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> I think the same is true for all the psychiatric disorders, but people talk about diagnosing and "having" these disorders as if they're definite things. This

> I think the same is true for all the psychiatric disorders, but people talk about diagnosing and "having" these disorders as if they're definite things. This kind of reasoning is completely faulty and rampant in discussions that usually hold a fair amount of stigma towards people experiencing mental health conditions (it’s also extremely insulting fyi). I can have a headache, and there may be an unknown biological mechanism, but that doesn’t mean I’m not experiencing a headache.

andoando 2y ago
As I said "Thats not to say I don't think people truly have physical issues". I have diagnosed ADHD, and I take mental health very seriously. I have zero such prejudice. By "definite" things I mean, singular, physical causes which can be pointed to.
- JohnMakin 2y ago
  I understand that you believe this, I am merely pointing out that the type of reasoning you’re using is typically seen in the type of psychiatric gatekeeping used in discussions that are laden with stigma against people experiencing mental conditions.
  - akoboldfrying 2y ago
    > I am merely pointing out that the type of reasoning you’re using is typically seen in the type of psychiatric gatekeeping You called this reasoning "completely faulty" in your previous comment, which clearly goes well beyond that. What you are actually trying to do is stigmatise a valid form of reasoning, by association.
  - elefanten 2y ago
    “I understand that you believe” …that questioning diagnostic clarity is associated with some nebulous conversational or clinical scenarios that make you uncomfortable. But sticking your head in the epistemological sand and chastising people for being “extremely insulting” (based on your own extrapolated associations with their position) is extremely …condescending argument-by-assertion. I have skin in the game on this one and in my own experience sloppy diagnostics have caused way more suffering than stigma. I was nodding along with gp’s entire point. Your confidently dismissive chastisement is what feels out of line.
    - JohnMakin 2y ago
      I don’t really disagree with you other than to say that if your issue is with my tone and not my point, I don’t really have anything to say. Nothing I’ve said has been far off and I am speaking from a lot of experience here as a former admin of multiple large private mental health support groups. These arguments are all very much the same, and serving a very specific subtle purpose that does not actually advance discussion on this topic, and that is to cast doubt onto people suffering whethering they are “actually” suffering from whatever and therefore, in this hypercapitalist healthcare system (speaking of the USA specifically here), whether or not it is “worthy” of care, especially in the eyes of doctors that should know, who frequently have a high amount of control in these situations wrt to what care you are deemed “worthy” to receive. Thus the result of these situations is many people cannot afford (or even if they can, sometimes no) proper care necessary to them. Gatekeeping types of arguments like these do not make that better.
      - akoboldfrying 2y ago
        This gets to the quick of one half of the matter, and in another post you acknowledge the other half too -- the incentive that exists for healthy people to "game the system" (whether it be to get access to stimulants, or "just" sympathy). I agree with almost everything you've written here, and have the same sympathies, except that I don't think it's legitimate to criticise the style of argument you criticise just because it's often used to subtly question whether people are "actually" suffering (and I agree that it is often used that way).
      - andoando 2y ago
        What Ive seen from these support communities like /r/Adhd is admins gatekeeping their interpretations with this guise of knowing whats best for everyone. The admins there for example have decided that 1. The word "neurotypical" is banned, 2. One cannot say adhd isnt a disorder / adhd might have benefits. 3. Discussing negatives of medication seems to be removed
