The Battle to Define Mental Illness (2010)

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.

But autism isn't defined by intelligence or age. You might as well say 'isn't alcoholism such a broad definition, when everyone from world leaders to young people to a perennial loner 80+ year old finally discovering that their traits are shared with many others.

I think it's just the complexity of our brains that's the issue here. Your brains can be different in really many ways, and many of those differences can cause multiple symptoms, which are then used as a basis for diagnosis. That's why autism, adhd and others have such a high rate of comorbid diagnosis.

I don't think there are any as broad as "autism" in general, but "ADHD" in general is close. That's why both have been divided up in recent years for the sake of precision.

Seriously 5/10 people in my friends group have ADHD (some with autism too) and we all have such wildly different symptoms and struggles with it that it took quite some time for us to recognize our shared syndrome lol

> 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 arts, or sports. At some level it's a fundamentally authoritarian argument as well: if you have the biology worked out, what's to keep the holders of power from altering people to whatever norm they want? Having the biology completely worked out won't magically reveal natural disorder states.

The biological explication of a behavior doesn't obviate the need to have some norm for intervention decisions. Biology doesn't have norms, psychosocial systems have norms. Non-behavioral medicine is still full of ethics. And that doesn't even get into issues about whether you could ever identify any biological substrate as synonymous with a human experiential state or history.

Sounds like programmers are obsolete because software will become redundant once we've solved everything in hardware :D

So, this: https://xkcd.com/435/

> 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 discourse urgently searches for a cause - "why did this person do this? was it terrorism? revenge? drugs?". But no, soon enough the media latches on to Mental Health, and everyone sighs in relief that the reason is now found. "Ahh!", the mainstream can reassure themselves, "It was a Mental Health Person that did this! Of course!".

> 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?

"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.

Defining mental illness in terms of deviance from law is actually an insane idea.

Were the opponents to Nazis mentally ill, simply because they did not adhere to Nazi law?

Think about the implications.

> Mental illness could also be defined by a person's ability to function in their community and social constructs.

No, I think mental illness should be defined relative to a person's capacity to change behaviour volitionally or in response to feedback signals, like a scolding or rehab or imprisonment. People who are mentally ill do not respond to feedback signals like this, they have little volition over their behaviours without significant pharmaceutical or other interventions first. It's like asking someone with Tourette's to stop having verbal tics as compared to someone who just likes swearing. There's a fundamental difference in volitional control and responsiveness to feedback.

>But could you not plausibly define anyone who commits major crimes to be mental ill?

Yes, and it makes punishment in the manners we do it [US] frankly unconsciable for being torturous. What else do you call forcing a man to sit in a concrete and iron box for ten years involuntarily, if he would willingly expatriate instead? Imprisonment should become optional with expatriation. It is assinine that we take away passports from criminals; you should be wanting them to depart for good! Throwing a man in a box completely involuntarily and without any reachable alternative recourse except to wait it out, in lieu of just seizing all assets and kicking them out permanently if they so choose as the prison-alternative, is assuaging what internet trolls would call... your booty-blastedness for him giving you a really bad time.

It's definitely a growing profession.

It only came into existence fairly recently, and it continues to innovate and develop new approaches.

Good psychologists can provide enourmous value to their clients, and contrary to what the drug pushers want people to believe, mental illness isn't a physiological problem but a complex problem involving much more than that.

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.

> It's not a great situation, and I don't see many signs that it's improving.

I think this is a little too pessimistic on the one hand, and very accurate on the other.

On the accurate side: this discipline took one of the most significant hits from the replication crisis, and was one of the most resistant to acknowledging and changing practices. Everyone should keep pushing for open science and preregistered studies to improve quality of the evidence here.

On the optimistic side, there is one potentially huge change that's just starting to crest as opinions improve and acceptance spreads: psychedelics. MDMA for PTSD was a huge win and indicates a potentially large untapped realm of possibilities for altering cognition in positive ways.

There's also hope that neuroscience can start to supplant at least parts of psychology in a few decades.

> 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 still unreliable and many of the theories still fairly reek of superstition and magical thinking.

Ah this is also my stance. There are lots of good will in this subject, but trusting it is like trusting surgeons in 19th century. There may be no other option, but sometimes it's better to leave the bullet in your chest rather than letting it be infected by doctors with dirty hands.

> Legitimate advances are being made

Like what? Realizing that lobotomies aren't a legitimate treatment?

>You can't totally reject some of these diagnoses, regardless of how porous the boundaries, without depriving a lot of people of the care they need.

Which is precisely why the DSM is a political document, designed for clinical utility, and not a scientific one.

