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Comment by deanresin | Hacker News Reader

This conundrum reminds me of a thought experiment. You have people use a mental illness as a defense in courts of law. But could you not plausibly define anyone who commits major crimes to be mental ill? Mental illness could also be defined by a person's ability to function in their community and social constructs. But a healthy species, evolutionary speaking, requires these outliers. These deviations from the "norm" offer the species a safety net should conditions change rapidly. Should we really be trying to herd everyone back to a norm?

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.

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> 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.

If you understand the systems that manifest a mental illness then you can treat it more directly with medicine, you can test for the mental illness directly with physical sampling. We've already seen this shift from psychology to medicine with the invention of anti-depressants. Less people are seeking counsel from psychologists and instead just getting a prescription from their doctor. While the systems and even antidepressants aren't fully understood we have seen the shift away from psychology due to advances in treating the physical biological system. Simply projecting this natural trend to its limit is not reductionist IMO.

> If you understand the systems that manifest a mental illness then you can treat it more directly with medicine, you can test for the mental illness directly with physical sampling. We've already seen this shift from psychology to medicine with the invention of anti-depressants.

Except they only work in 30% the cases, regardless whether the patient has strong indication for depression and it's noted throughout literature that treatment with medication should go hand in hand with psychological counseling, because it increases recovery rate and leads to the patient not relying on medication anymore. They're also massively overprescribed, have as of yet unexplainable side effects in a significant part of the population and there is surprisingly little information on how they achieve their intended effect.

I think you're also misrepresenting why people don't seek counseling: It's because it's far from readily available.

The arguments you provide are really one sided and it feels like you're intentionally leaving out information to justify your position.

Sure, people are prescribed psychotropic medication for depression. But as more stringent scrutiny has been paid to those, the effect sizes have gone down over time and with more adjustment for publication bias.

There's no shortage of demand for psychotherapy services, and head-to-head they are comparable and both in combination fare best.

There is no blood test for depression, and if there is, no one uses it in practice. Sure, we're seeing this sort of thing with alzheimer's dementia but that's one thing that has never been amenable to psychotherapy, and even then there's a lot of psychotherapy around it in a palliative and coping sense because it's still uncurable.

FWIW, I was involved in the creation of DSM-5 so I'm very familiar with the whole area of mental healthcare.

How familiar are you with factor analysis? I worry that because the best mathematical minds are often not attracted to psychology as a field, that psychologists as a group are somewhat blind to implications of statistical choices and assumptions that they inherit or make.

What would you like to say about factor analysis? Lay it on me

It’s poorly understood by many who use the DSM, and without understanding how arbitrary and or subjective it can be it may be difficult to avoid “overfitting” in the clinical setting.

I'm not sure I'm particularly convinced that this is an issue with the method of factor analysis and by extension psychometrics, per-se. Unless one specifies a causal model and actually tries to do a risky test of their theory, any other method is liable to the issue of arbitrariness and subjectivity. Psychometrics itself has come a long way and there have been many advancements to put it on firmer footing. If anything, the issue isn't with the method, but by the user of the method. I don't know if I agree that it's an issue of understanding a method, rather than an over-reliance on data (analysis) over theoretical guidance and trying to take a hammer to theories.

It’s not a problem with FA, it’s a problem with people using the DSM who don’t understand how the math behind it influences what they are doing. Ditto for IQ. If you use IQ measures professionally, you should grok FA.

But what would you have them do instead of FA? I think we're partially agreeing here, but my thinking is that no analytical technique on its-own will be a panacea whether the users really understand it or not. Why would increasing their understanding of the technique affect what they do, when there's not really any other truly different methodological alternative?

Even if we, as humans, collectively have the knowledge to reduce something down to some fundamental axioms, it does not mean there is no value to separating the disciplines. All fields of engineering are fundamentally just physics, math, and some civil knowledge. Likewise, being a biologist doesn't necessarily qualify you to be a doctor.

> We've already seen this shift from psychology to medicine with the invention of anti-depressants. Less people are seeking counsel from psychologists and instead just getting a prescription from their doctor.

I think that peaked somewhere between the 80s and 2000s; there's been a pushback both popularly and in parts of the medical community and therapy as opposed to jumping straight to medication is having a big moment currently.

I haven't seen such a shift at all. My country has a record shortage of psychologists, and mental health epidemics, particularly in the young. Antidepressants kind of suck too, major side effects and often barely better than placebo in studies.