        JohnMakin 2y ago
        ADHD forums are notorious for this. I do not personally moderate this way. Everyone’s opinions should be valid if they respect others. No one’s problems are any more special than anyone else’s, and if someone is displaying that type of behavior, they probably don’t belong in a support group. ADHD in particular is further complicated by the fact that there are many, many drug seekers that game the system and even fool themselves. Even worse these drug seekers have collectively done alot to create scarcity in a limited supply of a class of drugs that many people think they need to survive - (i am making no comment about the efficacy of adhd meds) - so strong violent opinions are evoked (understandably). That is why these rules are in place. People simply cannot discuss the subject rationally. I do not try to involve myself in those communities, but many of the Autism spectrum disorder communities and depression support groups don’t suffer similar issues and people that try to gatekeep are promptly scolded. I do acknowledge adhd forums are a unique place for the reasons I mentioned above.
  - andoando 2y ago
    I understand the first sentence I've said "seems like" a statement made by with someone with prejudice saying something like "people with adhd are lazy". But as I clarified, my actual criticism is entirely different and I for one have never even seen it be mentioned. We will never advance our understanding of psychiatry if we can't criticize it, and I for one definitely don't think we already perfected it.
dfgtyu65r 2y ago
I don't think that's entirely fair. There does seem to be something distinct about mental disorders - namely, they are defined by the symptoms. With physical ailments, symptoms are surface manifestations of an underlying physical cause. For example, fever and fatigue in flu are the result of the influenza virus. Crucially, you can have the physical cause without symptoms (such as in the presymptomatic period), so the two are dissociable. Even where the physical cause is unknown, there's still this symptom-cause distinction. In the case of mental disorders, they're essentially defined by the symptoms. To have depression is to be depressed. To have anxiety is to be anxious. What would it even mean to have depression without being depressed? While on some level these are physical in a sense (insofar as they result from brain activity), I don't necessarily think we should think about their cause in the same way as a physical ailment. More to the point, there's a much more obvious sociocultral element to mental disorders. There's no 'objective' line between being sad and being depressed so while we clearly can and should treat depression, it seems to be very different from other diseases. None of this is to take away from the real suffering people undergo with these disorders. I just don't think that treating them through a strict biological-pathological lens is as useful as people think it is.
- jaggederest 2y ago
  > namely, they are defined by the symptoms. This is what we see historically, in the 19th and early 20th centuries, in "body medicine". We're just at an earlier stage of understanding and treating psychiatric disorders. I assume in a couple hundred years we'll look back at the current state of the art as hopelessly outmoded. > In the case of mental disorders, they're essentially defined by the symptoms. To have depression is to be depressed. To have anxiety is to be anxious. What would it even mean to have depression without being depressed? What would it mean to have typhoid without an actual fever? The disease is something else, some causative factor that is not the actual symptom itself, but is no less real for that. > I just don't think that treating them through a strict biological-pathological lens is as useful as people think it is. Agreed, but that's with the current state of the art. I would be surprised indeed if by 2080 we didn't have a different lens to view these things through.
  - 2y ago

