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The Battle to Define Mental Illness (2010)

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Re: The Battle to Define Mental Illness (2010)

#21

Post by awesomeMilou »

crtified wrote: post #17
deanresin wrote: post #6

This conundrum reminds me of a thought experiment. You have people use a mental illness as a defense in courts of law. But could you not plausibly define anyone who commits major crimes to be mental ill? Mental illness could also be defined by a person's ability to function in their community and social constructs. But a healthy species, evolutionary speaking, requires these outliers. These deviations from the "norm"…

> But could you not plausibly define anyone who commits major crimes to be mentally ill? Mental illness could also be defined by a person's ability to function in their community and social constructs. A converse is the way public/media perception will use mental health itself as the reason or motivator for major crime. For example, with the just-happened knife attacker in Bondi Australia : the resulting public disco…

I'm not sure I follow? If you rule out any other motive, someone stabbing someone else in broad daylight, unprovoked may be attributed to mental health issues.

Re: The Battle to Define Mental Illness (2010)

#22

Post by triumphblr »

0xcde4c3db wrote: post #9

Frances's concerns definitely aren't wrong on the whole, but I feel like he's not seeing the forest for the trees. This ultimately isn't just a question of whether this or that DSM revision is helpful. The patterns of the mental health establishment of the 21st century are oddly reminiscent of where physics and chemistry stood ca. the mid-19th century. Legitimate advances are being made, but most of the tools are sti…

Frances I think was worried about his legacy disappearing with DSM-5, because there was a big push to change things in a major way compared to DSM-IV. Ultimately I don't think that really happened; DSM-5 was a change but not the radical change I think the chairs and primary committees wanted it to be.

Frances' flooding of media outlets around that time was sort of strange in certain ways. He seemed to correctly identify potential problems in the mental healthcare system but then had this idea that changing things in the DSM to address some of its issues would make everything worse. It felt as if he was co-opting concerns everyone was having to argue for not changing anything at all, and in the process turned everything on its head.

The DSM is a very political document with a lot of interest groups involved at all levels, which is why it didn't change even more than it did. As a result, you had NIMH circumvent the whole process with RDoC, which then in turn seems to have had a relatively short life (maybe?) associated with changeover in its own administration.

It feels as if everyone has their own schema for thinking about mental illness, and the whole field moves along without any serious consequences. There's probably a lot of reasons for this, including scientific and medical sociology, and the complexity of mental wellness and illness as a domain. But it makes me wonder if some of the distinctions that are argued to be critical are really that critical in the end.

Re: The Battle to Define Mental Illness (2010)

#23

Post by awesomeMilou »

deanresin wrote: post #13
triumphblr wrote: post #7

Earlier quoted context omitted.

> Also, psychology is a dying profession. A mental illness is described as a set of symptoms manifested from physical biological systems we don't fully understand yet. But once understood, psychology becomes obsolete. That's a fundamentally reductionist perspective and assumes everything is biological in its etiology? For example, you could say we don't need a justice system once we have the biology worked out, or ar…

If you understand the systems that manifest a mental illness then you can treat it more directly with medicine, you can test for the mental illness directly with physical sampling. We've already seen this shift from psychology to medicine with the invention of anti-depressants. Less people are seeking counsel from psychologists and instead just getting a prescription from their doctor. While the systems and even anti…

> If you understand the systems that manifest a mental illness then you can treat it more directly with medicine, you can test for the mental illness directly with physical sampling. We've already seen this shift from psychology to medicine with the invention of anti-depressants.

Except they only work in 30% the cases, regardless whether the patient has strong indication for depression and it's noted throughout literature that treatment with medication should go hand in hand with psychological counseling, because it increases recovery rate and leads to the patient not relying on medication anymore. They're also massively overprescribed, have as of yet unexplainable side effects in a significant part of the population and there is surprisingly little information on how they achieve their intended effect.

I think you're also misrepresenting why people don't seek counseling: It's because it's far from readily available.

The arguments you provide are really one sided and it feels like you're intentionally leaving out information to justify your position.

Re: The Battle to Define Mental Illness (2010)

#24

Post by crtified »

awesomeMilou wrote: post #21
crtified wrote: post #17

Earlier quoted context omitted.

> But could you not plausibly define anyone who commits major crimes to be mentally ill? Mental illness could also be defined by a person's ability to function in their community and social constructs. A converse is the way public/media perception will use mental health itself as the reason or motivator for major crime. For example, with the just-happened knife attacker in Bondi Australia : the resulting public disco…

I'm not sure I follow? If you rule out any other motive, someone stabbing someone else in broad daylight, unprovoked may be attributed to mental health issues.

