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Comments here are predictably (and depressingly) misstating this research as "medicalizing normal emotions." This is due to two widespread misconceptions: 1) A

Comments here are predictably (and depressingly) misstating this research as "medicalizing normal emotions." This is due to two widespread misconceptions: 1) A refusal to distinguish between mental illness and permanent psychological disability (along with the idea that all mental illnesses are neurostructural in nature) 2) A refusal to acknowledge that "biologically normal" human emotions can nevertheless be a cause for medical concern, in the sense that a high fever is a "normal" and necessary response to infection that can nevertheless cause serious problems. If someone is deeply depressed after their mother dies, they should be considered as having a mental injury that should heal on its own but needs to be monitored for "infection" or otherwise problematic healing. Saying ahead of time "this person isn't mentally ill so this is just normal bereavement" is bad medicine and bad science. US society in particular (but also humans in general) really wants to draw a distinction between "the mentally ill" and "the mentally well." If you were to try to draw a similarly strong distinction between "people with stomach problems" and "people without stomach problems" the absurdity would be self-evident: there is no reason to lump people with norovirus in with people with IBD. But because mental illness is so much more mysterious (and, frankly, scary), and so entwined with social and societal expectations and norms, it is much harder to approach it from the same medical-first perspective.

montagg 6y ago
The book Emotional First Aid by Dr. Guy Winch was my first introduction to a mental model of emotions that allowed for this type of thinking: injuries, ways to heal, and the difference between an emotional paper cut and an emotional broken arm and how it’s common to treat the latter like the former. Great book for anyone who wants to learn strategies for taking their own emotions and needs seriously.
Godel_unicode 6y ago
I've always been surprised by the lack of the chronic vs acute verbiage that is used other places in medicine, for instance in physical pain management.
DubiousPusher 6y ago
> (along with the idea that all mental illnesses are neurostructural in nature) I agree with everything you said except I'm having trouble with this bit. Neurostructural as opposed to what? All thoughts are physical things happening in the head. The brain changes. Sometimes it changes to a state that creates problems for a person (perhaps long term depression spurred by grieving a loved one.) Sometimes talk or time can change it back. Or change it to another state that isn't impaired by ticks or grief or anger. But it is a physical process. I understand that sometimes working at the granular level of neurons or chemistry isn't as productive as working at the psychological level. i.e. sometimes talking about emotions can get the brain to start to encourage different pathways that will eventually become the norm and take one away from the problematic ones. But this is still a neurostructural change in the brain. It is just mediated by the brain itself. Perhaps I am missing some subtle point or misinterpreting you?
- ojnabieoot 6y ago
  No, I was being vague and you are basically correct: I really meant "occurring due to a static abberation in the brain present since birth / puberty / adulthood", like schizophrenia, bipolar disorder, many forms of depression, versus something that can be induced by circumstances or upbringing. Making it more vague is, for instance, that PTSD is obviously "induced by circumstances" but is also thought to be due to a brain injury caused by emotional trauma. Scientifically there isn't a boundary, and I am speaking very loosely here and probably should have said something more specific. But "all thoughts are physical things happening in the head" is perhaps too reductive, similar to saying "all physics is quantum mechanics" - just because it's true doesn't mean it's a useful way to think about a specific problem. There's a distinct medical difference between someone with chronic depression without a specific life event ("neurostructural"), and someone who started out being "legitimately" depressed after being laid off, but spiralled downwards. Both can be described as a "deficit in the structure of the brain" but in the former case that structural deficit likely cannot be fixed by the brain itself (even with the guidance of a therapist) and drugs are probably necessary. In the latter case, perhaps only CBT and general wellness habits are enough - the brain can fix its own "structural problem."
  - 6y ago
rjkennedy98 6y ago
What? I'm sorry... what? Nothing you said here made any sense. > 1) A refusal to distinguish between mental illness and permanent psychological disability (along with the idea that all mental illnesses are neurostructural in nature) You mean by doctors, right? Certainly you can't mean by posters, because you know posters make the DSM. > 2) A refusal to acknowledge that "biologically normal" human emotions can nevertheless be a cause for medical concern, in the sense that a high fever is a "normal" and necessary response to infection that can nevertheless cause serious problems. Yes because a high fever is a biologically normal human state. Seriously, how does this nonsense get voted to the top of the responses. > US society in particular (but also humans in general) really wants to draw a distinction between "the mentally ill" and "the mentally well." No Big Pharma and the NIMH do. Not "society". If you know anything about the history of the space you know how much of this was driven by greed. Billions and billions of dollars are made off of antidepressants, antipsychotics and the like. It is HUGE HUGE business.
- ojnabieoot 6y ago
  > Certainly you can't mean by posters, because you know posters make the DSM. I was specifically talking about the commenters and society, not psychiatrists! > Yes because a high fever is a biologically normal human state It is when you're sick! Just like being too depressed to get out of bed is "biologically normal" after being dumped. You are completely misunderstanding my point, which would be much less irritating if you weren't so dismissive and arrogant. As for your last point: this is very subtle and not really a good thing for an HN comment. However, the biggest logical problem you have is that you are separating "Big Pharma" and the "NIMH" from "society," which is transparently ridiculous. The human rights problems in psychopharmacology are not induced by a cabal of independent pharma executives and corrupt psychiatrists: it is a symptom of the same societal problems that, on one hand, makes people with severe schizophrenia sleep on the street; and, on the other hand, markets serious medical interventions (benzos, SSRIs, etc) as "self-improvement" (or blatant recreational drugs) for the upper-middle-class.
  - rjkennedy98 6y ago
    I'm arrogant because I know way more about this than you probably ever will. My brother is a psychiatrist and has published papers on systematic issues with psychiatric drug trials. You are another internet commentator that thinks they have grasped the current zeitgeist, when actually you don't understand that what you call "society" is just manufactured B.S. shoved down our throats to make billions and billions of dollars for Big Pharma and their cronies. Do you even know who Peter Gotzsche, Robert Whitaker, or David Healy are? Do you actually follow this stuff? And I'm really glad that you are such an expert on Big Pharma corruption /s. I'm sure next you will lecture me on how the opiod scandal is about our society and not about the Sacklers and Purdue Pharma.

