Are psychological diseases discovered or invented?

Valmont

Is that even a valid question?

I'm thinking of homosexuality as a case in point: first it was then it wasn't based not on any new discovery per sé but on a set of criteria that were expanded to include it and then constricted to push it back out again.

What about other mental illnesses like ADHD? Was this discovered as a disease of the brain or were a loose set of behaviours just newly defined as being disorderly?

Could I not class grumpiness as a psychological disorder using the same logic? Anyway, I'm interested to hear what you all think about this idea.

cranks

I think your question misses the point. New psychological (I'll use the term) 'disorders' are often more reflective of new qualitative judgements around what's normal or not. Your example of homosexuality being a good case in point. (Though you probably know as well as I that there are still many who subscribe to the disorder hypothesis when it comes to homosexuality).

You should check out the book 'Selling Sickness' by Ray Moynihan and Alan Cassels. I think it's a Canadian publication (I picked it up in Canada a few years back). While it's basically it's a pop a big pharmaceutical companies and an exposition on how many behaviours are pathologised in the name of selling more drugs, it does prompt thinking along the very lines you question. The chapter on ADHD appealed to my cynical side about the diagnosis I must say.

Puts me in mind of a nice little book 'Opening Skinner's Box' by a Lauren Slater - somewhere in that book she mentions an early 19th century preparation for children, a 'Mrs. Winslow's Soothing Syrup'. Based on opium as I recall. It seems that certain kids have needed sedation for at least the last 200 years. The Moynihan and Cassels book has the cheek to suggest that the notion of a behaviourally disordered, and therefore diagnosable and treatable-by-medication child has its roots in, and has been pushed by, WASPish North America where little brats really do upset the decorum. (Now that I think of it, maybe this book was a Canadian did at the US! Hmmmm). Anyhow, Mrs.Winslow would have been proud of Rialin.

Interesting question. Looking forward to other replies.

kisaragi

Considering that there is not yet any biological marker (that I'm aware of) for any psychological disorder that is (known to be) present within 100% of people with the condition I don't think it's really fair to compare something like depression with something like a broken arm.

So of course psychological disorders are generally diagnosed based on a certain symptomatology, rather than testing for some kind of marker. I do think that these disorders (I'm not just talking about behaviour which is against the norm) do likely have a biological basis - which we are making progress towards uncovering. People love to bash pharmaceutical companies but their products do help a lot of people.

Tony EH

Isn't homosexuality a psychological issue though? I'm loath to say disorder, because I don't subscribe to that. But to me, it is a twist (of which there are many) in the natural psycho-sexual imperative and as all sexual orientation is largely psychological, it can be classed as an issue of this type. No?

In the case of "inventing" psychological "disease", the case of Bi-polar disorder is interesting. Formally known as "Manic-depression", the repackaging (or Reinvention) of this disorder into the more friendly termed "Bi-polar" has, in my opinion, led to an "increase" of it's diagnosis and more importantly self-diagnosis and doctors are far too quick to conclude and medicate, instead of actually helping.

Bi-polar is a clear case of "invention" of psychological disease because again, in my opinion, there are a number of patients that are diagnosed as such, that have no business being so. In fact, I personally know a number of people who have been "diagnosed" as Bi-polar and are clearly not. But they are and do suffer from an preponderance on singularly bad issues that pervade their lives and thus believe themselves to be "depressed", when in fact they are nothing of the sort. Instead they are in need of proper management of their normal life "issues" and dilemmas which are, in all probability, no different that many other people.

Valmont

kisaragi wrote: »

I do think that these disorders (I'm not just talking about behaviour which is against the norm) do likely have a biological basis - which we are making progress towards uncovering.

Why is it likely? Why hasn't it been discovered already? I'm sure if we took everyone who was perfectly happy and who occasionally became really happy and examined their brains we would find a structural or chemical difference between them and people who didn't exhibit these behavioural patterns--so why call certain putatively pathological patterns illnesses? What's the difference? It would seem to be simply a value judgment by one individual on another individual.

I'm thinking (and not the first to do so either) that what we call depression, ADHD, bipolar etc are simply behavioural patterns that have been deemed abnormal or pathological by certain professionals towards a treatment paradigm that is medical in nature.

I guess what I'm getting at here is why should we "medicalise" behaviour in the first place? Is there a legitimate argument for helping an individual with a severe tendency towards melancholy by telling them they have a "disease" and need to visit a doctor? Help yes, if a person wants to helped; but why provide that help in a medical format?

Sorry if I'm not being clear; I'm still exploring these ideas myself.

