
Should Mental Disorders Have Names? - LinuxBender
https://blogs.scientificamerican.com/observations/should-mental-disorders-have-names/
======
trombonechamp
Most researchers agree that mental disorders should not have names, as it is
difficult or impossible to draw discrete boundaries in this complex and
poorly-understood spectrum of symptoms. However, as a broad generalization,
researchers are the only group who feel this way:

\- Doctors like names because then they can provide a diagnosis and recommend
action based on the diagnosis

\- Patients and their loved ones (often) like names because it is easier to
think/say "I have schizophrenia" than it is to describe their factor scores on
a myriad of benchmarks

\- Drug companies like names because they can develop drugs for specific
disorders rather than for a combinatorially large number of factors

\- Regulators like names because they can approve treatments and standards of
care for a finite number of situations

\- Insurance companies like names because it allows them to approve or deny
claims in a more straightforward way.

While names are often times arbitrary, they make many things more convenient.
I am not saying that I personally agree or disagree that there should or
should not be names, only that this is a complex issue with many complexities
besides the underlying science.

Also, I see nobody has mentioned RDoC yet, which is the taxonomy researchers
are starting to use to classify mental disorders:
[https://www.nimh.nih.gov/research-
priorities/rdoc/constructs...](https://www.nimh.nih.gov/research-
priorities/rdoc/constructs/rdoc-matrix.shtml)

~~~
mindgam3
I completely agree with your overall analysis, as well as the main point of
the original article. The one thing I would add or clarify is that even the
phrase "mental disorder" may not be the best way to refer to this class of
symptoms/behaviors. I believe that "mental injury" would be both more
accurate, and more conducive to healing.

A substantial portion of the things we refer to as "mental illness" are the
after-effects of trauma. When you break your leg and you can't walk for 6
months afterwards, people don't say you have a "leg illness". It's not some
unspecified thing which caused your leg to stop performing like most people's
legs. It's a fracture. If set properly and given time to heal, it will resume
normal functioning. If it's never set, or if it gets reinjured, it may lead to
a permanent disability.

Minds can be broken as well. Any one who has ever experienced an abusive
relationship knows this. Survivors of child abuse know this. A "mental
fracture" isn't primarily physical, like a fracture of the leg, but it has a
similar effect in terms of impairing the organ to perform its role correctly.

But mental injuries can be "set" and healed, just like physical ones. Perhaps
not 100%, perhaps there will always be scar tissue or some version of impaired
mobility where the injury occurred. But injuries heal with time, given proper
care.

I am aware that this concept is fairly at odds with the western conception of
mental health with its myriad disorders, all of which are unexplained and
presumably lifelong diseases. I attribute this entire weird world of DSM
pseudoscience with its gargantuan and ever-growing list of labels to the
massive social pressure against dealing with the actual problem of trauma and
abuse.

Correctly diagnosing someone with a "mental injury resulting from
trauma/abuse" would lead to some extremely difficult conversations, which most
people (even the ones experiencing the abuse) would prefer not to have.

~~~
arandr0x
How exactly would you "set" a mental injury?

~~~
mindgam3
It's like setting a physical injury, but significantly harder because usually
you're not dealing with it at the time of injury, only much later.

You find the original source, some event or series of events that caused the
psyche to fracture. By fracture I mean caused the mind to operate according to
some models that were necessary to survive at the time of crisis, but are no
longer adaptive in the normal/real/adult world. You then update your mental
model to one that is more aligned with reality.

In other words: go to the source of the pain, unlearn whatever lesson you
learned at the time to deal with the situation, learn a different/healthier
way of looking at it, and then practice a lot until the new mental model is
firmly in place.

This is hard. But it gets easier with practice. And it's much easier than
trying to set an injury by taking lots of pain-killers.

------
DoreenMichele
The root issue here is finding some path forward for helping people.
Psychiatry, psychology etc aren't doing a great job with that.

He tries to determine what has happened historically but not _why._

Why was this guy using drugs starting at age ten? What led up to that?
Shouldn't it be classified as a parenting failure, not a "disorder" on his
part?

What was the history with the father? Perhaps assaulting his father wasn't
simply due to insanity. Some parents are really awful to their kids and it's a
huge problem for the kid. That doesn't necessarily stop being true just
because the kid became a legal adult.

Labels determine what mental models we use when trying to intercede in a
problem. Different labels get very different reactions and treatment modes.

We need to up our game in myriad ways, but labels are a critical tool for this
problem space. I hate labels, but they are a useful communication tool.

