
Aren't we all somewhere on the spectrum of disease? - scripthacker
https://thedeductible.com/2020/07/18/arent-we-all-somewhere-on-the-spectrum-of-disease/
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blame_lewis
This is a really dangerous and misleading way to look at bipolar.

The disease proper of bipolar disorder is progressive and degenerative. This
progression is accompanied by structural changes in the brain [1] as well as
biological changes in the body [2].

If someone had the syndromes of manic or depressed symptoms in response to a
medication, that does not prove either way that the person actually has the
progressive and degenerative disease that can induce those syndromes
spontaneously. If withdrawing the medication completely solves the problem, it
simply indicates that they don't have the disease.

The sentiment of "we're all a little crazy" is very old, and very dangerous to
go around repeating. There's a specific threshold where things suddenly get
orders of magnitude more fucked up, and anyone who has crossed this threshold
will know how damaging it is to treat these diseases as if they're just an
extension of normal human experiences.

If you have this disease, you need to halt the degenerative process. I've
taken my meds every single day for the last 14 years because I know what will
happen if I stop. I have friends and family that went down that road, and it
isn't pretty.

[1]
[https://www.sciencedirect.com/science/article/abs/pii/S00063...](https://www.sciencedirect.com/science/article/abs/pii/S0006322307002338)
[2]
[https://www.sciencedaily.com/releases/2016/05/160531104421.h...](https://www.sciencedaily.com/releases/2016/05/160531104421.htm)

~~~
jniedrauer
> The disease proper of bipolar disorder is progressive and degenerative.

This is also not entirely true. It may spontaneously resolve itself in many
cases[0]. I suspect that we've grouped a number of different disorders under
the label "bipolar" because they all manifest with similar symptoms.

[0]
[https://www.sciencedaily.com/releases/2009/09/090929141530.h...](https://www.sciencedaily.com/releases/2009/09/090929141530.htm)

~~~
blame_lewis
Thank you for that! I hadn't seen it before.

I'm a little nervous about the idea of coming to conclusions about individual
outcomes based on national surveys of self-reported diagnoses. It seems like
there are vast opportunities for outside factors to mislead attempts at
analysis.

For example, the proportion of people who were misdiagnosed to start with; the
increased openness over time when it comes to accepting or speaking about the
diagnosis; the improvement in mental health resources meaning more diagnoses;
the possibility that patients decompensate and lose insight or reject
diagnoses over time; etc etc.

If you're thinking "that sounds like a No True Scotsman", you're right. The
disease is clearly progressive for some people. Declaring that people who
don't demonstrate that progression don't have the disease is semantically
useless but may be clinically useful.

~~~
Skgqie1
I think a large part of the problem lies in the difficulty of accurate
diagnosis, coupled with people's personal experiences with misdiagnosis.

I've been misdiagnosed as bipolar in the past, and the medication regime I was
put on lead to schizoid delusions and incredibly unstable emotional state that
only resolved once I stopped taking the medication (under the monitoring of
the psychiatrist who initially prescribed them).

My mother was also misdiagnosed as bipolar, leading to her actual condition of
Borderline Personality Disorder going untreated until she attempted suicide
(she died 6 months after because of complications relating to the attempt).

A friend of mine who is schizophrenic was also misdiagnosed as bipolar,
because his delusions and paranoia were fairly minimal. In his case, the
misdiagnosis was probably more helpful than not, as the medications were
helpful in stabilising his mood.

My point here isn't that the medical establishment is bad or that doctors are
stupid. It's that disorders related to mental illness are very, very difficult
to diagnose and treat, even for incredibly intelligent trained professionals.
Many disorders have significant overlap with other disorders. An effect whose
impact is only made worse by the fact that a bunch of these disorders are
highly co-morbid. Mix in the fact that the borders between healthy and
unhealthy are not especially well defined, and it's easy to see where a lot of
the contention comes from

~~~
mercer
I'll add that someone who might be (self-)destructively bipolar in one
environment, might be able to 'manage' in another, even without medication.

