Thanks. Much clearer. And, I share your concern on that issue. I also worry that people who are signifcantly ill will be minimized becasue of a general callousness towards the mentally ill - brought upon by the tendency to assign everything an “ism”.
Sheesh. Destroy my faith in ya why dontcha. 
Not trying to destroy the huggy feely tone of the thread here but,
It would help if you would back up and justify the claims you make.
For instance, how do you know anything about “the people who are forced into treatment?” Where can I learn about such people so we can have that knowledge in common?
Can we not detect the symptoms of, in this case, bipolar disorder? If so, why not claim that it exists?
If you could interview a bunch of people who have deep melancholy and irrational exhuberance and see in which ways they have similar things that we can also say are wrong and in which ways they are different, and determine a set of these similarities, and then see if using these similarities helps to distiguish these people from others in the problems they have, the course of their melancholy and irrational exhuberance over time, and see if other people have similar experiences using this set of similarities, and test these similarities to find out which ones really help to identify people who are going to have problems with deep melancholy and irrational exhuberance, at what point do we have a taxon?
“There are no diseases, there are only sick people.” In one sense, this is true. However, if enough people have similar signs and symptoms, perhaps it behooves a would-be healer to look towards a possible general principle that might be applicable. Thus we recognize the existence of “disease”. Mental medicine is much younger than physical medicine (so to speak). Thus, there is still much more fumbling around. Consider treatment of illness in the 18th century. There was some basic idea that hygeine might be a good idea–but it wasn’t universal. Really obvious things like figuring out a broken limb, had been long handled, but causes of infectious disease? Not yet understood. Thus, there was a lot of unproductive activity. Likewise, there was a good deal of what we would consider “misdiagnosis” these days. Ever hear of “dropsy”? Likewise, any number of conditions that had wasting away as a sign would be classified as “consumption”, although that usually was assigned to what we would call “tuberculosis”. Were TVAA alive in 1703, perhaps he would call for people to stop using the concept of “illness” or “disease” in connection with the body, since it seems that diagnosis could often be imprecise or inaccurate.
First-medicine is still more art than science,& psychiatry even more so. But having spent many shifts working in psych ER’s- that’s the best place to see real mental illness (disorders). Those poor folks have a lot more than environmental problems. Half the hospital beds in the US are for psych patients. It is so costly that state hospitals had to be created-the mentally ill are more costly than cancer or heart patients ,for example. It is, since 2000, the DSM TR-text revision ,until 2006 when the DSM V is published. The DSM is far from pefect, but the best there is.
OK, let’s talk about a “panic attack”.
I have seen my mother have a panic attack, and it is extremely distressing even for someone merely witnessing it. She is genuinely terrified, such that if you were to suspend here above a swimming pool full of starving rats she would not be more terrified.
Now, panic attacks are symptomatic of several disorders:[ul][li]Schizophrenia[]Depression (clinical or bipolar - not sure about “atypical”)[]Panic disorder[]Obsessive-compulsive disorder[]Generalised anxiety disorder[]Phobia[]Post-traumatic stress disorder.[/ul]Recent research (citations to be produced upon request) shows that panic attacks are the result of a malfunctioning amygdala. [/li]
So, Aide: How is a panic attack caused by a malunctioning amygdala different to an asthma attack caused by a malfunctioning trachea? Do you contend that there is “nothing objectively wrong” with someone plainly experiencing utter terror without any apparent threat nearby? Of course misdiagnosis occurs, but you appear to be contending that there might be no such thing as mental illness. Are you?
[QUOTE]
Originally posted by SentientMeat *
**Now, panic attacks are symptomatic of several disorders:[ul][li]Schizophrenia[]Depression (clinical or bipolar - not sure about “atypical”)[]Panic disorder[]Obsessive-compulsive disorder[]Generalised anxiety disorder[]PhobiaPost-traumatic stress disorder.[/ul][/li][/QUOTE]
I agree with you in principle, but technically panic attacks are not symptomatic of all these disorders. One may certainly experience a panic attack and also have any of these disorders, but having panic attacks is part of the definition only of (from your list) Panic Disorder or Specific or Social Phobia. Your point, however, that there clearly is something wrong with a person while having a panic attack is no less valid.
As you seemed to be aware with your quotation marks, there is no such diagnosis as “atypical depression.” TVAA is prone to that sort of misstatement when it comes to this topic. There is a qualifier that may be applied to a “typical” diagnosis of depression for “Atypical Features,” but the fact is that changes in appetite (either an increase or decrease), and changes in sleep (either an increase or decrease) are both symptoms of depression itself.
Thanks, Hentor. Yes, I admit my laymanship in this area and apologise for any misleading or incorrect statements.
And yes, the point of my post was to pose the question: Surely there is something objectively wrong with a person screaming in genuine, abject horror for no apparent reason, and if a person does this regularly then they have a mental disorder.
Incidentally, Aide, having now read the linked thread, you seem to be merely arguing that psychiatry is not physics. Just because diagnosis is not as straightforward as for a broken bone does not, in my view, warrant statements such as “mental disorders are not necessarily valid”.
