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

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

#31

Post by Skgqie1 » Sun, Jul 19, 2020, 2:01 AM UTC

blame_lewis wrote: post #23

jniedrauer wrote: post #21

Earlier quoted context omitted.

> 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…

I think a large part of the problem lies in the difficulty of accurate diagnosis, coupled with people's personal experiences with misdiagnosis.

I've been misdiagnosed as bipolar in the past, and the medication regime I was put on lead to schizoid delusions and incredibly unstable emotional state that only resolved once I stopped taking the medication (under the monitoring of the psychiatrist who initially prescribed them).

My mother was also misdiagnosed as bipolar, leading to her actual condition of Borderline Personality Disorder going untreated until she attempted suicide (she died 6 months after because of complications relating to the attempt).

A friend of mine who is schizophrenic was also misdiagnosed as bipolar, because his delusions and paranoia were fairly minimal. In his case, the misdiagnosis was probably more helpful than not, as the medications were helpful in stabilising his mood.

My point here isn't that the medical establishment is bad or that doctors are stupid. It's that disorders related to mental illness are very, very difficult to diagnose and treat, even for incredibly intelligent trained professionals. Many disorders have significant overlap with other disorders. An effect whose impact is only made worse by the fact that a bunch of these disorders are highly co-morbid. Mix in the fact that the borders between healthy and unhealthy are not especially well defined, and it's easy to see where a lot of the contention comes from

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

#32

Post by Skgqie1 » Sun, Jul 19, 2020, 2:06 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'm not sure where you get your information, but mental illnesses certainly can be identified by physical (neurochemical) differences from a statistical baseline. Probably one of the easier ones to identify is dopamine deficiency and dysthymia.

Drugs can certainly mess up someone's life (see my earlier post). But untreated mental illness can literally end your life (either directly, via suicide, or indirectly, via medical complications from body dysmorphic conditions)

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

#33

Post by falcolas » Sun, Jul 19, 2020, 2:10 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…

While this may be true for Bi-Polar disorder (I'm not as familiar with this), there are some mental disorders that do display as differences in the brain (such as ADHD).

However, while these differences can't be rectified with medication or other therapies (yet), the side effects of these differences can be ameliorated by medication.

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

#34

Post by TylerE » Sun, Jul 19, 2020, 2:16 AM UTC

markdown wrote: post #27

TylerE wrote: post #5

Earlier quoted context omitted.

> 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?

Well, when 3 guys start it and work on it for a long time, incorporate for a year, have an office and employees, and then a VC comes in, the VC definitely did not "found it", no matter when you define the actual date.

https://web.archive.org/web/20150228163500/http://www.busine...

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

#35

Post by [deleted] » Sun, Jul 19, 2020, 2:29 AM UTC

[deleted]

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

#36

Post by guerrilla » Sun, Jul 19, 2020, 2:30 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…

> Bipolar cannot be identified by any physical means

Most diseases couldn't be at one point and many still can't be now.

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

#37

Post by geofft » Sun, Jul 19, 2020, 2:35 AM UTC

KerryJones wrote: post #14

roland00 wrote: post #11

Earlier quoted context omitted.

Mental Illness as defined by the DSM as not thriving. You can have the symptoms of a disorder, but if you are thriving then you do not have the disorder. >It can seriously mess someone's life up. Treatment to try fix someone who is not thriving, is precisely because someone's life is already messed up. Yes treatment may make it worse, but it often makes it better and there are treatment algorithms where we use best p…

The DSM is based off the "top" Psychiatrists at the time voting on the illnesses (literally), without scientific backing. Treatment's don't fix anything, they might lessen one issue and often give a host of other problems that are often more severe. I think more studying of iatrogenics is in order and more data about what "making it better" means -- as often the patient and doctor have different meanings. Again, beca…

> The DSM is based off the "top" Psychiatrists at the time voting on the illnesses (literally), without scientific backing.

What, precisely, would provide scientific backing here, if a vote by professional scientists doesn't count? A vote by academics? A committee of academics, appointed by a prior generation? A team at Harvard, because Harvard is the oldest? A committee appointed by the government?

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

#38

Post by phnofive » Sun, Jul 19, 2020, 2:37 AM UTC

Jommi wrote: post #29

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.…

Great example of that barrier is gestational diabetes, which may as well be called secondary type two diabetes.

It’s not a rubicon, either, since it’s so commonly reversible (though this isn’t trivially easy).

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

#39

Post by Talanes » Sun, Jul 19, 2020, 2:39 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...

This is very interesting. I had a childhood diagnoses that I've always chalked up to just imitating my properly diagnosed single-mother. I was also under the impression that if I truly had the disease, that my current level of mood stability would be impossible.

Though my years don't line up with the results of the study at all. I was medicated from 8-14, and then really mellowed out around 19.

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

#40

Post by geofft » Sun, Jul 19, 2020, 2:43 AM UTC

JumpCrisscross wrote: post #17

roland00 wrote: post #11

Earlier quoted context omitted.

Mental Illness as defined by the DSM as not thriving. You can have the symptoms of a disorder, but if you are thriving then you do not have the disorder. >It can seriously mess someone's life up. Treatment to try fix someone who is not thriving, is precisely because someone's life is already messed up. Yes treatment may make it worse, but it often makes it better and there are treatment algorithms where we use best p…

> Mental Illness as defined by the DSM as not thriving Isn’t that a two-system measure? The person. And their society. A gay man in Tehran won’t thrive, but the solution isn’t medicating him into submission.

Yes, it is, and that's precisely why the removal of homosexuality from the DSM (in 1974) was not a sign of the DSM's authors giving into cultural pressures - it was a combination of the authors avoiding the cultural pressures that had caused the previous edition to list it, plus a realization (after scientific study) that the problem wasn't with the person, it was with their society.

The nature of the scientific method is that we learn new things over time, and the nature of society is that we are all subject to various kinds of cultural pressures, most of which we don't even recognize. The meta-level goal of the DSM - describing those disorders which prevent someone from thriving and are properly treated by psychiatrists - seems sound, even if each edition always needs to be succeeded by a new one.