I think it's questionable to treat something like depression with medicine without even fully understanding what causes depression, and how the medicine works. Of course it's the least bad option for some cases, but for many milder cases therapy, or even physical exercise, is likely to be a safer, and quite possibly just as efficient option. It's just not as profitable and easy to prescribe as SSRI's.

Do you have a source to back up your claim that "less people are seeking counsel from psychologists and instead just getting a prescription from their doctor"?

The shape of that argument works equally well for unduly centering psychosocial mechanisms, though. That's how we got pseudoscientific garbage like the "refrigerator mother" theory of autism, the "anal retentive" theory of OCD, "tabula rasa" theories of social behavior, and so on.

Maybe what I'm getting at is that double standards abound when it comes to mental illness, and it's fucking exhausting work to even attempt to avoid them. I'm not blaming anybody (least of all you). I suppose it's just one of those Lovecraftian/Cronenbergesque sorts of things where once you see it, the world never quite makes sense again.

Regarding the refrigerator mother theory, autism as a diagnosis has expanded over 100x since that was first debunked and I have no idea why people have any confidence whatsoever that bad parenting cannot cause Autism. This was from a time before people as functional as "Rain Man" were the norm. Twin/Sibling studies were used to debunk this but twin studies don't totally control for shared environmental influences.

It seems more like a politically controversial thing than something which has been seriously scientifically examined either way. It can't be the smoking gun only cause but I see no actual evidence that it's impossible that parental neglect can't be a contributing cause. I will note that it is more politically convenient to simply blame a child's inherent defects instead of parental neglect, since the children relative to their parents lack political power.

I'll also point out that contemporary autism diagnosis relies on parent reports to establish a diagnosis, and people often only get diagnosed if a parent actively seeks out a diagnosis. Autism is also based on observation, if somebody was socially impaired due to neglect, how exactly would an examiner know the difference between that and somebody being socailly impaired due to say epigenetics? I would be rather surprised if who raised somebody doesn't have a rather large impact on if somebody will end up with an autism diagnosis. As in an especially well resourced and attentive parent might mean somebody who would be considered autistic might not be, and somebody who was overstretched and inattentive might have a child who would otherwise not be considered autistic be considered autistic.

> 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!".

I'm not sure I follow? If you rule out any other motive, someone stabbing someone else in broad daylight, unprovoked may be attributed to mental health issues.

But everyone has mental health. If you have a mind, then it's in some form of health. An extremely broad, arguably meaningless, classification. All it does in this context is reinforce the public stigma towards the millions of perfectly good people in the community dealing with hugely diverse situations from depression to autism and far beyond.

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

A surprising number of people seem to believe this is actually true when they discuss Copilot and ChatGPT!

> 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.

So is being gay, transgender, an outspoken women, or left-handed mental illness since such people do not, by all appearance and objective measures, have the capacity to change their behaviours volitionally without for instance chemically castrating gay men or lobotomising women?

There's two big things wrong with this definition. First is that it makes non-compliance a pathology and assumes society is right and the patient is wrong. Second is that pays zero heed to ethics and what is actually good for the supposedly mentally ill person, it just labels them mentally ill if they don't do what people want without thinking of if that's best for them.

Of course, that's not THAT different from how mental disorders are defined in practice.

> First is that it makes non-compliance a pathology and assumes society is right and the patient is wrong.

My post said absolutely nothing about society or non-compliance, it spoke only about whether the patient can respond volitionally. Gay people absolutely can choose not have gay sex, it's just wrong to expect that. Outspoken women absolutely can choose to be silent, it's just wrong to expect that. Left handed people absolutely can choose to write with their non-dominant hand, it's just wrong to expect that. There is clear volitional control here.

I made this very clear with the example of Tourettes vs. someone who just likes to swear. The person with Tourettes cannot simply choose to not have verbal tics and then enact that choice, but the person who just likes swearing absolutely can. It's just a physical impossibility to regulate behaviour based on feedback or internal motivations.

> Second is that pays zero heed to ethics and what is actually good for the supposedly mentally ill person, it just labels them mentally ill if they don't do what people want without thinking of if that's best for them.

I have no idea what you mean. There's nothing unethical about pointing out that the mentally ill have a distinct behaviour in that they do not respond to specific kinds of feedback. It is in fact the starting point for ethical treatment of mental illness.

