. It almost doesn't matter what you have going on, if it doesn't cause problems its not worth using medical care on, so it doesn't get diagnosed. And again, if you only have one kind of thing causing you problems, it's more likely to not be severe enough to warrant some kind of diagnosis. 3. Similar to the previous factor, mental health diagnoses are used to gatekeep medical care and social support. So, people who need more resources than they currently have are going to push more for additional mental health diagnoses, while people who are more okay are going to be fine with the first one proffered. Eg, a young woman who is extremely anxious and whose mom yells at her all the time goes in, gets diagnosed with anxiety and prescribed anxiolytics, things are still bad because her mom keeps yelling, so she goes back and gets a depression diagnosis and anti-depressants. Or a school can offer accommodations for ADHD and not autism, or vice versa, so someone with one goes back and asks the psychologist for the other. In short, there's a general willingness-to-seek-diagnosis that's an obvious latent variable for mental health diagnoses. I'd be more surprised to not find a positive correlation between two arbitrarily picked mental health diagnoses. If there's an outright negative correlation, that's something that would be actually indicative of a biological link of some sort - either the biochemistry of one complex protects against the other, or they're a pair of under/over-activity of a system, or the like.
- toomanybeersies 7y ago
  As you said in point 3, mental health diagnostic criteria are a tool for diagnosing and treating people who experience distress from their cognitive process. Doctors and psychiatrists exist to give medical advice and treat people who need help, not to tell them how their brain works out of curiosity. On that point though, depression and anxiety are two completely different things, I've experienced both (separately and simultaneously) and they're distinctly different in how they feel and how one would describe the symptoms to a doctor or a friend. I went to the doctor in my mid-20s to get treated for ADHD, as it was causing me significant problems in my life, having gone through bouts of anxiety, depression, and suicidal ideation for the year or two prior, which the manifested itself in an inability to manage the negative traits of my ADHD. I've had it all my life, but only realised I likely had it a couple of years prior, but it was never something that caused big enough problems to go to a doctor about, mostly just report cards stating "easily distracted and distracters others". At the same time I was diagnosed with ADHD, the doctor said it was likely I also had high functioning autism. I guess maybe I have it, but it's not something that's ever caused me any particular problems in life, so the doctor basically said not to worry about it and only to seek treatment (therapy or counselling) if I felt like I needed it. Same story for the ADHD too, he said there was no need to continue seeking treatment if I felt like I didn't need it at any point in the future. On the other hand, being put on medication for ADHD (clonidine and dexamphetamine) has made a world of difference for me, and I've seen vast improvements in quality of life. Most importantly though has been recognising and accounting for the fact that my mind functions in a different way than most people, and making accomodations (and asking others to accomodate) for this. Interestingly enough, he also mentioned the possibility of having bipolar disorder as well, but said that it was likely the symptoms were actually ADHD masquerading as bipolar and decided to treat the ADHD first and see if the symptoms remain. Diagnosing mental health issues is a difficult task, a lot of people with ADHD are misdiagnosed with bipolar, or people with bipolar diagnosed with clinical depression. If it wasn't for the fact that I was fairly certain that I had ADHD when I went to the doctor, I wonder what I would've been diagnosed with. I think the language around mental functioning and disorders isn't great. If you have Asperger's or ADHD and don't experience distress or difficulty in life from it, then it's not really a mental illness or disorder, it's just a different way your mind works. ADHD has a particularly bad name, it's not an attention deficit to begin with, but rather an inability to chose what your attention is on (you should see me if I'm in a hyperfocus/flow state, it's definitely not a deficit of attention), and it's not always hyperactive. I have primarily inattentive-type ADHD, you wouldn't pick me as having it just from looking at me, I display barely any "typical" traits of ADHD, it's mostly mental for me (mood swings, inattentiveness, impulsiveness, poor working memory, no concept of time, rejection sensitivity and a lack of emotional permanence). I don't think it's intrinsically a disorder either, it's been hugely beneficial in parts of my life, and I don't really want to be labelled as disordered or broken for the entirety of my life, it only became a disorder at a certain point in my life, largely due to external factors at the time. Often it's helped me function above and ahead of neurotypical people. I know plenty of people with ADHD who don't take any medication and don't feel the need to, and get by perfectly fine in life. My father very likely has ADHD (it's hereditary, and he displays a lot of traits), and has never seeked treatment for it, and he's a very successful man. Same for people with bipolar, autism, or other neurodiverse minds.
