9 ms·

Aren't we all somewhere on the spectrum of disease?

61 points by scripthacker 6y ago

oneplane 6y ago
Well yes. But that shouldn't be much of a surprise to anyone, humanity isn't made of absolutes or boxes or borders. A spectrum you can be 'on', as the word suggests, is just a range or a degree within a classification so we have a common concept when communicating about things. If we had to develop a new word for every unique combination of attributes it would become very hard to talk about things.
awillen 6y ago
I've always thought about mental illness in this context - we define it as illness because of negative consequences, but it's really just the deviation from a norm. I think Elon Musk is the best example of this - even ignoring some of his childish Twitter behavior, the guy's brain is waaaaaaaaay far off from the normal human brain. He thought he could start an electric car company from scratch and be successful. That's... crazy. And yet, because he's been successful at it, we don't label him as mentally ill. The really interesting cases are people like artists - David Foster Wallace committed suicide because of his depression, but only after creating one of the great works of American literature. We label him as mentally ill for his depression, but we don't really have a label for the positive side of the fact that his brain was far from an average brain.
- blueprint 6y ago
  I would suggest a meaningful interpretation of the word normal is kind of like 'a reliably orthogonal measurement of the thing being reacted to'.
- TylerE 6y ago
  > He thought he could start an electric car company from scratch Except he didn't. He invested in one that was already started with several employees, and had himself given founder status by fiat as part of the deal.
  - markdown 6y ago
    At what point do you consider a company founded? At the moment the business is registered by the local government?
    - TylerE 6y ago
      Well, when 3 guys start it and work on it for a long time, incorporate for a year, have an office and employees, and then a VC comes in, the VC definitely did not "found it", no matter when you define the actual date. https://web.archive.org/web/20150228163500/http://www.businessinsider.com/tesla-the-origin-story-2014-10 https://web.archive.org/web/20150228163500/http://www.busine...
    - Talanes 6y ago
      Regardless of how elastic you can get with the term "founded," the actual assertion of "founded from scratch" is much more specific.
- dontcarethrow2 6y ago
  From what I have heard, Musk bought the electric car company and not built it with his bare hands in his garage in college. But to your point, everyone is on the spectrum sure.
- coldtea 6y ago
  >I think Elon Musk is the best example of this - even ignoring some of his childish Twitter behavior, the guy's brain is waaaaaaaaay far off from the normal human brain. He thought he could start an electric car company from scratch and be successful. That's... crazy. Tons of people have started successful mega-companies from scratch. What's crazy, as opposed to ambitious and with slim chances of success due to practical reasons, about it?
- mercer 6y ago
  > David Foster Wallace committed suicide because of his depression, but only after creating one of the great works of American literature. We label him as mentally ill for his depression, but we don't really have a label for the positive side of the fact that his brain was far from an average brain. I'm a huge DFW fan, but I'd hesitate to use him as an example, for various reasons. First off, from what I understand he stabilized on particular meds but then quit them because he felt he'd be more creative without. Instead of being more creative, he slid back into depression and the medication didn't work anymore (apparently that's a thing? I'm not too familiar with anti-depressants). While I won't make any judgment as an outsider, it's not unreasonable to argue that he made a really bad gamble. It's quite possible that the it wasn't the medication that kept him from producing his next great work, but rather just the difficulty of what he was trying to do after Infinite Jest. Reading about it, it reminded me of various artists who 'jumped off the wagon' to return to previous glory, only to rediscover what being off the wagon really meant. Furthermore, his struggles with depression and suicidal ideation, as well as drawing his self-worth from his work seemed to be a running thread in his life. That said, his brain clearly wasn't average and I'm sure it played a positive role in his work. I'm just arguing against the common 'trope' that to do his work he had to be 'mentally ill'. I don't know either way, I just hold hope that these two don't need to be mutually exclusive.