I will mention that several of the barriers to create we create to care are artificial. One of the most common fears I've heard from those with ADHD is that without their diagnosis being taken seriously they will lose access to their medication. Yet that's only an issue because we won't give people drugs, even if they find them helpful, unless prescribing physicians believes they are disordered. Consequently, there are ADHD communities who ban people diagnosed with ADHD for having too positive of a self-outlook.

The entire system is deeply twisted. We've made acceptance of an intrinsically derogatory pseudoscientific nosology a gatekeeper, and put reflexively categorising patients as disordered at the centre of our care model.

Thanks. Text is at https://pastebin.com/LTbtPCsV.

https://archive.ph/XQzIG works, for those who can access it

Reader mode works fine for me.

It is exactly the role religions used to play - more so in the past, yes, but still pretty much in scene today still, although perhaps weaker - so this answer your question:

> Why does it do both?

Demand. For what? For adaptation to the current metagame.

While writing this reply, I remembered a few passages from a great thinker, that I think may contribute and expand the conversation, for those interested:

"Art, ethics, philosophy bear witness: under the crust of words and concepts, the living reality of non-adaptation to the world is always crouched, ready to spring. Since neither gods nor words can manage to cover it up decently any longer, this commonplace creature roams naked in railway stations and vacant lots; it confronts you at each evasion of yourself, it touches your elbow, catches your eye; and the dialogue begins." [0]

"After all, if an individual refuses both to adapt to the violence of the world, and to embrace the violence of the unadapted, what can he do? If he doesn't raise his will to achieve unity with the world and with himself to the level of coherent theory and practice, the vast silence of society's open spaces will raise around him the palace of solipsist madness." [1]

"People are bewitched into believing that time slips away, and this belief is the basis of time actually slipping away. Time is the work of attrition of that adaptation to which people must resign themselves so long as they fail to change the world." [2]

Raoul Vaneigem

0, 1: https://www.darkmatterarchives.net/wp-content/uploads/2013/0... 2: https://voidnetwork.gr/wp-content/uploads/2016/09/The-Revolu...

I look at this from the other direction and find psychology's obsession and fixation on trying to discover what is wrong with their patients and labelling them to be an uncalled for and likely harmful.

I feel the idea that a psychologist should make your life better regardless of how healthy you are to be the normal, obvious idea. It's the compulsive pathologization that is truly bizarre. Why is that helping them?

> It's kind of strange that psychology has this dual role of both giving advice to the [healthy] and managing the [unhealthy]

That's medicine!

Not strange.

You can go to the doctor to get advise on how to prepare for a sports event, you can also go to the doctor if you are sick. You can also go to the mechanic to tune the performance of your car and also to replace a broken head gasket. And while computer engineers are not repair technicians, they usually know better than the average person on how to fix a computer.

When you know about a subject, you are generally in a good position to both give advise and deal with problems, though you can specialize in one or the other.

Do we even have a definition of of biology or biologist that’s acceptable to the vast majority?

e.g. some of the very small viruses, viruses and similar structures seem pretty close to chemistry.

Incidentally, the species debate is fairly simply summarized / resolved, at least for typical sexual organisms: There is nothing whatsoever in first-principles evolutionary biology that says that these can always be partitioned into discrete categories that one might call "species". What evolutionary biology says is

  1. When two populations overlap in space and time and have the opportunity to interbreed, they might do so.
  2. In the absence of interbreeding, populations evolve, divergently w.r.t. most markers other than the occasional selection-mediated convergence.

So, divergence might be the result of lack of opportunity to interbreed (this allows genetic and phenotypic diversity to accrue, but does not itself represent a biologically real division), or it might be the result of inability to interbreed (biologically meaningful, but impossible to discern if opportunity to interbreed is absent). And that's it, for sexual organisms that is the gist. In general there's nothing to say that our systems of related populations spread through space and time can always be divided into "species". On the other hand any cursory look around a single locality shows that many discrete biological entities do exist; there's nothing wrong with giving them the name "species" as long as we acknowledge that for closely related allopatric populations the question of whether they are the same "species" is not defined.

There are various problems. One is that some humans are attached to the idea that entities exist for which the word "species" is apt; or put another way they are convinced that "species" must mean _something_ and they ask what (e.g. because they like their neatly divided up bird lists).

Another is that if scientists go around saying "animals can't always be divided into things which it makes sense to call 'species'" then it significantly weakens certain arguments for the protection of populations in conservation biology / legal contexts, since these invariably name the species-level taxa they are intended to protect. Since the modern trend is towards splitting subspecies (i.e. geographical races) into species (as opposed to lumping), many conservation initiatives are based on protecting "species" for which the species designation is subjective. That doesn't mean they are flawed of course -- they are nearly always protecting valuable ecosystems. It's just that as we split geographical races, we (by definition) create rarer and more vulnerable taxa, and so conservation initiatives arise around these.