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Should Mental Disorders Have Names?

blogs.scientificamerican.com

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Re: Should Mental Disorders Have Names?

#11

Post by MrQuincle »

teekert wrote: post #3

Us humans certainly prefer to put boundaries and names on things. And indeed, it is often unwise i.e. with (one of our) species definitions: A can procreate with B, B can with C but A cannot with C, meaning A==B, B==C but A!=C, a paradox because of our tendencies. Could it be a cultural thing? While I grow older I find it more natural to think of things as continuous or to assign uncertainty to "facts", but perhaps o…

True, but do definitions not encourage a more thorough analysis?

If A is a male, B is a female, C is a male, your operator definition is even troublesome within a species.

What kind of mathematical object comes closer to this abstraction of a species? Maybe it's not about names and boundaries, but about getting to understand things for which you need abstractions.

I always appreciate when people do not fuss about definitions and easily change them but reason consistently after indicating their interpretation of those concepts.

Re: Should Mental Disorders Have Names?

#12

Post by padolsey »

The neurological field has grappled, over the last few decades, with an increasing understanding of the interconnectedness and pliability of the brain and the rest of the body. We've gone from categorical localization of function to neuroplasticity for example, and likewise we've seen how distinct disorders can involve a number of different physiological differences and deficits (comorbidites are rife, e.g. see atopy + neurological sensitivities). The brain is especially complex. Our grappling with the terminology around its disorders is entirely ok IMHO. It's important to not get tied down in dogmatic categorical thinking. It's also important to let people explore different treatment paths, and find what works for them. There is never going to be a canonical "cure" for depression, just as there won't be for IBS.

Re: Should Mental Disorders Have Names?

#13

Post by jstarfish »

komali2 wrote: post #6

I'm skeptical as hell of the entire field of psychotherapy, psychology, psychiatry, and cog sci. I think we're doing better than before, sure, but it's all such a shit show from my perspective as a participant. Rambles: Back in highschool we had a massively depressed friend. They tried it all with her: cognitive behavioral therapy, drugs (ALL OF THEM), weed, religion. Tough love. Exercise. Diet. Nothing cured her and…

Sorry to hear about your friend. I swear psychiatrists are exempt from observing the Hippocratic oath.

"I need help. My life is falling apart. I'm struggling with work and school. I might have a learning disability."

"You sound depressed. Here's a prescription for some obscure variant of an SSRI not covered by your insurance."

"These meds you put me on make me feel sick."

"Let's increase your dose."

"I want to hurt other people. I want to die."

"It takes 4-6 weeks for it to take full effect."

"This just isn't working."

"Let's add another variable to the equation. Here's a second prescription. Take both and see what happens."

The experiment must continue. It always ends the same way.

I know psychiatry helps some people (especially where sedatives are involved), but for the rest of us who slip through the cracks it's just the new Nazi science.

Re: Should Mental Disorders Have Names?

#14

Post by fromthestart »

komali2 wrote: post #6

I'm skeptical as hell of the entire field of psychotherapy, psychology, psychiatry, and cog sci. I think we're doing better than before, sure, but it's all such a shit show from my perspective as a participant. Rambles: Back in highschool we had a massively depressed friend. They tried it all with her: cognitive behavioral therapy, drugs (ALL OF THEM), weed, religion. Tough love. Exercise. Diet. Nothing cured her and…

Financial interests, publish or perish, p value abuse, reproducibility crisis...you're right to be skeptical of any soft, non experimental science.

Re: Should Mental Disorders Have Names?

#15

Post by teekert »

MrQuincle wrote: post #11
teekert wrote: post #3

Us humans certainly prefer to put boundaries and names on things. And indeed, it is often unwise i.e. with (one of our) species definitions: A can procreate with B, B can with C but A cannot with C, meaning A==B, B==C but A!=C, a paradox because of our tendencies. Could it be a cultural thing? While I grow older I find it more natural to think of things as continuous or to assign uncertainty to "facts", but perhaps o…

True, but do definitions not encourage a more thorough analysis? If A is a male, B is a female, C is a male, your operator definition is even troublesome within a species. What kind of mathematical object comes closer to this abstraction of a species? Maybe it's not about names and boundaries, but about getting to understand things for which you need abstractions. I always appreciate when people do not fuss about def…

Agreed, of course we need definition to discuss, and indeed we should be fluent about them. This is difficult to explain to a child or indeed to some adults.

Re: Should Mental Disorders Have Names?

