A few thoughts, as someone who has been deeply researching this topic for my own reasons and for several loved ones over many years (I think I first started looking up the DSM-IV in 2005).
- This article reveals the folly of viewing a complex system (the mind) through a mechanistic lens. We want to be able to look at the mind the way we look at a malfunctioning car ("ah, the timing belt's out") or computer ("one of the memory sticks died"), repair/replace that component and expect it to carry on as "normal". This can never work. The mind is an organic, emergent phenomenon, not something that has been "designed" to work in any "normal" way; it has evolved to adapt to circumstances that can change and differ dramatically for all kinds of reasons. So, trying to categorise "disorders" into discrete definitions with distinct "causes" in order to restore the mind to some "normal" state cannot possibly work.
- I realised after a few years of researching this stuff that the notion that psychiatric "disorders" manifest due to "bad genes" doesn't make sense. The whole point of evolution is that only genes that promote survival and replication can make it through. Sure, you can get random mutations, but that doesn't explain why so many people have the same kinds of "disorders". So whatever are the genes that "cause psychiatric disorders" in big enough clusters that they can even be attempted to be named and described in the DSM, those genes must be there for a reason that has aided our survival - even if they have some negative aspects too (nature is all about tradeoffs after all). Realising this changed the way I view mental "illness". I realised that my depression was my mind's way of telling me that something was wrong in my life (relationships, career, physiological health) and I needed time out to examine it, understand it and correct it. Schizophrenia can be seen as an alteration of your perceptions to numb you from a stressful/traumatic situation, a trigger of extreme creative thinking to help solve serious life problems, or a display of aberrant behaviour to signal to outsiders that you are in need of help (see studies of how often schizophrenia manifests after a period of severe stress or trauma). Bipolar can be seen as a pattern of swinging between a high energy/creativity state in order to get important things achieved quickly, and a low-energy state for recovery.
- The discussion in this article seems astonishingly simplistic and naïve to anyone who has read/heard any of the many researchers who have spent years examining mental "illness" from the perspective of trauma, and who have found success treating all kinds of conditions through trauma healing techniques. Such figures include Stan Grof, Ram Dass, Iain McGilchrist, Peter Levine and Gabor Maté.
- My own experience: I'm one of those who has fit the diagnosis for several conditions at times in my life; depression and anxiety most clearly, but also (at least mildly) bipolar, borderline PD, ADHD, some addiction. I tried all the conventional things (pharmaceuticals, mainstream psychiatric talk therapy) and didn't get much relief. About 8 years ago I discovered unconventional approaches to subconscious trauma healing, and have undertaken these consistently ever since, and my "disorders" have steadily resolved. All that's left is some latent anxiety, but that continues to improve too.
> The whole point of evolution is that only genes that promote survival and replication can make it through
While this has been true in our past, we as a species have completely diverged from this. We do everything in our power to save every life no matter what the disorder or weakness. So it is no longer survival of the fittest in the traditional sense.
Whereas in the past someone with schizophrenia or major depression would not likely live a “normal” life and have children, now obviously it is very likely.
I think it also helps to think of it in a community or society sense too. If a community has a small number of neurodiversity they are better for it, but if everyone had it then there would be problems. For example depression could be thought of as a kind of introspection and are good at noticing negative things, having that kind of person in a group noticing problems and prompting change would be useful. Those with ADHD would be better noticing/finding things, again not great at things like sitting through boring meetings but useful to a community. Even most pre modern societies had a role like that of a shaman or a spiritual leader who was often schizophrenic, and this again would be useful to the community on the whole.
So my theory is that some of our evolution is not at the individual level but the societal.
A central point of the article is to acknowledge the clumsiness of the categories.
It specifically mentions co-morbidities and such. It mentions that hundreds if not thousands of genes are involved and that this was pointed out by a study which contrasted the obviously genetic conditions of epilepsy and multiple sclerosis with disorders like bipolar or schizophrenia.
> This article reveals the folly of viewing a complex system (the mind) through a mechanistic lens.
Nobody is saying that current research views the mind through a mechanistic lens. The article is explicitly saying, "hey, this is a complex problem – let's observe and analyse the phenomena"
> We want to be able to look at the mind the way we look at a malfunctioning car ("ah, the timing belt's out") or computer ("one of the memory sticks died"), repair/replace that component and expect it to carry on as "normal".
Says who? The article is not saying this. The argument that researchers have an unsophisticated model of the brain/mind and its corresponding disorders is frequently put forward to justify a rejection of conventional therapy – which is what you end up doing, surprise surprise.
> The discussion in this article seems astonishingly simplistic and naïve to anyone who has read/heard any of the many researchers who have spent years examining mental "illness"
That's a gross mischaracterization of the article, which says:
“Researchers are also drastically rethinking theories of how our brains go wrong. The idea that mental illness can be classified into distinct, discrete categories such as ‘anxiety’ or ‘psychosis’ has been disproved to a large extent. Instead, disorders shade into each other, and there are no hard dividing lines — as Plana-Ripoll’s study so clearly demonstrated”
So when you say
> So, trying to categorise "disorders" into discrete definitions with distinct "causes" in order to restore the mind to some "normal" state cannot possibly work.