pharrington 7y ago
We're going to need some sort of coherent theory of socialization if we want to properly understand mental illness. I suspect we're currently in a "fish can't see water" situation regarding that.
- Toine 7y ago
  Mimetic theory
  - pharrington 7y ago
    Memes are certainly a fundamental component, but simple mimicry seems like it's an obviously degenerate form of socialization.
tomhoward 7y ago
A few thoughts, as someone who has been deeply researching this topic for my own reasons and for several loved ones over many years (I think I first started looking up the DSM-IV in 2005). - This article reveals the folly of viewing a complex system (the mind) through a mechanistic lens. We want to be able to look at the mind the way we look at a malfunctioning car ("ah, the timing belt's out") or computer ("one of the memory sticks died"), repair/replace that component and expect it to carry on as "normal". This can never work. The mind is an organic, emergent phenomenon, not something that has been "designed" to work in any "normal" way; it has evolved to adapt to circumstances that can change and differ dramatically for all kinds of reasons. So, trying to categorise "disorders" into discrete definitions with distinct "causes" in order to restore the mind to some "normal" state cannot possibly work. - I realised after a few years of researching this stuff that the notion that psychiatric "disorders" manifest due to "bad genes" doesn't make sense. The whole point of evolution is that only genes that promote survival and replication can make it through. Sure, you can get random mutations, but that doesn't explain why so many people have the same kinds of "disorders". So whatever are the genes that "cause psychiatric disorders" in big enough clusters that they can even be attempted to be named and described in the DSM, those genes must be there for a reason that has aided our survival - even if they have some negative aspects too (nature is all about tradeoffs after all). Realising this changed the way I view mental "illness". I realised that my depression was my mind's way of telling me that something was wrong in my life (relationships, career, physiological health) and I needed time out to examine it, understand it and correct it. Schizophrenia can be seen as an alteration of your perceptions to numb you from a stressful/traumatic situation, a trigger of extreme creative thinking to help solve serious life problems, or a display of aberrant behaviour to signal to outsiders that you are in need of help (see studies of how often schizophrenia manifests after a period of severe stress or trauma). Bipolar can be seen as a pattern of swinging between a high energy/creativity state in order to get important things achieved quickly, and a low-energy state for recovery. - The discussion in this article seems astonishingly simplistic and naïve to anyone who has read/heard any of the many researchers who have spent years examining mental "illness" from the perspective of trauma, and who have found success treating all kinds of conditions through trauma healing techniques. Such figures include Stan Grof, Ram Dass, Iain McGilchrist, Peter Levine and Gabor Maté. - My own experience: I'm one of those who has fit the diagnosis for several conditions at times in my life; depression and anxiety most clearly, but also (at least mildly) bipolar, borderline PD, ADHD, some addiction. I tried all the conventional things (pharmaceuticals, mainstream psychiatric talk therapy) and didn't get much relief. About 8 years ago I discovered unconventional approaches to subconscious trauma healing, and have undertaken these consistently ever since, and my "disorders" have steadily resolved. All that's left is some latent anxiety, but that continues to improve too.
slim 7y ago
mental disorders come from the genes of cromagnon
LifeLiverTransp 7y ago
My assumption always was- that they are not disorders. They are adaptions to circumstances, that thrive in these circumstances, through which human societys cycled regularly. With the advent of modern farming, the ceasing of constant warfare and the finalization of the "expansion" to ever area of the planet, the usefullness of some of these neuro-archetypes just ceased to be, and they become first "troublesome" and then a illness. That mentally unstable homeless person under the bridge, is rather better adapted to a country sliding into warfare with a neighbouring tribe or a hunter community who needs to move again, to catch up to animal herds moving onwards.
deleted 7y ago
[deleted]
TopHand 7y ago
I've found this article, and the associated comments to be very enlightening and insightful. I suppose that is because almost every human alive has been touched by these disorders. What I find most interesting about the discussion on this page is that no one has chimed in with "leave it to the experts" in a manner that is usually seen in the comment section of complex social problems on HN.
dr_dshiv 7y ago
One factor that is under examined is the role of subjective Wellbeing in mental illness. All disorders are highly correlated with feeling bad...!

