• Galuchat
    703

    That's great. Thanks for the elaboration.
  • Anaxagoras
    349
    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
    1.8k
    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
    703
    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, brain stimulation, and medication, however; there is apparently not sufficient data available to make that determination.
  • I like sushi
    1.8k
    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
    703

    Thanks for the links.
  • csalisbury
    2k
    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
    703
    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 mental 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, brain stimulation, 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
    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
    4.1k
    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.
  • Chisholm
    14
    This is the best summary of the evidence and arguments against biopsychiatry I’ve ever seen.

    Opposition to the illness model predates the writings of Drs. Szasz and Laing, and was promoted by various individuals and professions, including psychiatry itself. The history of how this opposition was muted within psychiatry and of how the vast majority of psychiatrists came to align themselves with the Pharma--APA orthodoxy has not yet been fully written, but WILL probably emerge in the coming years, as increasing numbers of retiring psychiatrists speak out against the hoax and the recruitment methods used to promote it.

    [....]

    Psychiatry is not something good that needs minor adjustments. Rather, it is something fundamentally flawed and rotten. Based on spurious premises, and devoid of even a semblance of critical self-scrutiny, it is utterly and totally irremediable. It has locked itself into the falsehood that every-problem-is-an-illness-and-for-every-illness-there’s-a-drug from which it cannot extricate itself. It is nothing more than legalized drug-pushing, endlessly attempting to mask its guilt by proclaiming its innocence, vilifying its critics, and calling for more “treatment.” It has built into itself the seeds of its own destruction, and will eventually fade away as its credibility dwindles, and more and more potential recruits recognize the sordid reality and seek careers in genuine, ethically-driven medicine.

    Read here:

    https://www.madinamerica.com/2019/04/in-defense-of-anti-psychiatry/
  • Wallows
    9.6k
    Forgive me for barging in without addressing every interesting point raised thus far in this discussion, and having skimmed the article; but, if mental illness is a normative claim, then shouldn't we first address what does the term "normal" ought to mean in this context?

    I mean, everything else, from 'lack of insight' into one's condition to above and beyond would fall into place.

    Now, obviously, one can surmise that this task is inherently dangerous and prone to authoritarian superstition; but, the can be only be kicked down the road as long as it has been.
  • sime
    437
    The natural concept of depression isn't descriptive of the state of the individual per-se, but of the individual's behavioral relationship to society. That is to say, the natural concept of depression is holistically irreducible to the individuals themselves.

    On the other hand, the medical concept of depression is merely a description of the neuro-anatomical correlates of individuals who tend to be judged by society as being depressed in the natural sense. Consequently, a medical diagnosis of medical depression is neither necessary nor sufficient for establishing a diagnosis of natural depression.

    The natural concept of depression should be compared to the legal concept of guilt. In both cases, judgements are sought for political reasons, and hence both concepts are inherently political. In being political, the outcome of such judgements often refer more to the state and needs of society than to the state and needs of the individual.
  • Wallows
    9.6k
    Would this thread apply to places like Cambodia, where ailments are treated as social issues instead of individual problems? Or just did we enlargen the scope of the issue?
  • Chisholm
    14
    The management of mental illness is one of the weakest pillars of Western medicine.

    There is a great deal of politics and special interests wrapped up in the approval of drugs, and the lack thereof. Many remedies are rebuffed and suppressed, and diagnostic procedures are constantly warped and twisted by socio-political agendas.

    I was diagnosed with ADHD in kindergarten. I was so distracted they couldn't get me to complete the diagnostic test. That was when I started learning to take pills. I took Ritalin, and Strattera, and eventually Adderall, which I took for years through high school and into college. The approval of amphetamine use in children was a huge boon for drug companies, but it doomed children like me to a life of unforeseen problems. Now that we've be had by this great experiment, it has surfaced that childhood stimulant use likely hypersensitizes us to dopaminergics for the rest of our lives. The rather common-sensical idea that "you shouldn't give kids speed" was completely oblated in the minds of my parents by the dictum of educated psychiatry.

    Now I have Raynaud's — another side effect of the help doctors gave me — and will probably be dependent on some sort of motivationally modulatory drugs for the rest of my life.

    So no, I don't judge people who want to pursue solutions outside of the system. I think that this can be far worse than trusting your life to psychiatrists, and that some people waste themselves on stupid delusions of medicament as they destroy their brains and bodies with drugs, but the comparison with organized medicine is far less distinct that you would think.

    I certainly don't shy from telling people to make use of the diagnostic power of blood assays and professional help, but psychiatry plays a pretentious game admonishing those who seek to help themselves without a doctor's permission. It's far from right for everyone, but it isn't evil, and wishing for the pharmacological domination of those who wish for autonomy isn't going to do any good.
  • Coben
    1.1k
    The approval of amphetamine use in children was a huge boon for drug companies, but it doomed children like me to a life of unforeseen problems.Chisholm

    I'm sorry to hear this. It is a money making paradigm based on poor philosophy and questionable science. My mother ended up 'in their care' and her medications caused untold problems. She had PTSD, but was diagnosed all over the place. Related to this is a generalized hatred of emotions, which pharma and psychiatrists systematize. There are also very strange assumptions of normality.
  • Coben
    1.1k
    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.I like sushi
    On the one hand it is less empirical, but on the other it is often more empirical since sociological studies can show correlation and cause related to external factors -poverty, sexual abuse, alcoholic parents, pretty much any trauma, sexuality, and more. IOW the brain based physicalism approach actually goes against much extremely well documented research. Pathologizing individual reactions to different kinds of traumatic and long term stress is a good business model, leads to terrible social policies - since the pharma/psychiatric model basically shuts off feedback about society both a the individual and the general levels - and create dependencies since it generally does not resolve resolvable patterns.

    It's a bit like if doctors prescribed pain killers for most symptom patterns. To do that is to shut off information and feedback our bodies are giving us.

    With psychotropics it oddly acts as if we were effectively solipsists, not part of any external relations and causal patterns.

    Which is delusional.
  • Chisholm
    14
    Thanks.

    A new book by the Harvard Medical historian Anne Harrington, “Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness,” argues that the “tunnel vision” of modern psychiatry, with its fixation on wiring and fixed diagnoses, cannot adequately address what has yet to be understood about the human psyche.


    https://www.nytimes.com/2019/07/27/opinion/sunday/its-not-just-a-chemical-imbalance.html?action=click&module=Opinion&pgtype=Homepage
  • James Pullman
    46
    Of course, all this is the cursed human tendency to normalize and standardize.
    You see, life tries everything, what endures, endures, all the rest is given up on. I know it is terribly cold and unemotional, but it is what it is. Parallel to this, and also human, the fear of difference.
    The point is that the brain is extremely complex, and just now we scientists and psychiatrists are getting to unravel the first layers. There are, indeed, defects, that can be corrected.
    But it´s not the psychologists way, today everyone is defected, in need of correction. Psychology is the just modern day fortune teller or witchcraft.
    We have a long way to go in truly understanding the brain.
    Did you know that if Einsteins' brain was analysed by modern models it would be immediately sent to an hospice?
    Also we must consider the hypotheses that the brain is not equipped to understand itself, as "security measure" :) .
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