~~~
jdietrich
_> He tries to determine what has happened historically but not why._

The biggest advance in the history of psychotherapy was to stop asking _why_
and start asking _what_ and _how_.

The psychoanalysts broadly believed that mental disorders could be treated by
revealing and resolving unconscious conflicts and forgotten childhood
memories. That's a very slow process, and eventually randomised controlled
trials would demonstrate that it wasn't particularly effective.

Rational emotive and cognitive behavioural therapists essentially argued _I
don 't care why you're nuts, I just want to teach you how to be less nuts_. If
you have habitually fearful or negative thoughts, you can learn to disregard
those thoughts as unhelpful and consciously replace them with more useful
thoughts. Knowing who to blame for your cognitive bugs doesn't really help you
fix them. Aaron T. Beck had the good sense to subject his psychotherapeutic
approach to randomised controlled trials, demonstrating that a relatively
short course of cognitive behavioural therapy was at least as effective as
several years of psychoanalysis.

Psychiatry, clinical psychology and psychotherapy undoubtedly has a lot of
shortcomings and there are a lot of patients we don't yet know how to treat
effectively. A far bigger problem however is lack of access - the vast
majority of people who could benefit from psychiatric medicine simply don't
get treated. In the developed world, it's usually fairly easy to get
prescribed medication, but there are often long waits or financial barriers to
access psychotherapy. In the developing world, most people can't even access
SSRIs despite the cost being around $1 a month. Stigma and a lack of awareness
are still a substantial barrier to accessing care.

We need better treatments, but the priority right now must be simply to get
more people to try the treatments we do have. Trying a treatment with a 40%
success rate is obviously better than doing nothing, but nothing is still the
default and it's causing immense amounts of needless suffering.

~~~
vanderZwan
> _The biggest advance in the history of psychotherapy was to stop asking why
> and start asking what and how._

> _Rational emotive and cognitive behavioural therapists essentially argued I
> don 't care why you're nuts, I just want to teach you how to be less nuts._

This is part of why schema therapy is getting so much attention right now: it
takes CBT but combines why, what and how into a cohesive whole. The success
rates seems to be even better than CBT, a lot better in some cases.

[0]
[https://en.wikipedia.org/wiki/Schema_therapy](https://en.wikipedia.org/wiki/Schema_therapy)

~~~
SolaceQuantum
It's interesting that a lot of the 'hot new thing' therapies are around
Personality Disorders or PTSD. I'm curious what the theory is to apply this to
depression or anxiety. And what about dissociastive disorders, or oppositional
defiant disorder, or autism?

~~~
vanderZwan
> _oppositional defiant disorder_

Tangent: I have a lot of skepticism about that one being a proper disorder on
its own, in the same sense that I wouldn't consider "fever" an illness in and
of its own, but a symptom of other illnesses.

~~~
SolaceQuantum
I agree, but even then, should the symptom be treated with the same treatment
designed for personality disorders? What is the evidence of it? etc. I
genuinely don't know these things.

------
mrburton
Just imagine a doctor telling you what ICD code you have. There's nothing
wrong with classification and labeling things. I think society is getting a
little carried away with such topics. Personally, I think it's a phase that
collectively we'll pass and reflect on how extreme we took things in order to
try and obtain balance.

There's a difference in calling someone "crazy" vs saying they have a mental
disorder. The meaning of "crazy" has changed over the years due to the abusive
context it's been used in more and more. A lot of words got redefined over the
years, so this isn't new, but the idea of dropping labels or trying to
eliminate well established scientific and testable classifications is new.

