# TVAA-you don't know jackshit about mental illness **URL:** \ **Category:** The BBQ Pit\ **Created:** [October 17, 2003, 11:45pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116 "2003-10-17T23:45:04Z")\ **Posts on this page:** 20\ **Page:** 7
**Author:** ![Mr.Svinlesha](https://avatars.discourse-cdn.com/v4/letter/m/22d042/32.png) [@Mr.Svinlesha](https://boards.straightdope.com/u/Mr.Svinlesha)\ **Post date:** [October 21, 2003, 10:46pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/121 "2003-10-21T22:46:32Z")
**Zoe** : ? > [@](#): > > _ **Mr. Svinlesha** , old textbooks are not reliable sources of current thinking in psychiatry. As a psychotherapist, you should be aware of that._ I never said they were. I simply quoted an interesting passage from a book on sociology three years ago in a discussion about the connection between culture and mental illness. _You_ were the one who brought it up in this debate. > [@](#): > > - Cheap shots about age are not characteristic of good psychotherapists either. It’s a good thing that I am content enough with my age to mention it often.\* I’m very glad to hear that, but truth to tell, I have absolutely no idea how old (or young) you might be, darlin’. Since you brought up something I wrote 3 years ago, and compared it with what I was writing in this thread, with the implication that there existed a significant difference between the two (or maybe not, since I’m not sure what you were implying, actually), I was in fact taking a cheap shot _at myself_. I am, after all, three years older now than I was then, and arguably not the enthusiastic webel I once was. Hence, _my modesty_ comes at the expense of _my age_. Although truth to tell, the entire thing was meant tongue-in-cheek. > [@](#): > > _As for whether or not you are a liar, this is TVAA’s pitting. Are you suggesting that I should address my opinion of your integrity here?_ Well, if you’ve got something you’d like to get off your chest, please don’t let Pit decorum stop you. If necessary, there is even a thread in my honor somewhere around here, in which I was described as nothing less than a “vile pustule,” I believe. And that was by a friend. I asked you outright if you were implying that I was lying, or misrepresenting something in some way, because I could not honestly make heads or tails of what you intended. You seemed to imply that there was some kind of difference between what I had written then and what I write now; and you accused me and **TVAA** of being separated at birth (I think). > [@](#): > > _I had always enjoyed your posts previously. I will miss that trust._ I’m sorry to hear that. Did you have to trust me to enjoy me? ---
**Author:** ![DocCathode](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/doccathode/32/18773_2.png) [@DocCathode](https://boards.straightdope.com/u/DocCathode)\ **Post date:** [October 21, 2003, 11:02pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/122 "2003-10-21T23:02:24Z")
> [@](#): > > \*Originally posted by Zoe \* > \*\* > > **DocCathode** , who went to Penn State, also had a jones about cultural bias in diagnosis. I think it may have been in the same thread. > \*\* How the heck did I get dragged into this? ---
**Author:** ![DocCathode](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/doccathode/32/18773_2.png) [@DocCathode](https://boards.straightdope.com/u/DocCathode)\ **Post date:** [October 21, 2003, 11:53pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/123 "2003-10-21T23:53:22Z")
**Zoe** Found the post > [@](#): > > As for the original op, what is and is not an illness is definitely defined by culture. In many societies the carrying of talismans and the casting of spells is a normal part of everyday life. Psychology textbooks define this as “magical thinking”. Diagnostic manuals list magical thinking as a symptom of some conditions and as something to be cured. To most psychologists, psychiatrists, and other shrinks a practicioner of Santeria, Voudoun, or Wicca is not some one with an active spiritual life but some one with delusions and megalomania. Alright, I mentioned Penn later in the same post. I wasn’t attempting to dazzle everybody with name dropping. I was attempting both to introduce myself and to establish that I knew what I was talking about. Later in the same post > [@](#): > > On the other hand, I need medication. The psychiatrist I have now wanted to be sure that my problems weren’t actually caused by medication. For two months things got steadily worse. At the two month mark I experienced panic attacks, various OCD’s and the most fun of all my death phobia returned. She put me back on medication. I still have problems, but there’s no