#16

Post by heisenbit »

keiferski wrote: post #5

The danger of naming mental disorders (or any other abstract concept) is when you confuse the map for the territory. The map (the name) should serve as the best possible mental model of the territory (the actual, descriptive physiological condition) - not as the thing-in-itself.

It is tempting to stare at the map when the territory is obscured by the fog of war. The rigor of the SCID very much hides the fact that several places on the territory have similar features but are miles apart. And then every observer loves certain places and hates working in others.

As bad as the state of diagnosis is (some say >50% for certain conditions) there is no way around a diagnosis for treatment as one needs to make decisions and these need to be based in whatever tenuous grasp one has on reality. At this point imho. we can only try to make sure all sources of bias, tendency to defend previous decisions, treatment capacity and financial considerations (diagnosis is key to insurance payments) are as far isolated from decision making as possible. There is lots to be done. SCID is only the symptom.

Re: Should Mental Disorders Have Names?

#17

Post by diminoten »

jstarfish wrote: post #13
komali2 wrote: post #6

I'm skeptical as hell of the entire field of psychotherapy, psychology, psychiatry, and cog sci. I think we're doing better than before, sure, but it's all such a shit show from my perspective as a participant. Rambles: Back in highschool we had a massively depressed friend. They tried it all with her: cognitive behavioral therapy, drugs (ALL OF THEM), weed, religion. Tough love. Exercise. Diet. Nothing cured her and…

Sorry to hear about your friend. I swear psychiatrists are exempt from observing the Hippocratic oath. "I need help. My life is falling apart. I'm struggling with work and school. I might have a learning disability." "You sound depressed. Here's a prescription for some obscure variant of an SSRI not covered by your insurance." "These meds you put me on make me feel sick." "Let's increase your dose." "I want to hurt o…

Would you rather: "This just isn't working." "Okay, well we tried."

Once you're in the "this isn't working" phase of your story, shit is pretty dire. Hard to blame the caregiver for trying something else.

Re: Should Mental Disorders Have Names?

#18

Post by baddox »

MrQuincle wrote: post #11
teekert wrote: post #3

Us humans certainly prefer to put boundaries and names on things. And indeed, it is often unwise i.e. with (one of our) species definitions: A can procreate with B, B can with C but A cannot with C, meaning A==B, B==C but A!=C, a paradox because of our tendencies. Could it be a cultural thing? While I grow older I find it more natural to think of things as continuous or to assign uncertainty to "facts", but perhaps o…

True, but do definitions not encourage a more thorough analysis? If A is a male, B is a female, C is a male, your operator definition is even troublesome within a species. What kind of mathematical object comes closer to this abstraction of a species? Maybe it's not about names and boundaries, but about getting to understand things for which you need abstractions. I always appreciate when people do not fuss about def…

I don’t think your example really applies, because no one expects the definition of “species” to imply that the “individual A can mate with individual B” relation to be transitive.

Re: Should Mental Disorders Have Names?

#19

Post by baddox »

jstarfish wrote: post #13
komali2 wrote: post #6

I'm skeptical as hell of the entire field of psychotherapy, psychology, psychiatry, and cog sci. I think we're doing better than before, sure, but it's all such a shit show from my perspective as a participant. Rambles: Back in highschool we had a massively depressed friend. They tried it all with her: cognitive behavioral therapy, drugs (ALL OF THEM), weed, religion. Tough love. Exercise. Diet. Nothing cured her and…

Sorry to hear about your friend. I swear psychiatrists are exempt from observing the Hippocratic oath. "I need help. My life is falling apart. I'm struggling with work and school. I might have a learning disability." "You sound depressed. Here's a prescription for some obscure variant of an SSRI not covered by your insurance." "These meds you put me on make me feel sick." "Let's increase your dose." "I want to hurt o…

I can only imagine the frustration you are describing, but I still wonder if the blame is really on the doctors or the branch of medicine. Is there a better alternative?

Re: Should Mental Disorders Have Names?

#20

Post by DoreenMichele »

The root issue here is finding some path forward for helping people. Psychiatry, psychology etc aren't doing a great job with that.

He tries to determine what has happened historically but not why.

Why was this guy using drugs starting at age ten? What led up to that? Shouldn't it be classified as a parenting failure, not a "disorder" on his part?

What was the history with the father? Perhaps assaulting his father wasn't simply due to insanity. Some parents are really awful to their kids and it's a huge problem for the kid. That doesn't necessarily stop being true just because the kid became a legal adult.

Labels determine what mental models we use when trying to intercede in a problem. Different labels get very different reactions and treatment modes.

We need to up our game in myriad ways, but labels are a critical tool for this problem space. I hate labels, but they are a useful communication tool.

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