To future generations, I hope you don't create a culture in which you're
continuously stressed out about how others will label you publicly. When I was
younger, a kid that was bullied in school could escape it by coming home.
These days, you have no escape because of social media. I hope you learn to
adjust and navigate these new times. Even older folks struggle with how things
are currently.

~~~
hrktb
For me one of the issue of the current names is that their definition change
too much depending on the context and the person interpreting them.

For instance if you say someone your arm is 'broken', they understand
something is deeply damaged (not just fissured). They might not know the
specifics on how it broke, where exactly, how you are healing it or how it
impacts you, but they know the basic criticality of it.

If you say you have "depression", they don't know if you'll take your week off
to recover or actually need extensive professional follow up with a long term
medication. There is no common sense of how bad it is 'broken'.

From there people all have their anecdotes, visions of how they solved
"depression" and come with a very personal idea of what your issue is that
most of the time will have nothing to do with your actual diagnosed issue.

In that sense the word doesn't work that much as a conveyor of information,
they'll just know you have "something". I see the reasoning behind getting rid
of a word in medical context if it doesn't bring any viable information with
it.

~~~
mrburton
I think what you're doing is comparing medical vs layman usage. A doctor will
tell his patient they have a "broken arm" due to past experiences in speaking
with patients using medical terms. e.g, fracture or distal radius fracture in
the case of a broken wrist.

When it comes to mental disorders, it can be very difficult to accurately
classify the severity. It reminds me of how doctors prescribe blood pressure
medication; it's guess work. e.g, They will prescribe what they think will
work and have you come back later to see if it's working properly. In my mom's
case, the first prescription made things worse.

Depression can be rooted in chemical imbalances, diet, sudden loss of a job or
family member, etc,. It's not like taking a walk will solve everyone's
depression. In most cases, it's much more complex than that. That's why
there's psychologist and psychiatrist. In some cases cognitive therapy works,
some a good diet + workout routine works, and other cases medication is
required. There are different levels of depression and they are properly
classified by professionals. The word "depression" is like a doctor telling
you that you're arm/wrist is broken. e.g, Bipolar Disorder is a type of
depression that's treated with medication.

It's a terribly complex thing we're talking about and telling professionals
how to define their own vernacular is pretty foolish. It would be like my mom
telling me that engineers should drop the phrase "eventually consistent" and
just say "consistent". :)

~~~
theoh
I'm afraid you are giving the psychiatric profession way too much credit.

Most DSM disorder categories don't perform well on measures of inter-rater
reliability. ([https://en.wikipedia.org/wiki/Inter-
rater_reliability](https://en.wikipedia.org/wiki/Inter-rater_reliability)).
One implication of this is that the categories can't be assumed to be well-
defined scientific entities. Now, the DSM _could_ be a shadow of some more
complete, correct taxonomy of mental disfunction—certainly it's based on
observation of genuine distress, so it's not completely arbitrary—but by
scientific or medical standards, it's very shaky.

Here's an article about the situation in relation to the DSM:

[https://www.madinamerica.com/2013/03/the-dsm-5-field-
trials-...](https://www.madinamerica.com/2013/03/the-dsm-5-field-trials-inter-
rater-reliability-ratings-take-a-nose-dive/)

It's not uncommon for people who haven't looked seriously at the mental health
field to assume that the so-called medical model of mental illness meets the
same high standards of intellectual rigour as other areas of medicine, or
other endeavours such as engineering. I put it to you that you are in exactly
that position: the very basic point you are making ("This is as complex as
engineering! Leave it to the experts!) indicates that you are unaware of the
unique flakiness of psychiatry. This is contested territory, and many
professionals are invested in a certain dubious framing of the situation.

------
keiferski
The danger of naming mental disorders (or any other abstract concept) is when
you confuse the map for the territory.

The map (the name) should serve as the best possible mental model of the
territory (the actual, descriptive physiological condition) - not as the
thing-in-itself.

~~~
heisenbit
It is tempting to stare at the map when the territory is obscured by the fog
of war. The rigor of the SCID very much hides the fact that several places on
the territory have similar features but are miles apart. And then every
observer loves certain places and hates working in others.

As bad as the state of diagnosis is (some say >50% for certain conditions)
there is no way around a diagnosis for treatment as one needs to make
decisions and these need to be based in whatever tenuous grasp one has on
reality. At this point imho. we can only try to make sure all sources of bias,
tendency to defend previous decisions, treatment capacity and financial
considerations (diagnosis is key to insurance payments) are as far isolated
from decision making as possible. There is lots to be done. SCID is only the
symptom.