142 points by BerislavLopac 7y ago

I think the main issue is that most mental illnesses are vaguely defined clusters of problems - if you represented a diagnosis as a vector where each index corresponded to severity of a particular symptom, the diagnosis space would not properly aligned with the actual disease basis. This introduces ambiguity - a single disease tends to fall into multiple clusters when your representational domain is misaligned with the actual data axes. The solution is ML. Neural networks with appropriate architectures effectively perform a change of basis, mapping the data basis to an output coordinate system. When properly trained they can automagically orient their internal representation with the true data bases.

ColanR 7y ago
I agree with your first paragraph. However, a NN can't explain its reasoning. You start with a set of symptoms, and you end with a vector, and they're two representations of exactly the same thing. The problem is that NNs are representational, not explanatory, so they won't help a doctor get to a root cause any more than just thinking about the collection of symptoms and what they're associated with.
- dooglius 7y ago
  I think what's implicit in the comment is that the output vector can correspond to things like dosages of drugs or recommended therapeutic treatments.
  - deathgrips 7y ago
    I'm not sure why but I wouldn't feel comfortable letting some tech bros decide what drugs people should take.
    - 9HZZRfNlpR 7y ago
      Psychiatry works as a trial and error of different drugs so it wouldn't be far too off.
      - ColanR 7y ago
        Yeah, but at least a malpracticing psychiatrist can lose their license.
  - ColanR 7y ago
    Yes: but what was implicit in mine is that that output vector is no more or less informative than the current method of associating strong symptoms with specific diagnoses which have known drug dosages. Same idea, different representation. The difference is whether the process can be automated, and that is where the problem of the black box comes in. With the current system, we know why the drug was prescribed. With an ML system, we would have no clue.

afarrell 7y ago

One challenge here is that there is that a lot of disorders are diagnosed with reference to moods and life experiences. An ADHDer who repeatedly finds that their distractibility leads to them to fail at obvious tasks and disappoint the people around them can very easily develop symptoms of depression. Would that require having the biological underpinnings of depression?

DaiPlusPlus 7y ago
I understand Clinical Depression is more than just feeling down, “depressed”, or demotivated - it’s an actual depression in brain activity (which tends to manifest itself as feelings of sadness, but not necessarily - and people with CD can still laugh, smile, and have a good time... at times). (I wish they’d change the name of CD to something that avoids the layperson’s concept of “depression” - that alone would help the well-meaning but ignorant people who think it’s just a matter of finding a way to cheer oneself up and certainly nothing to do with serotonin...).
- esotericn 7y ago
  Depression is not sadness, it is emptiness.
- Ensorceled 7y ago
  Clinical depression is often associated the ADHD exactly as the parent said, so please leave off with the “well actually” explanation. https://www.webmd.com/add-adhd/depression-adhd-link https://www.webmd.com/add-adhd/depression-adhd-link
  - jdudhebee 7y ago
    It seems like you're the one who should be laying off the "well actually" explanations. The example they were responding to, as it was laid out, is not an example of clinical depression. Just because a person in with adhd is depressed due to factors catalyzed by their adhd does not mean they have clinical depression.

afarrell 7y ago

Not a psychiatrist, but I'm pretty skeptical of the approach of trying to sort things according to a few dimensions. I understand the appeal -- There is a reason why memes like sanguine vs melancholic or The Political Spectrum are popular -- but I don't see why it should be likely to cleave reality at its joints. I'd naively think we're more likely to get a useful theory by trying to push a Predictive Processing approach too far for a while and then find a way to incorporate the signaling impact of hormones & ambient levels of neurotransmitters on various feedback loops. I certainly found https://slatestarcodex.com/2017/09/12/toward-a-predictive-theory-of-depression/ https://slatestarcodex.com/2017/09/12/toward-a-predictive-th... useful for overcoming my writing anxiety and issues with motivation.