comparison. Where do I scorn medication? I’ve only skimmed the GD thread and was only skimming this when I saw my name. What exactly am I being accused of? ---
**Author:** ![TVAA](https://avatars.discourse-cdn.com/v4/letter/t/c57346/32.png) [@TVAA](https://boards.straightdope.com/u/TVAA)\ **Post date:** [October 24, 2003, 1:59pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/124 "2003-10-24T13:59:50Z")
It’s quite clear at this point that I do in fact know a great deal about mental illness. Also that the people who Pitted me are willing to rail against anyone who offers an opinion or statement that contradicts their claims – like **Doc Cathode** without the least bit of justification. Conclusion: well, I think you can do the math. ---
**Author:** ![singersargent](https://avatars.discourse-cdn.com/v4/letter/s/edb3f5/32.png) [@singersargent](https://boards.straightdope.com/u/singersargent)\ **Post date:** [October 24, 2003, 5:35pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/125 "2003-10-24T17:35:30Z")
I apologize if I am repeating someone else’s post content… I can’t wade through all of them. Some fairly fantastic work has been done this year on genetics & mental illness. Here are recent studies connecting mental illnesses to genetic mutations: Journal Article #1 - Obsessive-Compulsive disorder, OCD > **[Mutant gene linked to obsessive compulsive disorder](https://www.eurekalert.org/news-releases/797554)** > > Analysis of DNA samples from patients with obsessive compulsive disorder (OCD) and related illnesses suggests that these neuropsychiatric disorders affecting mood and behavior are associated with an uncommon mutant, malfunctioning gene that leads to... I don’t believe the article or journal issue have been posted on the Molecular Psychiatry website yet: [http://www.nature.com/mp/](http://www.nature.com/mp/) Journal Articles #2 & 3 - Manic-depressive illness, bipolar disorder June Press Release: [http://health.ucsd.edu/news/2003/06\_15\_Kelsoe.html](http://health.ucsd.edu/news/2003/06_15_Kelsoe.html) Kelsoe PowerPoint presentation: [http://ethics.ucsd.edu/seminars/2003/kelsoe.ppt](http://ethics.ucsd.edu/seminars/2003/kelsoe.ppt) (I think slide number 20 is fascinating.) Two journal articles: [http://www.nature.com/mp/journal/v8/n5/index.html](http://www.nature.com/mp/journal/v8/n5/index.html) 1. Evidence that a single nucleotide polymorphism in the promoter of the G protein receptor kinase 3 gene is associated with bipolar disorder T B Barrett, R L Hauger, J L Kennedy, A D Sadovnick, R A Remick, P E Keck, S L McElroy, M Alexander, S H Shaw & J R Kelsoe 2. Linkage of a bipolar disorder susceptibility locus to human chromosome 13q32 in a new pedigree series S H Shaw, Z Mroczkowski-Parker, T Shekhtman, M Alexander, R A Remick, A D Sadovnick, S L McElroy, P E Keck Jr & J R Kelsoe So, beyond current APA DSM diagnostic criteria, TVAA, how about reviewing recent journal articles on genetics & mental illness? Hijack: After reading those articles my questions are: If/when a genetic or “physical” component to mental illness is substantiated, will this/could this (1) remove the current physical vs. mental coverage disparity by the insurance industry (2) change the way mental illnesses are viewed legally (3) destigmatize mental conditions, disorders, & illnesses? Interested in Doper’s feedback… I am not a scientist or doctor. ---
**Author:** ![Liberal](https://avatars.discourse-cdn.com/v4/letter/l/848f3c/32.png) [@Liberal](https://boards.straightdope.com/u/Liberal)\ **Post date:** [October 24, 2003, 6:00pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/126 "2003-10-24T18:00:59Z")
You musn’t question Vorlon (TVAA). He knows a great deal about mental illness. If you don’t believe it, just ask him. ---
**Author:** ![TVAA](https://avatars.discourse-cdn.com/v4/letter/t/c57346/32.png) [@TVAA](https://boards.straightdope.com/u/TVAA)\ **Post date:** [October 24, 2003, 6:14pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/127 "2003-10-24T18:14:08Z")
Those are some excellent questions, **singersargent**. You should really post them (and your article links) in Great Debates – they’re worthy of discussion, and they’ll just be buried in this Pit thread. **Libertarian** : I know about mental illness just as you know about philosophy, with the sole difference that I know what I’m talking about. Don’t let the server hit you on the head on your way out. ---