------
nrev
I personally think this is a great sort of walk-through of the pitfalls of the
strictly DSM-based approach. I don’t necessarily see it as something that
particularly reflects this guy. If he wanted to create a new diagnostic
approach to include people who are, in a sense, indistinguishable from the
patient population of strictly DSM-V bipolar that would be its own study. In
addition to the above, and a host of other matters, this article does
demonstrate something about how diagnosis and diagnostic approaches greatly
influence how we understand, classify, and teach psychiatry, psychology,
medicine, and other clinical fields. Plus, it presents some things about
practitioners understanding of patients and clinical priorities in patient
visits can be so structured by these approaches, research based on them, even
conventional clinical wisdom structured by them, and so on. They cause a
ripple effect, and one that influences clinical and academic practice in a
sufficiently complex and opaque way. So, even clinical providers, academics
who try to radically depart from these approaches are still quite effected by
it.

That said, the point I really want to reach is that it’s my opinion—and there
is a body of academic work within and about many clinical fields on this
matter— that the longevity of these diagnostic approaches and their bases, the
categorization of disorders, how clinical fields themself are taught, how
priorities are set in the clinic is owed and hugely influenced by the
necessity (and the hegemony) of US insurance coding, especially as it relates
to prescription drugs. I’m not insisting that prescriptions, or necessarily
any of this is inherently negative in it’s effects, just that insurance coding
as it is, health insurance in the US as it is, has (sometimes quite extreme)
far reaching influence over essentially every aspect of clinical practice,
research practices. At least that’s my opinion/conclusion/interest in this
article.

------
padolsey
The neurological field has grappled, over the last few decades, with an
increasing understanding of the interconnectedness and pliability of the brain
and the rest of the body. We've gone from categorical localization of function
to neuroplasticity for example, and likewise we've seen how distinct disorders
can involve a number of different physiological differences and deficits
(comorbidites are rife, e.g. see atopy + neurological sensitivities). The
brain is especially complex. Our grappling with the terminology around its
disorders is entirely ok IMHO. It's important to not get tied down in dogmatic
categorical thinking. It's also important to let people explore different
treatment paths, and find what works for them. There is never going to be a
canonical "cure" for depression, just as there won't be for IBS.

------
Lerc
I tell people I have Tourette's. I don't have Tourette's. I'm missing one of
the required criteria

\- must have tics that begin before he or she is 18 years of age.

In a medical standpoint that makes it different, but in any practical sense
the name conveys all of the information people need, it is perhaps unusual in
that it is also a condition that occasionally requires rapid explanation.

~~~
jstarfish
> I'm missing one of the required criteria

Are you sure about that? Tics don't always manifest in obvious ways. You may
well have had them in a very mild form but never noticed.

------
teekert
Us humans certainly prefer to put boundaries and names on things. And indeed,
it is often unwise i.e. with (one of our) species definitions: A can procreate
with B, B can with C but A cannot with C, meaning A==B, B==C but A!=C, a
paradox because of our tendencies.

Could it be a cultural thing? While I grow older I find it more natural to
think of things as continuous or to assign uncertainty to "facts", but perhaps
our educational system does not give much attention to this. Perhaps it's too
much about facts and names and boundaries.

In this articles' case though, of course mental disorders are a continuum but
the drugs and methods for treatment we have are not. So perhaps in this case a
label is nice. One should always keep the continuous nature in the back of
one's mind though.

~~~
MrQuincle
True, but do definitions not encourage a more thorough analysis?

If A is a male, B is a female, C is a male, your operator definition is even
troublesome within a species.

What kind of mathematical object comes closer to this abstraction of a
species? Maybe it's not about names and boundaries, but about getting to
understand things for which you need abstractions.