Tony EH

If you haven't done so already, you should check out the "Anti psychiatry movement". Very interesting.

Valmont

Tony EH wrote: »

If you haven't done so already, you should check out the "Anti psychiatry movement". Very interesting.

I'm aware of it and have both a copy of The Divided Self by R. D. Laing and Psychiatry and Anti-Psychiatry by David Cooper. I haven't gotten around to reading either one though!

cranks

Tony EH wrote: »

Isn't homosexuality a psychological issue though? I'm loath to say disorder, because I don't subscribe to that. But to me, it is a twist (of which there are many) in the natural psycho-sexual imperative and as all sexual orientation is largely psychological, it can be classed as an issue of this type. No?

Agree with the 'psychological' aspect is as much as any behaviour and/or orientation has a psychology that underpins it; not so sure that 'issue' pertains though.

I would argue that the 'issue' arises when arguments along the lines of homosexuality as a "a twist in the natural psycho-sexual imperative" are used. I can see where you're coming from but the language is so loaded and, in my view, is a first step along the pathologising road. It's the notion of the "twist" that's the issue - therein lies an implicit qualitative (normal/abnormal) behaviour/psychological judgement.

If the view is taken that in the natural order of things, the 'psychosexual imperative' is concerned solely with reproduction then yes, homosexuals are certainly twisted (sorry for playing with language:o). Homosexuals that I know would subscribe to the notion that it's not they that have the 'issues'. The fear that's often associated with coming out and the knowledge that others may take issue with them seems to be a case in point.

I trust that mention of psycho-sexual imperatives will have the psychoanalysts chomping at the bit! GO Analysts, GO!!

kisaragi

Valmont wrote: »

Why is it likely? Why hasn't it been discovered already? I'm sure if we took everyone who was perfectly happy and who occasionally became really happy and examined their brains we would find a structural or chemical difference between them and people who didn't exhibit these behavioural patterns--so why call certain putatively pathological patterns illnesses? What's the difference? It would seem to be simply a value judgment by one individual on another individual.

I'm thinking (and not the first to do so either) that what we call depression, ADHD, bipolar etc are simply behavioural patterns that have been deemed abnormal or pathological by certain professionals towards a treatment paradigm that is medical in nature.

I guess what I'm getting at here is why should we "medicalise" behaviour in the first place? Is there a legitimate argument for helping an individual with a severe tendency towards melancholy by telling them they have a "disease" and need to visit a doctor? Help yes, if a person wants to helped; but why provide that help in a medical format?

Sorry if I'm not being clear; I'm still exploring these ideas myself.

Well it's likely because all behaviour originates in the brain, therefore it makes sense to assume that behaviour typical of these disorders has origins in the brain. In addition, there is plenty of literature and research findings out there finding support for a biological etiology for these conditions - the precise process is obviously yet to be discovered. I suppose I would be inclined towards the genetic disposition meets environmental stress in many situations.

As for why it hasn't been discovered, I think you're being very simplistic. There's lots of things which haven't been discovered - why do we sleep? It's not really a feasible experimental protocol to take ALL the happy people and compare their brains with ALL the people who might be depressed.

I'm not a psychiatrist but I would assume that people don't generally get a psychiatric diagnosis of major depressive disorder for being "a little down" or something else mildly outside the normal range of behaviour. If doctors are handing out diagnoses like candy then that's more a problem with the doctors rather than evidence that these conditions don't actually exist.

My legitimate argument for giving someone antidepressants (or whatever drug) would be that they work for many people. I would still think they should do therapy in addition to their medication (which I think everyone agrees is the best thing), but if medication plus therapy is better than just therapy alone then why not give them medication? They can come off it if they do not find it helpful.

Valmont

kisaragi wrote: »

I'm not a psychiatrist but I would assume that people don't generally get a psychiatric diagnosis of major depressive disorder for being "a little down" or something else mildly outside the normal range of behaviour.

But they do get diagnosed with something called Dysthymia! You've raised some good points in your post and I'll respond in more detail later on when I'm at home.

sambuka41

Valmont wrote: »

I guess what I'm getting at here is why should we "medicalise" behaviour in the first place? Is there a legitimate argument for helping an individual with a severe tendency towards melancholy by telling them they have a "disease" and need to visit a doctor? Help yes, if a person wants to helped; but why provide that help in a medical format?

I would think the main reason is to alleviate suffering; their behaviour or way of being in the world is causing them distress. I'd imagine the reason it is approached in a medical way is down to a default reaction, in particular nowadays where if someone is in distress they go to the doctor, whose natural approach is within the medical model. But there are types of therapy that acknowledges the same distress in a less medical way.

