Wouldn't this just tell us that these categories are completely meaningless?
On the contrary, mental disorders are labels expressely intended to inform and enable treatment of distress. Disorder and treatment are inextricably linked.
This is all according to how the DSM defines things, of course. Others may have opinions on how mental disorders should be defined.
If someone has low occupational functioning, you could call that a disorder. But why would you call it "ADHD"? Why would you call it ADHD for some people and OCD for other people? Suppose you have two lists of symptoms:
Attention Deficit Hyperactivity Disorder
- Patient has an active mind.
- Patient has a crummy job.
Borderline Personality Disorder
- Patient rubs me the wrong way.
- Patient has a crummy job.
What did you learn about the reasons why people with bad jobs (your primary diagnostic criterion, after all!) have bad jobs?
The criteria is essentially ‘you meet these criteria AND it causes clear problems with your ability to live your life’.
It doesn’t mean you have a bad job and X, therefore you have ADHD. Rather, you show ADHD traits and they get in the way (and cause you distress) in doing a job you otherwise would be entirely capable of doing. Or consistently fail (and have distress) on social environments you’d otherwise be perfectly fine in, etc.
If you don’t have a criteria like that, there is no useful criteria at all, since practically all medicine is oriented towards fixing things that aren’t working correctly/causing problems.
It’s the same type of criteria used for evaluating everything from heart disease to stroke to a broken bone. Or in other words ‘if it ain’t broken, then it isn’t broken.’
I'm diagnosed with bipolar disorder. Sometimes I feel axnious and euphoric, other times depressed and lethargic, both at extremes noticably deviant from the average person. This has caused all sorts of turbulence and distress in my personal and academic life. Being diagnosed allowed me access to therapy and prescriptions.
There exist plenty of people who oscillate between distinctively high and low moods, but have never found themselves in serious distress because of it. Thus, they have not been diagnosed with bipolar disorder. Whether or not they "are bipolar" is a subjective question that mainstream psychiatry doesn't seem to have an opinion on.
Which makes the idea of "bipolar disorder" meaningless. That person demonstrates that your problems are not caused by bipolar disorder. But the disorder is defined by you having problems, even though the problems come from somewhere else.
Your argument seems to hinge on this idea that a good life => no distress, which, if you've interacted with anyone diagnosed with a mental disorder, is obviously not true.
My life is great. If I didn't take a mood stabilizer, it'd probably still be good, but not as good. Regardless, my mood swings can negatively affect me and those around me.
If one day I reach a point where I can live without meds or therapy and reap no negative consequences, then yes, it would be fair at that point to say that I no longer had bipolar disorder.
> That person demonstrates that your problems are not caused by bipolar disorder. But the disorder is defined by you having problems, even though the problems come from somewhere else.
Bingo. My symptoms (mood swings) + my problems ARE the cause my bipolar disorder diagnosis. Until I had problems, I had no disorder.
What causes the mood swings, then? Genetics, upbringing, life experiences, diet, idk. Nobody knows for sure. It's an active area of research, but there is no one known cause. For all we know, there may be five independent and unrelated risk factors that lead to someone developing bipolar disorder.
It's like you get it, but you're still dismissing it for some reason. I'm curious what ulterior point you're trying to make.
But it's still a thing. Maybe you can't refer to it as a disorder, but you are hallucinating stuff. It's a set of material facts about your mental state.
Some of Donald Trump's various disorders have objectively rewarded him, generously. But he has those conditions. He doesn't not have narcissism just because his narcissism is good for his bottom line.
I think the issue is that medical criteria are functional- what should doctors do about this. If it's not even bad, they shouldn't do anything! And this gets translated as "nothing is there to treat" but shouldn't be translated as "nothing is there to notice"
In discussing whether they'd need to try to correct this movement via surgery, the doctor very much said "it's a problem if it's a problem". When it fully healed the person had full use of their arm, so the doctor was satisfied with the outcome.
The doctor did also say that different countries had different philosophies on what they expected a healed bone to look like. In their experience Canadians were more likely to be OK with an imperfect solution, but Australians were more likely to want the break healed in a "like new" condition.