**Author:** ![greck](https://avatars.discourse-cdn.com/v4/letter/g/7ab992/32.png) [@greck](https://boards.straightdope.com/u/greck)\ **Post date:** [October 24, 2003, 7:00pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/128 "2003-10-24T19:00:18Z")
> [@](#): > > \*Originally posted by TVAA \* > \*\* > > 1. If someone tells you that they’re the Second Coming of Christ, it’s reasonable to be skeptical, but much less so if the person is speaking from a fiery throne descending from the sky and borne aloft by seraphim who sing “Hosanna” in unspeakably harmonious tones. > > 2. I am not familiar with the functional conventions of therapy, either psychological or psychiatric. In other words, I don’t know much about how to be a clinician. > > 3)I have intimate knowledge of how medicine is practiced, and I know a lot more about the theory and philosophy of logic and the scientific method than the vast majority of clinicians. > > The responses I’ve gotten from the self-proclaimed medical authorities in these threads would seem to support those claims, eh? \*\* 1. If you see this as an accurate metaphor for your posts in this thread or any other arena, it’s time to see a psychiatrist, seriously. 2. great to hear you finally admit this. 3. see #1 above. I’ve heard this story before. “I’m among the most brilliant minds in the world, but I couldn’t ethically continue in the field, so now I just study on my own, I know way more than the ‘experts’ do, so much in fact, that people can’t even comprehend me.” that, and when people start speaking to you in “codes” are your indicators that it’s time to get another opinion. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [October 24, 2003, 7:02pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/129 "2003-10-24T19:02:36Z")
singersargent, There is really no question that there is a genetic/biologic component to many mental illnesses. How strong, what exact mechanism, etc, is far from understood for almost all. Whether or not the current labels will end up correlating with common pathophysiologies or perhaps reclassifications will be needed as research progresses is also an open question. Insurance coverage is another thing and unrelated mostly. That is economic and fraught with concerns about the potential for abuse of the system by Woody Allen type analysis. Maybe the development of metrics better than the current DSM would be of help here. Stigma is slowly improving. I thank Colin Powell some. I loved his bit when he declined running for president and was asked if he had been scared out by concerns that his wife’s depression would be brought out. his answer went something like “No. Everyone already knows and her medications work better than my a high blood pressure pills do for me.” TVAA is a delusional self aggradinzing putz. I could even believe that he works for the pharmaceuticals since his main effect is to unite nearly everyone, even those ususally critical of big pharma and organized psychiatry, against his points of view (if we can ever pin them down) as they are presented with such inarticulation, confusion, extremism, arrogance, and hostility. He has joined the ranks of a very small handful on these boards that I utterly disrespect. And that number is small indeed as I have often developed great respect for those with views very different than my own (ie people very wrong :)) as they are usually able to defend their viewpoints with intelligence and with some interest in understanding another POV if only to better argue against it. TVAA has displayed neither intelligence nor interest. His major characteristics have been the ability to drive people away from any agreement with any position that he takes and the arrogance of those too stupid to even know how little they know. What a twit. ---
**Author:** ![TaxGuy](https://avatars.discourse-cdn.com/v4/letter/t/b19c9b/32.png) [@TaxGuy](https://boards.straightdope.com/u/TaxGuy)\ **Post date:** [October 24, 2003, 7:08pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/130 "2003-10-24T19:08:03Z")
> [@](#): > > _Originally posted by Gadfly_\*\* > People. As far as I can tell, TVAA’s crux is thus: Diagnosing and treating mental illnesses is a sketchy and questionable process, because most haven’t been traced to provable physiological problems. It’s an interesting point, and after clarification, I really don’t see why panties are bunched. \*\* I agree with this. **TVAA** is only saying that it is not currently possible to tell whether ODD, OCD, ADHD, etc. has a physiological or a psychological cause. He is not saying that the disorder “isn’t real” or anything like that. It’s so sad that **Guinistasia** isn’t smart enough to realize the difference, so she starts this trainwreck of a thread with an absolutely asinine OP. I’ve had run-ins with **Guin** ’s stupidity before, and I guess I shouldn’t have expected her to get any smarter. I was at least hoping that she’d learn to keep quiet about it. ---