> 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.

Yeah, this is exactly what someone without mental illness will never understand. Awareness is not static. It ebbs and flows. Sometimes I know that I'm saying/doing something but completely unaware of what it is. I have to ask someone else about my actions/words once I regain awareness. However, I do hold a full time position and can respond to feedback signals depending on the day. I was told growing up to think of consequences of my actions before doing it. Yeah right, for that to happen I need to understand what I'm doing let alone think through the consequences. Pharmaceutical or other interventions aren't a silver bullet to all mental illness issues. Yes, they do help and curb some symptoms but you can't predict when someone will have an episode. And they come with their own side effects. Their effectiveness also depends on the person being treated. Not everyone with depression responds equally well to anti-depressants. It's much more complicated than you think.

> 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?

it already is https://en.wikipedia.org/wiki/Oppositional_defiant_disorder

That's not what that page says ODD is.

The page does say it, I'll agree with that. But I think that the classification as of the disorder basically is a method of classifying people who generally have real life experience with life going wrong, they have reason for behavior which doesn't make it a disorder but instead self preservation.

They are classifying the symptom, not the cause. "Treating" it is fixing their environment and not the person. Too bad drugging the individual is the cheapest solution to create compliant individuals who won't take action.

it does, just your ODD keeps you from realizing that :)

You cherry picked one sentence and stripped away the entire context and meaning of my post.

Because I take issue with that sentence.

In a way, yes. That's why repressive governments here in Eastern Europe had started using psychology as a tool/weapon in order to institutionalise dissidents, because it was seen as a mental illness not to be on the same page as the predominant ideology back then.

I think a similar thing is starting happening in the West, even though (fortunately) not at the same scale just yet, meaning people who are seen as being against the system are already categorised by the powers that be as "deplorables" (to quote a recent US presidential candidate), i.e. one step way from those having a mental illness.

Later edit:

Something like this [1]

> Ken Stern, a former CEO of National Public Radio, in his new book Republican Like Me: How I Left the Liberal Bubble and Learned to Love the Right, explains that most of the media has been feeding America a negatively skewed view of Trump along with negative characterizations of the "deplorables," the people who hold more conservative viewpoints. Insistence that Trump is "mentally ill" can be regarded as part of this contemptuous discrediting of others whose beliefs differ from theirs.

[1] https://www.psychologytoday.com/us/blog/resolution-not-confl...

"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.

I think a lot of people have a hysterically warped perspective on the insanity defense because of American legal/police media.

People don't understand how near impossible it is to deploy successfully in trial, in the US.

Indeed. As I understand it (ianal), insanity is a positive defense, meaning that you have to prove to the judge/jury in court that you were insane, i.e., that you were functionally incapable of distinguishing right from wrong at the moment you committed the crime. This is because a mens rea, or guilty mind, is necessary to establish guilt and thus criminal culpability, in addition to the actus reus or the criminal deed itself; you have to be in a state where you know, or could/should have known, not to do what you did. Proving a negative, especially when it comes to this, is extremely difficult. You will have to undergo an extensive psychiatric evaluation by a psychiatrist and they have to come to the very strong conclusion that you were well and truly out of your mind at the time of the commission of the crime. Otherwise, just the evidence that you did the crime is enough to establish guilt.

Oh, and if you somehow successfully plead insanity, you will spend quite possibly the rest of your life in a mental institution instead of prison, which isn't much better.

And yes, it's good to remember that police procedurals are to criminal justice what Hackers (1995) is to hacking: a lot of stuff is distorted to make good cinema/television. In the UK, judges on cop shows use gavels (that is strictly an American custom); how can we expect them to get the details of rare events like an insanity defense right?

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.

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.

>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.

This will be interpreted as.

"Come to the US, commit crimes until you get caught, then leave instead of jail time".

This is not a deterrant.

Does deterrance actually work? Show me someone in the US who doesn't know about jails. Also a secure border was assumed but not stated. This presumes social groups want to be exclusive and are choosey of membership.

> Does deterrance actually work? Show me someone in the US who doesn't know about jails.

I don't know how to address this disconnection in logic. Do you assume that knowledge of a deterrent should create zero crimes ?

You are right though, maybe deterrence doesn't work and summary execution will be the only long term solution to prevent any possible reoffending. I for one welcome Judge Dredd-like overlords.

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

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