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Should Mental Disorders Have Names?

blogs.scientificamerican.com

71–80 of 108 posts

Re: Should Mental Disorders Have Names?

#71

Earlier quoted context omitted.

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.

I agree, but even then, should the symptom be treated with the same treatment designed for personality disorders? What is the evidence of it? etc. I genuinely don't know these things.

Re: Should Mental Disorders Have Names?

#73
Most researchers agree that mental disorders should not have names, as it is difficult or impossible to draw discrete boundaries in this complex and poorly-understood spectrum of symptoms. However, as a broad generalization, researchers are the only group who feel this way:

- Doctors like names because then they can provide a diagnosis and recommend action based on the diagnosis

- Patients and their loved ones (often) like names because it is easier to think/say "I have schizophrenia" than it is to describe their factor scores on a myriad of benchmarks

- Drug companies like names because they can develop drugs for specific disorders rather than for a combinatorially large number of factors

- Regulators like names because they can approve treatments and standards of care for a finite number of situations

- Insurance companies like names because it allows them to approve or deny claims in a more straightforward way.

While names are often times arbitrary, they make many things more convenient. I am not saying that I personally agree or disagree that there should or should not be names, only that this is a complex issue with many complexities besides the underlying science.

Also, I see nobody has mentioned RDoC yet, which is the taxonomy researchers are starting to use to classify mental disorders: https://www.nimh.nih.gov/research-priorities/rdoc/constructs...

Re: Should Mental Disorders Have Names?

#74
post #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.

Are names quantities?

Re: Should Mental Disorders Have Names?

#75

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…

Psychiatry, psychology etc aren't doing a great job with that.

I'm not sure that's a fair criticism. They're certainly not doing a perfect job but the number of people who have a higher quality of life than a century ago is a real success.

There are people who are living fulfilling lives who would have been housed in mental institutions or who would have long since killed themselves, given the state of mental health care 50 or 60 years ago.

Re: Should Mental Disorders Have Names?

#76

Most researchers agree that mental disorders should not have names, as it is difficult or impossible to draw discrete boundaries in this complex and poorly-understood spectrum of symptoms. However, as a broad generalization, researchers are the only group who feel this way: - Doctors like names because then they can provide a diagnosis and recommend action based on the diagnosis - Patients and their loved ones (often…

[deleted]

Re: Should Mental Disorders Have Names?

#77
post #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.

Are names quantities?

Yes, categories are as long as they’re well-defined. Measurement instruments get better over time.

Re: Should Mental Disorders Have Names?

#78
post #31

Earlier quoted context omitted.

The first thing you need to ask is are we, collectively, seeing an improvement or a deterioration of aggregate mental health? And how does this compare and contrast against nations where pharmacological treatment of illness is less and, if such a thing exists, more common? In other words is what we are doing better than nothing? The answer to this question is not always yes, because it's entirely possible that in the…

I don't disagree with your basic point, but that's a huge correlation bias. Why would a country with little mental illness introduce these medications?

It's not countries introducing drugs, but companies. And companies are driven primarily by a profit motive. This is not a bad thing in and of itself since it creates a private incentive for the research and development of drugs. However, when the money starts to become prioritized more heavily than the product being made, it creates a severe conflict of interest. The recent issue with opioids being an obvious example of this. Quoting this [1] great article from the Houston Chronicle:

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"The trigger of the opioid crisis was a misrepresentation of a 1980 letter published in the New England Journal of Medicine, reporting on 11,000 hospitalized patients receiving opioids. It concluded that “despite widespread use of narcotic drugs in hospitals… addiction is rare in medical patients with no history of addiction.” This became a landmark study, cited more than 600 times, particularly after Purdue Pharma introduced OxyContin (extended-release oxycodone) in 1995.

Large opioids manufacturers began funding nonprofit groups such as the American Pain Society; and pain experts advocated for pain to become an important “fifth vital sign” to be queried in every doctor’s visit when checking blood pressure, heart rate, respiration and temperature.

Caught in the trend, the Federation of American Medical Boards encouraged punishing physicians for under-treating pain. This policy was drafted by individuals with ties to opioids manufacturers. Some were members of industry speakers’ bureaus, and later became company executives.

