Should Mental Disorders Have Names? • Hacker News Board

Re: Should Mental Disorders Have Names?

#101

Post by TheOperator » Thu, Feb 21, 2019, 12:12 AM UTC

LordKano wrote: post #75

DoreenMichele wrote: post #20

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…

I believe its a perfectly fair criticism because honestly what has western psychiatry accomplished on a broad scale over the last two decades? Self-reported mental illess which correlates with poor health outcomes overall has shot up. Suicide rate is up. Resources dedicated to mental health and the mentally ill can't be dedicated elsewhere. There has been a pretty substantial stalling when it comes to developing truly innovative new drugs and therapies. Most of what's being developed are new takes on ssris, cbt, talk therapy etc. Most of the existing therapies are getting less effective over time which I would guess is due to saturation/diminishing returns.

The Mental Health field collectively doesn't know what the fuck it's doing. More time and money is spent on mental health every year and things are actually getting worse. People are not as skeptical of the mental health field as they should be. Either our current efforts are counterproductive or they're failing to address a bigger picture concern which outweighs any positives of increased mental health treatment.

Re: Should Mental Disorders Have Names?

#102

Post by TheOperator » Thu, Feb 21, 2019, 12:28 AM UTC

jVinc wrote: post #97

DoreenMichele wrote: post #20

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…

> 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? "So you say your father broke your arm.... This isn't a bone fracture! It's bad parenting, now go home, no medical attention for you". You are looking to see if some mental/physiological process is in disorder, so it's not about whether you caused it or your father…

You're missing his point. A doctor can treat you every time your father breaks your arm but the problem you have doesn't lie with your body or your brain. Yet the first line approach to mental health is treating the patients as the problem, assuming their brains are malufunctioning, and giving them behavioral therapy and drugs. If your depressed because your father keeps breaking your arm no amount of ssris and therapy will fix that...

I'm not saying the mental health field doesn't take into account external factors. It does especially psychology. I still think psychology overestimates how sick people are and underestimates how sick society is.

Re: Should Mental Disorders Have Names?

#103

Post by darkerside » Thu, Feb 21, 2019, 1:31 AM UTC

betulaq wrote: post #81

darkerside wrote: post #56

The conclusion of the article raises a great question. Wouldn't it be more valuable to diagnose based on quantitative criteria instead of binary answers to extremely complex questions? I'd love to hear an opinion from a SCID practitioner.

Something like the SCID is useful as a structured way of measuring or assessing behavior. A binary output is probably not helpful though. What's interesting is that the people who developed the SCID (and the DSM and its predecessor, the RDC) actually developed a very similar tool in the 60s, but instead of it producing binary diagnoses, it produced scale scores more like test scores. It actually had better statistica…

That's interesting. It reminds of the BMI, a metric intended only for use at the population level. It's been adopted (some would say misappropriated) as a yardstick for individual health, because... reasons?

Re: Should Mental Disorders Have Names?

#104

Post by babyloneleven » Thu, Feb 21, 2019, 3:55 AM UTC

DoreenMichele wrote: post #70

renholder wrote: post #41

Earlier quoted context omitted.

> 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 Twic…

> 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.

Helping the family change how they interact with their children is therapy!

Re: Should Mental Disorders Have Names?

#105

Post by existentialhalt » Thu, Feb 21, 2019, 4:25 AM UTC

I have been diagnosed with bipolar disorder, schizophrenia, depression, anxiety, and autism. All caused by chronic mercury toxicity. The name of the disorder should be "mercury toxicity" in my case.

Re: Should Mental Disorders Have Names?

#106

Post by DoreenMichele » Thu, Feb 21, 2019, 6:02 AM UTC

babyloneleven wrote: post #104

DoreenMichele wrote: post #70

Earlier quoted context omitted.

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 Twic…

> 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. Helping the family change how they…

But it was often accomplished in one or a few emails, not months or years of intensive effort.

Someone would join the list and complain about the intractable, crazy making behavior of their impossible child. I would write a reply and say something like "That's a common issue with gifted kids. It's due to boredom and is easily solved by keeping them adequately occupied." They would go "Oh. My. God. That makes so much sense! Just before the last incident, he did actually say out loud 'I'm bored.'" and a long-standing, intractable pattern of problem behavior that had stubbornly resisted all prior intervention would largely disappear overnight once the parent made sure to keep their kid adequately occupied.

Or a parent of a particularly hard case would exchange a few emails with me for a week or two and then report back to me months later that all these terrible, intractable issues had magically changed and it had involved almost zero effort on the part of the parent who had spent years sinking enormous time, money and effort into resolving these problems, all to no avail until they spent a little time talking to me.

If it was therapy, it was like an *easy button" version of it, very unlike the roughly 3.5 years of intensive therapy I pursued in my youth to get my personal issues to simmer down to a dull roar before really resolving things around the age of forty when I got divorced and yadda.

Re: Should Mental Disorders Have Names?

#107

Post by darkerside » Thu, Feb 21, 2019, 4:17 PM UTC

tremon wrote: post #57

darkerside wrote: post #47

Earlier quoted context omitted.

I understand that cancer may have similar characteristics. All cancers are similar in that they are uncontrolled cell division, but the causes, symptoms, treatments, and characteristics of every cancer can be very different.

But we don't have that level of knowledge yet when it comes to schizophrenia. The closest I can get to such an absolute is "all schizophrenia cases are similar in that they manifest as sensory inputs uncorrelated to the outside world", but that isn't really a useful classification -- that description is based on symptoms, not on causes.

I think we only have a partial understanding of cancer as well. Uncontrolled cell division is something in between a symptom and a cause.

Re: Should Mental Disorders Have Names?

#108

Post by mindgam3 » Thu, Feb 21, 2019, 6:14 PM UTC

arandr0x wrote: post #99

mindgam3 wrote: post #94

Earlier quoted context omitted.

I completely agree with your overall analysis, as well as the main point of the original article. The one thing I would add or clarify is that even the phrase "mental disorder" may not be the best way to refer to this class of symptoms/behaviors. I believe that "mental injury" would be both more accurate, and more conducive to healing. A substantial portion of the things we refer to as "mental illness" are the after-…

How exactly would you "set" a mental injury?

It's like setting a physical injury, but significantly harder because usually you're not dealing with it at the time of injury, only much later.

You find the original source, some event or series of events that caused the psyche to fracture. By fracture I mean caused the mind to operate according to some models that were necessary to survive at the time of crisis, but are no longer adaptive in the normal/real/adult world. You then update your mental model to one that is more aligned with reality.

In other words: go to the source of the pain, unlearn whatever lesson you learned at the time to deal with the situation, learn a different/healthier way of looking at it, and then practice a lot until the new mental model is firmly in place.

This is hard. But it gets easier with practice. And it's much easier than trying to set an injury by taking lots of pain-killers.