6 ms·

I'm not sure what to think about this. I accept that the author is suffering and in anguish, and I truly wish him well. Despite his obvious accomplishments an

by JackFr 13y ago

I'm not sure what to think about this. I accept that the author is suffering and in anguish, and I truly wish him well. Despite his obvious accomplishments and all the trappings of success, I would not trade places with him. His subjective experience seems to be painful and is no less real to him than mine is to me. At the same time, I don't think he is ill. While I don't doubt that he is suffering, I don't think it it is helpful to class his suffering as an illness. I don't think anyone argues that his symptoms are caused by an infection or a defect in an organ, so his disorder lacks the physical basis for a typical illness. At the same time, he has symptoms. And therapy, and possibly drugs, make him feel subjectively better. He chooses to engage in a regime of therapy which (presumably) has self reported benefits. But I don't think it is helpful to think of his plight like we think of malaria or polio or heart disease. When we talk about 'emotional disorders', we implicitly take on an enormous amount of cultural context as well as normative judgements about how someone 'should' feel. And the danger is that one will come to believe that an unpleasant mental state in an otherwise healthy brain is something to be cured through the application of science. That being said, I agree with the main point -- that there is no shame in his mental state. I suppose my point is that it is not necessary (and should not be necessary) to reclassify what a disease is in order for a class of people to maintain their dignity. And above all, I wish this man well and by no means mean to diminish his pain, or the courage it took to write this.

