Aren't we all somewhere on the spectrum of disease? • Hacker News Board

Re: Aren't we all somewhere on the spectrum of disease?

#21

Post by jniedrauer » Sun, Jul 19, 2020, 1:26 AM UTC

blame_lewis wrote: post #18

This is a really dangerous and misleading way to look at bipolar. The disease proper of bipolar disorder is progressive and degenerative. This progression is accompanied by structural changes in the brain [1] as well as biological changes in the body [2]. If someone had the syndromes of manic or depressed symptoms in response to a medication, that does not prove either way that the person actually has the progressive…

> The disease proper of bipolar disorder is progressive and degenerative.

This is also not entirely true. It may spontaneously resolve itself in many cases[0]. I suspect that we've grouped a number of different disorders under the label "bipolar" because they all manifest with similar symptoms.

[0] https://www.sciencedaily.com/releases/2009/09/090929141530.h...

Re: Aren't we all somewhere on the spectrum of disease?

#22

Post by dwd » Sun, Jul 19, 2020, 1:37 AM UTC

zabzonk wrote: post #13

What practitioners call mental health problems a "disease"? Surely that should be reserved for things like Covid or the plague?

They all have two aspects, the cause and the disease it triggers.

COVID-19 is the disease caused by the SARS-CoV-2 virus like AIDS is caused by HIV.

It gets complicated where they don't know or understand the cause like a lot of autoimmune diseases.

Re: Aren't we all somewhere on the spectrum of disease?

#23

Post by blame_lewis » Sun, Jul 19, 2020, 1:39 AM UTC

jniedrauer wrote: post #21

blame_lewis wrote: post #18

This is a really dangerous and misleading way to look at bipolar. The disease proper of bipolar disorder is progressive and degenerative. This progression is accompanied by structural changes in the brain [1] as well as biological changes in the body [2]. If someone had the syndromes of manic or depressed symptoms in response to a medication, that does not prove either way that the person actually has the progressive…

> The disease proper of bipolar disorder is progressive and degenerative. This is also not entirely true. It may spontaneously resolve itself in many cases[0]. I suspect that we've grouped a number of different disorders under the label "bipolar" because they all manifest with similar symptoms. [0] https://www.sciencedaily.com/releases/2009/09/090929141530.h...

Thank you for that! I hadn't seen it before.

I'm a little nervous about the idea of coming to conclusions about individual outcomes based on national surveys of self-reported diagnoses. It seems like there are vast opportunities for outside factors to mislead attempts at analysis.

For example, the proportion of people who were misdiagnosed to start with; the increased openness over time when it comes to accepting or speaking about the diagnosis; the improvement in mental health resources meaning more diagnoses; the possibility that patients decompensate and lose insight or reject diagnoses over time; etc etc.

If you're thinking "that sounds like a No True Scotsman", you're right. The disease is clearly progressive for some people. Declaring that people who don't demonstrate that progression don't have the disease is semantically useless but may be clinically useful.

Re: Aren't we all somewhere on the spectrum of disease?

#24

Post by blame_lewis » Sun, Jul 19, 2020, 1:50 AM UTC

KerryJones wrote: post #6

It's weird that we consider mental illness to be a disease, in my opinion -- none of the drugs have been linked to physical/chemical shortages in the brain or the like. We're able to mask symptoms but have absolutely no proof about underlying reasons, and so we create names of things and put it in the same classification of a medical disease... but that's very different. Bipolar cannot be identified by any physical m…

> I am very hesitant to use this when a drug can be prescribed (with knowing bad side effects) can be applied. It can seriously mess someone's life up.

This is why it's so important to understand that psychiatric treatment must be a collaborative process. The prescribing physician is only making decisions with the consent of the patient, because the patient is the one who has to choose to actually take the medication anyway.

Those decisions are made based on the patient's description of their experience of the disease. A medication can only push you in a certain direction, and when trying to find the right direction, all the clinician has to go by is what the patient says they're experiencing.

If your psychiatrist is simply telling you what your problems are, and prescribing you medications without your say in anything, then what you are receiving is not treatment. And it will, as you say, seriously mess [your] life up.

Re: Aren't we all somewhere on the spectrum of disease?

#25

Post by zabzonk » Sun, Jul 19, 2020, 1:53 AM UTC

dwd wrote: post #22

zabzonk wrote: post #13

What practitioners call mental health problems a "disease"? Surely that should be reserved for things like Covid or the plague?

