What exactly is mental illness, and how do we avoid having this term misused

Great Debates
1

I’m sure people way smarter than me have already researched this, but is there a field of study that studies the concept of mental illness that takes the biological, sociological, environmental, etc aspects of mental illness into affect to determine what is a mental illness?

For example the standard definition of mental illness seems to be.

  • Behaviors that are based on aberrant molecular biology and neuroscience

  • Behaviors and thoughts that are harmful to the person who has them

  • Behaviors and thoughts that are harmful to others

  • Behaviors and thoughts that make a person too disabled to be capable of fulfilling their responsibilities as an adult

Well and good. Someone with PTSD is miserable, so they suffer from a mental illness.

Someone with narcissistic personality disorder or anti-social personality disorder makes life hell for other people. So thats a mental illness. Even though the person suffering from ASPD themselves may not suffer, they make other people suffer.

Someone with psychosis or severe depression cannot fulfill their daily functions and is disabled.

Well and good.

But there are other definitions of mental illness too

  • Behaviors that are threatening to the social order, or threatening to the interests of powerful groups or individuals.

For example:

  • In the civil rights movement, some blacks who fought for civil rights were classified as schizophrenic because they were angry and hostile about oppression

  • Being gay was a mental illness until 1973

  • In the soviet union, people who fought for civil rights were deemed mentally ill

  • Women who didn’t conform to the oppressive, abusive patriarchy of the 19th century were deemed mentally ill

etc.

So how do we distinguish between someone being mentally ill because they’re suffering, or making others suffer, or unable to function vs someone being mentally ill because they’re threatening the social order?

Also as far as suffering, even that gets complex.

Suffering from grief after a breakup or the death of a loved one isn’t considered mental illness, despite the person who has it is suffering.

Meanwhile personality traits like right wing authoritarianism or social dominance orientation cause suffering to others. The person who has them is fine, but people who score high on these traits tend to also embrace ideas like fascism, which makes life hell for others. Yet people who score high on RWA or SDO are not considered mentally ill.

So why is a condition like ASPD a mental illness that causes suffering and misery to others but doesn’t cause suffering to the person who has it, but traits like RWA or SDO are not mental illnesses?

For that matter, a person who subscribes to a socially dominant religion is considered mentally healthy, but many times a socially aberrant religion is considered a sign of mental illness.

People may accuse you of being mentally ill if you reject christianity or islam in cultures where that is the dominant faith. Or they may accuse you of being mentally ill if you worship ants.

Meanwhile christians thing that begging a day laborer who was executed for treason 2000 years ago to help cure their cancer is not a sign of mental illness. Or following the teachings of a man who probably had religious delusions due to temporal lobe epilepsy in the desert 1400 years ago is not a mental illness.

If you say you’ll pray to a deity like god, and you think that deity answers your prayers in various ways thats not mental illness. But Sam Harris once mentioned that if you think god is talking to you via morse code from the patterns of raindrops hitting your car window, that is mental illness.

Meanwhile there are mental illnesses. Schizophrenia, from what I understand of it, is due to neural pruning gone wrong. In childhood our brains build too many neural connections, in late adolescence our brains prune back the unnecessary connections. In schizophrenics this process goes wrong, and the wrong connections are cut. This makes the person become delusional and disabled. Thats a mental illness. Autism by comparison, is supposedly in part due to too many neural connections.

But like with many mental illnesses like PTSD, borderline personality disorder, ASPD, etc there is a spectrum. PTSD is measured on a spectrum of 0-80 I think, and I think the cutoff is 33. ASPD is measured on a spectrum of 0-40, and I think the cutoff is 30. With BPD, I think you have to hit 5 or the 9 diagnostic criteria.

So you can have ASPD traits or PTSD traits, but not hit the cutoff for official diagnosis. So you have PTSD, you score a 46 on the checklist. Then you do therapy, now you’re at a 28. You still suffer, just not enough to be labeled as suffering from PTSD anymore.

2

Would ASPD ever be diagnosed if it wasn’t causing problems for a person? They likely don’t recognize the problems it causes for themselves even after they get fired, dumped, or end up in jail. It’s not the only mental illness where the sufferer doesn’t realize the effect it has on their own quality of life, or how it affects others.

3

Like physical illness, everyone’s a little bit sick - high cholesterol, blood pressure, a few extra pounds. And everyone carries a bit of trauma or anxiety or some unhealthiness.

It’s when it gets really out of the bounds of normal that it becomes a true physical/mental disorder. If your blood pressure’s a bit high, that’s typical, but if you have a bulging aneurysm, it’s not.

