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Should Mental Disorders Have Names?

blogs.scientificamerican.com

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Re: Should Mental Disorders Have Names?

#61
post #29

Earlier quoted context omitted.

For me one of the issue of the current names is that their definition change too much depending on the context and the person interpreting them. For instance if you say someone your arm is 'broken', they understand something is deeply damaged (not just fissured). They might not know the specifics on how it broke, where exactly, how you are healing it or how it impacts you, but they know the basic criticality of it. I…

I think what you're doing is comparing medical vs layman usage. A doctor will tell his patient they have a "broken arm" due to past experiences in speaking with patients using medical terms. e.g, fracture or distal radius fracture in the case of a broken wrist. When it comes to mental disorders, it can be very difficult to accurately classify the severity. It reminds me of how doctors prescribe blood pressure medicat…

I'm afraid you are giving the psychiatric profession way too much credit.

Most DSM disorder categories don't perform well on measures of inter-rater reliability. (https://en.wikipedia.org/wiki/Inter-rater_reliability). One implication of this is that the categories can't be assumed to be well-defined scientific entities. Now, the DSM could be a shadow of some more complete, correct taxonomy of mental disfunction—certainly it's based on observation of genuine distress, so it's not completely arbitrary—but by scientific or medical standards, it's very shaky.

Here's an article about the situation in relation to the DSM:

https://www.madinamerica.com/2013/03/the-dsm-5-field-trials-...

It's not uncommon for people who haven't looked seriously at the mental health field to assume that the so-called medical model of mental illness meets the same high standards of intellectual rigour as other areas of medicine, or other endeavours such as engineering. I put it to you that you are in exactly that position: the very basic point you are making ("This is as complex as engineering! Leave it to the experts!) indicates that you are unaware of the unique flakiness of psychiatry. This is contested territory, and many professionals are invested in a certain dubious framing of the situation.

Re: Should Mental Disorders Have Names?

#62
post #29

Just imagine a doctor telling you what ICD code you have. There's nothing wrong with classification and labeling things. I think society is getting a little carried away with such topics. Personally, I think it's a phase that collectively we'll pass and reflect on how extreme we took things in order to try and obtain balance. There's a difference in calling someone "crazy" vs saying they have a mental disorder. The m…

For me one of the issue of the current names is that their definition change too much depending on the context and the person interpreting them. For instance if you say someone your arm is 'broken', they understand something is deeply damaged (not just fissured). They might not know the specifics on how it broke, where exactly, how you are healing it or how it impacts you, but they know the basic criticality of it. I…

>If you say you have "depression", they don't know if you'll take your week off to recover or actually need extensive professional follow up with a long term medication. There is no common sense of how bad it is 'broken'.

I think that's primarily because severe and enduring mental illness is still strongly stigmatised.

The public conversation about mental health is dominated by what I call "the narrative". We see a succession of successful and healthy people talking about how they had depression or anxiety, they plucked up the courage to ask for help but now they're OK. Our conversations about mental health are dominated by brief episodes of illness in the past tense.

That's not a terrible narrative and I'm sure it has encouraged a lot of people to seek treatment, but it's a very selective image of mental illness. We don't hear from people in the throes of severe illness. We don't hear from people who have struggled for years or decades and haven't found an effective treatment. We don't hear from people whose lives have been blighted by unmanaged schizophrenia or bipolar disorder. We don't hear from people who know they need treatment, but can't access it for financial reasons.

"There are effective treatments and you don't have to suffer in silence" is an important message, but so is "some people can't access treatment, some people don't benefit from treatment, so we need to work as a society to improve the quality and availability of treatment and help people with unresolved mental illness to live fulfilling lives".

Re: Should Mental Disorders Have Names?

#63
Why is the author is so troubled? They’re just using an instrument to transform qualitative data into quantitative data. Such methods are used pretty much anywhere there’s subjectivity in observation. To do science, you have to have a standard way of measuring.

Re: Should Mental Disorders Have Names?

#64
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…

>> 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"....

Yay! You've overcome splitting! Now if the profession could achieve what they want from patients...

Re: Should Mental Disorders Have Names?

#65

Just imagine a doctor telling you what ICD code you have. There's nothing wrong with classification and labeling things. I think society is getting a little carried away with such topics. Personally, I think it's a phase that collectively we'll pass and reflect on how extreme we took things in order to try and obtain balance. There's a difference in calling someone "crazy" vs saying they have a mental disorder. The m…

ICD is not a public facing label, I use them every day for healthcare analysis but they'd never be intelligible to lay people.

Re: Should Mental Disorders Have Names?

#66
I tell people I have Tourette's. I don't have Tourette's. I'm missing one of the required criteria

- must have tics that begin before he or she is 18 years of age.

In a medical standpoint that makes it different, but in any practical sense the name conveys all of the information people need, it is perhaps unusual in that it is also a condition that occasionally requires rapid explanation.

Re: Should Mental Disorders Have Names?