I've had multiple friends with diagnosed bipolar disorder, and harrowing and
heartbreaking stories of how this affected their lives well into their
twenties or even early thirties.

All of them have found ways to 'manage' their condition, without medication,
through a combination of lifestyle changes, (odd) environments, and, perhaps
most importantly, a group of friends who can deal with it or provide support
in various ways. Some of them have been on medication for periods, and much
prefer their current, imperfect situation.

By no means would I advocate avoiding medication, and I'm absolutely not
saying that this can work for everyone. I'm also not arguing that their lives
are just peachy now. It's a serious disorder.

And I do agree that people making statements like "we're all a little
bipolar/autistic/borderline/etc." are often not helping and often actively
harming those who are any of that more than 'a little'.

I've been diagnosed with autism and it's maddening how often, when I open up
about it, people will say stuff like "well isn't that 'just' <x>" or "everyone
has that". At this point I usually don't even bother trying to explain that
there's a difference between, say, being punctual and curmudgeonly about it,
and having a borderline-meltdown when plans change.

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KerryJones
It's weird that we consider mental illness to be a disease, in my opinion --
none of the drugs have been linked to physical/chemical shortages in the brain
or the like. We're able to mask symptoms but have absolutely no proof about
underlying reasons, and so we create names of things and put it in the same
classification of a medical disease... but that's very different.

Bipolar cannot be identified by any physical means. Different doctors will
tell you different things. I agree that gradient approaches are useful in most
contexts, but I am very hesitant to use this when a drug can be prescribed
(with knowing bad side effects) can be applied. It can seriously mess
someone's life up.

~~~
roland00
Mental Illness as defined by the DSM as not thriving. You can have the
symptoms of a disorder, but if you are thriving then you do not have the
disorder.

>It can seriously mess someone's life up.

Treatment to try fix someone who is not thriving, is precisely because
someone's life is already messed up. Yes treatment may make it worse, but it
often makes it better and there are treatment algorithms where we use best
practices of how to go from here, and what signs should we be mindful for
often when the meds make things worse the doctor should be asking the right
questions for there are warning signs when the med is making things worse.

~~~
JumpCrisscross
> _Mental Illness as defined by the DSM as not thriving_

Isn’t that a two-system measure? The person. And their society.

A gay man in Tehran won’t thrive, but the solution isn’t medicating him into
submission.

~~~
mftrhu
Yes. From page 20 of the DSM,

> Definition of mental disorder

> A mental disorder is a syndrome characterized by clinically significant
> disturbance in an individual’s cognition, emotion regulation, or behavior
> that reflects a dysfunction in the psychological, biological, or
> developmental processes underlying mental functioning. Mental disorders are
> usually associated with significant distress or disability in social,
> occupational, or other important activities. An expectable or culturally
> approved response to a common stressor or loss, such as the death of a loved
> one, is not a mental disorder. Socially deviant behavior (e.g., political,
> religious, or sexual) and conflicts that are primarily between the
> individual and society are not mental disorders unless the deviance or
> conflict results from a dysfunction in the individual, as described above.

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oneplane
Well yes. But that shouldn't be much of a surprise to anyone, humanity isn't
made of absolutes or boxes or borders.

A spectrum you can be 'on', as the word suggests, is just a range or a degree
within a classification so we have a common concept when communicating about
things. If we had to develop a new word for every unique combination of
attributes it would become very hard to talk about things.

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aj7
Not only are we all somewhere on a spectrum, we’re on a linear combination of
different spectra.

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Jommi
As far as I understand, this kind of thinking is especially visual with
Diabetes.

People have different levels of insulin sensitivity, which changes over time
with thing such as diet and excercise.

Then magically one day you cross some arbitrary barrier, and you have type 2
diabetes. Crazy.

Only recently has this even been taken under scrutiny, and the phrase "pre
diabetic" is used more. But it's clearly not enough.

I think the key to unlocking this is getting more people into measuring their
insulin sensitivity through products like Veri[1]

[1][https://www.veristable.com](https://www.veristable.com)

~~~
phnofive
Great example of that barrier is gestational diabetes, which may as well be
called secondary type two diabetes.

