4 ms·

No. It's a misconception that mental disorders are meant to categorize folks by sets of character/personality traits, whether or not they negatively impact some

No. It's a misconception that mental disorders are meant to categorize folks by sets of character/personality traits, whether or not they negatively impact someone. No, you do not have "a bit of OCD" if disorganization simply stresses you out. On the contrary, mental disorders are labels expressely intended to inform and enable treatment of distress. Disorder and treatment are inextricably linked. This is all according to how the DSM defines things, of course. Others may have opinions on how mental disorders should be defined.

thaumasiotes 5y ago
You're elaborating on how the categories are intended to be meaningless, but you're not doing much to claim that they are in fact not meaningless. If someone has low occupational functioning, you could call that a disorder. But why would you call it "ADHD"? Why would you call it ADHD for some people and OCD for other people? Suppose you have two lists of symptoms: Attention Deficit Hyperactivity Disorder - Patient has an active mind. - Patient has a crummy job. Borderline Personality Disorder - Patient rubs me the wrong way. - Patient has a crummy job. And you have several people who display every combination of mental activity, mental lethargy, likeability, unlikeability, good jobs, and bad jobs. You say everyone with a good job has no mental disorder, unlikeable people with mental lethargy and a bad job have borderline personality disorder, likeable people with mental activity and a bad job have ADHD, and unlikeable people with mental activity and a bad job have borderline personalities _and_ ADHD. Likeable people with mental lethargy and a bad job have a disorder as yet unnamed. What did you learn about the reasons why people with bad jobs (your primary diagnostic criterion, after all!) have bad jobs?
- lazide 5y ago
  That is definitely not how it is defined through - it seems to be a straw man? The criteria is essentially ‘you meet these criteria AND it causes clear problems with your ability to live your life’. It doesn’t mean you have a bad job and X, therefore you have ADHD. Rather, you show ADHD traits and they get in the way (and cause you distress) in doing a job you otherwise would be entirely capable of doing. Or consistently fail (and have distress) on social environments you’d otherwise be perfectly fine in, etc. If you don’t have a criteria like that, there is no useful criteria at all, since practically all medicine is oriented towards fixing things that aren’t working correctly/causing problems. It’s the same type of criteria used for evaluating everything from heart disease to stroke to a broken bone. Or in other words ‘if it ain’t broken, then it isn’t broken.’
  - thaumasiotes 5y ago
    That is absolutely not how strokes and broken bones are diagnosed. If one of your bones breaks, you have a broken bone. Whether it hurts, or stops you from doing things you'd like to do, is an unrelated question.
    - kdmccormick 5y ago
      I think you're missing the point. Let me be concrete. I'm diagnosed with bipolar disorder. Sometimes I feel axnious and euphoric, other times depressed and lethargic, both at extremes noticably deviant from the average person. This has caused all sorts of turbulence and distress in my personal and academic life. Being diagnosed allowed me access to therapy and prescriptions. There exist plenty of people who oscillate between distinctively high and low moods, but have never found themselves in serious distress because of it. Thus, they have not been diagnosed with bipolar disorder. Whether or not they "are bipolar" is a subjective question that mainstream psychiatry doesn't seem to have an opinion on.
      - thaumasiotes 5y ago
        So when you find a person whose highs are higher than yours, and whose lows are lower than yours, and whose life is better than yours, that person doesn't have bipolar disorder, because they're not experiencing problems. Which makes the idea of "bipolar disorder" meaningless. That person demonstrates that your problems are not caused by bipolar disorder. But the disorder is defined by you having problems, even though the problems come from somewhere else.
        kdmccormick 5y ago