moron4hire 13y ago
This attitude--that mental illness is not a real disease--is what helps the stigma to continue. You mince it up with nice words around the edges, but it boils down to this: you're part of the problem.
- Einstalbert 13y ago
  Agreed. I've dealt with mental illness in my family since I was a young child. It's affected my entire life. It's not just some meandering mood or state of mind, it's a frightening thing for which most people have no time or patience.
- JackFr 13y ago
  I would say it boils down to this: I believe that mental illness is fundamentally different than infectious disease and defects and injuries to organs, and it is not productive to treat them as fundamentally alike. If that makes me part of the problem, I guess it's not clear to me what the problem is.
  - MartinCron 13y ago
    You seem to be conflating the terms "disease" and "infectious disease", a common mistake Chicken Pox and alcoholism are both diseases. Seriously.
  - Thriptic 13y ago
    I see what you're getting at, but a number of mental disorders are actually purely biochemical in nature, and not the result of psychological trauma. Treatment and diagnosis of these diseases would be nearly identical to the treatment of infectious disease or other internal medical issues if our diagnostic tools were better...
  - deleted 13y ago
    [deleted]
  - kumph 13y ago
    The brain is an organ, and medical terminolgy is very clear that something like major depressive disorder is a disease that adversely affects that organ. This is medical science. Its really not up for debate. If you are really questioning the entire field of medical science and the vast corpus of research on mental illness, the only people who will take you seriously are lay-persons. And thats precisely the problem. While I trust you mean well, attitudes like yours are extremely dangerous because they increase stigma and disuade people from seeking medical help for treatable illnesses.
    - aridiculous 13y ago
      The question of mental illness is much more complicated than that. This is an issue with a rich and long history and shoe-horning mental illnesses into biological diseases (I suspect) will prove to be a foolish error historically. It's wishful thinking. It's true that yes, biochemically, the brain's abnormal activity often correlates with subjective experience. But a) the subjective nature of the condition is what makes it so damn tricky and b) we don't know what's causing what. It could easily be the case that an individual (organism) in a bad (social) environment leads to a biochemically abnormal brain state. Treating the brain state is like playing whack-a-mole. There could also be complex feedback loops. We don't know. We're throwing shit at the wall right now. Though there is good evidence for the basic nervous system strengthening properties of SSRI's, there's also very compelling evidence that SSRI's have absolutely zero impact in credible, controlled studies. From my personal experience and observations, I believe SSRI's can be good at 'stopping the bleeding', which sits well with why they are often known for having a dampening effect. But that will only get you so far, because there's no set way of determining what 'cured' is. There's no such thing as normal in the same way that it's normal to be free of strep throat. Functioning and succeeding in society has positive qualities, but can sometimes be at the expense of individualized growth and healthiness. The point is, mental life is really complicated, and possibly wrapped up in broader, deeper things like spirituality, love, and economic and social conditions. Your bio-reductionist view (which isn't an insult, it's simply the view of much of the middle to upper middle class) doesn't match reality in my experience. I've found that most people suffer deeply with modern conditions (the less neurotic they are, the less they're aware of the causes of their malcontent) because there are fewer sources of authority, purpose, or truth. A la carte medicine and treatments won't solve that. Besides all that, the drug industry just stinks of hypocrisy and deserves its popular skepticism. If a sufferer is to experiment with drug treatments, ayahuasca (and similar) should be legal and just as available as XYZ SSRI's.
- bjt 13y ago
  I think the grandparent post has a point, but rather than trying to bucket disorders into whether they're a "real disease" or not, it's a lot more useful to think of a spectrum where there are some illnesses that have really clear diagnoses and mechanisms on one end, and very vague things on the other end that we hardly understand at all. Mental illnesses cluster at that more vague end. See strep throat for a counter example (http://en.wikipedia.org/wiki/Streptococcal_pharyngitis http://en.wikipedia.org/wiki/Streptococcal_pharyngitis). There's a five point diagnosis checklist that looks a bit similar to checklists you might see in the DSM for a mental illness. But there's also a gold standard test of actually culturing the cells, which is 90-95% accurate at diagnosing strep. It may be just my ignorance, but I don't see comparably accurate tests for diagnosing mental illness. It's extremely common to see someone's diagnosis change over months or years from depression to bipolar to something else. This tends to undermine the scientific credibility of mental illness diagnosis, leading people to wonder how much diagnoses are influenced by fashions, drug companies, or the practitioner's whim. Ninja edit: For the counter counter example, see the Rosenhan experiment (http://en.wikipedia.org/wiki/Rosenhan_experiment http://en.wikipedia.org/wiki/Rosenhan_experiment). There are huge confirmation bias problems in mental illness diagnosis.