Yeah, nobody's trying to do that. Researchers are clearly aware of that.
I'm happy for you that whatever mental disorders you were suffering from seem to be receding but the attitude that mental health researchers are stuck is a conventional rut needs to be put to bed. If you're going to refute an article at least refute what the article says and not what you claim it says.
I understand the article is trying to convey that (some) researchers are rethinking the old approach of thinking of distinct definitions of disease.
My point is that they're still largely making the same mistakes; yes they're blurring the distinctions between "disorders", but they're not going back to first principles, nor giving due consideration to the coherent and compelling work of other eminent figures in their field.
> > So, trying to categorise "disorders" into discrete definitions with distinct "causes" in order to restore the mind to some "normal" state cannot possibly work.
> Yeah, nobody's trying to do that. Researchers are clearly aware of that.
They are still focused on identifying biological causes for disorders, rather than seeing variations in behaviour – even extreme ones – as adaptations that have been selected for by evolution.
It's articulated here:
> They have a few theories. Perhaps there are several dimensions of mental illness — so, depending on how a person scores on each dimension, they might be more prone to some disorders than to others. An alternative, more radical idea is that there is a single factor that makes people prone to mental illness in general: which disorder they develop is then determined by other factors. Both ideas are being taken seriously, although the concept of multiple dimensions is more widely accepted by researchers.
I sigh at that statement, when several prominent figures in the field, all with advanced qualifications in mainstream medicine or psychology, have been offering coherent explanations and effective treatment approaches for years or decades.
Yes, quite so, how would one characterize psychosis in terms of atoms and quarks? Schizophrenia is a uniquely human and philosophical disorder.
I recently finished Hidden Valley Road and one of the interesting things mentioned was the use of nicotine/anabaseine to improve attentional gating. Apparently due to the acetylcholine release in the PFC. Similar effect to modafinil for attentional switching and alertness.
Philosophically, I think it is true that noone can save someone from the torments of a wayward mind. The trick is to overcome this "powerful elephant" with the intelligent use of the mind in the first place, and tranquilize it by studying scripture, satsanga, and renouncing desire/hope. We must identify not with the mind or thoughts, but with what Kant called the noumenal world, the solar existence, pure consciousness.
> The whole point of evolution is that only genes that promote survival and replication can make it through. Sure, you can get random mutations, but that doesn't explain why so many people have the same kinds of "disorders"
Evolution is not proactive. It's passive. Genes introduce possibilities, so are beneficial, so are not.
The mind is plastic. Human "conform" to the world around them. Perhaps the commonness of disorders are the result in common patterns in the human condition, as well as a finite number of genetic contributions?
And of course, there's gut bacteria. A wonky gut often leads to a wonky mind. Perhaps diseases of the mind are actually symptoms of other abnormalities?
It's interesting to note that human brain size is a result of a mutation that severely weakened our bite strength, as the jaw muscles no longer extend to the top of the skull (as it does in other great apes), limiting it's size.
Point being... what appears to be a major weakness sometimes turns into a significant advantage.
As a result, the world’s largest funder of mental-health science, the US National Institute of Mental Health, changed the way it funded research.
Like so much in medical research, efforts are governed by what research will be funded, and ideally what will lead to the discovery of a drug or intervention that can generate billions of dollars of revenues. Those researchers who figured this stuff out decades ago don't need to be considered.
Beginning in 2011, it began demanding more studies of the biological basis of disorders, instead of their symptoms, under a programme called the Research Domain Criteria. There has since been an explosion of research into the biological basis of psychopathology, with studies focusing on genetics and neuroanatomy, among other fields.
"Focusing on genetics and neuroanatomy" is the perfect way to miss the forest for the trees.
But if researchers hoped to demystify psychopathology, they still have a long way to go: the key finding has been just how complex psychopathology really is.
Complexity doesn't have be difficult to understand.
> About 8 years ago I discovered unconventional approaches to subconscious trauma healing, and have undertaken these consistently ever since, and my "disorders" have steadily resolved. All that's left is some latent anxiety, but that continues to improve too.
Having hit my head quite a few times over the past years, I've dug into cutting-edge mTBI (concussion) research pretty hard.
What I learned was that the long-term effects of concussion are now fundamentally thought of as neurometabolic in nature. That is, the loss of metabolic homeostasis within the brain due to an initial trauma. Unless this process arrests, what you're left with is neurodegeneration. How much really depends on the circumstance and patient.
The most striking takeaway I had, was that much of the latest research is suggesting that different etiologies lead to the same pathology in many instances. For example, it may be that you can acquire Alzheimer's Disease, or Parkinson's Disease, or even ALS via way of: chronic poor sleep quality (poor glymhpatic performance), history of frequent subconcussive head trauma (CTE), history of concussive or severe head truama (mTBI/TBI), neuroimmune factors, and of course genetic factors. Often times a combination thereof. That example isn't even remotely comprehensive on either the etiology or pathology side.
Point being, your brain is like a washing machine. If it goes out of balance, sometimes it will only oscillate further out of balance unless the process is arrested.