I always appreciate when people do not fuss about definitions and easily
change them but reason consistently after indicating their interpretation of
those concepts.

~~~
baddox
I don’t think your example really applies, because no one expects the
definition of “species” to imply that the “individual A can mate with
individual B” relation to be transitive.

------
darkpuma
If you don't have multiple names, you'll have a single name ('insane', or some
new euphemism.) People with any sort of disorder would all get lumped
together, and human nature being what it is, others would tend to assume the
worst of all of them. I find it hard to believe this would be an improvement
over the status quo, as imperfect as it may be.

------
jgrowl
The thing that unsettles me is that the diagnosis is all self reported. If I'm
already going in to see a doctor because I think my mind isn't right, how can
I trust that I am answering the questions correctly with respect to how they
are intending them. You're trusting me to answer your questions when I don't
feel confident in my ability to answer them and in a couple of hours you've
handed down a diagnosis which basically amounts to 'here take these drugs and
we'll see you again in a month' Good luck navigating the side effects as well
as the problems you originally came in here with by yourself.

~~~
leemailll
Most of the neurological diseases have no conclusive and unique biomarkers or
tests, and symptoms often not unique. There is not much can do to without
scales with current knowledge

------
komali2
I'm skeptical as hell of the entire field of psychotherapy, psychology,
psychiatry, and cog sci. I think we're doing better than before, sure, but
it's all such a shit show from my perspective as a participant.

Rambles:

Back in highschool we had a massively depressed friend. They tried it all with
her: cognitive behavioral therapy, drugs (ALL OF THEM), weed, religion. Tough
love. Exercise. Diet. Nothing cured her and her depression killed her via
suicide. What's the psych tell me after? Sometimes there's nothing we can do?
That sucks. Human genome, done. Prevent HIV from killing someone. Can't do
shit about depression sometimes.

And if you get depression - do you take the ssris? Fuck knows?
[http://www.healthtalk.org/peoples-experiences/mental-
health/...](http://www.healthtalk.org/peoples-experiences/mental-
health/experiences-antidepressants/deciding-take-antidepressant) and the "next
page." Sometimes they make you numb to the world or feel like you're being
controlled. Sometimes they make you have suicidal thoughts. Sometimes they
take a weight off your shoulders. Sometimes they make you feel like you
actually have a chance. None of my psychs were able to describe any of this. I
had to research it on my own.

And Lord forbid you've got multiple. Is it ADHD still? Newest psych has the
idea that it's all ADD now - so, my memories of wildcat behavior that I'd be
ashamed of in seconds as a kid, what was that? When shit bubbles up out of my
mouth without me thinking, is that not the H anymore but just something else?
And why did nobody tell me in 2 decades that a common symptom of ADD is shit
memory? I had to find out on Reddit. Is it actually? Who knows!

Does Adderall help? Well, I suppose! Hard to say. Technically, I _could_ work
without it. I am more productive with. But, also more robotic. And, it's
nearly impossible to track the subtle personality changes that come with
medicating via Adderall, no matter how hard I journal. Ask the psychs and they
shrug and say "keep a journal." Ask what dosage and they say "higher until the
side effects are unbearable, then one dosage down," instead of "lower until
the medicine is ineffective, then one dose up." And as for those personality
changes - perhaps that's a "better" me anyway? It's certainly a smarter one.

Don't get me started on what fresh hell you find yourself in if the State
discovers someone is suicidal and locks them in a psych ward. Came damn close
to ruining my life by performing a full on jail break to get my friend out of
that psuedo science nightmare.

I welcome all thoughts on my rambles and I apologize if no helpful meaning was
able to be extracted, on this subject I can think of no other way to get my
thoughts on paper.

~~~
jstarfish
Sorry to hear about your friend. I swear psychiatrists are exempt from
observing the Hippocratic oath.

"I need help. My life is falling apart. I'm struggling with work and school. I
might have a learning disability."

"You sound depressed. Here's a prescription for some obscure variant of an
SSRI not covered by your insurance."

"These meds you put me on make me feel sick."

"Let's increase your dose."

"I want to hurt other people. I want to die."

"It takes 4-6 weeks for it to take full effect."

"This just isn't working."

"Let's add another variable to the equation. Here's a second prescription.
Take both and see what happens."

The experiment must continue. It always ends the same way.

I know psychiatry helps some people (especially where sedatives are involved),
but for the rest of us who slip through the cracks it's just the new Nazi
science.