  - DanBC 13y ago
    I strongly agree that diagnosis is problematic. This is especially weird when people can be forced to take a medication against their will based on that diagnosis. This is really fantastically intrusive and oppressive and etc. Another problem with diagnosis: some illnesses haw a list of (say) 9 things, and the patient must match 5 of them for 6 months. So the patient is a good match of 3 and a weak match for 2 and a poor match for the other 4. But anyone seeing that patient will read the diagnosis and will apply all the criteria to everything the patient does. "You would say that. People with your diagnosis are {manipulative}" (even if the patient was a poor match for manipulative).
mey 13y ago
He is ill. https://en.wikipedia.org/wiki/Disease https://en.wikipedia.org/wiki/Disease Mental illness's are disorders, that can be disabling to normal daily life. Our society accepting that things like OCD, Anxiety/Depression and Addition are diseases will allow us to actually address them. Your brain is not a magical thing that is beyond being ill, unfortunately it is extremely complex. I say this as someone who has been "sucking it up" for years until I finally hit a point that I sought help for depression. http://www.hhs.gov/asl/testify/2010/06/t20100623a.html http://www.hhs.gov/asl/testify/2010/06/t20100623a.html https://en.wikipedia.org/wiki/Major_depressive_disorder https://en.wikipedia.org/wiki/Major_depressive_disorder
- coldtea 13y ago
  >Mental illness's are disorders, that can be disabling to normal daily life. Our society accepting that things like OCD, Anxiety/Depression and Addition are diseases will allow us to actually address them. Or you know, it will allow us to "invent" them, because we have drugs to sell, and because we have the luxury to overanalyse every whim.
  - comrh 13y ago
    So people are "inventing" symptoms? This just sounds cynical and unhelpful.
mattgreenrocks 13y ago
Really? Your response to this guy owning up to something taboo is to chide him on his use of terminology? What kind of priorities do you have, and why is you being right on the Internet ahead of respecting the vulnerable?
SerpentJoe 13y ago
You cite heart disease as a "real disease", but all that term means is "the heart's operation is being impacted by a pathology". What makes the brain so different from the heart that it can't be ill, even when it's dysfunctional?
DanBC 13y ago
Sadness is a normal part of life. Grief is a normal reaction to death of a loved one. Sadness for no reason, that persists for weeks or months or years, that interferes with your ability to live your day to day life is not normal. Talking therapies help most people. Medications help some of the rest. For extreme cases ECT (electro convulsive therapy) might help. There are other extreme interventions being looked at such as vagus nerve stimulation. Leaving people to experience these feelings of hopelessness because we do not want to interfere with their right to be depressed means some of them will die by suicide; or by neglect or alcoholism; and many of these people will not live their life to anywhere near their potential. J.G. Ballard wrote a short story where psychiatry had been outlawed to prevent people having their rights to honest emotion interfered with. (I can't remember what it's called but it's good!)
ScottBurson 13y ago
I think the opprobrium you are receiving here is unfair. You've been very careful to say that you're not trying to bring back the shame and the stigma. You're just asking a very important question: is the medical model really the most appropriate for problems of this kind? I agree with you that it is ultimately not the most appropriate. However, for many people it is a big improvement over suffering alone and without help. And in our world, the things that really can heal emotional problems -- psychotherapy, meditation, spiritual practice, hypnotherapy, therapeutic bodywork, breathwork, psychedelic therapy, etc. etc. etc. -- are much too "woo woo" for most people. They're too scary, or short of that, people's belief systems don't admit the possibility that such things can work. Taking a drug, though, is something familiar to people. And the drugs do help people live with their problems, though not as well as the drug manufacturers would suggest. The unfortunate thing, though, is that people get the message that all they need to do is find the right drug and dosage. The drug can help them stabilize their lives, but then they need to start in on the emotional work. That's what can eventually get them to where they don't need the drug.
milesf 13y ago
I don't know why people are down voting your comment! You seem very honest and sincere in your opinion. I disagree with you that you don't think he's ill, but I've upvoted you because disagreeing with someone is not grounds to end their inclusion in the discussion.
stefantalpalaru 13y ago
You might be interested in WHO's definition of "health"[1]: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." [1]: http://www.who.int/about/definition/en/print.html http://www.who.int/about/definition/en/print.html
WalterSear 13y ago
From what you write, I can only assume you have had very little conscious experience with mental health disorders. Some (most?), like OCD and BPD have extremely specific symptomatologies that are often counter intuitive and quite surprising similarities between people. The generalized, lay-person, conceptions of these illness miss these specific symptoms. As such it doesn't make sense to call them anything but diseases.