Oekeai 7y ago
Abstraction does not happen at 3D or higher dimensions. Abstraction happens in the second dimension. The Greeks made lifelike marble sculptures during the Hellenistic era (300 B.C.) but it took almost 2,000 more years before artists could make lifelike 2D pictures.
- mkl 7y ago
  I'm not sure that's true. Marble sculptures last much longer than paintings (case in point: the paint that used to cover the sculptures is gone), and Roman artists were able to paint well not much later. Most Roman paintings are gone too, but some have been uncovered in Pompeii, Herculaneum, etc.
throwlaplace 7y ago
>Not a psychiatrist, but I'm pretty skeptical i don't understand why people do this - if you're not an expert why are you pontificating? if a psychiatrist decided to pronounce on OOP vs FP or raft vs paxos or whatever would you give absolutely any credence to their opinion? this is an article on nature about a nature paper for god's sake - i trust them over my own opinion on the matter let alone your opinion. edit: lest we forget a psychiatrist is an MD plus a 4 year residency. that's a total of 8 years of domain specific education.

rl3 7y ago

Layperson here. Having hit my head quite a few times over the past years, I've dug into cutting-edge mTBI (concussion) research pretty hard. What I learned was that the long-term effects of concussion are now fundamentally thought of as neurometabolic in nature. That is, the loss of metabolic homeostasis within the brain due to an initial trauma. Unless this process arrests, what you're left with is neurodegeneration. How much really depends on the circumstance and patient. The most striking takeaway I had, was that much of the latest research is suggesting that different etiologies lead to the same pathology in many instances. For example, it may be that you can acquire Alzheimer's Disease, or Parkinson's Disease, or even ALS via way of: chronic poor sleep quality (poor glymhpatic performance), history of frequent subconcussive head trauma (CTE), history of concussive or severe head truama (mTBI/TBI), neuroimmune factors, and of course genetic factors. Often times a combination thereof. That example isn't even remotely comprehensive on either the etiology or pathology side. Point being, your brain is like a washing machine. If it goes out of balance, sometimes it will only oscillate further out of balance unless the process is arrested. Psychiatric disorders are much the same way. I suspect it is for this reason that comorbidity is so commonplace. The interesting part about psychiatric disorders however, is to a degree they can self-reinforce in a unique way. Your behavior and thought literally influence your brain's neurochemical state. Likewise, your brain's neurochemical state influences behavior and thought. I suspect this is why behavioral intervention in conjunction with medication generally works better than medication alone in treating psychiatric disorders. Of course, it's not as simple as brain chemistry affecting thought and vice versa. You brain chemistry (and as such your behavior and thought) is still subject to effects of neurodegeneration, neurostructural changes, neuroinflammation, immune activation, and so forth. So what we have is a very, very complex puzzle wherein you have many different factors—often vastly different in mechanism—each affecting the other.

enchiridion 7y ago
Is there the implication that a single concussion could cause long-term neurodegeneration?
- rl3 7y ago
  In most cases probably not, or if so mild. It depends on the hit, and it depends on the person. It's worth noting the second order effects of mTBI (such as sleep disturbance) can in some cases kick off neurodegenerative processes.[0] If it's acute (TBI), then almost certainly yes.[1] It's no longer considered a concussion at that point however. [0] https://www.neuroskills.com/brain-injury/mtbi-and-concussion/does-mtbi-contribute-to-neurodegenerative-disease/ https://www.neuroskills.com/brain-injury/mtbi-and-concussion... [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057689/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057689/

danieltillett 7y ago

I wonder how much of this correlation between disorders is just an artefact of inconsistent classification of patients by psychiatrists? What might be being measured here is not the likelihood of getting a second illness, but the probability that person with illness X get diagnosed with illness Y despite the underlying symptoms not changing. I have always thought that mental disorders are no different to physical disorders. We all know some people who are robustly healthy while others seem to get a bewildering array of different diseases. Illness is not randomly distributed.