But just to note, there are some disorders that are so pervasive, in my opinion, the medical approach is the only one that is efficient at helping; like schizophrenia or severe depression. I was watching some afternoon program yesterday and there was an Irish actor on it (I should know her but I'm embarrassed to say I dont!! ) she spoke about her depression and how she tried to kill herself 30 something times. I'm sure that lady would have taken any approach going to alleviate her pain.

But I think you have a good point about their being something almost therapeutic in the diagnosis itself. I think there is something to that; I work with the families of people with dementia, in their case its the other who is diagnosed, but when they explore the illness and realise that others are experiencing the same there is a huge wave of relief. They aren't the only ones going through this; that knowledge can be freeing, nothing has changed, their loves one is still ill but now it seems more manageable.

Anyway I'm rambling now. There are good and bad points to the medical/psychiatric model but behind the science I think it is motivated by a genuine attempt to alleviate the suffering of people who are presenting with these behaviours.

JuliusCaesar

How the diagnostic categories have been developed is an interesting story - how the ICD and DSM were developed.

Valmont

sambuka41 wrote: »

I would think the main reason is to alleviate suffering; their behaviour or way of being in the world is causing them distress. I'd imagine the reason it is approached in a medical way is down to a default reaction, in particular nowadays where if someone is in distress they go to the doctor, whose natural approach is within the medical model.

This is where I would question if a label of "mentally ill with a disease" really helps anyone anyway; but I guess that's for another thread I probably should have started before this one.

sambuka41 wrote: »

But there are types of therapy that acknowledges the same distress in a less medical way.

This is what I'm really interested in--being able to alleviate distress and suffering without slapping on labels and telling people they're sick.

Valmont

kisaragi wrote: »

As for why it hasn't been discovered, I think you're being very simplistic. There's lots of things which haven't been discovered - why do we sleep?

That's not a valid analogy; sleep isn't classed as a mental illness. The behavioural patterns that we have classed as illnesses are still relatively mysterious in terms of their aetiology and we should be asking why is this the case?

kisaragi wrote: »

It's not really a feasible experimental protocol to take ALL the happy people and compare their brains with ALL the people who might be depressed.

I didn't say it was a feasible experimental protocol. I was trying to point out that, just like depressed people, happy people probably have physiological processes going on in their brains that would distinguish them from non-happy people; so this isn't a valid reason by itself to class a behaviour pattern as an illness because arguably all behaviour patterns have exclusive neurological correlates--whether it's something that has been classed as an 'illness' or not.

kisaragi wrote: »

If doctors are handing out diagnoses like candy then that's more a problem with the doctors rather than evidence that these conditions don't actually exist.

Or that the evidence doesn't give the doctors much to go on except what essentially boils down to a value judgement?

kisaragi

Valmont wrote: »

That's not a valid analogy; sleep isn't classed as a mental illness. The behavioural patterns that we have classed as illnesses are still relatively mysterious in terms of their aetiology and we should be asking why is this the case?

I was just making the point that there're many processes which occur which we cannot explain. In other words... it would be great to know what leads to a particular behavioural pattern but we are still relatively far off determining the neural processes behind ANY process on a behavioural level - we might know some of the areas involved or some of the genes responsible but I don't think there's a systematic explanation for any single behaviour.

Valmont wrote: »

I didn't say it was a feasible experimental protocol. I was trying to point out that, just like depressed people, happy people probably have physiological processes going on in their brains that would distinguish them from non-happy people; so this isn't a valid reason by itself to class a behaviour pattern as an illness because arguably all behaviour patterns have exclusive neurological correlates--whether it's something that has been classed as an 'illness' or not.

I see your point (I think ). Yes, every behavioural pattern has an underlying process, but a process that leads to behaviour typical of a mental illness may be disordered compared to that which leads to what is considered "normal" behaviour. For example, immune cells in the brain typically carry out neuroprotective functions in terms of fighting infection etc etc... however these cells can also become chronically active (dysfunctioning so to speak), leading to neurotoxicity and possibly contributing to neuroinflammatory diseases such as parkinsons disease / alzheimers disease which produce atypical behaviour. So just because a process is happening in the brain doesn't mean it's happening "in the right way"...

So it's not a problem if people have a different neurological process occurring, leading to different behaviour UNTIL that behaviour becomes harmful to the person. E.g. A different process might underly being attracted to red heads vs. blondes, not a problem until one's neurology leads to them being attracted to childern.