**Author:** ![rickiwatts](https://avatars.discourse-cdn.com/v4/letter/r/b9e5f3/32.png) [@rickiwatts](https://boards.straightdope.com/u/rickiwatts)\ **Post date:** [October 24, 2003, 8:13pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/131 "2003-10-24T20:13:24Z")
TVAA, you have to be the worst poster I have come across on the straighdope boards. You complain about a subjuct’s intrinsic characteristics, and you have no solutions to any real or percieved problems. for example: If I give several people the instructions to “go north for a while, then head east, then walk south-southeast until you reach the destinationi”, and they all end up in the same place even though they travelled independently, it’s clear they’re not really following the instructions – they’re following a more specific set of instructions that isn’t obviously incompatible with my much looser set. That is not a valid conclusion. If the destination was a sufficiently wide area, every person possibly could end up at the same destination, even if they were following exact compass directions. You need to think before you type TVAA. You still haven’t answered my question from the earlier thread, what is a “known disease process?” You relentlessly slam the DSM, yet you give no worthwile suggestions as to a replacement. The funniest, and most aggrivating, part of the original thread was were you suggested “we need an objective test for autism.” Idiot! What do you think the DSM is trying to do? I’m not going to go over again how complaining that something is vague when there is no possible way of measuring it anyway is pointless at best. You are obviously not smart enough to grasp the concept. * * * Valid: (from the online webster dictionary) 1. having legal efficacy or force; especially : executed with the proper legal authority and formalities \ 2. well-grounded or justifiable : being at once relevant and meaningful \ b : logically correct \ \ 3. appropriate to the end in view : EFFECTIVE \ 4. of a taxon : conforming to accepted principles of sound biological classification Posted by TVAA: I’m saying that the claims that mental illnesses are physiological diseases with known etiologies aren’t valid. Lets walk through this shall we? Is the claim that mental illnesses are phsyiological dieases with known causes well-grounded and justifiable? From the previous thread there was an impressive amount of evidence that many mental disorders could be caused physically. Such as ADHD. In addition, there is the blatently obvious effects of “uppers and downers” on a patients mental state. If a drug can cause a patients brain to function incorretly, such decreasing the rate a certain brain-chemical or hormone is processed or recieved. Then it is also possible that a defect could cause this to happen in another patients brain, much like a mental diabeties. It can also be a logical conclusion, since a mental state can cause a physical state, therefore it is possible that by reproducing the physical state(or at least the correct hormones and neurochemicals) you can also cause the mental state. Is it appropriate to the end in view? I assume it aims at curing or at least easing the discomfort of those affected. If studying the physiological aspects brings us a better understanding of mental disorders, why not. If a medication can release a patient from suffering, or at least aid in its therapy, why deny it to them? Is this approach effective? Considering the subject matter, it the most effective thing we’ve got. A better concept may be discovered in the future, but until then we must work with what we have. I believe that the claim that mental disorders can have physilogical casues can be considered quite valid. Its justifiable in respect to current medical knowledge. Its logical in the respect that cause and effect may be interchangable. It is appropriate because it can bring insight and solutions to a vague subject matter. It is effective since it is a measureable approach to a difficult problem. ---
**Author:** ![TVAA](https://avatars.discourse-cdn.com/v4/letter/t/c57346/32.png) [@TVAA](https://boards.straightdope.com/u/TVAA)\ **Post date:** [October 24, 2003, 8:26pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/132 "2003-10-24T20:26:01Z")
**DSeid** , if you can’t even grasp that the DSM _defines_ mental disorders instead of _measuring_ them, there really isn’t any point in continuing to talk to you. There can be no “better” metric than the DSM unless you accept that our working definitions don’t actually match the DSM’s criteria. Criminy, don’t you understand even basic logic? We can compare surveys and checklists to the DSM criteria to see how well they match, but we have nothing to compare the DSM _to_ in order to judge its validity. That’s precisely why it’s determined by vote instead of through empirical research. **rickiwatts** : What’s with the duplicate posting? Could there be a _reason_ no one’s responded to your posts? ---
**Author:** ![Liberal](https://avatars.discourse-cdn.com/v4/letter/l/848f3c/32.png) [@Liberal](https://boards.straightdope.com/u/Liberal)\ **Post date:** [October 24, 2003, 9:13pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/133 "2003-10-24T21:13:23Z")
Basic logic? I’m still waiting to hear about that deductive system with no undefined terms. What a jackass. ---