deathgrips 7y ago
There are plenty of psychiatric disorders that are demonstrably structural in nature, such as schizophrenia (likely genetic, lifelong and incurable), but there are plenty of others that seem to be a disorder in the contents of your brain rather than its structure. An example is depression, where people seem to be able to think themselves into depression and think themselves out of it.
mirimir 7y ago
That's been my experience. For decades, I was diagnosed with depression. Eventually, I was prescribed an SSRI. And that became a disaster, over the course of a few years. But then I saw a psychiatrist who inquired about my use of psychoactive drugs. And based on my love of stimulants, he diagnosed me as having bipolar disorder, manifesting primarily as depression. And so he prescribed modafinil, with lamotrigine to reduce the risk of mania. So I wonder if bipolar disorder is actually relatively common. I mean, I was self medicating primarily with caffeine, and for many years used nicotine to take the edge off. Maybe that's fundamentally why coffee, tea, etc are so popular. Edit: typo
- dillondoyle 7y ago
  Lamotrigine has been a life saver for me! Way more effective than snri, ssri for me at least. I wish more people knew about it. Bonus it's like 5 cents a pill unlike so many patented depression meds
- ineedasername 7y ago

unexaminedlife 7y ago

Probably 10 or so years ago I had a few episodes that made me think I may be suffering from some form of mental illness (low on the "spectrum", but something nonetheless). Since then I've thought a fair amount about mental illness in general and have a few theories. 1) Diet. Get the right materials into your body so it can do with them what it needs to. Especially early in life while brain is still forming. 2) Exercise. Make sure your body can get sufficient blood / oxygen to all parts of the body so it can function properly. 3) The brain, IMO, should be viewed as a TOOL Sure it is already part of our body but this is why I think it's so overlooked as a perspective. If I decided to do some landscaping and needed an excavator, I would need to learn how to use it, and practice in order to become efficient and effective with my use of it. I think it's same with the brain. New circumstances come up all the time and sometimes the people who experience them have not trained their brains to deal with them in an effective / efficient way. There should be more focus on this sort of perspective / reflection / learning and perform these generally-applicable exercises early in life. Not just math, science, english, etc. -- There is no doubt in my mind there are going to be SOME genetically relevant issues. But I would be surprised if, once this stuff gets fleshed out further, we don't come to realize most of it was preventable.

james_s_tayler 7y ago
Im sort of half surprised at the down votes and not surprised at the same time. I think you're probably right to a large degree. To paraphrase you're basically saying yes, there for sure is a very real genetic and environmental component, however if we simulate a reality where everyone runs their bodies and minds in an optimal manner we'd be far less likely to see all forms of disease including mental illness/psychiatric disorders. The takeaway is if you're struggling with it, they are both important components that ought to be a part of a wholistic treatment plan. I was watching something on Health Theory the other day and she psychiatrist being interviewed said they start with an elimination diet and the nutritionists have more success than the psychiatrists. Food for thought.
- DanBC 7y ago
  > Im sort of half surprised at the down votes and not surprised at the same time. Reducing the complexity of the bio-psycho-social model down to "exercise" and "eat better" isn't great.