Valmont wrote: »

Or that the evidence doesn't give the doctors much to go on except what essentially boils down to a value judgement?

I suppose it can be partly a value judgement on the doctors part, in conjunction with the patient fulfilling certain criteria. Hopefully they are qualified to make that judgement.

I see your point about medicalising certain behaviours - or calling them disordered. I'm gay, and all over the world that's seen as something that's wrong, or needs treatment etc... but I feel that if one suffers from symptoms which are affecting their lives negatively and leading to the possibility of them harming themselves / others, then they should be given whatever treatment has been validated to be most effective. This may be psychotherapy and/or medication.

I don't mean this in a sarky way, but what would you propose as an alternative to the medical model, which incorporates the possibility of pharmacological treatment?

JuliusCaesar

kisaragi wrote: »

what would you propose as an alternative to the medical model, which incorporates the possibility of pharmacological treatment?

The biopsychosocial model?

The biopsychosocial model (abbreviated "BPS") is a general model or approach that posits that biological, psychological (which entails thoughts, emotions, and behaviors), and social factors, all play a significant role in human functioning in the context of disease or illness. Indeed, health is best understood in terms of a combination of biological, psychological, and social factors rather than purely in biological terms.

Linky

I saw Kinderman at a conference a few years ago and was very impressed. Many Clinical Psychology training course have taken his ideas on board in the way they are organised.

There are also a few psychological models of emotion - SPAARS, ICS etc.

As for anti-depressants work for people, so lets prescribe them - well there is evidence that they work no better than placebo, and often have worse side-effects and then there's the rather disturbing studies that show that anti-psychotics can worsen psychoses etc etc.

It seems paradoxical that drugs that ameliorate acute psychotic symptoms over the short term will increase the likelihood that a person so treated will fare poorly over the long term.

Lots of studies quoted here.

Cathquig

JuliusCaesar wrote: »

The biopsychosocial model?

Linky

I saw Kinderman at a conference a few years ago and was very impressed. Many Clinical Psychology training course have taken his ideas on board in the way they are organised.

There are also a few psychological models of emotion - SPAARS, ICS etc.

As for anti-depressants work for people, so lets prescribe them - well there is evidence that they work no better than placebo, and often have worse side-effects and then there's the rather disturbing studies that show that anti-psychotics can worsen psychoses etc etc.


Lots of studies quoted here.

Following the BPS (which health psychologists use when looking at a health issue, either mental, physical or both) the drugs would only affect the biological side of things. The psychological side of psychosis, depression and many other illness or disorders. To fully treat the person at the center of the diagnosis you have to look at their own psychological and social health. Otherwise, the interactions between these can make things worse (eg. treat with drugs but nothing is done psychologically. the side effects on the body can cause psychological stress making things worse for the person as a whole).

Im not saying medications should be written off nor should they be fully depended on. All these things have to be 'married up' to suit the needs of an individual.

ciarafem

Homosexuality used to be classified a s a mental illness by psychiatrists not so long ago!

ciarafem

kisaragi wrote: »

I'm not a psychiatrist but I would assume that people don't generally get a psychiatric diagnosis of major depressive disorder for being "a little down" or something else mildly outside the normal range of behaviour. If doctors are handing out diagnoses like candy then that's more a problem with the doctors rather than evidence that these conditions don't actually exist.

Try reading 'On Being Sane in Insane Places' for insight into how psychiatrists diagnose whether one has a mental illness or not.
www.box.com/shared/static/hyzf8tvfyx.pdf

JuliusCaesar

ciarafem wrote: »

Try reading 'On Being Sane in Insane Places' for insight into how psychiatrists diagnose whether one has a mental illness or not.
www.box.com/shared/static/hyzf8tvfyx.pdf

Things have moved on a little in the world of psychiatry since 1973. Most 'big bins' have been closed and treatment is as much as possible in the community.

EUSSR

The state of Psychiatric mental health is so poor now that the major professional psychological associations are "revolting" against the proposed changes and lack of scientific validity for most Psychiatric disorders in the DSM-5. Over 10,000 sigs, not to be ignored:)

http://www.salon.com/2011/12/27/therapists_revolt_against_psychiatrys_bible/

JuliusCaesar

EUSSR wrote: »

The state of Psychiatric mental health is so poor now that the major professional psychological associations are "revolting" against the proposed changes and lack of scientific validity for most Psychiatric disorders in the DSM-5. Over 10,000 sigs, not to be ignored:)

http://www.salon.com/2011/12/27/therapists_revolt_against_psychiatrys_bible/

Any article that starts

Anyone who’s ever tried to get reimbursed by a health insurance company after seeing a psychiatrist or psychotherapist, or taking a child or teenager to one, has no doubt noticed the incomprehensible numbers that appear on the clinician’s statement, perhaps preceding some slightly less imponderable phrase.

is highly unlikely to originate in Ireland!