montagg 6y ago

The book Emotional First Aid by Dr. Guy Winch was my first introduction to a mental model of emotions that allowed for this type of thinking: injuries, ways to heal, and the difference between an emotional paper cut and an emotional broken arm and how it’s common to treat the latter like the former. Great book for anyone who wants to learn strategies for taking their own emotions and needs seriously.

Godel_unicode 6y ago

I've always been surprised by the lack of the chronic vs acute verbiage that is used other places in medicine, for instance in physical pain management.

DubiousPusher 6y ago

> (along with the idea that all mental illnesses are neurostructural in nature) I agree with everything you said except I'm having trouble with this bit. Neurostructural as opposed to what? All thoughts are physical things happening in the head. The brain changes. Sometimes it changes to a state that creates problems for a person (perhaps long term depression spurred by grieving a loved one.) Sometimes talk or time can change it back. Or change it to another state that isn't impaired by ticks or grief or anger. But it is a physical process. I understand that sometimes working at the granular level of neurons or chemistry isn't as productive as working at the psychological level. i.e. sometimes talking about emotions can get the brain to start to encourage different pathways that will eventually become the norm and take one away from the problematic ones. But this is still a neurostructural change in the brain. It is just mediated by the brain itself. Perhaps I am missing some subtle point or misinterpreting you?

ojnabieoot 6y ago
No, I was being vague and you are basically correct: I really meant "occurring due to a static abberation in the brain present since birth / puberty / adulthood", like schizophrenia, bipolar disorder, many forms of depression, versus something that can be induced by circumstances or upbringing. Making it more vague is, for instance, that PTSD is obviously "induced by circumstances" but is also thought to be due to a brain injury caused by emotional trauma. Scientifically there isn't a boundary, and I am speaking very loosely here and probably should have said something more specific. But "all thoughts are physical things happening in the head" is perhaps too reductive, similar to saying "all physics is quantum mechanics" - just because it's true doesn't mean it's a useful way to think about a specific problem. There's a distinct medical difference between someone with chronic depression without a specific life event ("neurostructural"), and someone who started out being "legitimately" depressed after being laid off, but spiralled downwards. Both can be described as a "deficit in the structure of the brain" but in the former case that structural deficit likely cannot be fixed by the brain itself (even with the guidance of a therapist) and drugs are probably necessary. In the latter case, perhaps only CBT and general wellness habits are enough - the brain can fix its own "structural problem."
- 6y ago

rjkennedy98 6y ago

What? I'm sorry... what? Nothing you said here made any sense. > 1) A refusal to distinguish between mental illness and permanent psychological disability (along with the idea that all mental illnesses are neurostructural in nature) You mean by doctors, right? Certainly you can't mean by posters, because you know posters make the DSM. > 2) A refusal to acknowledge that "biologically normal" human emotions can nevertheless be a cause for medical concern, in the sense that a high fever is a "normal" and necessary response to infection that can nevertheless cause serious problems. Yes because a high fever is a biologically normal human state. Seriously, how does this nonsense get voted to the top of the responses. > US society in particular (but also humans in general) really wants to draw a distinction between "the mentally ill" and "the mentally well." No Big Pharma and the NIMH do. Not "society". If you know anything about the history of the space you know how much of this was driven by greed. Billions and billions of dollars are made off of antidepressants, antipsychotics and the like. It is HUGE HUGE business.

ojnabieoot 6y ago
> Certainly you can't mean by posters, because you know posters make the DSM. I was specifically talking about the commenters and society, not psychiatrists! > Yes because a high fever is a biologically normal human state It is when you're sick! Just like being too depressed to get out of bed is "biologically normal" after being dumped. You are completely misunderstanding my point, which would be much less irritating if you weren't so dismissive and arrogant. As for your last point: this is very subtle and not really a good thing for an HN comment. However, the biggest logical problem you have is that you are separating "Big Pharma" and the "NIMH" from "society," which is transparently ridiculous. The human rights problems in psychopharmacology are not induced by a cabal of independent pharma executives and corrupt psychiatrists: it is a symptom of the same societal problems that, on one hand, makes people with severe schizophrenia sleep on the street; and, on the other hand, markets serious medical interventions (benzos, SSRIs, etc) as "self-improvement" (or blatant recreational drugs) for the upper-middle-class.
- rjkennedy98 6y ago
  I'm arrogant because I know way more about this than you probably ever will. My brother is a psychiatrist and has published papers on systematic issues with psychiatric drug trials. You are another internet commentator that thinks they have grasped the current zeitgeist, when actually you don't understand that what you call "society" is just manufactured B.S. shoved down our throats to make billions and billions of dollars for Big Pharma and their cronies. Do you even know who Peter Gotzsche, Robert Whitaker, or David Healy are? Do you actually follow this stuff? And I'm really glad that you are such an expert on Big Pharma corruption /s. I'm sure next you will lecture me on how the opiod scandal is about our society and not about the Sacklers and Purdue Pharma.