Should Mental Disorders Have Names?

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 statistical properties and provided fairly detailed information. It's always been a mystery why they moved away from that, except that the DSM as a whole moved away from that.

Pretty great article. This characteristic that many patients have multiple disorders is an interesting point. Reminded me of my real world PCA applications which were never satisfying. In such a case you'd take the attributes of answers to questions in a population, and then get principle components (PCs) to these vectors of examples. Who says that each example in a population has to be dominated by 1 principle component? Many people have the view that PCs are just whatever linear combinations of attributes that explain your data, and I've seen many people try to name them in ways that encapsulate the attributes that each PC selects for, but it always seems like an awkward exercise after you get past the first few PCs.

And of course, I'm not literally saying this SCID is the attributes to the DSM "PCA," or any other subspace method. I don't work with subspace methods often, so if anyone wants to fill me in on what is done in the medical world (or other high stakes domains) in practice, much appreciated.

In cases of segmenting customers and then targeting each one differently, I have found that subspace methods work well for raising typical startup metrics. But the interpretability was not cut and dry in my experience, something that obviously is needed when you work with individuals like Doctors, not populations like many companies.

My guess is that the DSM segments patients to different treatments though. If this is the case then it does't really matter what the name of the constellation is as long as after they send the patient there, everything is hunky dory.

From a Nursing perspective, which is a meld of sociology-psychology-medicine, it helps to ask the why to build compassion toward the individual in direct care situations. The overlap between mental health and what makes someone act like a jerk or insecure is almost 1:1 and hard to discern from the outset, but contextualization separates the two.

I think the big problem is that all those fields are still very new and the thing they're studying is extremely complex and hard to directly study.

I'd argue that chemistry really began with Lavoisier in the late 1700s. Physics? Late 1600s with Galileo and Newton. What about psychiatry? I'd argue that it really got going in the latter half of the 20th century. Freud and lobotomies? They were the equivalent of alchemy. Other fields have been around in a recognizably modern fashion for hundreds of years. The same cannot be said of psychiatry and psychology.

And that's not surprising. The brain and mind are incredibly difficult to study directly. Until the advent of EEC, fMRI, and other modern tools, the only real way to do it was by studying behavior. Similarly, the brain is very complex. We didn't have, what could be considered, a modern picture of the atom until the early 1900s and that was after several major discoveries spread over a few decades. It's not surprising that we're still struggling with the brain.

>Back in highschool we had a massively depressed friend. They tried it all with her: cognitive behavioral therapy, drugs (ALL OF THEM), weed, religion. Tough love. Exercise. Diet. Nothing cured her and her depression killed her via suicide. What's the psych tell me after? Sometimes there's nothing we can do? That sucks. Human genome, done. Prevent HIV from killing someone. Can't do shit about depression sometimes.

That's still the case for a lot of things. You have ALS? On average, you'll be dead in two to four years. 90% of people die within 10 years. Treatment is mainly supportive. Likewise, it's the 1800s and you contract a bacterial disease? Can't do anything about that, antibiotics won't be invented for decades. Drain the pus and hope that you survive.

On ADHD, it turns out that Concerta and Adderall are indistinguishable to me. I take a low dosage and the side effects are basically non-existent and it also gets rid of my anxiety and depression. But it also happens that exercise reduces the intensity of all my symptoms. I only found this out when I stopped going to the gym for two weeks and noticed that my medication doesn't seem to be as effective.

It's quite possible that, if I hadn't been in the habit of exercising regularly, I would've required a higher dosage that would give me severe side effects. It's also possible that I would be fine. How is my psychiatrist supposed to know that? Maybe exercise doesn't work for some people, maybe diet is critical, maybe it's getting enough sunlight. The entire web of interactions is extremely complex and we don't currently have the ability to examine it at a fine level.

Speaking of complex interactions, ADHD is predominantly genetic and there are a number of genes that can contribute to it. For example, a variant of the gene that codes the protein Latrophilin 3 is estimated to be responsible for roughly 10% of ADHD cases. People with this variant are also very responsive to stimulant medication. Given the way that I respond to medication, it wouldn't be surprising if that's responsible for my ADHD.

But other people might have multiple gene variants, each contributing to a portion of the severity of their ADHD. Adequately treating them might require a very specific combination of drugs. The current process is trial and error, but it's possible that you'll never hit that magic combination. Likewise, maybe there is no magic combination in existing drugs or maybe the ideal dose is 6mg, but it only comes in 5mg and 10mg doses.

The medication situation is getting better. There are services that will run a genetic analysis to determine which medications might be most effective. But it's still in its infancy and that's only a portion of the picture.

The brain is complex and our current tools for examining and treating it are still blunt. Don't get me wrong, there are definitely systemic issues in those fields that need to be corrected. But a lot of criticisms seem to boil down to the equivalent of "It's 1819, why haven't chemists invented acrylic to replace the glass in my glasses?"

I hail from the hard sciences and used give a all the psy* disciplines a considerable amount of flack. But then, what do you know, I found myself in need of their help, and now I live a much happier life thanks to a doctor who knew their way around the application of CBT. And I'll never talk sh*t again :)