I have schizophrenia and would like to know exactly what is not wrong with me. Is hearing voices in my head normal? Fearing that everyone around me, and not around me, is out to harm/kill me…is this normal? I could go on…
I suppose you could talk all day about how it shouldn’t be valid, but as someone who has actual experience in this area, I have to say “I win” to this (in a convoluted way, unfortunately).
Thankfully, instead of listening to the likes of TVAA, I sought actual treatment, got an actual diagnosis, and now take actual medication, that allows me to live a relatively normal and productive life.
IMO it is just hard for those who haven’t experienced something like it to fathom what it is like. I’ve come across people who thought I should just “not think like that”, not realising that my illness is not voluntary. Unfortunately, applying logic in a world where logic is the other way around doesn’t really work. As painful as it may be, I sometimes wish people like this could be forced to live with one day of schizophrenia so they actually know what it is like.
Welcome, revolutionarily. There will, I’m sure, be many threads in future where your input will be just as valueable as this one.
Schizophrenia is a terrible, terrible, real disorder which killed one of my friends. I genuinely don’t think TVAAide is saying “there might be no such thing as schizophrenia”, but I think it would be helpful if he were to clarify as succinctly as possible just what it is he is saying.
Not likely, in my estimation. I’d guess that I’d be challenging people to justify their categories of illness, and not merely accept traditional explanations for certain conditions without proof.
The people at that time sincerely believed that reading certain kinds of material or listening to certain kinds of stories could be physically injurious.
I’d also challenge the use of cold-water baths, full-body restraint chairs, and whirling people around until they bled from the nose and ears as effective treatments for disturbed people. Yes, they often suceeded in increasing the passivity of such individuals – but they weren’t treatments in any medical sense.
And Hentor is prone to giving out accurate but limited and misleading information.
Point One: the “atypical features” tend to be associated with each other. It’s much less likely for a person to have typical and atypical symptoms mixed than typical alone or atypical alone.
Remember Hentor inquiring as to what it takes to establish a taxon? By his line of argument, we should consider atypical depression as a distinct disorder.
Point Two: Do you know why atypical depression isn’t considered a distinct disorder? People with atypical presentations don’t respond to treatment any differently than people with typical ones. Since patient response is the same, it’s presumed that the underlying cause is the same for both categories. This is a logical fallacy, but it’s continued because of the circular reasoning inherent in a lot of clinical psychiatry.
We once made a distinction between endogenous and exogenous depression. Endogenous depressions were presumed to be the result of inner neurophysiological factors: they were distinguished by “vegetative” and impaired thinking and reaction time, gross disturbances in sleeping time, and other physical symptoms. They were much more likely to be treated with physical methods: drugs, electroconvulsive therapy, etc. Exogenous depressions were presumed to be the result of external psychological factors: they were distinguished by feelings of sadness or grief, lack of interest in previously desired things, etc. They were much more likely to be treated with psychological methods: psychotherapy and so forth.
Of course, not only was there no empirical evidence to support the contention that these categories reflected actual differences in cause, it turned out there wasn’t any clinical evidence either: the success rate of any given treatment was the same, regardless of whether the patient was identified as endogenous or exogenous.
The distinction was eventually dropped completely, and is rarely mentioned in modern psychiatry except as history.
As Hentor noticed, panic reactions are not aspects of any of those disorders, although they may be present. They’re diagnostic only for Panic Disorder – which is nothing more than having panic attacks, so it’s fairly obvious why it’s diagnostic.
** Now, if the cause of panic reactions can genuinely be demonstrated to have a specific physiological cause – or a variety of specific physiological causes, or a psychological cause, or a mixture of causes, or any sort of specific cause or causes – it is tremendously important that we do so, and work to find treatments that undo the specific problem.
But what you need to realize, SentientMeat, is that historically there have always been excited researchers announcing that they’ve discovered the true cause of some mental disorder. As time passes, it becomes clear that their findings are simply wrong, or they don’t apply generally, or they’re grossly insufficient to explain the complexities we observe.
** Of course not – but there are some things we need to remember.
First, we need to acknowledge that our opinions about what should justify utter terror are opinions. If someone seems unreasonably afraid of something, we must be aware of the possibility that they have a perfectly reasonable explanation – or if not, that our definition of “reasonable” might be at fault.
But we would probably both agree that this issue doesn’t arise with your mother.
Secondly, we need to realize that what is objectively wrong is that she’s becoming utterly terrified for no reason. Without evidence for a specific physiological or psychological cause, we can’t presume any problem deeper than the behaviors and emotions we observe and use to define the problem.
No. Now, if her doctor tells her that she must take a certain medication because she has a problem with her brain, that claim is not objectively supported. If her doctor tells her that she must undergo cognitive-behavioral therapy to unlearn her psychological feat, that claim is not objectively supported either.