**Author:** ![TVAA](https://avatars.discourse-cdn.com/v4/letter/t/c57346/32.png) [@TVAA](https://boards.straightdope.com/u/TVAA)\ **Post date:** [October 24, 2003, 10:36pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/134 "2003-10-24T22:36:46Z")
[sigh] What an incredible wetbrain. Terms can be perfectly well defined as operations or categories in a system but not be defined in terms of their referents. Saying that “goodness is what God values” includes a number of basic assumptions (including that God exists and that it can value). More to the point, without a way of determining just what it is that is being valued, giving it a name of “goodness” is pointless. I can talk about “things that fall into the category ‘blkaip’” all I like, but if I never describe the criteria for that category, what conclusions can I draw? Get a life, you uneducated wanna-be. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [October 25, 2003, 12:51am UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/135 "2003-10-25T00:51:02Z")
Actually Taxguy, he hasn’t been saying that, although he does fly all over the place with his claims and misinformation, so it is impossible to know what his points are most of the time. But even that statement isn’t true. For many mental disorders (and it would be unfair to lump tham all together) there is _conclusive_ evidence of biologic factors. Short of knowing and testing for a particular gene or gene product, the gold standard to prove that there is a genetic component is the twin study: a significantly higher concordance for a particular mental illness between identical twins relative to fraternal twins is considered as very good evidence for a biologic component. Many mental illnesses have had these studies done with positive results. So we know that for these disorders something is different about these individuals even in those cases were we cannot yet say what that difference is. What isn’t known for most mental disorders is how much of a role this biologic predisposition plays versus environmental effects, and which sorts of environmental effects. And how they interact. There is great work showing that various alleles protect or place an individual at risk for adverse outcome from social stresses early in life, for example. We also are early in our understanding of brain function and many current models will likely seem crude in a few decades. Or sooner. And all of this is a different question than what should be called a “disorder” vs what should be called a “difference”. And a different question that what condition (disorder or difference) should be treated and how. Despite TVAA’s all-powerful mind interchanging these questions continuously. ---
**Author:** ![Computer\_Guru](https://avatars.discourse-cdn.com/v4/letter/c/ed655f/32.png) [@Computer\_Guru](https://boards.straightdope.com/u/Computer_Guru)\ **Post date:** [October 25, 2003, 1:02am UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/136 "2003-10-25T01:02:06Z")
> [@](#): > > \*Originally posted by Themis00 \* > \*\*People who claim to have ADHD/OCD/Whatever are retards that want to get high off their medcine. > > Not really. \*\* Excuse me, but I never got high on my medicine. ---
**Author:** ![TVAA](https://avatars.discourse-cdn.com/v4/letter/t/c57346/32.png) [@TVAA](https://boards.straightdope.com/u/TVAA)\ **Post date:** [October 25, 2003, 1:29am UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/137 "2003-10-25T01:29:42Z")
> [@](#): > > \*Originally posted by DSeid \* > \*\*For many mental disorders (and it would be unfair to lump tham all together) there is _conclusive_ evidence of biologic factors. Short of knowing and testing for a particular gene or gene product, the gold standard to prove that there is a genetic component is the twin study: a significantly higher concordance for a particular mental illness between identical twins relative to fraternal twins is considered as very good evidence for a biologic component. \*\* Yes, biology has an effect. I wasn’t claiming, nor have I