#67

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 wa…

>He tries to determine what has happened historically but not why. The biggest advance in the history of psychotherapy was to stop asking why and start asking what and how . The psychoanalysts broadly believed that mental disorders could be treated by revealing and resolving unconscious conflicts and forgotten childhood memories. That's a very slow process, and eventually randomised controlled trials would demonstrat…

> The biggest advance in the history of psychotherapy was to stop asking why and start asking what and how.

> Rational emotive and cognitive behavioural therapists essentially argued I don't care why you're nuts, I just want to teach you how to be less nuts.

This is part of why schema therapy is getting so much attention right now: it takes CBT but combines why, what and how into a cohesive whole. The success rates seems to be even better than CBT, a lot better in some cases.

[0] https://en.wikipedia.org/wiki/Schema_therapy

Re: Should Mental Disorders Have Names?

#68

Earlier quoted context omitted.

>He tries to determine what has happened historically but not why. The biggest advance in the history of psychotherapy was to stop asking why and start asking what and how . The psychoanalysts broadly believed that mental disorders could be treated by revealing and resolving unconscious conflicts and forgotten childhood memories. That's a very slow process, and eventually randomised controlled trials would demonstrat…

> The biggest advance in the history of psychotherapy was to stop asking why and start asking what and how. > Rational emotive and cognitive behavioural therapists essentially argued I don't care why you're nuts, I just want to teach you how to be less nuts. This is part of why schema therapy is getting so much attention right now: it takes CBT but combines why, what and how into a cohesive whole. The success rates s…

It's interesting that a lot of the 'hot new thing' therapies are around Personality Disorders or PTSD. I'm curious what the theory is to apply this to depression or anxiety. And what about dissociastive disorders, or oppositional defiant disorder, or autism?

Re: Should Mental Disorders Have Names?

#69

Earlier quoted context omitted.

> The biggest advance in the history of psychotherapy was to stop asking why and start asking what and how. > Rational emotive and cognitive behavioural therapists essentially argued I don't care why you're nuts, I just want to teach you how to be less nuts. This is part of why schema therapy is getting so much attention right now: it takes CBT but combines why, what and how into a cohesive whole. The success rates s…

It's interesting that a lot of the 'hot new thing' therapies are around Personality Disorders or PTSD. I'm curious what the theory is to apply this to depression or anxiety. And what about dissociastive disorders, or oppositional defiant disorder, or autism?

> oppositional defiant disorder

Tangent: I have a lot of skepticism about that one being a proper disorder on its own, in the same sense that I wouldn't consider "fever" an illness in and of its own, but a symptom of other illnesses.

Re: Should Mental Disorders Have Names?

#70

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 wa…

> Labels determine what mental models we use when trying to intercede in a problem. Different labels get very different reactions and treatment modes. I think he ever-so-briefly touched on a different angle of that problem: " The psychoanalysts don’t like it because it ignores the “unique milieu of individuality.” The more biologically-oriented clinicians don’t like it because it ignores biology. The DSM lacks “valid…

I was a homeschooling parent and had a role in a TAG/parenting/education organization to support that role. My feedback on very difficult kids, some of whom had been failed by multiple experts, was pretty popular, enough so that I de facto got "referrals," though I had no real formal credentials and charged no money. Parents would just talk to friends and say "Go talk to her" basically.

In many cases, these were Twice Exceptional kids who had started doing really strange things around the time they were toddlers or preschoolers. The strong negative reactions of adults around them then compounded the problem and made it an intractable issue.

I was often able to help parents back off from this dynamic so the family and child could get unstuck. I wrote an anecdote about that sort of process in January. It can be read here: https://raisingfutureadults.blogspot.com/2019/01/the-hand-li...

I'm a former military wife and homeschooling parent. People are quick to be dismissive and tell me I don't know anything about x, y or z, etc.

But my experiences suggest to me that a lot of mental health issues are rooted in relatively prosaic cases of "kids do weird and stupid things because they are kids, some kids do very weird and stupid things for various reasons, and parents often don't have effective tools for handling the situation, thereby compounding the problem." My experiences also suggest that a lot of this is fixable, without drugs or therapy, if you can help the family disengage from long-standing patterns of interaction and help the child in question understand where their dysfunctional behaviors came from in a non-blaming manner and give them some better answers and/or just breathing room to change on their own without interference.

I spent about two weeks writing the above piece and it's based on many years of education and experience. It got more than 60k page views and people are republishing it, some with my permission and giving me credit.

I would like to do more of that kind of writing, but it made me zero money. I am routinely told my writing has zero value and I should go get a real job. I'm not good at the self promotion thing etc.

I think I know some useful things that could help parents avoid becoming mired in the kinds of problems this man in the article has. But I have no audience and people who know what I used to do mostly are in my past or simply unwilling to vouch for me, including some prominent people on HN who knew of my work in that area at the time, to some degree or another.

I've largely made my peace with the fact that I can't afford to write for free and lots of people on the internet expect excellent content for free. They don't want ads and they don't want to pay anything for it either. No, they don't want to be a Patreon supporter.

So I content myself as best I can with leaving comments on the internet and generally being percieved as a blowhard and arm chair politician type who has an opinion on everything and zero credibility.

Que sera, sera.

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