KerryJones 6y ago
It's weird that we consider mental illness to be a disease, in my opinion -- none of the drugs have been linked to physical/chemical shortages in the brain or the like. We're able to mask symptoms but have absolutely no proof about underlying reasons, and so we create names of things and put it in the same classification of a medical disease... but that's very different. Bipolar cannot be identified by any physical means. Different doctors will tell you different things. I agree that gradient approaches are useful in most contexts, but I am very hesitant to use this when a drug can be prescribed (with knowing bad side effects) can be applied. It can seriously mess someone's life up.
- roland00 6y ago
  Mental Illness as defined by the DSM as not thriving. You can have the symptoms of a disorder, but if you are thriving then you do not have the disorder. >It can seriously mess someone's life up. Treatment to try fix someone who is not thriving, is precisely because someone's life is already messed up. Yes treatment may make it worse, but it often makes it better and there are treatment algorithms where we use best practices of how to go from here, and what signs should we be mindful for often when the meds make things worse the doctor should be asking the right questions for there are warning signs when the med is making things worse.
  - KerryJones 6y ago
    The DSM is based off the "top" Psychiatrists at the time voting on the illnesses (literally), without scientific backing. Treatment's don't fix anything, they might lessen one issue and often give a host of other problems that are often more severe. I think more studying of iatrogenics is in order and more data about what "making it better" means -- as often the patient and doctor have different meanings. Again, because there's no physical symptom, you can't say "levels have returned to normal". If you were feeling depressed but now you feel nothing, is that better?
    - Kalium 6y ago
      The DSM can perhaps be viewed as a field guide to systems we can see the outer manifestations of but have limited deep insight into.
aj7 6y ago
Not only are we all somewhere on a spectrum, we’re on a linear combination of different spectra.
roland00 6y ago
There is a good video done by Philosophy Tube about this subject (it also talks about Jordan Peterson.) Some words are inherently subjective, like we can't define what "healthy" is without using so many words that are beyond description. (About 10 minutes in this metaphor appears, when Philosophy Tube references Richard Boyd.) https://www.youtube.com/watch?v=SEMB1Ky2n1E https://www.youtube.com/watch?v=SEMB1Ky2n1E
zabzonk 6y ago
What practitioners call mental health problems a "disease"? Surely that should be reserved for things like Covid or the plague?
- dwd 6y ago
  They all have two aspects, the cause and the disease it triggers. COVID-19 is the disease caused by the SARS-CoV-2 virus like AIDS is caused by HIV. It gets complicated where they don't know or understand the cause like a lot of autoimmune diseases.
  - zabzonk 6y ago
    > like a lot of autoimmune diseases. I worked for some years in a lab testing for auto-immune conditions - we called it that - a condition. I suppose other labs might have labelled it otherwise. Would you call cancer a disease? I wouldn't. But I suppose this is just arguing over semantics.
    - dwd 6y ago
      It is semantics but then words matter if you're the one affected - having the doctor say you have a condition would be better than having a disease. I guess it depends on your definition of disease, which is technically broad in the literal sense of an abnormal negative medical condition. A condition in itself can be positive or negative and also has an implied connotation that it's just the current state. Seem to be hitting that original argument about labeling things that are on a spectrum, where a condition could becalled a disease once it reaches a cetain state. Disease does imply a level of sickness and incapacitation, and maybe a permanent state? Alternatively we could classify and reclassify disorders but the general public gets left way behind. EDIT: There's also the notion that a disease is something you catch, which given our understanding of viruses and bacteria in triggering various diseases and conditions (and potentially some cancers) maybe excludes genetic and environmentally caused conditions?