They all have two aspects, the cause and the disease it triggers. COVID-19 is the disease caused by the SARS-CoV-2 virus like AIDS is caused by HIV. It gets complicated where they don't know or understand the cause like a lot of autoimmune diseases.

> like a lot of autoimmune diseases.

I worked for some years in a lab testing for auto-immune conditions - we called it that - a condition. I suppose other labs might have labelled it otherwise.

Would you call cancer a disease? I wouldn't.

But I suppose this is just arguing over semantics.

Re: Aren't we all somewhere on the spectrum of disease?

#26

Post by ip26 » Sun, Jul 19, 2020, 1:55 AM UTC

KerryJones wrote: post #6

It's weird that we consider mental illness to be a disease, in my opinion -- none of the drugs have been linked to physical/chemical shortages in the brain or the like. We're able to mask symptoms but have absolutely no proof about underlying reasons, and so we create names of things and put it in the same classification of a medical disease... but that's very different. Bipolar cannot be identified by any physical m…

We knew what scarlet fever looked like & could do for at least two thousand years before the creation of germ theory.

Re: Aren't we all somewhere on the spectrum of disease?

#27

Post by markdown » Sun, Jul 19, 2020, 1:56 AM UTC

TylerE wrote: post #5

awillen wrote: post #3

I've always thought about mental illness in this context - we define it as illness because of negative consequences, but it's really just the deviation from a norm. I think Elon Musk is the best example of this - even ignoring some of his childish Twitter behavior, the guy's brain is waaaaaaaaay far off from the normal human brain. He thought he could start an electric car company from scratch and be successful. That…

> He thought he could start an electric car company from scratch Except he didn't. He invested in one that was already started with several employees, and had himself given founder status by fiat as part of the deal.

At what point do you consider a company founded? At the moment the business is registered by the local government?

Re: Aren't we all somewhere on the spectrum of disease?

#28

Post by nradov » Sun, Jul 19, 2020, 1:56 AM UTC

blame_lewis wrote: post #24

KerryJones wrote: post #6

It's weird that we consider mental illness to be a disease, in my opinion -- none of the drugs have been linked to physical/chemical shortages in the brain or the like. We're able to mask symptoms but have absolutely no proof about underlying reasons, and so we create names of things and put it in the same classification of a medical disease... but that's very different. Bipolar cannot be identified by any physical m…

> I am very hesitant to use this when a drug can be prescribed (with knowing bad side effects) can be applied. It can seriously mess someone's life up. This is why it's so important to understand that psychiatric treatment must be a collaborative process. The prescribing physician is only making decisions with the consent of the patient, because the patient is the one who has to choose to actually take the medication…

What about patients who present a serious risk of harm to themselves and others? Should they be medicated without consent? Sometimes the only other option is indefinite confinement in a mental facility.

Re: Aren't we all somewhere on the spectrum of disease?

#29

Post by Jommi » Sun, Jul 19, 2020, 1:58 AM UTC

As far as I understand, this kind of thinking is especially visual with Diabetes.

People have different levels of insulin sensitivity, which changes over time with thing such as diet and excercise.

Then magically one day you cross some arbitrary barrier, and you have type 2 diabetes. Crazy.

Only recently has this even been taken under scrutiny, and the phrase "pre diabetic" is used more. But it's clearly not enough.

I think the key to unlocking this is getting more people into measuring their insulin sensitivity through products like Veri[1]

[1]https://www.veristable.com

Re: Aren't we all somewhere on the spectrum of disease?

#30

Post by blame_lewis » Sun, Jul 19, 2020, 1:59 AM UTC

nradov wrote: post #28

blame_lewis wrote: post #24

Earlier quoted context omitted.

> I am very hesitant to use this when a drug can be prescribed (with knowing bad side effects) can be applied. It can seriously mess someone's life up. This is why it's so important to understand that psychiatric treatment must be a collaborative process. The prescribing physician is only making decisions with the consent of the patient, because the patient is the one who has to choose to actually take the medication…

What about patients who present a serious risk of harm to themselves and others? Should they be medicated without consent? Sometimes the only other option is indefinite confinement in a mental facility.

Asterisk. I meant in the long term. In the very short term, hospital can be an option, but asylums no longer exist in first-world nations.

Our treatment systems simply do not currently have an effective long-term way of handling patients that outright refuse to take their medication.

In practical terms, these days most people in that situation end up in prisons instead.