And circumstances make this different - a sports star is going to want to do everything to improve performance, whereas an office worker may just want functionality.
My response is, mental illness is something more personal than a broken bone and at present diagnosis needs to be cruder, which does make the categories a bit more "meaningless" but I don't think it gets all the way there.
So, like, take depression for example. I am being slightly unfair but hopefully on-the-nose when I say that DSM defines depression essentially as "you are too sad, too often, and you are not in a situation like mourning a parent or spouse where that level of sadness would be expected." The point is, it's a symptomatic diagnosis.
Other symptomatic diagnoses include “migraine” or “hypertension” or “diabetes” being symptomatic is not necessarily something that excludes meaningfulness, I think we could agree? But it also means that there is a difficulty with treatment. This medicine might work for your migraine but not her migraine; whereas my hypertension is caused by not getting a good night's sleep due to mild apnea and can be cured by a CPAP machine, his hypertension is caused by the fact that he weighs 350 pounds and CPAP therapy will fail.
OK, so like diabetes there is not just one major depression, and maybe some day we will distinguish between "type 1 depression, type 2 depression, gestational depression, predepression" and have specific causes subsumed as different "types" of the symptoms. Maybe not. But the label still has some sort of meaning, just like we can have "migraine medicine" as a group of things worth trying if you have migraines, or like how we can use insulin to handle diabetes in general and so on.
But then combine this with another question which is, "for mental illness, what does cured or managed even look like?" and that's where this occupational functioning criterion starts to look quite reasonable. Because the deal is that if "depression" isn't going to single out a particular cause, the causes of your depression will still likely be around, just like "we have you using insulin" has technically fixed your diabetes (that is, the symptom -- the hypoglycemia) but the cause is still not addressed. That these illnesses take place in the mind makes them harder to quantify. So we need a qualitative criterion, a "how bad is the pain from 1 to 10?", so that we can measure if the intervention is improving things.
Asking questions about your occupational functioning is thus a reasonable qualitative scale to indicate the severity of the symptoms and the success of treatment, even though it says nothing about cause. The different "buckets" of symptoms still make sense as they suggest categories of things-going-wrong and clusters of treatments-for-those-things.
Heaven help you if the effort or circumstance becomes unsustainable, when you could've had years to treat the underlying problem but medicine denied it was a problem.
As for your point w.r.t. circumstances: yes, this seems to be by design. Someome who might be diagnosed with schizophrenia in the US could easily be considered just quirky or even revered as a sort of spiritual guru in other cultures where symptoms have fewer/no negative impacts (and thus do not present so "horribly").
If the success has a lot more ADHD-tendency than the failure, how do we defend the idea that the failure has ADHD, and the success doesn't?
It's just shorthand for "this is something we'd like to fix".
You have two people with ADHD-like tendencies. One person feels they have found their own ways to adapt to their ADHD-like tendencies and that they are successful. Another person feels that they have not found ways to adapt to their ADHD-like tendencies and their life could be better if they found ways to adapt.
In this case, the actual magnitude is less important than how individuals adapt.
The criteria is more like “but for this tendency, the patient would be/feel better, all else being equal.” A software engineer making $$$ could meet the criteria if their inability to focus keeps costing them promotions, launch their own company, or whatever their goal might be. A neurotypical buggy whip maker who can’t find or hold a job doesn’t qualify, even if he is obviously worse off overall.
And it's not like you can just count them or something. It's not like you can say "5.2 distracto-particles is normal, but 5.3 distracto-particles is ADHD".
And traditionally, "too distracted to hold a job" is a common place you might draw the line between "normal" and "ADHD".
So yeah, you might have to draw the line somewhere arbitrary, but that doesn't mean that the thing it's trying to measure doesn't exist. Any line you draw between "short" and "tall" will be arbitrary, but that doesn't mean height doesn't exist.
ADHD is a category of psychiatric diagnosis; psychiatric diagnoses exist to address deficiencies in function. Separating the one from the other, as you perceive, renders it meaningless -- or perhaps, useless. If one happens to have some of the traits of ADHD but it doesn't affect their life negatively, so what?
[1] https://slatestarcodex.com/2014/11/21/the-categories-were-ma...