        > whose life is better than yours, that person doesn't have bipolar disorder, because they're not experiencing problems Your argument seems to hinge on this idea that a good life => no distress, which, if you've interacted with anyone diagnosed with a mental disorder, is obviously not true. My life is great. If I didn't take a mood stabilizer, it'd probably still be good, but not as good. Regardless, my mood swings can negatively affect me and those around me. If one day I reach a point where I can live without meds or therapy and reap no negative consequences, then yes, it would be fair at that point to say that I no longer had bipolar disorder. > That person demonstrates that your problems are not caused by bipolar disorder. But the disorder is defined by you having problems, even though the problems come from somewhere else. Bingo. My symptoms (mood swings) + my problems ARE the cause my bipolar disorder diagnosis. Until I had problems, I had no disorder. What causes the mood swings, then? Genetics, upbringing, life experiences, diet, idk. Nobody knows for sure. It's an active area of research, but there is no one known cause. For all we know, there may be five independent and unrelated risk factors that lead to someone developing bipolar disorder. It's like you get it, but you're still dismissing it for some reason. I'm curious what ulterior point you're trying to make.
- crdrost 5y ago
  Like I understand why you are being downvoted here, your comment is kind of confrontational and kind of strawmanny, but the concern I think is quite valid and deserves a real response. My response is, mental illness is something more personal than a broken bone and at present diagnosis needs to be cruder, which does make the categories a bit more "meaningless" but I don't think it gets all the way there. So, like, take depression for example. I am being slightly unfair but hopefully on-the-nose when I say that DSM defines depression essentially as "you are too sad, too often, and you are not in a situation like mourning a parent or spouse where that level of sadness would be expected." The point is, it's a symptomatic diagnosis. Other symptomatic diagnoses include “migraine” or “hypertension” or “diabetes” being symptomatic is not necessarily something that excludes meaningfulness, I think we could agree? But it also means that there is a difficulty with treatment. This medicine might work for your migraine but not her migraine; whereas my hypertension is caused by not getting a good night's sleep due to mild apnea and can be cured by a CPAP machine, his hypertension is caused by the fact that he weighs 350 pounds and CPAP therapy will fail. OK, so like diabetes there is not just one major depression, and maybe some day we will distinguish between "type 1 depression, type 2 depression, gestational depression, predepression" and have specific causes subsumed as different "types" of the symptoms. Maybe not. But the label still has some sort of meaning, just like we can have "migraine medicine" as a group of things worth trying if you have migraines, or like how we can use insulin to handle diabetes in general and so on. But then combine this with another question which is, "for mental illness, what does cured or managed even look like?" and that's where this occupational functioning criterion starts to look quite reasonable. Because the deal is that if "depression" isn't going to single out a particular cause, the causes of your depression will still likely be around, just like "we have you using insulin" has technically fixed your diabetes (that is, the symptom -- the hypoglycemia) but the cause is still not addressed. That these illnesses take place in the mind makes them harder to quantify. So we need a qualitative criterion, a "how bad is the pain from 1 to 10?", so that we can measure if the intervention is improving things. Asking questions about your occupational functioning is thus a reasonable qualitative scale to indicate the severity of the symptoms and the success of treatment, even though it says nothing about cause. The different "buckets" of symptoms still make sense as they suggest categories of things-going-wrong and clusters of treatments-for-those-things.
myself248 5y ago
But basically, if you have some horrible effects from the thing, and by some herculean effort or remarkable circumstance you're able to work around it, then by definition you don't have a disorder and it's not treatable. Heaven help you if the effort or circumstance becomes unsustainable, when you could've had years to treat the underlying problem but medicine denied it was a problem.
- kdmccormick 5y ago
  Such "herculean efforts" would constitute distress. If you're successfully busting ass every day to compensate for depressive symptoms, you might have a depressive disorder. As for your point w.r.t. circumstances: yes, this seems to be by design. Someome who might be diagnosed with schizophrenia in the US could easily be considered just quirky or even revered as a sort of spiritual guru in other cultures where symptoms have fewer/no negative impacts (and thus do not present so "horribly").

