[HN Gopher] The Battle to Define Mental Illness (2010)
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The Battle to Define Mental Illness (2010)
Author : Alex3917
Score : 21 points
Date : 2024-04-14 18:35 UTC (4 hours ago)
(HTM) web link (www.wired.com)
(TXT) w3m dump (www.wired.com)
| rtb wrote:
| EDIT: this was an attempt to get past the paywall, but looks like
| it's javascript driven, so this archived version breaks after a
| moment, unless you disable js
|
| https://web.archive.org/web/20240324050221/https://www.wired...
| Myrmornis wrote:
| Thanks. Text is at https://pastebin.com/LTbtPCsV.
| neonate wrote:
| https://archive.ph/XQzIG works, for those who can access it
| deanresin wrote:
| This conundrum reminds me of a thought experiment. You have
| people use a mental illness as a defense in courts of law. But
| could you not plausibly define anyone who commits major crimes to
| be mental ill? Mental illness could also be defined by a person's
| ability to function in their community and social constructs. But
| a healthy species, evolutionary speaking, requires these
| outliers. These deviations from the "norm" offer the species a
| safety net should conditions change rapidly. Should we really be
| trying to herd everyone back to a norm?
|
| Also, psychology is a dying profession. A mental illness is
| described as a set of symptoms manifested from physical
| biological systems we don't fully understand yet. But once
| understood, psychology becomes obsolete.
| triumphblr wrote:
| > Also, psychology is a dying profession. A mental illness is
| described as a set of symptoms manifested from physical
| biological systems we don't fully understand yet. But once
| understood, psychology becomes obsolete.
|
| That's a fundamentally reductionist perspective and assumes
| everything is biological in its etiology? For example, you
| could say we don't need a justice system once we have the
| biology worked out, or arts, or sports. At some level it's a
| fundamentally authoritarian argument as well: if you have the
| biology worked out, what's to keep the holders of power from
| altering people to whatever norm they want? Having the biology
| completely worked out won't magically reveal natural disorder
| states.
|
| The biological explication of a behavior doesn't obviate the
| need to have some norm for intervention decisions. Biology
| doesn't have norms, psychosocial systems have norms. Non-
| behavioral medicine is still full of ethics. And that doesn't
| even get into issues about whether you could ever identify any
| biological substrate as synonymous with a human experiential
| state or history.
| 0xcde4c3db wrote:
| The shape of that argument works equally well for unduly
| centering psychosocial mechanisms, though. That's how we got
| pseudoscientific garbage like the "refrigerator mother"
| theory of autism, the "anal retentive" theory of OCD, "tabula
| rasa" theories of social behavior, and so on.
|
| Maybe what I'm getting at is that double standards abound
| when it comes to mental illness, and it's fucking exhausting
| work to even attempt to avoid them. I'm not blaming anybody
| (least of all you). I suppose it's just one of those
| Lovecraftian/Cronenbergesque sorts of things where once you
| see it, the world never quite makes sense again.
| deanresin wrote:
| If you understand the systems that manifest a mental illness
| then you can treat it more directly with medicine, you can
| test for the mental illness directly with physical sampling.
| We've already seen this shift from psychology to medicine
| with the invention of anti-depressants. Less people are
| seeking counsel from psychologists and instead just getting a
| prescription from their doctor. While the systems and even
| antidepressants aren't fully understood we have seen the
| shift away from psychology due to advances in treating the
| physical biological system. Simply projecting this natural
| trend to its limit is not reductionist IMO.
| xboxnolifes wrote:
| Even if we, as humans, collectively have the knowledge to
| reduce something down to some fundamental axioms, it does
| not mean there is no value to separating the disciplines.
| All fields of engineering are fundamentally just physics,
| math, and some civil knowledge. Likewise, being a biologist
| doesn't necessarily qualify you to be a doctor.
| ACow_Adonis wrote:
| Sounds like programmers are obsolete because software will
| become redundant once we've solved everything in hardware :D
| selfie wrote:
| So, this: https://xkcd.com/435/
| johnea wrote:
| Taking another species' infant offspring from it's suckling
| mother's tit, to raise as your own child?
| 0xcde4c3db wrote:
| Frances's concerns definitely aren't _wrong_ on the whole, but I
| feel like he 's not seeing the forest for the trees. This
| ultimately isn't just a question of whether this or that DSM
| revision is helpful. The patterns of the mental health
| establishment of the 21st century are oddly reminiscent of where
| physics and chemistry stood ca. the mid-19th century. Legitimate
| advances are being made, but most of the tools are still
| unreliable and many of the theories still fairly reek of
| superstition and magical thinking. Practitioners are frequently
| defined more by which tradition or thought leader they adhere to
| than by their specialization in established subfields.
|
| It's not a great situation, and I don't see many signs that it's
| improving. A great deal is said about "awareness" and "stigma".
| Phrases like "get help" have been around long enough to turn from
| hero to villain (i.e. from an earnest plea to close friends or
| loved ones to a passive-aggressive dismissal of strangers). Who's
| seriously talking about materially improving the situation
| instead of promoting an allegedly more "correct" theory? Hell if
| I know. Please tell me if you do.
|
| I guess I broadly agree with the article author that the DSM
| process is "caught between paradigms" and has "no obvious way
| forward", but that's a profoundly unsatisfying place to find
| common ground.
| dangle1 wrote:
| It's very sad. DSM was never strictly meant to be a clinical
| diagnostic tool, but rather it was originally meant to define
| specific illnesses in a manner that would facilitate further
| research by allowing investigators to at least be talking about
| the same phenomena when comparing results. (and it
| unintentionally became very popular with lawyers, who argued that
| presence in the DSM equated to unimpeachable evidence of an
| illness in a client, another use that it was never designed to
| accommodate)
|
| It's still true that there are only on the order of 8-12 well-
| validated diagnoses in the manual. Increases in the number of
| included diagnoses over editions is primarily due to concessions
| to important researchers as opposed to clear identification of
| previously undescribed illnesses.
|
| There are lumpers and splitters in academic psychiatry. Lumpers
| are suspicious that there are several hundred discrete disorders
| of the brain that can't be more parsimoniously explained with
| existing, better validated illnesses.
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