      - Talanes 6y ago
blame_lewis 6y ago
This is a really dangerous and misleading way to look at bipolar. The disease proper of bipolar disorder is progressive and degenerative. This progression is accompanied by structural changes in the brain [1] as well as biological changes in the body [2]. If someone had the syndromes of manic or depressed symptoms in response to a medication, that does not prove either way that the person actually has the progressive and degenerative disease that can induce those syndromes spontaneously. If withdrawing the medication completely solves the problem, it simply indicates that they don't have the disease. The sentiment of "we're all a little crazy" is very old, and very dangerous to go around repeating. There's a specific threshold where things suddenly get orders of magnitude more fucked up, and anyone who has crossed this threshold will know how damaging it is to treat these diseases as if they're just an extension of normal human experiences. If you have this disease, you need to halt the degenerative process. I've taken my meds every single day for the last 14 years because I know what will happen if I stop. I have friends and family that went down that road, and it isn't pretty. [1] https://www.sciencedirect.com/science/article/abs/pii/S0006322307002338 https://www.sciencedirect.com/science/article/abs/pii/S00063... [2] https://www.sciencedaily.com/releases/2016/05/160531104421.htm https://www.sciencedaily.com/releases/2016/05/160531104421.h...
- jniedrauer 6y ago
  > The disease proper of bipolar disorder is progressive and degenerative. This is also not entirely true. It may spontaneously resolve itself in many cases[0]. I suspect that we've grouped a number of different disorders under the label "bipolar" because they all manifest with similar symptoms. [0] https://www.sciencedaily.com/releases/2009/09/090929141530.htm https://www.sciencedaily.com/releases/2009/09/090929141530.h...
  - blame_lewis 6y ago
    Thank you for that! I hadn't seen it before. I'm a little nervous about the idea of coming to conclusions about individual outcomes based on national surveys of self-reported diagnoses. It seems like there are vast opportunities for outside factors to mislead attempts at analysis. For example, the proportion of people who were misdiagnosed to start with; the increased openness over time when it comes to accepting or speaking about the diagnosis; the improvement in mental health resources meaning more diagnoses; the possibility that patients decompensate and lose insight or reject diagnoses over time; etc etc. If you're thinking "that sounds like a No True Scotsman", you're right. The disease is clearly progressive for some people. Declaring that people who don't demonstrate that progression don't have the disease is semantically useless but may be clinically useful.
Jommi 6y ago
As far as I understand, this kind of thinking is especially visual with Diabetes. People have different levels of insulin sensitivity, which changes over time with thing such as diet and excercise. Then magically one day you cross some arbitrary barrier, and you have type 2 diabetes. Crazy. Only recently has this even been taken under scrutiny, and the phrase "pre diabetic" is used more. But it's clearly not enough. I think the key to unlocking this is getting more people into measuring their insulin sensitivity through products like Veri[1] [1]https://www.veristable.com https://www.veristable.com
- phnofive 6y ago
  Great example of that barrier is gestational diabetes, which may as well be called secondary type two diabetes. It’s not a rubicon, either, since it’s so commonly reversible (though this isn’t trivially easy).
deleted 6y ago
[deleted]
WarOnPrivacy 6y ago
I'd long believed that cognitive issues like autism are on a 2 dimension spectrum and that all of us lie on it. Perhaps something similar applies to the personality disorders. However those disorders tend to overlap; I can't imagine the geometry that might to represent it.