ever claimed, that mental disorders are not affected by biology. I am claiming that they’re not known to be physiological problems, that there is equally strong evidence for the effects of environment as biological predisposition, and that we do not know how our treatments help. It would be nice if **DSeid** would actually debate _those_ claims for once, instead of ranting about how stupid and uninformed I am. :rolleyes: If people wouldn’t claim that these differences were actually disorders because they’re biological faults in the brain, these “debates” wouldn’t be necessary. If people didn’t suggest that physical treatments are as necessary for improvement with depression as they are for diabetes, they wouldn’t be necessary. And if people weren’t convinced that “biochemical imbalances” were the cause of mental disorders (we have no meaningful evidence in favor of this claim) they wouldn’t be necessary. But **DSeid** in his wisdom can ignore these problems, despite lacking rudimentary knowledge about the history and validity of such claims. Oh, and **DSeid** : I never claimed to be smarter, I claimed to be more knowledgeable. ---
**Author:** ![Computer\_Guru](https://avatars.discourse-cdn.com/v4/letter/c/ed655f/32.png) [@Computer\_Guru](https://boards.straightdope.com/u/Computer_Guru)\ **Post date:** [October 25, 2003, 1:37am UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/138 "2003-10-25T01:37:20Z")
> [@](#): > > \*Originally posted by Computer Guru \* > \*\*Excuse me, but I never got high on my medicine. \*\* Sorry \*\* Themis00\*\* I didn’t see the last part of your post. My mistake. :o ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [October 25, 2003, 5:26am UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/139 "2003-10-25T05:26:56Z")
Let’s see, your claims have included that psychological disorder labels are not “valid”, that the study and terms of psychology are not scientific, that mental disorders are not disorders at all, that psychiatrists intially weren’t MDs and have physics (sic) envy, that a review article is a meta-analysis, and oh a host of others not including those statements that are just plain delusional. But now you’ve restated your points as “I am claiming that they’re not known to be physiological problems, that there is equally strong evidence for the effects of environment as biological predisposition, and that we do not know how our treatments help.” What is physiology? All it means is the study of the way a biological system works. An organism functions. How it functions, how, for example, it manifests and changes mood states, changes behavior, swallows, digests, etc … all is physiological. So what do you really mean to say? That there is a biologic predisposition but no mechanism that it occurs by? Or only that we do not yet really understand the physiology involved? Relative effects of biology and environment? Better be a little more precise than lumping all mental disorders together. You need to define precisely which condition you are talking about. And the DSM is the best we got for that purpose, warts, fuzzies, and all. Some have very good evidence for little effect of environment, others have little evidence for much biological effect at all, others have good evidence for a complex interplay. And others have no where near enough research done to even be able to make an educated guess yet. And on your last point, absolutely correct. We do not understand the systems involved well enough at this point to understand why treatments work. Most psychopharmocology was developed by happenstance, not by design. We don’t know how well they work even, sometimes. Or why one medication works well for one person and not another and how to differentiate that response better proactively rather than by trial and error. We have crude tools and limited knowledge. The model that a particular neurotransmitter does X or Y and raising its level will do Z is a bit bizzare … boy I see a lot of number 5 hex bolts in a particular portion of my car that helps it accelerate, and if some are missing my car doesn’t work well. Therefore number 5 hex bolts are accelerating bolts and maybe throwing a bunch more into the engine will help it accelerate better. What it is a bit more complex than that? And the brain isn’t? We have a loooong way to go. Now onto “disorder.” Again define the term. Due to a physiologic cause? Well everything biological is, including normal variations. No. _“Disorder” implies that a condition is maladaptive for the function of the organism in its environment._ Therein lies the difference between normal variation and disorder. A certain level of blood sugar is defined as a disorder