The battle to define mental illness

"Every so often Al Frances says something that seems to surprise even him. Just now, for instance, in the predawn darkness of his comfortable, rambling home in Carmel, California, he has broken off his exercise routine to declare that “there is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it.” Then an odd, reflective look crosses his face, as if he’s taking in the strangeness of this scene: Allen Frances, lead editor of the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (universally known as the DSM-IV), the guy who wrote the book on mental illness, confessing that “these concepts are virtually impossible to define precisely with bright lines at the boundaries.” For the first time in two days, the conversation comes to an awkward halt.

But he recovers quickly, and back in the living room he finishes explaining why he came out of a seemingly contented retirement to launch a bitter and protracted battle with the people, some of them friends, who are creating the next edition of the DSM. And to criticize them not just once, and not in professional mumbo jumbo that would keep the fight inside the professional family, but repeatedly and in plain English, in newspapers and magazines and blogs. And to accuse his colleagues not just of bad science but of bad faith, hubris, and blindness, of making diseases out of everyday suffering and, as a result, padding the bottom lines of drug companies. These aren’t new accusations to level at psychiatry, but Frances used to be their target, not their source. He’s hurling grenades into the bunker where he spent his entire career.

As a practicing psychotherapist myself, I can attest that this is a startling turn. But when Frances tries to explain it, he resists the kinds of reasons that mental health professionals usually give each other, the ones about character traits or personality quirks formed in childhood. He says he doesn’t want to give ammunition to his enemies, who have already shown their willingness to “shoot the messenger.” It’s not an unfounded concern. In its first official response to Frances, the APA diagnosed him with “pride of authorship” and pointed out that his royalty payments would end once the new edition was published—a fact that “should be considered when evaluating his critique and its timing...."----
I'm not sure what this guy said or whether it's hyperbolically overstated. But it is a valid point.

I think that psychiatry is currently at about the same stage of development as conventional medicine was back when physicians used to bleed people in hopes of adjusting their "humors".

Psychiatric diagnoses are largely intuitive, the product of the shrink's judgement and evaluation of the patient's behavior. There's little or no understanding of what is happening beneath the surface making the behavior bizarre, so the psychiatrist has little recourse but to 'treat the symptoms'. There's no lab tests to identify a specific problem that can be effectively addressed and treated.

I'm inclined to speculate that what we think of as 'schizophrenia' or 'bipolar disorder' are more analogous to symptoms than diseases. It's as if people thought that fevers or nausea were diseases in their own right and tried to treat the symptoms directly. That would certainly help a lot of people, but it would help those people even more to know why a person is running a fever or feeling nausea, and then proceeding to treat that problem.
"What the battle over DSM-5 should make clear to all of us—professional and layman alike—is that psychiatric diagnosis will probably always be laden with uncertainty, that the labels doctors give us for our suffering will forever be at least as much the product of negotiations around a conference table as investigations at a lab bench. Regier and Scully are more than willing to acknowledge this. As Scully puts it, “The DSM will always be provisional; that’s the best we can do.” Regier, for his part, says, “The DSM is not biblical. It’s not on stone tablets.” The real problem is that insurers, juries, and (yes) patients aren’t ready to accept this fact. Nor are psychiatrists ready to lose the authority they derive from seeming to possess scientific certainty about the diseases they treat. After all, the DSM didn’t save the profession, and become a best seller in the bargain, by claiming to be only provisional.

It’s a problem that bothers Frances, and it even makes him wonder about the wisdom of his crusade against the DSM-5. Diagnosis, he says, is “part of the magic,” part of the power to heal patients—and to convince them to endure the difficulties of treatment. The sun is up now, and Frances is working on his first Diet Coke of the day. “You know those medieval maps?” he says. “In the places where they didn’t know what was going on, they wrote ‘Dragons live here.'”

He went on: “We have a dragon’s world here. But you wouldn’t want to be without that map.”
I'm not sure it's a matter of how we define it, as much as the stigma that seems attached to it all. As a culture, we seem tentative to seek help for people who exhibit signs of mental illness, as to not offend. Then, that person commits suicide and many people act surprised. Or they admit that they ''knew something was wrong,'' but did nothing. I'd rather offend someone who is showing signs of depression and/or mental illness, than stand by, do nothing, and they hurt themselves or others. We have to change the narrative around mental illness.
(Feb 3, 2018 07:39 PM)Magical Realist Wrote: [...]
Quote:. . . Whether physical or mental, a disease is really a statistical construct, a group of symptoms that afflicts a group of people similarly. [...] The fact that diseases can be invented (or, as with homosexuality, uninvented) and their criteria tweaked in response to social conditions is exactly what worries critics like Frances about some of the disorders proposed for the DSM-5—not only attenuated psychotic symptoms syndrome but also binge eating disorder, temper dysregulation disorder, and other “sub-threshold” diagnoses. To harness the power of medicine in service of kids with hallucinations, or compulsive overeaters, or 8-year-olds who throw frequent tantrums, is to command attention and resources for suffering that is undeniable. But it is also to increase psychiatry’s intrusion into everyday life, even as it gives us tidy names for our eternally messy problems....

Social technology has enabled physiologically disabled and impaired individuals to more easily overcome isolation and connect / bond with their fellows. Thus engendering new identity-groups on the diversity landscape which seek to be normalized (i.e., be rid of the "handicapped" categorization and other negative language).

So with each new statistical construct that's outputted by this professional family or psychiatric caste of experts, the afflicted "group of people" might also be a precursor to a new subcultural denomination as well. Possessing some members who may not desire any potential "cure" in the future and be quite content to maintain either their customs or their lifestyle of medication. In the spirit of pride or authenticity as "to who I am" and allegiance to the group (subsuming their individuality under the properties of that general concept). Though -- if not already transpiring -- it may first seem a stretch in possibility to the uninitiated among us, that it could happen in a massively coordinated way, on the psychological side.

Specific example from the physiological side:

The deaf community, via the Deaf Society of NSW and Vicdeaf, responded with anger. [...] "The deaf community is angry and sees this as a form of cultural assimilation, similarly to what has happened, or attempted to happen, with the indigenous Australians. [Dr] Dornan feels she can 'cure' deafness and confine it to history, when she has not considered the whole picture of the culture, the language and the lives of many deaf and hard-of-hearing people."--The divided culture of the Deaf

The protesters were angry, but acting peacefully. The majority of them were Deaf. (Yes, with a capital D. In the book *America: Voices from a Culture*, Carol Padden and Tom Humphries explain, “We use the lowercase deaf when referring to the audiological condition of not hearing, and the uppercase Deaf when referring to a particular group of deaf people who share a language [...] and a culture.”) --Understanding Deafness: Not Everyone Wants to Be 'Fixed'

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