Purdue funded more than 20,000 educational programs between 1996 and 2002 to influence physician prescription habits nationwide, and developed a misleading advertising campaign that claimed that the risk of addiction from prescription opioids was “much less than 1%.” OxyContin sales grew from $48 million in 1996, to over $1.5 billion in 2002. With increased sales came increased abuse and addiction. By 2004, OxyContin was the leading drug of abuse in the United States.

In 2007, Purdue (and three executives) pleaded guilty to misrepresenting the risks of OxyContin addiction and paid $634 million in penalties, a fraction of the $35 billion in sales in two decades."

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It's pretty sick stuff, but extremely clear evidence that these comes have come to see profit as the sole point of their existence. And these companies have extensive reach. And opioids are obviously not the only example here. This is a typical pattern, even if a rather extreme case. For instance the nonprofit industry tool used to push medicating and diagnosing of ADD is CHADD - Children and Adults with ADD.

[1] - https://www.houstonchronicle.com/opinion/outlook/article/Opi...

Re: Should Mental Disorders Have Names?

#79

Most researchers agree that mental disorders should not have names, as it is difficult or impossible to draw discrete boundaries in this complex and poorly-understood spectrum of symptoms. However, as a broad generalization, researchers are the only group who feel this way: - Doctors like names because then they can provide a diagnosis and recommend action based on the diagnosis - Patients and their loved ones (often…

We used to get drunk and debate the merits of the DSM as undergrads. Most of my friends who went on to get their PhDs still see it as a imperfect but necessary evil. As a researcher, you need a common language to discuss what you're researching. There is value to studying one particular group of symptoms vs another; different ones have different treatment guideless, medications, and potentially common biomarkers. But people don't always fit neatly in these boxes, as the article shows. It's entirely possible someday that we'll move past specific labels, but we don't have viable alternatives to the DSM right now.

Re: Should Mental Disorders Have Names?

#80

Most researchers agree that mental disorders should not have names, as it is difficult or impossible to draw discrete boundaries in this complex and poorly-understood spectrum of symptoms. However, as a broad generalization, researchers are the only group who feel this way: - Doctors like names because then they can provide a diagnosis and recommend action based on the diagnosis - Patients and their loved ones (often…

I do research on the topic of the article. I actually initially clicked on it because the title seems so uncannily similar in content to an article I wrote that I thought they might mention something about it. They did not but it's still really salient to me.

The article is sort of strange in that it brings up these issues and then fails to discuss the huge range of research in this area. The p-factor stuff is sort of hot lately but is just one subtopic in a vast area, somewhat controversial, and more of theoretical interest than clinical utility.

Part of the problem is that there are different purposes for classification systems. I think you're right in that categorical diagnoses have all the appeals you mention at least among some subgroups, but those are a little detached from (1) how many clinicians actually think about a lot of problems, and (2) how many researchers think about these things. Putting aside the "syndrome"-favoring clinicians, a lot of clinicians focus more on behavioral patterns, which tend to be very specific, more targetable, and far removed from broad categorical labels. Many researchers are moving away from these categorical labels also, for many reasons, but mostly generally because the patterns you see in behavior don't map onto the categories in the DSM in reality. Think blood pressure or height as analogies for depression or disorganized thinking, rather than Huntington's disease or malaria.

RDoC is important to mention but it's ending up to be about as controversial as the DSM for various reasons. First, it suffers from the same "names by committee fiat" as the DSM, which is problematic when you are dealing with something like neurobehavioral pathology, which can be examined at many levels and from many directions, which is fuzzy and complex, and about which we know very little. Second, despite its noble intents, was kind of developed by neuroscientists with little connection to actual clinical human behavior. I don't mean any offense to them, but when you get together a bunch of researchers, a substantial number of whom study rodent neurobiology, you're going to start losing touch with what clinicians are actually wrestling with in clinical settings. Look for psychosis or subdimensions of psychosis, for example, and it's missing from RDoC. I like to think of RDoC as "revenge of the neuroscientists," people who got tired of trying to connect their research to human public health, and decided to just redefine problems so it's closer to their own research. A similar initiative is HiTOP, which is more phenotypically focused, and uses statistical/quantitative models for classification rather than committee decisions (I'm not saying HiTOP is better, it just is a similar but different approach from RDoC).

I think the issue is not whether or not mental disorders should have names, it's whether or not there are mental disorders per se, or how to best describe mental-neural-behavioral patterns. You need to be able to quantify to study something scientifically, and quantifying implies labeling; the question is how.

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