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.