Mental Disorder | Hacker News Reader

Mental Disorder

plato.stanford.edu

50 pointslainon16 comments

One of the interesting problems with the medical model that emerged during our regular contact with it when our first kid was born is that medicine is intensely normative - that is, it assumes a median condition and looks for outliers that require correction. From a statistical and biological perspective this does not make sense. There is no underlying biological norm - variation is real (as in, our fundamental biology differs), and any normal behavior is merely the result of the central limit theorem, etc. Defining this real variation as disordered seems a fundamental problem. This becomes particularly problematic when those norms are measured using a non-representative sample (e.g. white Americans) and applied to everyone else.

> Defining this real variation as disordered seems a fundamental problem.

It's a problem that's been recognized in medicine for a very long time. That's why formal definitions of terms like disease and disorder usually aren't based solely on variation, and include a requirement that something actually interferes with a person's ability to function.

> that is, it assumes a median condition and looks for outliers that require correction

I think that's all evidence based medicine can really do. It's just a series of "well, people with high blood pressure tend to die early" and "people with high cholesterol have heart attacks". I don't know how they would approach it differently - if it was assumed that everyone was different with entirely different baselines, I don't know how it would be possible to make any sort of predictive assumptions. Really, the best solution would be to increase the granularity of the samples, but that's all they can do, develop more diverse pools of generalizations.

Increasing the pool of generalizations would certainly help. So would keeping this fundamental problem in front of mind.

My kid was an outlier because my genetics tend to being tall and thin. If he was being measured against a set of healthy people with similar genetics he would not be considered an outlier - but this calculus is not considered when he is measured and judged aberrant. Our doctor being Indian was able to see from her experience that he was "normal" - for a kid with an Indian parent. Another doctor (like all the ones I grew up with) might not have the same insight and conclude there is a problem.

Could I ask what concerns they had with your child being tall and thin for his age? I was a 99%'er growing up but I don't remember there being health concerns.

Defining this real variation as disordered seems a fundamental problem.

This has been recognized in medicine and mental health for so long that I don't know if you could find someone still practicing who wasn't taught it in school. If you go to a mental health care provider and tell them that your family thinks you have a disorder because you prefer not to socialize and get everything you need delivered so you don't need to leave the house again after work, they're going to ask you if you're unhappy about it or if you feel your life is diminished in some way by an inability to leave the house when you want to. If your kid has six fingers, a doctor's concern will be whether all the fingers are developing in a healthy way or one needs to be removed because it isn't functional and will be a source of pain and injury.

The principle hasn't been a panacea for prejudice, of course, notably in the case of homosexuality, but difference itself is not automatically treated as pathology in the absence of social prejudice. Doctors aren't treating people for having red hair or 20/10 vision or thinking stamp collecting is fascinating.

I have lot of questions on the whole psychology seriousness, but I will skip on them and just ask a simple one:

In the case of, let's say, 60% of the population suffering of depression, is that a mental disorder or something that have to be ascribed to external conditions (maybe political, related to environment etc)?

Possibly either, possibly both, possibly neither.

It might be the case that social or environmental factors are causing people to become depressed, in a way that could only be fixed by addressing those external factors. It might be the case that people are experiencing difficulty in coping with those external factors, but could learn to thrive with the right cognitive tools. It might be the case that we're over-diagnosing depression, or that the concept of depression itself has caused an iatrogenic epidemic. It might be something totally unexpected, like a hitherto-unrecognised prion disease or a strange reaction to an organic pollutant.

It's worth noting that, while rates of depression have been rising in recent decades, only 7.3% of the US population suffer from a depressive illness at any given moment; a larger proportion suffer from diabetes. Most people who are diagnosed with depression do get better with the right treatment. We're still a very long way from the point where we can reasonably argue "what does depression even mean if depression is the new norm?".

https://www.sciencedaily.com/releases/2017/10/171030134631.h...

http://www.diabetes.org/diabetes-basics/statistics/

Even SZ has been associated with poor social relationships, as one of the causal mechanisms. Adler's psychology attributes most psychological issues with poor social relationships. In the 70s there was this whole idea that SZ was caused by bad mothers, something which the feminists had a lot problems with.

In the end we have no way in modern society to address any of the deeper causes, so the technician simply gives you a medicine that chemically manipulates parts of the brains to make them behave differently... in some cases those manipulations cause long term damage to the brain which often is written off as a side effect of the disorder.

Every single time I have experienced episodes of depression, I have been able to trace the depression to environmental causes/stressors. In most cases I had at least an inkling of the cause at the time I was suffering, but there were reasons why correctly identifying the source of suffering would be problematic. In all cases the causal relationship became obvious in hindsight, once the environment had changed.

For example:

When you're feeling depressed because you're a child being abused by your parents, consciously acknowledging that your parents are responsible for your suffering would pose an existential risk. The "correct" thing to do in this situation to end the depression would be to leave the abusive situation. But when you depend on your abusers for your survival, that's not really an option. Therefore the way that most kids survive these situations is by suppressing their true feelings, pretending that everything is okay, and exhibiting symptoms of depression/anxiety/oppositional defiant/name your disorder. This isn't done consciously, it just happens.

The same thing happens as adults, replace the abusive parent with a spouse/boss. The key factor is that removing oneself from the harmful environment would entail significant cost to one's social life, career, or ability to support oneself. Therefore you stay in the situation, and eventually the pain you are continually experiencing manifests itself in depression.

"Works of ancient philosophy are focused more on the psyche’s health (or eudaimonia) than its illness. Nonetheless, there are hints that just as a unified soul is one that is healthy (as well as rational and virtuous), a soul lacking unity will be disturbed, or mad. Offering an account of the harmonious soul, whose rational and non-rational elements achieve a unified whole, Aristotle leaves us a picture of the warring and fractured state of an unhealthy soul, for example."

> Socrates used to say, ‘What do you want? To have the souls of rational or irrational beings?’ ‘Of rational beings.’ And of what kind of rational beings, those that are sound or depraved?’ ‘Those that are sound.’ ‘Then why are you not seeking for them?’ ‘Because we have them.’ ‘Then why all this fighting and quarrelling?’

-- Marcus Aurelius, "Meditations"

On the other hand, I also really like this, even though it's probably one of those fake internet quotes:

> If your heart is broken, don't try to fix it, they work better that way.

-- Tibetan monk

If you keep spreading that last quote, eventually a Tibetan monk will read it and repeat it, and it’ll no longer be fake.

This looks interesting. Going to need to set time aside for something this extensive though.

Yes, this is the kind of thing that doesn't work well with this short window of time during which something is on the front page, I wish it was possible to subscribe to discussions to follow them over a few weeks, rather than hours or 1-2 days at most.

I know this is the opposite of helping, but just in case anyone isn't aware just how extensive the whole site is: https://plato.stanford.edu/contents.html

Exactly, only lurkers view them 9 months or years after. To the downside they cannot comment, but at least some provide useful links and resources was fascinated to read wikipedia views on: https://en.m.wikipedia.org/wiki/Suicide https://en.m.wikipedia.org/wiki/Depression , and boredom seeing them as learned helplessness.

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