~~~
baddox
I can only imagine the frustration you are describing, but I still wonder if
the blame is really on the doctors or the branch of medicine. Is there a
better alternative?

~~~
rjf72
The first thing you need to ask is are we, collectively, seeing an improvement
or a deterioration of aggregate mental health? And how does this compare and
contrast against nations where pharmacological treatment of illness is less
and, if such a thing exists, more common? In other words is what we are doing
better than nothing? The answer to this question is not always yes, because
it's entirely possible that in the process of trying to do something you end
up going backwards.

This also cannot be answered with isolated consideration such as the
effectiveness of drug 'x' since there are externalities involved. What happens
to these individuals in the longrun? The treatment of ADHD with amphetamines
is a great one for this question. For those who showed no response to the
treatment, are their outcomes better or worse than if they had never pursued
treatment? What is the false positive rate and what is the affect of
medication on these individuals?

The answer to this question should be obvious, but I'm not so sure it is
anymore.

~~~
darkerside
I don't disagree with your basic point, but that's a huge correlation bias.
Why would a country with little mental illness introduce these medications?

~~~
rjf72
It's not countries introducing drugs, but companies. And companies are driven
primarily by a profit motive. This is not a bad thing in and of itself since
it creates a private incentive for the research and development of drugs.
However, when the money starts to become prioritized more heavily than the
product being made, it creates a severe conflict of interest. The recent issue
with opioids being an obvious example of this. Quoting this [1] great article
from the Houston Chronicle:

\----

 _" The trigger of the opioid crisis was a misrepresentation of a 1980 letter
published in the New England Journal of Medicine, reporting on 11,000
hospitalized patients receiving opioids. It concluded that “despite widespread
use of narcotic drugs in hospitals… addiction is rare in medical patients with
no history of addiction.” This became a landmark study, cited more than 600
times, particularly after Purdue Pharma introduced OxyContin (extended-release
oxycodone) in 1995.

Large opioids manufacturers began funding nonprofit groups such as the
American Pain Society; and pain experts advocated for pain to become an
important “fifth vital sign” to be queried in every doctor’s visit when
checking blood pressure, heart rate, respiration and temperature.

Caught in the trend, the Federation of American Medical Boards encouraged
punishing physicians for under-treating pain. This policy was drafted by
individuals with ties to opioids manufacturers. Some were members of industry
speakers’ bureaus, and later became company executives.

Purdue funded more than 20,000 educational programs between 1996 and 2002 to
influence physician prescription habits nationwide, and developed a misleading
advertising campaign that claimed that the risk of addiction from prescription
opioids was “much less than 1%.” OxyContin sales grew from $48 million in
1996, to over $1.5 billion in 2002. With increased sales came increased abuse
and addiction. By 2004, OxyContin was the leading drug of abuse in the United
States.

In 2007, Purdue (and three executives) pleaded guilty to misrepresenting the
risks of OxyContin addiction and paid $634 million in penalties, a fraction of
the $35 billion in sales in two decades."_

\----

It's pretty sick stuff, but extremely clear evidence that these comes have
come to see profit as the sole point of their existence. And these companies
have extensive reach. And opioids are obviously not the only example here.
This is a typical pattern, even if a rather extreme case. For instance the
nonprofit industry tool used to push medicating and diagnosing of ADD is CHADD
- Children and Adults with ADD.

[1] -
[https://www.houstonchronicle.com/opinion/outlook/article/Opi...](https://www.houstonchronicle.com/opinion/outlook/article/Opioid-
crisis-began-with-a-lie-about-the-risks-12917033.php)

------
debbiedowner
Pretty great article. This characteristic that many patients have multiple
disorders is an interesting point. Reminded me of my real world PCA
applications which were never satisfying. In such a case you'd take the
attributes of answers to questions in a population, and then get principle
components (PCs) to these vectors of examples. Who says that each example in a
population has to be dominated by 1 principle component? Many people have the
view that PCs are just whatever linear combinations of attributes that explain
your data, and I've seen many people try to name them in ways that encapsulate
the attributes that each PC selects for, but it always seems like an awkward
exercise after you get past the first few PCs.

And of course, I'm not literally saying this SCID is the attributes to the DSM
"PCA," or any other subspace method. I don't work with subspace methods often,
so if anyone wants to fill me in on what is done in the medical world (or
other high stakes domains) in practice, much appreciated.

In cases of segmenting customers and then targeting each one differently, I
have found that subspace methods work well for raising typical startup
metrics. But the interpretability was not cut and dry in my experience,
something that obviously is needed when you work with individuals like
Doctors, not populations like many companies.

My guess is that the DSM segments patients to different treatments though. If
this is the case then it does't really matter what the name of the
constellation is as long as after they send the patient there, everything is
hunky dory.

------
jVinc
Person comes to conclusion that objective tool doesn't work because it doesn't
give him the results he wants. I'm glad he didn't get to just subjectively
call people bipolar or not based on what he wants, it would just bias his
research and make it all scientifically useless. Whether you like skid or not,
at least "According to skid patient is in box X" has a definite meaning, and
can be scientifically trusted to mean something. Opposite to that "This one
specific doctor based on this one single interaction decided that the person
fits in box Y" is just completely useless.

------
afpx
Why is the author is so troubled? They’re just using an instrument to
transform qualitative data into quantitative data. Such methods are used
pretty much anywhere there’s subjectivity in observation. To do science, you
have to have a standard way of measuring.

