7 ms·

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 t

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.
  - geofft 6y ago
    > The DSM is based off the "top" Psychiatrists at the time voting on the illnesses (literally), without scientific backing. What, precisely, would provide scientific backing here, if a vote by professional scientists doesn't count? A vote by academics? A committee of academics, appointed by a prior generation? A team at Harvard, because Harvard is the oldest? A committee appointed by the government?
    - Talanes 6y ago
      I believe their problem was with the structure of the process, and not with the composition of the governing body.
    - KerryJones 6y ago
      As Talanes mentioned -- the problem is with the decision method not the governing body. Again, comparing to the medical industry, where doctors don't vote on the existence or not of a virus causing a problem.
- treeman79 6y ago
  Doctors kept thinking I had a mental disorder. Several years of horrible experiences with medications were a waste Turned out it was a blood disorder. Proper treatment actually solved problems. Depression meds just meant I was cool with my mind not working right. I get some people are bipolar and such, but I think a lot of people have an underlying disorder they’re unaware of.
  - pdonis 6y ago
    Part of the diagnostic process is supposed to be checking for "non-mental" things like blood disorders, by doing blood tests and other evaluations. So it sounds like you went through a flawed diagnostic process. Unfortunately that is far more common than it should be. The best way I have found to mitigate that risk is to have an advocate with you (family member or close friend) whenever you talk to doctors or other medical personnel about diagnosis or treatment--preferably someone who isn't afraid to ask tough questions and be skeptical of what seem like cookbook answers.
    - treeman79 6y ago
      That was part of if. I had to bring someone to more or less break down in tears or yell at the doctor to get them to listen. Had several years of only basic blood work run. Check kidney function and the sort. Mri were always clean. This was across 20+ doctors. I had one that actually guessed correctly, but wasn’t his specialty. The specialist didn’t believe me. Later I realized the specialist was using very outdated diagnostic criteria. As it turns out this is very common.
- JumpCrisscross 6y ago
  > Mental Illness as defined by the DSM as not thriving Isn’t that a two-system measure? The person. And their society. A gay man in Tehran won’t thrive, but the solution isn’t medicating him into submission.
  - dragonwriter 6y ago
    > Isn’t that a two-system measure? Usually, three, because the specific “not thriving” criteria usually have a degree of subjectivity, so it's patient/society/clinician.
  - geofft 6y ago
    Yes, it is, and that's precisely why the removal of homosexuality from the DSM (in 1974) was not a sign of the DSM's authors giving into cultural pressures - it was a combination of the authors avoiding the cultural pressures that had caused the previous edition to list it, plus a realization (after scientific study) that the problem wasn't with the person, it was with their society. The nature of the scientific method is that we learn new things over time, and the nature of society is that we are all subject to various kinds of cultural pressures, most of which we don't even recognize. The meta-level goal of the DSM - describing those disorders which prevent someone from thriving and are properly treated by psychiatrists - seems sound, even if each edition always needs to be succeeded by a new one.
  - mftrhu 6y ago
    Yes. From page 20 of the DSM, > Definition of mental disorder > A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.
hnick 6y ago
I'd personally believe there are physical differences even if we can't see them yet, but there's no proof until we do see them one day. It depends if you subscribe to dualism or not I suppose. Until then we are finding fire through smoke. A spectrum will be based on a society so over time "normal" can shift. I wonder how many times that has happened? I've heard the USA as a population is typically very extroverted compared to many other countries, so perhaps that's one case.
- mercer 6y ago
  The problem is that even if we can do a 'perfect' brain scan and figure out consistent correlations in how its structure differs for people with various disorders, it still doesn't really help us all that much. It would be like doing a perfect read of a hard-drive and seeing correlations without understanding (for the most part) what the ones and zeroes actually mean.
blame_lewis 6y ago
> 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. This is why it's so important to understand that psychiatric treatment must be a collaborative process. The prescribing physician is only making decisions with the consent of the patient, because the patient is the one who has to choose to actually take the medication anyway. Those decisions are made based on the patient's description of their experience of the disease. A medication can only push you in a certain direction, and when trying to find the right direction, all the clinician has to go by is what the patient says they're experiencing. If your psychiatrist is simply telling you what your problems are, and prescribing you medications without your say in anything, then what you are receiving is not treatment. And it will, as you say, seriously mess [your] life up.