61 points by scripthacker 6y ago

Well yes. But that shouldn't be much of a surprise to anyone, humanity isn't made of absolutes or boxes or borders. A spectrum you can be 'on', as the word suggests, is just a range or a degree within a classification so we have a common concept when communicating about things. If we had to develop a new word for every unique combination of attributes it would become very hard to talk about things.

awillen 6y ago

I've always thought about mental illness in this context - we define it as illness because of negative consequences, but it's really just the deviation from a norm. I think Elon Musk is the best example of this - even ignoring some of his childish Twitter behavior, the guy's brain is waaaaaaaaay far off from the normal human brain. He thought he could start an electric car company from scratch and be successful. That's... crazy. And yet, because he's been successful at it, we don't label him as mentally ill. The really interesting cases are people like artists - David Foster Wallace committed suicide because of his depression, but only after creating one of the great works of American literature. We label him as mentally ill for his depression, but we don't really have a label for the positive side of the fact that his brain was far from an average brain.

blueprint 6y ago
I would suggest a meaningful interpretation of the word normal is kind of like 'a reliably orthogonal measurement of the thing being reacted to'.
TylerE 6y ago
> He thought he could start an electric car company from scratch Except he didn't. He invested in one that was already started with several employees, and had himself given founder status by fiat as part of the deal.
- markdown 6y ago
  At what point do you consider a company founded? At the moment the business is registered by the local government?
  - TylerE 6y ago
    Well, when 3 guys start it and work on it for a long time, incorporate for a year, have an office and employees, and then a VC comes in, the VC definitely did not "found it", no matter when you define the actual date. https://web.archive.org/web/20150228163500/http://www.businessinsider.com/tesla-the-origin-story-2014-10 https://web.archive.org/web/20150228163500/http://www.busine...
  - Talanes 6y ago
    Regardless of how elastic you can get with the term "founded," the actual assertion of "founded from scratch" is much more specific.
dontcarethrow2 6y ago
From what I have heard, Musk bought the electric car company and not built it with his bare hands in his garage in college. But to your point, everyone is on the spectrum sure.
coldtea 6y ago
>I think Elon Musk is the best example of this - even ignoring some of his childish Twitter behavior, the guy's brain is waaaaaaaaay far off from the normal human brain. He thought he could start an electric car company from scratch and be successful. That's... crazy. Tons of people have started successful mega-companies from scratch. What's crazy, as opposed to ambitious and with slim chances of success due to practical reasons, about it?
mercer 6y ago
> David Foster Wallace committed suicide because of his depression, but only after creating one of the great works of American literature. We label him as mentally ill for his depression, but we don't really have a label for the positive side of the fact that his brain was far from an average brain. I'm a huge DFW fan, but I'd hesitate to use him as an example, for various reasons. First off, from what I understand he stabilized on particular meds but then quit them because he felt he'd be more creative without. Instead of being more creative, he slid back into depression and the medication didn't work anymore (apparently that's a thing? I'm not too familiar with anti-depressants). While I won't make any judgment as an outsider, it's not unreasonable to argue that he made a really bad gamble. It's quite possible that the it wasn't the medication that kept him from producing his next great work, but rather just the difficulty of what he was trying to do after Infinite Jest. Reading about it, it reminded me of various artists who 'jumped off the wagon' to return to previous glory, only to rediscover what being off the wagon really meant. Furthermore, his struggles with depression and suicidal ideation, as well as drawing his self-worth from his work seemed to be a running thread in his life. That said, his brain clearly wasn't average and I'm sure it played a positive role in his work. I'm just arguing against the common 'trope' that to do his work he had to be 'mentally ill'. I don't know either way, I just hold hope that these two don't need to be mutually exclusive.

KerryJones 6y ago

It's weird that we consider mental illness to be a disease, in my opinion -- none of the drugs have been linked to physical/chemical shortages in the brain or the like. We're able to mask symptoms but have absolutely no proof about underlying reasons, and so we create names of things and put it in the same classification of a medical disease... but that's very different. Bipolar cannot be identified by any physical means. Different doctors will tell you different things. I agree that gradient approaches are useful in most contexts, but I am very hesitant to use this when a drug can be prescribed (with knowing bad side effects) can be applied. It can seriously mess someone's life up.

roland00 6y ago
Mental Illness as defined by the DSM as not thriving. You can have the symptoms of a disorder, but if you are thriving then you do not have the disorder. >It can seriously mess someone's life up. Treatment to try fix someone who is not thriving, is precisely because someone's life is already messed up. Yes treatment may make it worse, but it often makes it better and there are treatment algorithms where we use best practices of how to go from here, and what signs should we be mindful for often when the meds make things worse the doctor should be asking the right questions for there are warning signs when the med is making things worse.
- KerryJones 6y ago
  The DSM is based off the "top" Psychiatrists at the time voting on the illnesses (literally), without scientific backing. Treatment's don't fix anything, they might lessen one issue and often give a host of other problems that are often more severe. I think more studying of iatrogenics is in order and more data about what "making it better" means -- as often the patient and doctor have different meanings. Again, because there's no physical symptom, you can't say "levels have returned to normal". If you were feeling depressed but now you feel nothing, is that better?
  - Kalium 6y ago
    The DSM can perhaps be viewed as a field guide to systems we can see the outer manifestations of but have limited deep insight into.

aj7 6y ago

Not only are we all somewhere on a spectrum, we’re on a linear combination of different spectra.

roland00 6y ago

There is a good video done by Philosophy Tube about this subject (it also talks about Jordan Peterson.) Some words are inherently subjective, like we can't define what "healthy" is without using so many words that are beyond description. (About 10 minutes in this metaphor appears, when Philosophy Tube references Richard Boyd.) https://www.youtube.com/watch?v=SEMB1Ky2n1E https://www.youtube.com/watch?v=SEMB1Ky2n1E

zabzonk 6y ago

What practitioners call mental health problems a "disease"? Surely that should be reserved for things like Covid or the plague?