andoando 2y ago

As I said "Thats not to say I don't think people truly have physical issues". I have diagnosed ADHD, and I take mental health very seriously. I have zero such prejudice. By "definite" things I mean, singular, physical causes which can be pointed to.

JohnMakin 2y ago
I understand that you believe this, I am merely pointing out that the type of reasoning you’re using is typically seen in the type of psychiatric gatekeeping used in discussions that are laden with stigma against people experiencing mental conditions.
- akoboldfrying 2y ago
  > I am merely pointing out that the type of reasoning you’re using is typically seen in the type of psychiatric gatekeeping You called this reasoning "completely faulty" in your previous comment, which clearly goes well beyond that. What you are actually trying to do is stigmatise a valid form of reasoning, by association.
- elefanten 2y ago
  “I understand that you believe” …that questioning diagnostic clarity is associated with some nebulous conversational or clinical scenarios that make you uncomfortable. But sticking your head in the epistemological sand and chastising people for being “extremely insulting” (based on your own extrapolated associations with their position) is extremely …condescending argument-by-assertion. I have skin in the game on this one and in my own experience sloppy diagnostics have caused way more suffering than stigma. I was nodding along with gp’s entire point. Your confidently dismissive chastisement is what feels out of line.
  - JohnMakin 2y ago
    I don’t really disagree with you other than to say that if your issue is with my tone and not my point, I don’t really have anything to say. Nothing I’ve said has been far off and I am speaking from a lot of experience here as a former admin of multiple large private mental health support groups. These arguments are all very much the same, and serving a very specific subtle purpose that does not actually advance discussion on this topic, and that is to cast doubt onto people suffering whethering they are “actually” suffering from whatever and therefore, in this hypercapitalist healthcare system (speaking of the USA specifically here), whether or not it is “worthy” of care, especially in the eyes of doctors that should know, who frequently have a high amount of control in these situations wrt to what care you are deemed “worthy” to receive. Thus the result of these situations is many people cannot afford (or even if they can, sometimes no) proper care necessary to them. Gatekeeping types of arguments like these do not make that better.
    - akoboldfrying 2y ago
      This gets to the quick of one half of the matter, and in another post you acknowledge the other half too -- the incentive that exists for healthy people to "game the system" (whether it be to get access to stimulants, or "just" sympathy). I agree with almost everything you've written here, and have the same sympathies, except that I don't think it's legitimate to criticise the style of argument you criticise just because it's often used to subtly question whether people are "actually" suffering (and I agree that it is often used that way).
    - andoando 2y ago
      What Ive seen from these support communities like /r/Adhd is admins gatekeeping their interpretations with this guise of knowing whats best for everyone. The admins there for example have decided that 1. The word "neurotypical" is banned, 2. One cannot say adhd isnt a disorder / adhd might have benefits. 3. Discussing negatives of medication seems to be removed
      - JohnMakin 2y ago
        ADHD forums are notorious for this. I do not personally moderate this way. Everyone’s opinions should be valid if they respect others. No one’s problems are any more special than anyone else’s, and if someone is displaying that type of behavior, they probably don’t belong in a support group. ADHD in particular is further complicated by the fact that there are many, many drug seekers that game the system and even fool themselves. Even worse these drug seekers have collectively done alot to create scarcity in a limited supply of a class of drugs that many people think they need to survive - (i am making no comment about the efficacy of adhd meds) - so strong violent opinions are evoked (understandably). That is why these rules are in place. People simply cannot discuss the subject rationally. I do not try to involve myself in those communities, but many of the Autism spectrum disorder communities and depression support groups don’t suffer similar issues and people that try to gatekeep are promptly scolded. I do acknowledge adhd forums are a unique place for the reasons I mentioned above.
- andoando 2y ago
  I understand the first sentence I've said "seems like" a statement made by with someone with prejudice saying something like "people with adhd are lazy". But as I clarified, my actual criticism is entirely different and I for one have never even seen it be mentioned. We will never advance our understanding of psychiatry if we can't criticize it, and I for one definitely don't think we already perfected it.

dfgtyu65r 2y ago

I don't think that's entirely fair. There does seem to be something distinct about mental disorders - namely, they are defined by the symptoms. With physical ailments, symptoms are surface manifestations of an underlying physical cause. For example, fever and fatigue in flu are the result of the influenza virus. Crucially, you can have the physical cause without symptoms (such as in the presymptomatic period), so the two are dissociable. Even where the physical cause is unknown, there's still this symptom-cause distinction. In the case of mental disorders, they're essentially defined by the symptoms. To have depression is to be depressed. To have anxiety is to be anxious. What would it even mean to have depression without being depressed? While on some level these are physical in a sense (insofar as they result from brain activity), I don't necessarily think we should think about their cause in the same way as a physical ailment. More to the point, there's a much more obvious sociocultral element to mental disorders. There's no 'objective' line between being sad and being depressed so while we clearly can and should treat depression, it seems to be very different from other diseases. None of this is to take away from the real suffering people undergo with these disorders. I just don't think that treating them through a strict biological-pathological lens is as useful as people think it is.

jaggederest 2y ago
> namely, they are defined by the symptoms. This is what we see historically, in the 19th and early 20th centuries, in "body medicine". We're just at an earlier stage of understanding and treating psychiatric disorders. I assume in a couple hundred years we'll look back at the current state of the art as hopelessly outmoded. > In the case of mental disorders, they're essentially defined by the symptoms. To have depression is to be depressed. To have anxiety is to be anxious. What would it even mean to have depression without being depressed? What would it mean to have typhoid without an actual fever? The disease is something else, some causative factor that is not the actual symptom itself, but is no less real for that. > I just don't think that treating them through a strict biological-pathological lens is as useful as people think it is. Agreed, but that's with the current state of the art. I would be surprised indeed if by 2080 we didn't have a different lens to view these things through.
- 2y ago