- nradov 6y ago
  What about patients who present a serious risk of harm to themselves and others? Should they be medicated without consent? Sometimes the only other option is indefinite confinement in a mental facility.
  - blame_lewis 6y ago
    Asterisk. I meant in the long term. In the very short term, hospital can be an option, but asylums no longer exist in first-world nations. Our treatment systems simply do not currently have an effective long-term way of handling patients that outright refuse to take their medication. In practical terms, these days most people in that situation end up in prisons instead.
- mercer 6y ago
  My experience (and anecdotally the experience of many people I know) is that because a psychiatrist's proverbial hammer is medication, it's really important to either try other things first (like a psychologist who doesn't immediately send you to a psychiatrist) or to at least make sure you have sources of advice/expertise other than just a psychiatrist. This is in The Netherlands, where AFAIK we're not particularly known for overprescribing medication, and our health care provides caregivers with enough funds to not go for the 'easy' pill solution right away. I imagine it's quite a bit more an acute risk in the US.
ip26 6y ago
We knew what scarlet fever looked like & could do for at least two thousand years before the creation of germ theory.
Skgqie1 6y ago
I'm not sure where you get your information, but mental illnesses certainly can be identified by physical (neurochemical) differences from a statistical baseline. Probably one of the easier ones to identify is dopamine deficiency and dysthymia. Drugs can certainly mess up someone's life (see my earlier post). But untreated mental illness can literally end your life (either directly, via suicide, or indirectly, via medical complications from body dysmorphic conditions)
- KerryJones 6y ago
  I've studied it extensively. Please provide evidence to the contrary. Here's one of mine about ADHD: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1518691/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1518691/
falcolas 6y ago
While this may be true for Bi-Polar disorder (I'm not as familiar with this), there are some mental disorders that do display as differences in the brain (such as ADHD). However, while these differences can't be rectified with medication or other therapies (yet), the side effects of these differences can be ameliorated by medication.
- KerryJones 6y ago
  ADHD has not had any proof about differences in the brain: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1518691/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1518691/
guerrilla 6y ago
> Bipolar cannot be identified by any physical means Most diseases couldn't be at one point and many still can't be now.
newacct583 6y ago
> none of the drugs have been linked to physical/chemical shortages in the brain or the like That's certainly not true. These things aren't understood very well, but it's not at all true that there's NO understanding of how brain chemistry and mental illness interact. > It can seriously mess someone's life up. In general drugs for bipolar are prescribed only once someone's life is already "messed up". You seem to be invoking something like the hippocratic oath, but please believe that's already a solid criteria in medicine. These drugs are prescribed because they are known to work (no, not always and not with any certainty, but that they work is not meaningfully disputed).
maxerickson 6y ago
People with dementia, which is often driven by clear physical processes (like cell death), exhibit symptoms of mental illness. They unquestionably have a disease and often respond to drugs.
jychang 6y ago
> We're able to mask symptoms but have absolutely no proof about underlying reasons That's true for a ridiculously large amount of non mental illness diseases, too. In fact, I'd say the majority of non-microbial/cancerous diseases fall into this category. Off the top of my head, one example would be Alzheimer's, where recently what was thought to be the "underlying reason" for Alzheimer's (amyloid plaques) have been proven to be a later symptom, not the actual cause. [1] Most autoimmune diseases also have similar problems. Turns out it's hard to figure out how the human body works. [1] https://www.nature.com/articles/d41586-018-05719-4 https://www.nature.com/articles/d41586-018-05719-4
mercer 6y ago
> 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. I remember talking to a doctor and saying pretty much the same thing. He looked at me, chuckled, and told me that I have no idea how much there is about so many 'medical diseases' that doctors don't know the 'underlying reason' for, and how many of the typical treatments are really just a "hey it seems to work without (too many) negative side effects, but we don't know why. ¯\_(ツ)_/¯."