It’s not a rubicon, either, since it’s so commonly reversible (though this
isn’t trivially easy).

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awillen
I've always thought about mental illness in this context - we define it as
illness because of negative consequences, but it's really just the deviation
from a norm.

I think Elon Musk is the best example of this - even ignoring some of his
childish Twitter behavior, the guy's brain is waaaaaaaaay far off from the
normal human brain. He thought he could start an electric car company from
scratch and be successful. That's... crazy. And yet, because he's been
successful at it, we don't label him as mentally ill.

The really interesting cases are people like artists - David Foster Wallace
committed suicide because of his depression, but only after creating one of
the great works of American literature. We label him as mentally ill for his
depression, but we don't really have a label for the positive side of the fact
that his brain was far from an average brain.

~~~
TylerE
> He thought he could start an electric car company from scratch

Except he didn't. He invested in one that was already started with several
employees, and had himself given founder status by fiat as part of the deal.

~~~
markdown
At what point do you consider a company founded? At the moment the business is
registered by the local government?

~~~
TylerE
Well, when 3 guys start it and work on it for a long time, incorporate for a
year, have an office and employees, and then a VC comes in, the VC definitely
_did not_ "found it", no matter when you define the actual date.

[https://web.archive.org/web/20150228163500/http://www.busine...](https://web.archive.org/web/20150228163500/http://www.businessinsider.com/tesla-
the-origin-story-2014-10)

------
WarOnPrivacy
I'd long believed that cognitive issues like autism are on a 2 dimension
spectrum and that all of us lie on it.

Perhaps something similar applies to the personality disorders. However those
disorders tend to overlap; I can't imagine the geometry that might to
represent it.

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zabzonk
What practitioners call mental health problems a "disease"? Surely that should
be reserved for things like Covid or the plague?

~~~
dwd
They all have two aspects, the cause and the disease it triggers.

COVID-19 is the disease caused by the SARS-CoV-2 virus like AIDS is caused by
HIV.

It gets complicated where they don't know or understand the cause like a lot
of autoimmune diseases.

~~~
zabzonk
> like a lot of autoimmune diseases.

I worked for some years in a lab testing for auto-immune conditions - we
called it that - a condition. I suppose other labs might have labelled it
otherwise.

Would you call cancer a disease? I wouldn't.

But I suppose this is just arguing over semantics.

~~~
dwd
It is semantics but then words matter if you're the one affected - having the
doctor say you have a condition would be better than having a disease.

I guess it depends on your definition of disease, which is technically broad
in the literal sense of an abnormal negative medical condition. A condition in
itself can be positive or negative and also has an implied connotation that
it's just the current state.

Seem to be hitting that original argument about labeling things that are on a
spectrum, where a condition could becalled a disease once it reaches a cetain
state. Disease does imply a level of sickness and incapacitation, and maybe a
permanent state?

Alternatively we could classify and reclassify disorders but the general
public gets left way behind.

EDIT: There's also the notion that a disease is something you catch, which
given our understanding of viruses and bacteria in triggering various diseases
and conditions (and potentially some cancers) maybe excludes genetic and
environmentally caused conditions?

~~~
Talanes
I would ascribe the exact opposite feelings to the permanency of condition vs
disease. Disease feels like something you get, you fight off, and you get
better. A condition feels like something that you deal with and plan your life
around.

~~~
dwd
Yeah, your right. I added in that disease is historically thought of something
that you catch (and hopefully get over). Conditions can also be categorised as
chronic which would be that permanent state of you have it, deal with it.

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roland00
There is a good video done by Philosophy Tube about this subject (it also
talks about Jordan Peterson.)

Some words are inherently subjective, like we can't define what "healthy" is
without using so many words that are beyond description. (About 10 minutes in
this metaphor appears, when Philosophy Tube references Richard Boyd.)

[https://www.youtube.com/watch?v=SEMB1Ky2n1E](https://www.youtube.com/watch?v=SEMB1Ky2n1E)