If you worry a bit about this thing or that thing, you’re normal. But if you’re obsessively checking your dryer machine to see if vapors from your dehumidifier in the adjacent bedroom got sucked into it and changed into hydrofluoric acid, and go to the hospital to get calcium gluconate because you think you’ve become HF-poisoned, that’s probably OCD.

4

For one thing, you can’t have a mental illness that is defined even in part by one’s political beliefs. You cannot be seen as pathologizing any political take. Your link doesn’t even seem to treat RWA like a mental disorder, but more a description. It talks about beliefs, not delusions. There is no argument that sufferers are inherently harmful. Nor is set up like it’s something that could be treated with medicine or therapy.

SDO literally has “orientation” in the description, and is defined as a measure. You measure it. It’s more like anxiety itself than any anxiety disorder. Maybe an illness could be defined with a high SDO being part of the description. But something that you can measure in everyone can’t be a disorder.

I suspect that, in actual usage, RWA is also like SDO. It’s a number in a chart, not a disorder.

5

People with Cluster B personality disorders like anti-social personality disorder, narcissistic personality disorder and borderline personality disorder cause a lot of suffering to the people around them.

By the same token, people who score high in social dominance orientation or right wing authoritarianism cause suffering in those around them too.

So why the distinction?

https://www.nature.com/articles/s44159-023-00161-4#Sec6

In addition to identifying the distinct out-groups targeted by authoritarianism, the dual process motivational model illustrates how right-wing authoritarianism impacts broader beliefs and behaviours. Given that punishment can be used to foster conformity48,118, right-wing authoritarianism should promote aggressive behaviour towards others. Consistent with this thesis, authoritarianism predicts aggressive attitudes and behaviours including support for corporal punishment119, interpersonal aggression120 and the persecution of immigrants who are hesitant to assimilate

A related literature examines the socio-political implications of authoritarians’ increased propensity towards aggression. Consistent with its motivational goal to mitigate and extinguish societal threat23,31, right-wing authoritarianism predicts support for military interventions122,123,124 and the use of torture125,126, as well as opposition to human rights127,128,129. Right-wing authoritarianism also correlates positively with the justification of political violence against groups perceived to threaten in-group values130. Importantly, this association is independent of, and larger than, the relationship between the propensity for radicalism and the justification of political violence. Collectively, these studies demonstrate that right-wing authoritarianism can undermine core democratic ideals and incite violence.

Finally, right-wing authoritarianism influences people’s views on the environment and science, especially when these topics are perceived to conflict with long-standing conventions and traditional authorities. For example, right-wing authoritarianism predicts anti-climate change beliefs144, resistance to plant-based diets145 and science scepticism in general146,147. Longitudinal analyses further reveal that right-wing authoritarianism precedes both increases in climate change denial148 and decreases in environmentalism149.

Pro torture, pro war, anti democracy, pro aggression, anti minority right, anti human rights, opposed to addressing climate change, etc etc

How is that not harmful?

One of the tools used to determine a person’s level of RWA is how much they support child abuse in the form of corporal punishment.

Also why is politics somehow immune to mental health?

6

I for one am shocked that medical definitions of mental illness have evolved and been refined over time. It makes one doubt the whole concept of “mental illness”.

Similarly, why should we trust “medical experts” when accepted etiology and treatment of disease change in response to new “evidence”?

/s

7

Oh a sarcasm detector. Oh thats a real useful invention

8

That seems oddly specific…

9

Yes, because it’s an OCD phobia I’ve had before (except that I didn’t go see doctors or clinics for it.) OCD can you make you get really, really specific - specific beyond what a normal brain would ever dwell on.

Some other OCD thoughts: Thinking I would get lipid pneumonia from frying food with too much oil, thinking accidental pressure on eyes would increase intraocular eye pressure and damage the optic nerve and retina, thinking about how staph bacteria inside the nasal lining could get on all kinds of surfaces if one were to pick the nose but then not wash fingers/hands, thinking about lead contained within plastic electronic wiring/cords/cables, thinking about how dish detergent vapors are also getting heated up by flames on the flame cooker in a kitchen (if washing dishes but cooking food at same time,) etc.

10

Isn’t that more hypochondria?

11

I wouldn’t have realized that’s OCD, actually. I’d have just assumed it was some sort of catastrophizing, because in my admittedly untrained mind, OCD is about obsessive stuff like being super-particular about hand washing, etc… and things like unrealistic leaps of logic would be something else.

12

Perhaps the OCD resides not in the wild leaps of logic & far-fetched dire consequences, but rather in the inability to dismiss the silly idea as silly and instead have it uncontrollably dominating your thoughts and behaviors?

All of us can fantasize up some wacky Rube Goldberg disaster scenario. Hell, Hollywood lives on that crap.

It’s recognizing that it’s fantasy crap that’s seemingly hard / impossible for some folks.