by JackFr 13y ago

moron4hire 13y ago

This attitude--that mental illness is not a real disease--is what helps the stigma to continue. You mince it up with nice words around the edges, but it boils down to this: you're part of the problem.

Einstalbert 13y ago
Agreed. I've dealt with mental illness in my family since I was a young child. It's affected my entire life. It's not just some meandering mood or state of mind, it's a frightening thing for which most people have no time or patience.
JackFr 13y ago
I would say it boils down to this: I believe that mental illness is fundamentally different than infectious disease and defects and injuries to organs, and it is not productive to treat them as fundamentally alike. If that makes me part of the problem, I guess it's not clear to me what the problem is.
- MartinCron 13y ago
  You seem to be conflating the terms "disease" and "infectious disease", a common mistake Chicken Pox and alcoholism are both diseases. Seriously.
- Thriptic 13y ago
  I see what you're getting at, but a number of mental disorders are actually purely biochemical in nature, and not the result of psychological trauma. Treatment and diagnosis of these diseases would be nearly identical to the treatment of infectious disease or other internal medical issues if our diagnostic tools were better...
- deleted 13y ago
  [deleted]
- kumph 13y ago
  The brain is an organ, and medical terminolgy is very clear that something like major depressive disorder is a disease that adversely affects that organ. This is medical science. Its really not up for debate. If you are really questioning the entire field of medical science and the vast corpus of research on mental illness, the only people who will take you seriously are lay-persons. And thats precisely the problem. While I trust you mean well, attitudes like yours are extremely dangerous because they increase stigma and disuade people from seeking medical help for treatable illnesses.
  - aridiculous 13y ago
    The question of mental illness is much more complicated than that. This is an issue with a rich and long history and shoe-horning mental illnesses into biological diseases (I suspect) will prove to be a foolish error historically. It's wishful thinking. It's true that yes, biochemically, the brain's abnormal activity often correlates with subjective experience. But a) the subjective nature of the condition is what makes it so damn tricky and b) we don't know what's causing what. It could easily be the case that an individual (organism) in a bad (social) environment leads to a biochemically abnormal brain state. Treating the brain state is like playing whack-a-mole. There could also be complex feedback loops. We don't know. We're throwing shit at the wall right now. Though there is good evidence for the basic nervous system strengthening properties of SSRI's, there's also very compelling evidence that SSRI's have absolutely zero impact in credible, controlled studies. From my personal experience and observations, I believe SSRI's can be good at 'stopping the bleeding', which sits well with why they are often known for having a dampening effect. But that will only get you so far, because there's no set way of determining what 'cured' is. There's no such thing as normal in the same way that it's normal to be free of strep throat. Functioning and succeeding in society has positive qualities, but can sometimes be at the expense of individualized growth and healthiness. The point is, mental life is really complicated, and possibly wrapped up in broader, deeper things like spirituality, love, and economic and social conditions. Your bio-reductionist view (which isn't an insult, it's simply the view of much of the middle to upper middle class) doesn't match reality in my experience. I've found that most people suffer deeply with modern conditions (the less neurotic they are, the less they're aware of the causes of their malcontent) because there are fewer sources of authority, purpose, or truth. A la carte medicine and treatments won't solve that. Besides all that, the drug industry just stinks of hypocrisy and deserves its popular skepticism. If a sufferer is to experiment with drug treatments, ayahuasca (and similar) should be legal and just as available as XYZ SSRI's.
bjt 13y ago
I think the grandparent post has a point, but rather than trying to bucket disorders into whether they're a "real disease" or not, it's a lot more useful to think of a spectrum where there are some illnesses that have really clear diagnoses and mechanisms on one end, and very vague things on the other end that we hardly understand at all. Mental illnesses cluster at that more vague end. See strep throat for a counter example (http://en.wikipedia.org/wiki/Streptococcal_pharyngitis http://en.wikipedia.org/wiki/Streptococcal_pharyngitis). There's a five point diagnosis checklist that looks a bit similar to checklists you might see in the DSM for a mental illness. But there's also a gold standard test of actually culturing the cells, which is 90-95% accurate at diagnosing strep. It may be just my ignorance, but I don't see comparably accurate tests for diagnosing mental illness. It's extremely common to see someone's diagnosis change over months or years from depression to bipolar to something else. This tends to undermine the scientific credibility of mental illness diagnosis, leading people to wonder how much diagnoses are influenced by fashions, drug companies, or the practitioner's whim. Ninja edit: For the counter counter example, see the Rosenhan experiment (http://en.wikipedia.org/wiki/Rosenhan_experiment http://en.wikipedia.org/wiki/Rosenhan_experiment). There are huge confirmation bias problems in mental illness diagnosis.
- DanBC 13y ago
  I strongly agree that diagnosis is problematic. This is especially weird when people can be forced to take a medication against their will based on that diagnosis. This is really fantastically intrusive and oppressive and etc. Another problem with diagnosis: some illnesses haw a list of (say) 9 things, and the patient must match 5 of them for 6 months. So the patient is a good match of 3 and a weak match for 2 and a poor match for the other 4. But anyone seeing that patient will read the diagnosis and will apply all the criteria to everything the patient does. "You would say that. People with your diagnosis are {manipulative}" (even if the patient was a poor match for manipulative).