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.
- geofft 6y ago
  > The DSM is based off the "top" Psychiatrists at the time voting on the illnesses (literally), without scientific backing. What, precisely, would provide scientific backing here, if a vote by professional scientists doesn't count? A vote by academics? A committee of academics, appointed by a prior generation? A team at Harvard, because Harvard is the oldest? A committee appointed by the government?
  - Talanes 6y ago
    I believe their problem was with the structure of the process, and not with the composition of the governing body.
  - KerryJones 6y ago
    As Talanes mentioned -- the problem is with the decision method not the governing body. Again, comparing to the medical industry, where doctors don't vote on the existence or not of a virus causing a problem.
treeman79 6y ago
Doctors kept thinking I had a mental disorder. Several years of horrible experiences with medications were a waste Turned out it was a blood disorder. Proper treatment actually solved problems. Depression meds just meant I was cool with my mind not working right. I get some people are bipolar and such, but I think a lot of people have an underlying disorder they’re unaware of.
- pdonis 6y ago
  Part of the diagnostic process is supposed to be checking for "non-mental" things like blood disorders, by doing blood tests and other evaluations. So it sounds like you went through a flawed diagnostic process. Unfortunately that is far more common than it should be. The best way I have found to mitigate that risk is to have an advocate with you (family member or close friend) whenever you talk to doctors or other medical personnel about diagnosis or treatment--preferably someone who isn't afraid to ask tough questions and be skeptical of what seem like cookbook answers.
  - treeman79 6y ago
    That was part of if. I had to bring someone to more or less break down in tears or yell at the doctor to get them to listen. Had several years of only basic blood work run. Check kidney function and the sort. Mri were always clean. This was across 20+ doctors. I had one that actually guessed correctly, but wasn’t his specialty. The specialist didn’t believe me. Later I realized the specialist was using very outdated diagnostic criteria. As it turns out this is very common.
JumpCrisscross 6y ago
> Mental Illness as defined by the DSM as not thriving Isn’t that a two-system measure? The person. And their society. A gay man in Tehran won’t thrive, but the solution isn’t medicating him into submission.
- dragonwriter 6y ago
  > Isn’t that a two-system measure? Usually, three, because the specific “not thriving” criteria usually have a degree of subjectivity, so it's patient/society/clinician.
- geofft 6y ago
  Yes, it is, and that's precisely why the removal of homosexuality from the DSM (in 1974) was not a sign of the DSM's authors giving into cultural pressures - it was a combination of the authors avoiding the cultural pressures that had caused the previous edition to list it, plus a realization (after scientific study) that the problem wasn't with the person, it was with their society. The nature of the scientific method is that we learn new things over time, and the nature of society is that we are all subject to various kinds of cultural pressures, most of which we don't even recognize. The meta-level goal of the DSM - describing those disorders which prevent someone from thriving and are properly treated by psychiatrists - seems sound, even if each edition always needs to be succeeded by a new one.
- mftrhu 6y ago
  Yes. From page 20 of the DSM, > Definition of mental disorder > A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.

hnick 6y ago

I'd personally believe there are physical differences even if we can't see them yet, but there's no proof until we do see them one day. It depends if you subscribe to dualism or not I suppose. Until then we are finding fire through smoke. A spectrum will be based on a society so over time "normal" can shift. I wonder how many times that has happened? I've heard the USA as a population is typically very extroverted compared to many other countries, so perhaps that's one case.

mercer 6y ago
The problem is that even if we can do a 'perfect' brain scan and figure out consistent correlations in how its structure differs for people with various disorders, it still doesn't really help us all that much. It would be like doing a perfect read of a hard-drive and seeing correlations without understanding (for the most part) what the ones and zeroes actually mean.

blame_lewis 6y ago

> 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. This is why it's so important to understand that psychiatric treatment must be a collaborative process. The prescribing physician is only making decisions with the consent of the patient, because the patient is the one who has to choose to actually take the medication anyway. Those decisions are made based on the patient's description of their experience of the disease. A medication can only push you in a certain direction, and when trying to find the right direction, all the clinician has to go by is what the patient says they're experiencing. If your psychiatrist is simply telling you what your problems are, and prescribing you medications without your say in anything, then what you are receiving is not treatment. And it will, as you say, seriously mess [your] life up.