If her doctor tells her that certain methods exist for helping people with problems similar to hers, and that she can choose whichever she feels is most appropriate (or mix them if she desires), then that is responsible and compassionate medicine.
But since it’s often much easier to get insurance to pay for medication than therapy, and since medication works more quickly than therapy (but less reliably and with a greater chance of relapse when discontinued), she’ll probably be told that she needs to take a medication instead.
That is not good science. It’s not even good medicine.
I am not contesting the claim that there is something wrong with revolutionary.
I am contesting the claims that we know what causes his wrongness or that the available treatments are known to be other than merely symptomatic.
Now, if he was diagnosed with Parkinson’s Disease, we could immediately draw certain conclusions about what is wrong with his brain. We could discuss how the available treatments attempt to compensate for that problem. We can’t do that with schizophrenia.
Do you all understand the difference between a syndrome and a disease? Mental disorders are ALL syndromes at the moment – all of the conditions that were once mental disorders but proved amenable to scientific analysis were moved into neurology and medicine.
TVAA you still have provided no proof or even evidence of this presumption, as called upon to do.
First things first. Otherwise the rest of your ranting remains crap supported by a false assumption.
Why do we need to know the cause? The problem is that she is screaming in terror. Must we know the cause of the problem to say that there is very definitely a problem, and that the disorder is valid? If a patient arrives with a broken arm, but does not know its cause, do we question its validity?
People who have no problems with their brain do not scream in terror for several minutes at the dinner table. My mother definitely has a broken brain.
Now, agreed, the precise action of medication and therapy is currently highly intractable (antidepressants build new neurons in the hypothalamus, is that correct?), but remember that the doctor cannot order the man with the broken arm to submit to treatment either. I still fail to see any difference here to physiological science, save for added complexity and associated inflated chance of misdiagnosis.
As for your “insurance motive” hypothesis, well, she is lucky enough to live in a country we she has tried pretty much every possible treatment (including cognitive therapy -“catch that thought!” she often quips to me) over the last 30 years at absolutely no cost to her whatsoever.
** The problem is the pain and inability to move the arm; the cause is that the bone is broken, which is relatively easy to objectively verify and straightforward to treat.
** This is an assumption, and an unjustified one. How do you know that there’s a brain problem behind your mother’s screaming? Because only people with brain problems behave that way. How do you know that? Because your mother has a brain problem, and that’s how she acts. How do you know your mother has a brain problem? …and the circle continues.
I’ve seen people who are terrified of something scream for several minutes when confronted with that thing. Is there something wrong with their brains as well?
** [blinks] What?
First, I don’t think ‘intractable’ is the word you’re looking for, there.
Secondly, you’re referring to one of the currently-popular explanations of depression and the reason antidepressants supposedly work. There are problems with that theory and the explanation, but they’d take a while to explain.
** Lack of physical evidence? Lack of understanding how the treatments actually affect the symptoms (in a biological sense, we obviously know the extent of their symptomatic effects)?
That’s nice. Someone’s still paying for it, and I’ll bet they unreasonably prefer medications to therapy.
How do you know you have a broken arm? Because of the pain and the X-ray. How do you know that the pain and X-ray signify a broken arm? Because that man complained of such pain and his X-ray was similar, and he’s got a broken arm.
Come, Aide, let us agree that screaming in genuine terror unnecessarily is a brain problem.
I entirely agree that understanding of the causes and treatments of mental disorders is far more limited than physical disorders.
Incidentally, the mechanisms, causes, treatments of some types of cancer are also poorly understood. Are these types of cancer not “valid”?
To the OP - I would agree that head-shrinking is a field in which it’s easy for quacks to operate. However, that standard for the field is to determine to what extent someone seems to be a little too far north or south on the X spectrum, to what extent this is messing up that poor person’s abilty to live a normal life, and to move 'em toward a comfortable range. If you don’t have terms for the places on the spectrum, it’s a bit difficult to train new head-shrinkers and consult with peers.
** But you were able to show objectively that broken arm bones can result in such-and-such symptoms.
We could objectively determine if other, dissimilar conditions caused similar pain and arm unmovability – if there were, we could then establish what symptoms could be used to distinguish between the two.
We haven’t been able to show that any particular person with schizophrenia has an identifiable problem with their brain.
** Come, SentientMeat, let us do this thing, and so fling the standards of science and medicine to the four winds!
You’re making a very, very large assumption here with very little support.
** I would argue that even “far more limited” is not sufficient to describe the difference.
The cancer can be empirically detected. The effects of treatment on the cancer can be empirically determined, and the side effects of the treatment are better understood.
We don’t know the ultimate cause of Type I or II diabetes, either, but we know they’re caused by damage to the pancreas in Type I and dietary problems or obesity in Type II. Moreover, we understand what the secondary problem is – either insufficient insulin or insufficient response to it – and we know what effects our treatments have on the body. We can fully explain how the lack of insulin leads to the symptoms we observe, and we can fully explain how supplying insulin, and/or altering exercise and diet habits, compensates from the underlying problem.