deleted 7y ago

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lidHanteyk 7y ago

It is interesting how powerful the meme is which prevents discussion of psychology and psychiatry amongst the laity. Multiple threads started and died on the theme of being a layperson and not an expert, despite the fact that any science should be examinable on its premises, observations, models, and theories. Meanwhile, the Dodo Bird theory [0] has yet to be disproven, and there are good reasons to suspect that humans are merely smart mammals, rather than special animals who have no peers throughout the rest of the kingdom, which means that psychology and psychiatry are only the tip of a much bigger comparative discipline which handles humanity as a special case rather than as the main system of study. [0] https://en.wikipedia.org/wiki/Dodo_bird_verdict https://en.wikipedia.org/wiki/Dodo_bird_verdict

dodobirdlord 7y ago
The Dodo Bird theory may, as it states, be relevant to therapy, but it holds no water for psychiatric treatment. Some mental disorders are known to respond radically differently to certain psychoactive medications. SSRIs are a canonical example. They are an effective treatment for major depression, but in bipolar disorder they cause rapid cycling and increase suicide risk.
- lidHanteyk 7y ago
  Assuming mental disorders exist, sure. But there is also evidence that a sufficiently technocratic government will use psychoactive drugs indiscriminately on its population in order to coerce and control them [0][1][2][3]. We must demonstrate somehow that mental disorders not only exist, but that their classification is due to science, and not due to bigotry and a lack of understanding [4][5]. Your example of SSRIs is an especially poor one, as SSRIs are well-understood to have been developed by the pharmaceutical industry as part of a panpsychic wellness package which is meant to be sold pill-by-pill to the public [6][7]. SSRIs today are like sugar in the past [8], with a corporate army of compensated scientists ready to study the noise and find useful results from harmful chemicals. [0] https://en.wikipedia.org/wiki/Project_MKUltra https://en.wikipedia.org/wiki/Project_MKUltra [1] https://en.wikipedia.org/wiki/Edgewood_Arsenal_human_experiments https://en.wikipedia.org/wiki/Edgewood_Arsenal_human_experim... [2] https://en.wikipedia.org/wiki/Crack_epidemic_in_the_United_States https://en.wikipedia.org/wiki/Crack_epidemic_in_the_United_S... [3] https://en.wikipedia.org/wiki/CIA_involvement_in_Contra_cocaine_trafficking https://en.wikipedia.org/wiki/CIA_involvement_in_Contra_coca... [4] https://en.wikipedia.org/wiki/Homosexuality_and_psychology https://en.wikipedia.org/wiki/Homosexuality_and_psychology [5] https://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders#DSM-5_critiques https://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Man... [6] https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor#Controversy https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_i... [7] https://twitter.com/jcbonthedl/status/1159823784242753537 https://twitter.com/jcbonthedl/status/1159823784242753537 [8] https://en.wikipedia.org/wiki/Sugar_marketing#Influence_on_health_information_and_guidelines https://en.wikipedia.org/wiki/Sugar_marketing#Influence_on_h...

ThrustVectoring 7y ago

There's a couple related shared factors that cause correlation between diagnosis of various mental disorders. 1. People who are doing okay don't seek out diagnosis. One big example is Bill Gross, the "Bond King" who manages mutual funds - he happened to read the description of Asperger's and realize he had it in his seventies. Psychologists do not see a representative sample of society. If diagnosis A and B are both mild enough to cause some people with it to not seek treatment, but everyone with both to do so, you'll see a correlation between A and B. 2. All mental health diagnostic criteria share a clause that sounds like "and these symptoms cause a significant amount of distress or ill-functioning to the patient." This is similar to the first factor, but happens after people seek treatment; if you tell a psychologist that you aren't having any problems in your life, they do not diagnose you with depression, anxiety, ADHD, etc. It almost doesn't matter what you have going on, if it doesn't cause problems its not worth using medical care on, so it doesn't get diagnosed. And again, if you only have one kind of thing causing you problems, it's more likely to not be severe enough to warrant some kind of diagnosis. 3. Similar to the previous factor, mental health diagnoses are used to gatekeep medical care and social support. So, people who need more resources than they currently have are going to push more for additional mental health diagnoses, while people who are more okay are going to be fine with the first one proffered. Eg, a young woman who is extremely anxious and whose mom yells at her all the time goes in, gets diagnosed with anxiety and prescribed anxiolytics, things are still bad because her mom keeps yelling, so she goes back and gets a depression diagnosis and anti-depressants. Or a school can offer accommodations for ADHD and not autism, or vice versa, so someone with one goes back and asks the psychologist for the other. In short, there's a general willingness-to-seek-diagnosis that's an obvious latent variable for mental health diagnoses. I'd be more surprised to not find a positive correlation between two arbitrarily picked mental health diagnoses. If there's an outright negative correlation, that's something that would be actually indicative of a biological link of some sort - either the biochemistry of one complex protects against the other, or they're a pair of under/over-activity of a system, or the like.