Indeed the BPS protested the use of diagnoses recently. While the DSM is used and was originally intended for use in research, the 'bible' over this side of the Atlantic is the ICD (International Classification of Disorders). The ICD tends to be more conservative than the DSM - by which I mean it doesn't include new classifications as often as the DSM.

But I would agree with the BPS. Didn't I mention Kinderman in a post above? Tim Carey presented similar themes elsewhere.

Odysseus

JuliusCaesar wrote: »

Things have moved on a little in the world of psychiatry since 1973. Most 'big bins' have been closed and treatment is as much as possible in the community.

Of course your spot on JC, but it still is an interesting study do you not think. I use it regularly in my lectures around dual diagnosis and psycho-diagnostics; though imagine trying to get that past an ethics committe today. I think it still has something to tell us today about the difficulties involved in psycho-diagnostics, though I know you perfer the term formulations which hold different implications.

Though I awalys go for historical material,I would look at the whole beginning of classification systems, though that's the Friedian in me:)

JuliusCaesar

I don't think that's particularly Freudian; the historical origins of theories are important to understand as are the social contexts in which they arose.

I just sometimes get a little fed up with anti-psychiatry and anti-psychology posts by people waving ancient studies which they've just found out about and assuming they reflect current reality. And in fact people who have little to no experience of the reality of mental health care. I'm not saying it's brilliant, and I'm not saying ALL professionals are wonderful (I've worked with some doozies), but we are working within a very unresourced area. I've worked in hospitals where there was no money for patient comforts - couldn't provide slippers for emergency admissions - but the boardroom got a complete makeover. But most of us do try hard. All of us gasped at these studies when we trained.

OK rant over. I'll try to be more patient in future!

Odysseus

JuliusCaesar wrote: »

I don't think that's particularly Freudian; the historical origins of theories are important to understand as are the social contexts in which they arose.

I just sometimes get a little fed up with anti-psychiatry and anti-psychology posts by people waving ancient studies which they've just found out about and assuming they reflect current reality. And in fact people who have little to no experience of the reality of mental health care. I'm not saying it's brilliant, and I'm not saying ALL professionals are wonderful (I've worked with some doozies), but we are working within a very unresourced area. I've worked in hospitals where there was no money for patient comforts - couldn't provide slippers for emergency admissions - but the boardroom got a complete makeover. But most of us do try hard. All of us gasped at these studies when we trained.

OK rant over. I'll try to be more patient in future!

No I fully agree with you, I'm all for critical thought, but when it is abused like the examples you give, it gets me too.

EUSSR

Maybe Professional Psychologists should simply use the ICD-10 criteria instead? At least until the problems with the DSM are sorted out? It's going to help in the long run anyway. It's simply a fact that Psychology has not corrupted itself anywhere near to the same degree as Psychiatry.

Odysseus

EUSSR wrote: »

Maybe Professional Psychologists should simply use the ICD-10 criteria instead? At least until the problems with the DSM are sorted out? It's going to help in the long run anyway. It's simply a fact that Psychology has not corrupted itself anywhere near to the same degree as Psychiatry.

It depends some do, I'm a psychoanalyst, so the psycho-diagnostic system is totally different. However, for teaching I perfer the ICD-10 much easier to use and read, and most psych's I know use it rather than the DSM.

ciarafem

JuliusCaesar wrote: »

Things have moved on a little in the world of psychiatry since 1973. Most 'big bins' have been closed and treatment is as much as possible in the community.

Have they really? I referred to the Rosenhan studies to point out the problems of diagnosis, not the 'big bins' issue.

Why are the proposed DSM 5 revisions causing so much concern even though the Axis II revisions appear to be changing from a categorical to a more dimensional approach?

The American Psychological Association recognizes that there is a diversity of opinion concerning the ongoing DSM-5 development process. Our association has not adopted an official position on the proposed revision; rather, we have called upon the DSM-5 Task Force to adhere to an open, transparent process based on the best available science and in the best interest of the public.

Monitor January 2012

cranks

OP, you might find this article thought provoking with respect to your original question.

http://devepi.duhs.duke.edu/library/pdf/20070.pdf