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I think it's fair to compare modern psychological knowledge and treatment strategies to mid-19th century medical approaches to infectious disease, in that root

I think it's fair to compare modern psychological knowledge and treatment strategies to mid-19th century medical approaches to infectious disease, in that root causes of mental illness are poorly understood and diagnosis is based more on opinion than on irrefutable tests. For example, compare the understanding of tuberculosis in the 1850s to the understanding of today. Then it was called 'consumption' and there were various theories about its causes, its transmissibility, and its treatment, but today we can do a definitive PCR test and we know the root cause is an infectious bacteria (though even so, we are still not really sure why, in a cohort of exposed individuals, some immune systems are capable of defeating the microorganism and others are not). Doctors could fairly reliably diagnose it, but that was about it. Similarly, today there are no definitive tests for schizophrenia, bipolar disorder, ADHD, depression or anxiety, and it really just comes down to the opinion of the psychologist/psychiatrist. It's clear a history of trauma of various sorts increases the risks of developing mental illness, but nobody can say with much certainty if there are genetic predispositions or not. The two most prevalent approaches to treatment are therapy vs. a collection of drugs with problematic side effects, and even there, the psychedelic class of drugs has largely been banned though they do show promise in controlled treatment (this is changing, but slowly). Obviously the whole mental illness field has a long way to go if it wants to catch up to the infectious disease field (and even there, we're seeing a lot of recent failures of public health goals, be it from the rise of antibiotic resistance or reckless gain-of-function research).

dbspin 4y ago
"It's clear a history of trauma of various sorts increases the risks of developing mental illness, but nobody can say with much certainty if there are genetic predispositions or not." This isn't accurate. As far back as my psych degree in the late 2000s there were clear estimates of the degree of heritability of various psychological disorders - especially disorders with strong organic elements like schizophrenia and ADD/ADHD. What makes psychological disorders difficult to understand is not a mysterious hidden biogenic causation. We know at least in terms of percentage contributions, quite a bit about the involvement of physical processes and systems in psychological disorder, from the gut microbiome to inflammation. If psychological disorders were essentially diseases, with prognosis, a set of distinct aetiologies etc, psychology would just be a branch of medicine with poor data. Unfortunately mental illnesses are profoundly unlike physical illnesses in numerous ways. For example their symptomatology is usually culturally determined - e.g.: things we associate with depression in the West (dysphoria, anhedonia, melancholy etc) are quite different from the symptoms of epidemiologically similar disorders in other cultures (e.g.: pre-westernisation China). There's a lot to unpack here, but psychological disorders are profoundly more complex (ontologically) than physical disorders. Often the medical lens isn't particularly helpful. For example we see rates of disorders like anxiety and depression rise under stressful socioeconomic conditions. These are often disorders of meaning and the persons understanding of the world. There are also a host of 'culture bound' syndromes - from anorexia to folie a deux to koro, that make no sense to think of in terms of 'illness'. So it's as likely that the medical model is holding back understanding of these often sociological, psychological and cultural phenomena as helping. That said it's not nearly as simple as that, since there are genetic components to so many disorders!
- ThrowawayTestr 4y ago
  >For example their symptomatology is usually culturally determined Could you expand on that? How is depression different in China?
  - dbspin 4y ago
    So I have no idea what the current state of the research on this is, or how depression manifests in contemporary (culturally Westernised) China, but historically there was quite a bit of research indicating it was more somaticised. People suffering from a depression like disorder were more likely to feel physically exhausted and weak than sad or hopeless. Something more like what we'd today refer to as chronic fatigue in the West. This study (from the 80s) looks like one of the origins of that idea - https://link.springer.com/article/10.1007/BF00051427 https://link.springer.com/article/10.1007/BF00051427 Bear in mind my degree is quite old at this point, but a reference point for me during my undergrad was Malcolm MacLachlan's brilliant book Culture and Health A Critical Perspective Towards Global Health. https://brownsbfs.co.uk/Product/MacLachlan-M/Culture-and-health---a-critical-perspective-towards-global-health/9780470847374 https://brownsbfs.co.uk/Product/MacLachlan-M/Culture-and-hea... Here's a quote from the book (which I was lucky enough to receive as a PDF preprint in college) "The experience of depression within an individual can vary over time – commonly referred to as the disease course – and, as already noted, it can vary between individuals of the same culture – commonly referred to as a disease syndrome. Kleinman’s suggestion that depression can also vary across cultures and across different historical epochs is quite consistent with a biologi- cal view of depression. He has also studied a condition known as neurasthenia. This condition, commonly reported in China, is characterised by a lack of energy and physical complaints such as a sore stomach. Klein- man has suggested that, although depression and neurasthenia are different illness experiences, they are both products of the same underlying disease processes – depression. In other words, neurasthenia is the Chinese version of western depression." It's obscenely expensive, but you may hypothetically be able to find other ways of reading the book online.
    - ThrowawayTestr 4y ago
      Thank you for the detailed response!

