• Galuchat
    562

    That's great. Thanks for the elaboration.
  • Anaxagoras
    340
    You're getting ready to venture out into the jungle. What are your thoughts on borderline personality disorder (or NPD, HPD etc)?csalisbury

    Can you be more specific when you say what are my thoughts? Thoughts in what way? In general?
  • I like sushi
    616
    If you were a psychiatrist trained in a system where you are taught that concentration camps are normal, and that mentally healthy people are well-adapted to concentration camps, if your career and social status depended on you accepting that concentration camps are normal, would you look at the concentration camp itself as an external factor that could contribute to a person's dysfunction, or would you see the concentration camp as an essential part of reality that the person ought to adapt to? Would you then look for other causes behind the person's dysfunction, such as hypothesized brain defects, and then attempt to treat them by making the person ingest some drugs? If these drugs made the person's behavior appear less dysfunctional in the concentration camp, would you then consider these drugs to be an effective medication to treat the mentally ill? — leo

    Nice set up. This is known as “psychological fixedness”. This is relatable to “functional fixedness” but here we’re referring to the application of ideas beyond their immediate means. Simply put if X works for a,b,c,d and e we tend to assume it will work just as well beyond these - a kind of ubiquitous “cure” that can easily blind us from seeing the methodology as being either at fault or misapplied. This is a common occurrence in brain sciences in general.

    Note: There has been a push to refer to “mental illnesses” as “brain disorders/malfunctions” instead. The physicalist implication of this - if we stretch it somewhat - could be such that conditions are treated physically with bias toward pharmaceutical medications over more nuanced and less empirical scientific research in the field of psychology.
  • Galuchat
    562
    There has been a push to refer to “mental illnesses” as “brain disorders/malfunctions” instead.I like sushi

    By whom?

    The term "disorder" is used throughout the classification, so as to avoid even greater problems inherent in the use of terms such as "disease" and "illness". "Disorder" is not an exact term, but it is used here to imply the existence of a clinically recognizable set of symptoms or behaviour associated in most cases with distress and with interference with personal functions. Social deviance or conflict alone, without personal dysfunction, should not be included in mental disorder as defined here.ICD-10, Chapter V, Classification of Mental and Behavioural Disorders, Clinical descriptions and diagnostic guidelines, p.11.

    There is inductive evidence in terms of physiological correlates, and criterial evidence in terms of observed behaviour, which establish the relations between body, mind, and behaviour. Mind and behaviour have causal relations, whereas; mind and body (i.e., nervous systems) have correlative relations.

    That being the case, and given appropriate medical indications, it seems reasonable to expect that psychotherapy would be more effective than psychosurgery and medication, however; there is apparently not sufficient data available to make that determination.
  • I like sushi
    616
    By whom? — Galuchat

    Here are some more recent examples of the confused debate about how to label these things and the reach of biological reductionism:

    https://eiko-fried.com/all-mental-disorders-are-brain-disorders-not/

    https://www.madinamerica.com/2019/03/mental-health-concerns-not-brain-disorders-say-researchers/

    A lot of this likely stems from the advances in neuroscience as well as people pushing for a more reductionist approach as a means to fight the “snap out of it!” reactions by people who don’t understand the extent that some people are suffering. The argument being that showing a physical underlying condition is akin to someone telling another to “snap out of it” if they have a heart attack.
  • Galuchat
    562

    Thanks for the links.
  • csalisbury
    1.7k
    I disagree that that's why it was in quotes. The way one differentiates between mental and physical illness is simply to use the word "mental" or "physical." The reason mental illness was put in quotes was to question whether there really was such a thing.Hanover

    Well, there are definitely things that happen to people that are not good and are not primarily physical. I don't think anyone was denying that. But calling it 'mental illness' is to suggest that it is a certain kind of thing - like a physical illness, only mental. So the idea is that this is misleading, and contributes to methods of treatment which are not felicitous.

    I have sympathy for your personal experiences, but this comment seems to admit to the two things I was arguing for (1) that there is such a thing as mental illness, and (2) psychologists can and do help. Your complaint seems to be that you were burdened with some really bad therapists, but if you're acknowledging there is such a thing as good therapy, then the failure is in systematizing it so that it can be predictably available to everyone.Hanover

    Yes, I think there is such a thing as good therapy, though I probably overstated the degree to which it's contributed to my relative stabilization. It's a big part of it, but only one factor in a sort of recovery ecosystem.
    When this works, I think it usually works in spite of the existing paradigm. 'Systematizing it so that it can be predictably available to everyone' - I don't know. It makes me think of studies that show religion and a sense of community are good for people. But there would be no way to systematize it so that it could be predictably available without, in so doing, creating something totally different than what you were trying to make available.
  • andrewk
    2.1k
    This is non-scientific anecdotal opining.Hanover
    What a telling, pithy phrase! I will definitely use that, next time I get an opportunity.
  • Galuchat
    562
    Well, there are definitely things that happens to people that are not good and are not primarily physical. I don't think anyone was denying that. But calling it 'mental illness' is to suggest that it is a certain kind of thing - like a physical illness, only mental.csalisbury

    I agree.
    Terminology is key to:
    1) Accurately describing a problem.
    2) Determining how a problem is understood within a social group.
    3) Affecting the self-esteem of social group members who are labelled as having a problem.
    4) The selection of a problem-solving method (e.g., a Bio-Psycho-Social approach).