mey 13y ago

He is ill. https://en.wikipedia.org/wiki/Disease https://en.wikipedia.org/wiki/Disease Mental illness's are disorders, that can be disabling to normal daily life. Our society accepting that things like OCD, Anxiety/Depression and Addition are diseases will allow us to actually address them. Your brain is not a magical thing that is beyond being ill, unfortunately it is extremely complex. I say this as someone who has been "sucking it up" for years until I finally hit a point that I sought help for depression. http://www.hhs.gov/asl/testify/2010/06/t20100623a.html http://www.hhs.gov/asl/testify/2010/06/t20100623a.html https://en.wikipedia.org/wiki/Major_depressive_disorder https://en.wikipedia.org/wiki/Major_depressive_disorder

coldtea 13y ago
>Mental illness's are disorders, that can be disabling to normal daily life. Our society accepting that things like OCD, Anxiety/Depression and Addition are diseases will allow us to actually address them. Or you know, it will allow us to "invent" them, because we have drugs to sell, and because we have the luxury to overanalyse every whim.
- comrh 13y ago
  So people are "inventing" symptoms? This just sounds cynical and unhelpful.

mattgreenrocks 13y ago

Really? Your response to this guy owning up to something taboo is to chide him on his use of terminology? What kind of priorities do you have, and why is you being right on the Internet ahead of respecting the vulnerable?

SerpentJoe 13y ago

You cite heart disease as a "real disease", but all that term means is "the heart's operation is being impacted by a pathology". What makes the brain so different from the heart that it can't be ill, even when it's dysfunctional?

DanBC 13y ago

Sadness is a normal part of life. Grief is a normal reaction to death of a loved one. Sadness for no reason, that persists for weeks or months or years, that interferes with your ability to live your day to day life is not normal. Talking therapies help most people. Medications help some of the rest. For extreme cases ECT (electro convulsive therapy) might help. There are other extreme interventions being looked at such as vagus nerve stimulation. Leaving people to experience these feelings of hopelessness because we do not want to interfere with their right to be depressed means some of them will die by suicide; or by neglect or alcoholism; and many of these people will not live their life to anywhere near their potential. J.G. Ballard wrote a short story where psychiatry had been outlawed to prevent people having their rights to honest emotion interfered with. (I can't remember what it's called but it's good!)

ScottBurson 13y ago

I think the opprobrium you are receiving here is unfair. You've been very careful to say that you're not trying to bring back the shame and the stigma. You're just asking a very important question: is the medical model really the most appropriate for problems of this kind? I agree with you that it is ultimately not the most appropriate. However, for many people it is a big improvement over suffering alone and without help. And in our world, the things that really can heal emotional problems -- psychotherapy, meditation, spiritual practice, hypnotherapy, therapeutic bodywork, breathwork, psychedelic therapy, etc. etc. etc. -- are much too "woo woo" for most people. They're too scary, or short of that, people's belief systems don't admit the possibility that such things can work. Taking a drug, though, is something familiar to people. And the drugs do help people live with their problems, though not as well as the drug manufacturers would suggest. The unfortunate thing, though, is that people get the message that all they need to do is find the right drug and dosage. The drug can help them stabilize their lives, but then they need to start in on the emotional work. That's what can eventually get them to where they don't need the drug.

milesf 13y ago

I don't know why people are down voting your comment! You seem very honest and sincere in your opinion. I disagree with you that you don't think he's ill, but I've upvoted you because disagreeing with someone is not grounds to end their inclusion in the discussion.

stefantalpalaru 13y ago

You might be interested in WHO's definition of "health"[1]: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." [1]: http://www.who.int/about/definition/en/print.html http://www.who.int/about/definition/en/print.html

WalterSear 13y ago

From what you write, I can only assume you have had very little conscious experience with mental health disorders. Some (most?), like OCD and BPD have extremely specific symptomatologies that are often counter intuitive and quite surprising similarities between people. The generalized, lay-person, conceptions of these illness miss these specific symptoms. As such it doesn't make sense to call them anything but diseases.