dbspin 4y ago

"It's clear a history of trauma of various sorts increases the risks of developing mental illness, but nobody can say with much certainty if there are genetic predispositions or not." This isn't accurate. As far back as my psych degree in the late 2000s there were clear estimates of the degree of heritability of various psychological disorders - especially disorders with strong organic elements like schizophrenia and ADD/ADHD. What makes psychological disorders difficult to understand is not a mysterious hidden biogenic causation. We know at least in terms of percentage contributions, quite a bit about the involvement of physical processes and systems in psychological disorder, from the gut microbiome to inflammation. If psychological disorders were essentially diseases, with prognosis, a set of distinct aetiologies etc, psychology would just be a branch of medicine with poor data. Unfortunately mental illnesses are profoundly unlike physical illnesses in numerous ways. For example their symptomatology is usually culturally determined - e.g.: things we associate with depression in the West (dysphoria, anhedonia, melancholy etc) are quite different from the symptoms of epidemiologically similar disorders in other cultures (e.g.: pre-westernisation China). There's a lot to unpack here, but psychological disorders are profoundly more complex (ontologically) than physical disorders. Often the medical lens isn't particularly helpful. For example we see rates of disorders like anxiety and depression rise under stressful socioeconomic conditions. These are often disorders of meaning and the persons understanding of the world. There are also a host of 'culture bound' syndromes - from anorexia to folie a deux to koro, that make no sense to think of in terms of 'illness'. So it's as likely that the medical model is holding back understanding of these often sociological, psychological and cultural phenomena as helping. That said it's not nearly as simple as that, since there are genetic components to so many disorders!

ThrowawayTestr 4y ago
>For example their symptomatology is usually culturally determined Could you expand on that? How is depression different in China?
- dbspin 4y ago
  So I have no idea what the current state of the research on this is, or how depression manifests in contemporary (culturally Westernised) China, but historically there was quite a bit of research indicating it was more somaticised. People suffering from a depression like disorder were more likely to feel physically exhausted and weak than sad or hopeless. Something more like what we'd today refer to as chronic fatigue in the West. This study (from the 80s) looks like one of the origins of that idea - https://link.springer.com/article/10.1007/BF00051427 https://link.springer.com/article/10.1007/BF00051427 Bear in mind my degree is quite old at this point, but a reference point for me during my undergrad was Malcolm MacLachlan's brilliant book Culture and Health A Critical Perspective Towards Global Health. https://brownsbfs.co.uk/Product/MacLachlan-M/Culture-and-health---a-critical-perspective-towards-global-health/9780470847374 https://brownsbfs.co.uk/Product/MacLachlan-M/Culture-and-hea... Here's a quote from the book (which I was lucky enough to receive as a PDF preprint in college) "The experience of depression within an individual can vary over time – commonly referred to as the disease course – and, as already noted, it can vary between individuals of the same culture – commonly referred to as a disease syndrome. Kleinman’s suggestion that depression can also vary across cultures and across different historical epochs is quite consistent with a biologi- cal view of depression. He has also studied a condition known as neurasthenia. This condition, commonly reported in China, is characterised by a lack of energy and physical complaints such as a sore stomach. Klein- man has suggested that, although depression and neurasthenia are different illness experiences, they are both products of the same underlying disease processes – depression. In other words, neurasthenia is the Chinese version of western depression." It's obscenely expensive, but you may hypothetically be able to find other ways of reading the book online.
  - ThrowawayTestr 4y ago
    Thank you for the detailed response!