But everyone has mental health. If you have a mind, then it's in some form of health. An extremely broad, arguably meaningless, classification. All it does in this context is reinforce the public stigma towards the millions of perfectly good people in the community dealing with hugely diverse situations from depression to autism and far beyond.

Re: The Battle to Define Mental Illness (2010)

#25

Post by deanresin »

p_j_w wrote: post #20
deanresin wrote: post #6

This conundrum reminds me of a thought experiment. You have people use a mental illness as a defense in courts of law. But could you not plausibly define anyone who commits major crimes to be mental ill? Mental illness could also be defined by a person's ability to function in their community and social constructs. But a healthy species, evolutionary speaking, requires these outliers. These deviations from the "norm"…

> Mental illness could also be defined by a person's ability to function in their community and social constructs. Are you suggesting rebelliousness and non-conformity should be considered mental illnesses, defects to be cured?

You cherry picked one sentence and stripped away the entire context and meaning of my post.

Re: The Battle to Define Mental Illness (2010)

#27

Post by harimau777 »

crtified wrote: post #18

Is there any condition with as broad a definition as autism? It can cover anywhere from a non-verbal 9 year old with an IQ of 70, to a popular attractive valedictorian genius with incredible masking skills. A slow developing 3 year old labelled early and for life, or a perennial loner 80+ year old finally discovering that their traits are shared with many others.

I think that's likely a natural outcome of a diagnosing something that appears to be a spectrum rather than a discrete disorder. Perhaps analogous to how back pain can range from a mild inconvenience to completely debilitating. Or how there's a spectrum between someone who is harmlessly arrogant to a clinical narcissist.

Re: The Battle to Define Mental Illness (2010)

#28

Post by bitwize »

deanresin wrote: post #6

This conundrum reminds me of a thought experiment. You have people use a mental illness as a defense in courts of law. But could you not plausibly define anyone who commits major crimes to be mental ill? Mental illness could also be defined by a person's ability to function in their community and social constructs. But a healthy species, evolutionary speaking, requires these outliers. These deviations from the "norm"…

"Mental illness" alone is not a defense. The defense is insanity, which term in law means that your mental condition was such that you had no way of knowing what you did was wrong. If you're schizophrenic, say, and you kill someone, but you are compos mentis enough to understand that you killed a person and that is wrong, you don't get to plead insanity. If, on the other hand, you were under the delusion that you were killing an alien or a demon or something, then a plea of insanity might work.

I know that this is Hackernews, and the perspective that there's no such thing as responsibility for our actions, because we are all products of our biology and environment; and hence no such thing as evil, is popular here. But whether and how mental illness absolves, or does not absolve, you from criminal culpability is a fairly rigorous area of law.

Re: The Battle to Define Mental Illness (2010)

#29

Post by fakeart »

triumphblr wrote: post #19
deanresin wrote: post #13

Earlier quoted context omitted.

If you understand the systems that manifest a mental illness then you can treat it more directly with medicine, you can test for the mental illness directly with physical sampling. We've already seen this shift from psychology to medicine with the invention of anti-depressants. Less people are seeking counsel from psychologists and instead just getting a prescription from their doctor. While the systems and even anti…

Sure, people are prescribed psychotropic medication for depression. But as more stringent scrutiny has been paid to those, the effect sizes have gone down over time and with more adjustment for publication bias. There's no shortage of demand for psychotherapy services, and head-to-head they are comparable and both in combination fare best. There is no blood test for depression, and if there is, no one uses it in prac…

How familiar are you with factor analysis? I worry that because the best mathematical minds are often not attracted to psychology as a field, that psychologists as a group are somewhat blind to implications of statistical choices and assumptions that they inherit or make.

Re: The Battle to Define Mental Illness (2010)

#30

Post by majormajor »

deanresin wrote: post #13
triumphblr wrote: post #7

Earlier quoted context omitted.

> Also, psychology is a dying profession. A mental illness is described as a set of symptoms manifested from physical biological systems we don't fully understand yet. But once understood, psychology becomes obsolete. That's a fundamentally reductionist perspective and assumes everything is biological in its etiology? For example, you could say we don't need a justice system once we have the biology worked out, or ar…

If you understand the systems that manifest a mental illness then you can treat it more directly with medicine, you can test for the mental illness directly with physical sampling. We've already seen this shift from psychology to medicine with the invention of anti-depressants. Less people are seeking counsel from psychologists and instead just getting a prescription from their doctor. While the systems and even anti…

> We've already seen this shift from psychology to medicine with the invention of anti-depressants. Less people are seeking counsel from psychologists and instead just getting a prescription from their doctor.

I think that peaked somewhere between the 80s and 2000s; there's been a pushback both popularly and in parts of the medical community and therapy as opposed to jumping straight to medication is having a big moment currently.

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