dwd 6y ago
They all have two aspects, the cause and the disease it triggers. COVID-19 is the disease caused by the SARS-CoV-2 virus like AIDS is caused by HIV. It gets complicated where they don't know or understand the cause like a lot of autoimmune diseases.
- zabzonk 6y ago
  > like a lot of autoimmune diseases. I worked for some years in a lab testing for auto-immune conditions - we called it that - a condition. I suppose other labs might have labelled it otherwise. Would you call cancer a disease? I wouldn't. But I suppose this is just arguing over semantics.
  - dwd 6y ago
    It is semantics but then words matter if you're the one affected - having the doctor say you have a condition would be better than having a disease. I guess it depends on your definition of disease, which is technically broad in the literal sense of an abnormal negative medical condition. A condition in itself can be positive or negative and also has an implied connotation that it's just the current state. Seem to be hitting that original argument about labeling things that are on a spectrum, where a condition could becalled a disease once it reaches a cetain state. Disease does imply a level of sickness and incapacitation, and maybe a permanent state? Alternatively we could classify and reclassify disorders but the general public gets left way behind. EDIT: There's also the notion that a disease is something you catch, which given our understanding of viruses and bacteria in triggering various diseases and conditions (and potentially some cancers) maybe excludes genetic and environmentally caused conditions?
    - Talanes 6y ago

blame_lewis 6y ago

This is a really dangerous and misleading way to look at bipolar. The disease proper of bipolar disorder is progressive and degenerative. This progression is accompanied by structural changes in the brain [1] as well as biological changes in the body [2]. If someone had the syndromes of manic or depressed symptoms in response to a medication, that does not prove either way that the person actually has the progressive and degenerative disease that can induce those syndromes spontaneously. If withdrawing the medication completely solves the problem, it simply indicates that they don't have the disease. The sentiment of "we're all a little crazy" is very old, and very dangerous to go around repeating. There's a specific threshold where things suddenly get orders of magnitude more fucked up, and anyone who has crossed this threshold will know how damaging it is to treat these diseases as if they're just an extension of normal human experiences. If you have this disease, you need to halt the degenerative process. I've taken my meds every single day for the last 14 years because I know what will happen if I stop. I have friends and family that went down that road, and it isn't pretty. [1] https://www.sciencedirect.com/science/article/abs/pii/S0006322307002338 https://www.sciencedirect.com/science/article/abs/pii/S00063... [2] https://www.sciencedaily.com/releases/2016/05/160531104421.htm https://www.sciencedaily.com/releases/2016/05/160531104421.h...

jniedrauer 6y ago
> The disease proper of bipolar disorder is progressive and degenerative. This is also not entirely true. It may spontaneously resolve itself in many cases[0]. I suspect that we've grouped a number of different disorders under the label "bipolar" because they all manifest with similar symptoms. [0] https://www.sciencedaily.com/releases/2009/09/090929141530.htm https://www.sciencedaily.com/releases/2009/09/090929141530.h...
- blame_lewis 6y ago
  Thank you for that! I hadn't seen it before. I'm a little nervous about the idea of coming to conclusions about individual outcomes based on national surveys of self-reported diagnoses. It seems like there are vast opportunities for outside factors to mislead attempts at analysis. For example, the proportion of people who were misdiagnosed to start with; the increased openness over time when it comes to accepting or speaking about the diagnosis; the improvement in mental health resources meaning more diagnoses; the possibility that patients decompensate and lose insight or reject diagnoses over time; etc etc. If you're thinking "that sounds like a No True Scotsman", you're right. The disease is clearly progressive for some people. Declaring that people who don't demonstrate that progression don't have the disease is semantically useless but may be clinically useful.

Jommi 6y ago

As far as I understand, this kind of thinking is especially visual with Diabetes. People have different levels of insulin sensitivity, which changes over time with thing such as diet and excercise. Then magically one day you cross some arbitrary barrier, and you have type 2 diabetes. Crazy. Only recently has this even been taken under scrutiny, and the phrase "pre diabetic" is used more. But it's clearly not enough. I think the key to unlocking this is getting more people into measuring their insulin sensitivity through products like Veri[1] [1]https://www.veristable.com https://www.veristable.com

phnofive 6y ago
Great example of that barrier is gestational diabetes, which may as well be called secondary type two diabetes. It’s not a rubicon, either, since it’s so commonly reversible (though this isn’t trivially easy).

deleted 6y ago

[deleted]

WarOnPrivacy 6y ago

I'd long believed that cognitive issues like autism are on a 2 dimension spectrum and that all of us lie on it. Perhaps something similar applies to the personality disorders. However those disorders tend to overlap; I can't imagine the geometry that might to represent it.