nradov 6y ago
What about patients who present a serious risk of harm to themselves and others? Should they be medicated without consent? Sometimes the only other option is indefinite confinement in a mental facility.
- blame_lewis 6y ago
  Asterisk. I meant in the long term. In the very short term, hospital can be an option, but asylums no longer exist in first-world nations. Our treatment systems simply do not currently have an effective long-term way of handling patients that outright refuse to take their medication. In practical terms, these days most people in that situation end up in prisons instead.
mercer 6y ago
My experience (and anecdotally the experience of many people I know) is that because a psychiatrist's proverbial hammer is medication, it's really important to either try other things first (like a psychologist who doesn't immediately send you to a psychiatrist) or to at least make sure you have sources of advice/expertise other than just a psychiatrist. This is in The Netherlands, where AFAIK we're not particularly known for overprescribing medication, and our health care provides caregivers with enough funds to not go for the 'easy' pill solution right away. I imagine it's quite a bit more an acute risk in the US.

ip26 6y ago

We knew what scarlet fever looked like & could do for at least two thousand years before the creation of germ theory.

Skgqie1 6y ago

I'm not sure where you get your information, but mental illnesses certainly can be identified by physical (neurochemical) differences from a statistical baseline. Probably one of the easier ones to identify is dopamine deficiency and dysthymia. Drugs can certainly mess up someone's life (see my earlier post). But untreated mental illness can literally end your life (either directly, via suicide, or indirectly, via medical complications from body dysmorphic conditions)

KerryJones 6y ago
I've studied it extensively. Please provide evidence to the contrary. Here's one of mine about ADHD: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1518691/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1518691/

falcolas 6y ago

While this may be true for Bi-Polar disorder (I'm not as familiar with this), there are some mental disorders that do display as differences in the brain (such as ADHD). However, while these differences can't be rectified with medication or other therapies (yet), the side effects of these differences can be ameliorated by medication.

KerryJones 6y ago
ADHD has not had any proof about differences in the brain: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1518691/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1518691/

guerrilla 6y ago

> Bipolar cannot be identified by any physical means Most diseases couldn't be at one point and many still can't be now.

newacct583 6y ago

> none of the drugs have been linked to physical/chemical shortages in the brain or the like That's certainly not true. These things aren't understood very well, but it's not at all true that there's NO understanding of how brain chemistry and mental illness interact. > It can seriously mess someone's life up. In general drugs for bipolar are prescribed only once someone's life is already "messed up". You seem to be invoking something like the hippocratic oath, but please believe that's already a solid criteria in medicine. These drugs are prescribed because they are known to work (no, not always and not with any certainty, but that they work is not meaningfully disputed).

maxerickson 6y ago

People with dementia, which is often driven by clear physical processes (like cell death), exhibit symptoms of mental illness. They unquestionably have a disease and often respond to drugs.

jychang 6y ago

> We're able to mask symptoms but have absolutely no proof about underlying reasons That's true for a ridiculously large amount of non mental illness diseases, too. In fact, I'd say the majority of non-microbial/cancerous diseases fall into this category. Off the top of my head, one example would be Alzheimer's, where recently what was thought to be the "underlying reason" for Alzheimer's (amyloid plaques) have been proven to be a later symptom, not the actual cause. [1] Most autoimmune diseases also have similar problems. Turns out it's hard to figure out how the human body works. [1] https://www.nature.com/articles/d41586-018-05719-4 https://www.nature.com/articles/d41586-018-05719-4

mercer 6y ago

> 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. I remember talking to a doctor and saying pretty much the same thing. He looked at me, chuckled, and told me that I have no idea how much there is about so many 'medical diseases' that doctors don't know the 'underlying reason' for, and how many of the typical treatments are really just a "hey it seems to work without (too many) negative side effects, but we don't know why. ¯\_(ツ)_/¯."