~~~
nimonian
Are names quantities?

~~~
afpx
Yes, categories are as long as they’re well-defined. Measurement instruments
get better over time.

------
darkerside
The conclusion of the article raises a great question. Wouldn't it be more
valuable to diagnose based on quantitative criteria instead of binary answers
to extremely complex questions? I'd love to hear an opinion from a SCID
practitioner.

~~~
betulaq
Something like the SCID is useful as a structured way of measuring or
assessing behavior. A binary output is probably not helpful though.

What's interesting is that the people who developed the SCID (and the DSM and
its predecessor, the RDC) actually developed a very similar tool in the 60s,
but instead of it producing binary diagnoses, it produced scale scores more
like test scores. It actually had better statistical properties and provided
fairly detailed information. It's always been a mystery why they moved away
from that, except that the DSM as a whole moved away from that.

~~~
darkerside
That's interesting. It reminds of the BMI, a metric intended only for use at
the population level. It's been adopted (some would say misappropriated) as a
yardstick for individual health, because... reasons?

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existentialhalt
I have been diagnosed with bipolar disorder, schizophrenia, depression,
anxiety, and autism. All caused by chronic mercury toxicity. The name of the
disorder should be "mercury toxicity" in my case.

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ToFab123
Sure, we can label and categorize human behavior, but first you need to define
what is normal.

~~~
dsego
Jordan Peterson, is that you? Pretty sure we can ballpark it. I had a cup of
coffee this morning - normal, a woman in the news kept her dead sister in a
freezer for almost 20 years - not normal.

~~~
pennaMan
>I had a cup of coffee this morning - normal

You casually drank a psychoactive drug. Is "normal" just another word for
common?

If your culture demanded that you keep your dead refrigerated, and everyone
around you did exactly that, would that behavior be promoted to normality?

~~~
dsego
Now you're just playing semantics.

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Causality1
"It's seven am on a frosty Wednesday morning" Oh my God, not another one of
these articles that starts with a goddamn novel before it gets to the point.

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mhuffman
Should anything have a name?

It seems that people are just running out of shit to write about at this
point.

And from Scientific American! I trusted you as a kid!

~~~
nimonian
I not sure if you are just trolling here, but reading the article it seems
clear that the author has a point beyond the usual signifier-signified
semiotic crisis.

The author ends by musing about mental diseases being described by coordinates
in several dimensions. Sure, perhaps connected regions of that space can be
given their own names, but in general, the author believes that our vocabulary
lacks the granularity to identify the fingerprint of individual diseases.

I know a lot of hands have already been wrung over the ineffectiveness of
natural language in describing the phenomena of the inner world, but in a
clinical setting this takes on a new meaning, and the essay is, in my opinion,
poignant.

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elmo2you
Sure they should, they have a life of their own. Mine are called Alice and
Edward... Sorry, we could not resist.