because it is associated with morbidity and mortality. A certain level of blood pressure is labelled a disorder for the same reason. If it was not associated with adverse outcomes it would just be a normal variation. If a thin lanky Black child was born to an Inuit family 500 years ago, that child would be disordered. He would be outside the usual range of variation in that environment and have a poor chance at survival. Conversely a short squat husky pale kid born to a Batuu family in Africa at the same time would also be labelled appropriately as having a disorder. It would be maladaptive to his/her function within that environment that they were forced to function in. In the environment where sickle cell fostered survival by engendering malarial resistance, it was not a disorder. Outside of that environment it is. Disorder is both a function of the individual and the environment in which the individual must exist. When a condition, including mental conditions and temperments, can be be defined and is associated with adverse outcome and dysfunction in the organism’s environment, then that condition is a disorder. Whether we understand the physiology or not. Whether it was caused exclusively by a genetic or other factor of biologic predisposition, or as a reaction to experience, or both. And even if the condition could be functional if only the organism existed in a different time and/or place. Do you treat every disorder? No. You treat if you have treatments whose total risks and costs to the organism are outweighed by the benefits. That depends on the nature of the disorder, the risks of the treatment, and the efficacy of the treatment. Individual decisions to be made in individual cases based on past similar experiences. It helps if clinicians can share experiences about what worked well or did not work well with similar cases, what adverse outcomes occurred and so on, but you need some common language to do that. Again, fuzzies and all, the DSM is the best game in town to do that. Do we need to know how our treatments work? No, and history is full of mistaken beliefs about mechanisms for treatments that worked well. Clinically, I didn’t care if theophylline worked by a cyclic AMP cascade or actually by a combination of central mechanisms and diaphragmatic stimulation … I just cared that it did and that I knew how to use it safely, and that I knew when less risky more efficacious interventions were developed. I was glad that others were interested in finding out though. ---
**Author:** ![mrsam](https://avatars.discourse-cdn.com/v4/letter/m/b5ac83/32.png) [@mrsam](https://boards.straightdope.com/u/mrsam)\ **Post date:** [October 25, 2003, 11:05am UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/140 "2003-10-25T11:05:29Z")
I offer the following arguments. 1. Cultural norms are taken for granted in the formulation of the second law. 2. The criteria for the second law makes use of the extremely vague terminology such as “entropy” 3. It presume that the problem is necessarily with the environment rather than with the people. I mean, while physicists _claim_ that “entropy” increases or remains constant, this is clearly not the case. We are perfectly capable of rearranging things in more ordered states; look at origami! Origami clearly defies the second law. And while physicists claim that things become more disordered, this clearly ignores cultural norms. What if anthropologists were to discover a group of people who tidied things up all the time? Like the Japanese, maybe, except neater? Clearly this hypothesis has not been thorougly tested, as I am aware of no studies testing Japanese people for “entropy”. It could be the case that people merely choose to act in a way that increases “entropy”, rather than there being a universal trend towards it’s increase. And what is this “entropy” thing, anyway? It’s really complicated-like, and I don’t understand it. This must mean that it is needlessly ambiguous. I mean, surely I should understand it as a physicist? Well… actually… I didn’t study physics… but I did math once. Ten years ago. I even have a cite supporting my claims. [Evolution defies entropy.](http://www.unmaskingevolution.com/pdf_dl/posters/Thermodynamics.PDF) Until we have a theory for Quantum Gravity, physics is clearly in it’s dark ages. While we have a rough idea of how things work currently, we are far from a workable model of the universe. Thus all our current efforts are not necessarily valid, and may be disproven at a later point in time. [Previous page](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116.md?page=6) [Next page](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116.md?page=8)