    The underlying problem relevant to this thread is: the mental conditions which produce maladaptive (unproductive) behaviour. There are degrees of (mild to severe) maladaptive behaviour.

    Maladaptive behaviour is perceived to be a problem, because it:
    1) Prevents individuals from conforming to social norms (social group rules concerning appropriate and permitted behaviour), resulting in social exclusion and/or marginalisation (stigmatisation).
    2) Impedes social cohesion (a measure of the extent of agreement between social group members).
    3) May be a risk to personal and/or public safety.

    The mental conditions which produce maladaptive behaviour may be described in terms of:

    1) Illness: corporeal and/or mental condition which entails discomfort and dysfunction ("and" being the operative word).
    a) Mental Illness: mental condition which entails mental discomfort and dysfunction. This is consistent with the ICD-10.V definition of disorder, and implies treatment.
    b) Mental illness becomes a matter of public health, involving the regulation of therapeutic practise in certain jurisdictions. Therapy type (e.g., psychosurgery, medication, psychotherapy) depends on mental illness type.
    c) Mental illness may be curable or incurable.
    d) Symptomatic treatment may be effective or ineffective.

    2) Conformity: behaviour in accordance with social norms.
    a) Non-Conformity: behaviour not in accordance with social norms.
    b) Non-conformity becomes a matter of social control.
    c) Social norms are enforced formally and/or informally.
    d) In addition to corporeal and/or mental disability-disorder, other causes of non-conformity include: creativity, eccentricity, dissidence, and criminality.

    So, I agree with ICD-10.V that mental disorder should not be defined in terms of "social deviance or conflict alone, without personal dysfunction."

    3) Typicality: an independent variable within 1.96 standard deviations from the mean of a normal distribution.
    a) Mental Atypicality: mental condition greater than 1.96 standard deviations from the mean of a normal distribution.
    b) Mental atypicality becomes a matter of diversity within a social group.
    c) Mental atypicality is a conventional measure which should have cross-cultural validity, like intelligence.

    So, if a condition entails dysfunction, but not distress or discomfort to the person who has it, it should probably not be defined in terms of illness or disorder, but rather in terms of atypicality or diversity within a population.
  • Hanover
    4.5k
    Alright, let's keep this in order:

    You said:

    Thing is, what this demonstrates is that there is no essential difference between mental illness and social stigma.unenlightened

    I said:

    I can't buy into the argument, though, that Charles Manson was essentially fine and that I can't reliably tell him apart from the average man next door.Hanover

    You then said:

    Then don't make the argument. It's certainly not one that I make.unenlightened

    And no one would be so silly as to try and suggest that. So remove the stuffing from your straw man and put it on the compost heap.unenlightened

    Mine wasn't a straw man, it was a reductio ad absurdum. That is to say, if one holds that there is no essential difference between mental illness and social stigma, one implicitly holds that Charles Manson (or, another example, Jeffrey Dahmer who raped and ate his victims) is not mentally ill but just someone we have chosen to stigmatize. That there might be hard cases where it's hard to distinguish if the person is mentally ill or whether we just find the person's behavior violative of certain societal norms doesn't mean there aren't obvious cases of mental illness.
  • unenlightened
    3.5k
    Mine wasn't a straw man, it was a reductio ad absurdum. That is to say, if one holds that there is no essential difference between mental illness and social stigma, one implicitly holds that Charles Manson (or, another example, Jeffrey Dahmer who raped and ate his victims) is not mentally ill but just someone we have chosen to stigmatize. That there might be hard cases where it's hard to distinguish if the person is mentally ill or whether we just find the person's behavior violative of certain societal norms doesn't mean there aren't obvious cases of mental illness.Hanover

    Well Szaz would be your true absurdist. We do stigmatise murderers do we not? And sometimes we call them mad, and sometimes we don't. And what is the difference, and how do you tell in these supposedly easy to tell cases? Do you measure their madness on the scale of your own repugnance?

    I do not say these people are fine. Did you think I might? I say their relationship with others is in a bad way; do you disagree? The odd thing is that this view is not even controversial, merely old-fashioned. It is the basis of talk based therapy, that a personal relationship can be therapeutic, in a way that it is not when there is an organic illness. It is the first premise of the psychoanalytic tradition that the source of mental distress is the exigencies of civilised society. Bears do not become anal-retentive because they get to shit in the woods.
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