toomanybeersies 7y ago
As you said in point 3, mental health diagnostic criteria are a tool for diagnosing and treating people who experience distress from their cognitive process. Doctors and psychiatrists exist to give medical advice and treat people who need help, not to tell them how their brain works out of curiosity. On that point though, depression and anxiety are two completely different things, I've experienced both (separately and simultaneously) and they're distinctly different in how they feel and how one would describe the symptoms to a doctor or a friend. I went to the doctor in my mid-20s to get treated for ADHD, as it was causing me significant problems in my life, having gone through bouts of anxiety, depression, and suicidal ideation for the year or two prior, which the manifested itself in an inability to manage the negative traits of my ADHD. I've had it all my life, but only realised I likely had it a couple of years prior, but it was never something that caused big enough problems to go to a doctor about, mostly just report cards stating "easily distracted and distracters others". At the same time I was diagnosed with ADHD, the doctor said it was likely I also had high functioning autism. I guess maybe I have it, but it's not something that's ever caused me any particular problems in life, so the doctor basically said not to worry about it and only to seek treatment (therapy or counselling) if I felt like I needed it. Same story for the ADHD too, he said there was no need to continue seeking treatment if I felt like I didn't need it at any point in the future. On the other hand, being put on medication for ADHD (clonidine and dexamphetamine) has made a world of difference for me, and I've seen vast improvements in quality of life. Most importantly though has been recognising and accounting for the fact that my mind functions in a different way than most people, and making accomodations (and asking others to accomodate) for this. Interestingly enough, he also mentioned the possibility of having bipolar disorder as well, but said that it was likely the symptoms were actually ADHD masquerading as bipolar and decided to treat the ADHD first and see if the symptoms remain. Diagnosing mental health issues is a difficult task, a lot of people with ADHD are misdiagnosed with bipolar, or people with bipolar diagnosed with clinical depression. If it wasn't for the fact that I was fairly certain that I had ADHD when I went to the doctor, I wonder what I would've been diagnosed with. I think the language around mental functioning and disorders isn't great. If you have Asperger's or ADHD and don't experience distress or difficulty in life from it, then it's not really a mental illness or disorder, it's just a different way your mind works. ADHD has a particularly bad name, it's not an attention deficit to begin with, but rather an inability to chose what your attention is on (you should see me if I'm in a hyperfocus/flow state, it's definitely not a deficit of attention), and it's not always hyperactive. I have primarily inattentive-type ADHD, you wouldn't pick me as having it just from looking at me, I display barely any "typical" traits of ADHD, it's mostly mental for me (mood swings, inattentiveness, impulsiveness, poor working memory, no concept of time, rejection sensitivity and a lack of emotional permanence). I don't think it's intrinsically a disorder either, it's been hugely beneficial in parts of my life, and I don't really want to be labelled as disordered or broken for the entirety of my life, it only became a disorder at a certain point in my life, largely due to external factors at the time. Often it's helped me function above and ahead of neurotypical people. I know plenty of people with ADHD who don't take any medication and don't feel the need to, and get by perfectly fine in life. My father very likely has ADHD (it's hereditary, and he displays a lot of traits), and has never seeked treatment for it, and he's a very successful man. Same for people with bipolar, autism, or other neurodiverse minds.

pharrington 7y ago

We're going to need some sort of coherent theory of socialization if we want to properly understand mental illness. I suspect we're currently in a "fish can't see water" situation regarding that.