thaumasiotes 5y ago

You're elaborating on how the categories are intended to be meaningless, but you're not doing much to claim that they are in fact not meaningless. If someone has low occupational functioning, you could call that a disorder. But why would you call it "ADHD"? Why would you call it ADHD for some people and OCD for other people? Suppose you have two lists of symptoms: Attention Deficit Hyperactivity Disorder - Patient has an active mind. - Patient has a crummy job. Borderline Personality Disorder - Patient rubs me the wrong way. - Patient has a crummy job. And you have several people who display every combination of mental activity, mental lethargy, likeability, unlikeability, good jobs, and bad jobs. You say everyone with a good job has no mental disorder, unlikeable people with mental lethargy and a bad job have borderline personality disorder, likeable people with mental activity and a bad job have ADHD, and unlikeable people with mental activity and a bad job have borderline personalities _and_ ADHD. Likeable people with mental lethargy and a bad job have a disorder as yet unnamed. What did you learn about the reasons why people with bad jobs (your primary diagnostic criterion, after all!) have bad jobs?

lazide 5y ago
That is definitely not how it is defined through - it seems to be a straw man? The criteria is essentially ‘you meet these criteria AND it causes clear problems with your ability to live your life’. It doesn’t mean you have a bad job and X, therefore you have ADHD. Rather, you show ADHD traits and they get in the way (and cause you distress) in doing a job you otherwise would be entirely capable of doing. Or consistently fail (and have distress) on social environments you’d otherwise be perfectly fine in, etc. If you don’t have a criteria like that, there is no useful criteria at all, since practically all medicine is oriented towards fixing things that aren’t working correctly/causing problems. It’s the same type of criteria used for evaluating everything from heart disease to stroke to a broken bone. Or in other words ‘if it ain’t broken, then it isn’t broken.’
- thaumasiotes 5y ago
  That is absolutely not how strokes and broken bones are diagnosed. If one of your bones breaks, you have a broken bone. Whether it hurts, or stops you from doing things you'd like to do, is an unrelated question.
  - kdmccormick 5y ago
    I think you're missing the point. Let me be concrete. I'm diagnosed with bipolar disorder. Sometimes I feel axnious and euphoric, other times depressed and lethargic, both at extremes noticably deviant from the average person. This has caused all sorts of turbulence and distress in my personal and academic life. Being diagnosed allowed me access to therapy and prescriptions. There exist plenty of people who oscillate between distinctively high and low moods, but have never found themselves in serious distress because of it. Thus, they have not been diagnosed with bipolar disorder. Whether or not they "are bipolar" is a subjective question that mainstream psychiatry doesn't seem to have an opinion on.
    - thaumasiotes 5y ago
      So when you find a person whose highs are higher than yours, and whose lows are lower than yours, and whose life is better than yours, that person doesn't have bipolar disorder, because they're not experiencing problems. Which makes the idea of "bipolar disorder" meaningless. That person demonstrates that your problems are not caused by bipolar disorder. But the disorder is defined by you having problems, even though the problems come from somewhere else.
      - kdmccormick 5y ago
        > whose life is better than yours, that person doesn't have bipolar disorder, because they're not experiencing problems Your argument seems to hinge on this idea that a good life => no distress, which, if you've interacted with anyone diagnosed with a mental disorder, is obviously not true. My life is great. If I didn't take a mood stabilizer, it'd probably still be good, but not as good. Regardless, my mood swings can negatively affect me and those around me. If one day I reach a point where I can live without meds or therapy and reap no negative consequences, then yes, it would be fair at that point to say that I no longer had bipolar disorder. > That person demonstrates that your problems are not caused by bipolar disorder. But the disorder is defined by you having problems, even though the problems come from somewhere else. Bingo. My symptoms (mood swings) + my problems ARE the cause my bipolar disorder diagnosis. Until I had problems, I had no disorder. What causes the mood swings, then? Genetics, upbringing, life experiences, diet, idk. Nobody knows for sure. It's an active area of research, but there is no one known cause. For all we know, there may be five independent and unrelated risk factors that lead to someone developing bipolar disorder. It's like you get it, but you're still dismissing it for some reason. I'm curious what ulterior point you're trying to make.
crdrost 5y ago
Like I understand why you are being downvoted here, your comment is kind of confrontational and kind of strawmanny, but the concern I think is quite valid and deserves a real response. My response is, mental illness is something more personal than a broken bone and at present diagnosis needs to be cruder, which does make the categories a bit more "meaningless" but I don't think it gets all the way there. So, like, take depression for example. I am being slightly unfair but hopefully on-the-nose when I say that DSM defines depression essentially as "you are too sad, too often, and you are not in a situation like mourning a parent or spouse where that level of sadness would be expected." The point is, it's a symptomatic diagnosis. Other symptomatic diagnoses include “migraine” or “hypertension” or “diabetes” being symptomatic is not necessarily something that excludes meaningfulness, I think we could agree? But it also means that there is a difficulty with treatment. This medicine might work for your migraine but not her migraine; whereas my hypertension is caused by not getting a good night's sleep due to mild apnea and can be cured by a CPAP machine, his hypertension is caused by the fact that he weighs 350 pounds and CPAP therapy will fail. OK, so like diabetes there is not just one major depression, and maybe some day we will distinguish between "type 1 depression, type 2 depression, gestational depression, predepression" and have specific causes subsumed as different "types" of the symptoms. Maybe not. But the label still has some sort of meaning, just like we can have "migraine medicine" as a group of things worth trying if you have migraines, or like how we can use insulin to handle diabetes in general and so on. But then combine this with another question which is, "for mental illness, what does cured or managed even look like?" and that's where this occupational functioning criterion starts to look quite reasonable. Because the deal is that if "depression" isn't going to single out a particular cause, the causes of your depression will still likely be around, just like "we have you using insulin" has technically fixed your diabetes (that is, the symptom -- the hypoglycemia) but the cause is still not addressed. That these illnesses take place in the mind makes them harder to quantify. So we need a qualitative criterion, a "how bad is the pain from 1 to 10?", so that we can measure if the intervention is improving things. Asking questions about your occupational functioning is thus a reasonable qualitative scale to indicate the severity of the symptoms and the success of treatment, even though it says nothing about cause. The different "buckets" of symptoms still make sense as they suggest categories of things-going-wrong and clusters of treatments-for-those-things.

myself248 5y ago

But basically, if you have some horrible effects from the thing, and by some herculean effort or remarkable circumstance you're able to work around it, then by definition you don't have a disorder and it's not treatable. Heaven help you if the effort or circumstance becomes unsustainable, when you could've had years to treat the underlying problem but medicine denied it was a problem.

kdmccormick 5y ago
Such "herculean efforts" would constitute distress. If you're successfully busting ass every day to compensate for depressive symptoms, you might have a depressive disorder. As for your point w.r.t. circumstances: yes, this seems to be by design. Someome who might be diagnosed with schizophrenia in the US could easily be considered just quirky or even revered as a sort of spiritual guru in other cultures where symptoms have fewer/no negative impacts (and thus do not present so "horribly").