Toine 7y ago
Mimetic theory
- pharrington 7y ago
  Memes are certainly a fundamental component, but simple mimicry seems like it's an obviously degenerate form of socialization.

tomhoward 7y ago

A few thoughts, as someone who has been deeply researching this topic for my own reasons and for several loved ones over many years (I think I first started looking up the DSM-IV in 2005). - This article reveals the folly of viewing a complex system (the mind) through a mechanistic lens. We want to be able to look at the mind the way we look at a malfunctioning car ("ah, the timing belt's out") or computer ("one of the memory sticks died"), repair/replace that component and expect it to carry on as "normal". This can never work. The mind is an organic, emergent phenomenon, not something that has been "designed" to work in any "normal" way; it has evolved to adapt to circumstances that can change and differ dramatically for all kinds of reasons. So, trying to categorise "disorders" into discrete definitions with distinct "causes" in order to restore the mind to some "normal" state cannot possibly work. - I realised after a few years of researching this stuff that the notion that psychiatric "disorders" manifest due to "bad genes" doesn't make sense. The whole point of evolution is that only genes that promote survival and replication can make it through. Sure, you can get random mutations, but that doesn't explain why so many people have the same kinds of "disorders". So whatever are the genes that "cause psychiatric disorders" in big enough clusters that they can even be attempted to be named and described in the DSM, those genes must be there for a reason that has aided our survival - even if they have some negative aspects too (nature is all about tradeoffs after all). Realising this changed the way I view mental "illness". I realised that my depression was my mind's way of telling me that something was wrong in my life (relationships, career, physiological health) and I needed time out to examine it, understand it and correct it. Schizophrenia can be seen as an alteration of your perceptions to numb you from a stressful/traumatic situation, a trigger of extreme creative thinking to help solve serious life problems, or a display of aberrant behaviour to signal to outsiders that you are in need of help (see studies of how often schizophrenia manifests after a period of severe stress or trauma). Bipolar can be seen as a pattern of swinging between a high energy/creativity state in order to get important things achieved quickly, and a low-energy state for recovery. - The discussion in this article seems astonishingly simplistic and naïve to anyone who has read/heard any of the many researchers who have spent years examining mental "illness" from the perspective of trauma, and who have found success treating all kinds of conditions through trauma healing techniques. Such figures include Stan Grof, Ram Dass, Iain McGilchrist, Peter Levine and Gabor Maté. - My own experience: I'm one of those who has fit the diagnosis for several conditions at times in my life; depression and anxiety most clearly, but also (at least mildly) bipolar, borderline PD, ADHD, some addiction. I tried all the conventional things (pharmaceuticals, mainstream psychiatric talk therapy) and didn't get much relief. About 8 years ago I discovered unconventional approaches to subconscious trauma healing, and have undertaken these consistently ever since, and my "disorders" have steadily resolved. All that's left is some latent anxiety, but that continues to improve too.

slim 7y ago

mental disorders come from the genes of cromagnon

LifeLiverTransp 7y ago

My assumption always was- that they are not disorders. They are adaptions to circumstances, that thrive in these circumstances, through which human societys cycled regularly. With the advent of modern farming, the ceasing of constant warfare and the finalization of the "expansion" to ever area of the planet, the usefullness of some of these neuro-archetypes just ceased to be, and they become first "troublesome" and then a illness. That mentally unstable homeless person under the bridge, is rather better adapted to a country sliding into warfare with a neighbouring tribe or a hunter community who needs to move again, to catch up to animal herds moving onwards.

deleted 7y ago

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TopHand 7y ago

I've found this article, and the associated comments to be very enlightening and insightful. I suppose that is because almost every human alive has been touched by these disorders. What I find most interesting about the discussion on this page is that no one has chimed in with "leave it to the experts" in a manner that is usually seen in the comment section of complex social problems on HN.

dr_dshiv 7y ago

One factor that is under examined is the role of subjective Wellbeing in mental illness. All disorders are highly correlated with feeling bad...!