Psychiatric disorders are much the same way. I suspect it is for this reason that comorbidity is so commonplace.
The interesting part about psychiatric disorders however, is to a degree they can self-reinforce in a unique way. Your behavior and thought literally influence your brain's neurochemical state. Likewise, your brain's neurochemical state influences behavior and thought. I suspect this is why behavioral intervention in conjunction with medication generally works better than medication alone in treating psychiatric disorders.
Of course, it's not as simple as brain chemistry affecting thought and vice versa. You brain chemistry (and as such your behavior and thought) is still subject to effects of neurodegeneration, neurostructural changes, neuroinflammation, immune activation, and so forth.
So what we have is a very, very complex puzzle wherein you have many different factors—often vastly different in mechanism—each affecting the other.
In most cases probably not, or if so mild. It depends on the hit, and it depends on the person. It's worth noting the second order effects of mTBI (such as sleep disturbance) can in some cases kick off neurodegenerative processes.[0]
If it's acute (TBI), then almost certainly yes.[1] It's no longer considered a concussion at that point however.
> Point being, your brain is like a washing machine. If it goes out of balance, sometimes it will only oscillate further out of balance unless the process is arrested.
Not a psychiatrist, but I'm pretty skeptical of the approach of trying to sort things according to a few dimensions. I understand the appeal -- There is a reason why memes like sanguine vs melancholic or The Political Spectrum are popular -- but I don't see why it should be likely to cleave reality at its joints.
I'd naively think we're more likely to get a useful theory by trying to push a Predictive Processing approach too far for a while and then find a way to incorporate the signaling impact of hormones & ambient levels of neurotransmitters on various feedback loops.
> Not a psychiatrist, but I'm pretty skeptical of the approach of trying to sort things according to a few dimensions. ... I don't see why it should be likely to cleave reality at its joints.
One thing to understand about this is that they're not making up these dimensions from thin air. The dimensions are found in a data-driven manner using one of several techniques, most of which fall under the umbrella of factor analysis[1]. If you're familiar with principal component analysis or singular value decomposition, it's a pretty similar idea: you find the dimensions that explain as much variance as possible.
Then, once you have the dimensions, you try to make sense of them in some way. You may do something called factor rotation, which will change what these dimensions are, but you always have the same information among those five factors. Next, you have to give the factors arbitrary names. The names are usually given for the purpose of making it easy to discuss the factors. (This is the same way that the "Big 5" personality scale [2] was developed.)
For instance, if you had a factor which included the survey questions "Do you have trouble sleeping at night?" "Does it take you a long time to fall asleep?" and "Do you wake up not feeling refreshed?", you might name this an "insomnia" dimension. Really, it's just making it easier to discuss the math and data (though the names do end up having a big impact on how people think about the factors).
You can do this with survey data, brain imaging data, genetic data, etc. There are many different ways to find these. That means you can look at how they line up with each other. There are many theories and structures, but a popular one is about the "p factor" mentioned in the article which boils it down to a single dimension. I haven't read the literature for a few years, though, so I can't comment on current thinking about factor structures beyond what the article discusses.
But in the end, the idea is trying to find statistics which are useful and meaningful, either in the clinic or else for guiding future basic research. So when they say "how many dimensions are there?", what they really mean is "how many dimensions can we find that are useful?". It's not a perfect solution, but it is a good start.
>There is a reason why memes like sanguine vs melancholic or The Political Spectrum are popular -- but I don't see why it should be likely to cleave reality at its joints.
The point of models such at this isn't to 'cleave reality at its joints', it's to provide useful frameworks to reason about disease (or politics).
High level concepts such as schizophrenia attempt to given a human understandable account of what Schizophrenia is, why it emerges, and what treatments we may form.
Reductionism of the sort of, "we've looked at every neuron and figured out that 12301231723 of your 3782328372832 brain cells are out of whack" has no explanatory power. The goal of inquiry into mental illness is not to give some physical account of what is wrong with the brain, it is to give an account of what is wrong with the mind.
These brain chemistry accounts of psychological illness really have glaring problems. By definition they exclude all ecological or cultural factors by focussing on some individual's brain. But this is almost tautological, all psychological illness manifests in some sense in the brain.
When some local company pours lead into the river and everyone loses 20 IQ points then that manifests in the brain, like anything else does. However the right framework in that case is ecological.
Abstraction does not happen at 3D or higher dimensions. Abstraction happens in the second dimension. The Greeks made lifelike marble sculptures during the Hellenistic era (300 B.C.) but it took almost 2,000 more years before artists could make lifelike 2D pictures.
I'm not sure that's true. Marble sculptures last much longer than paintings (case in point: the paint that used to cover the sculptures is gone), and Roman artists were able to paint well not much later. Most Roman paintings are gone too, but some have been uncovered in Pompeii, Herculaneum, etc.
The blog he linked, Slate Star Codex, has a lot of good posts on predictive processing theory. I'd recommend checking them out. (The author is a psychiatrist, and in my opinion a semi-polymath.) Basically a theory positing that the brain fundamentally works, at least in part, by continuously updating a model of the environment and the self based on successful and unsuccessful predictions.
Although this may not seem like a crazy idea, some proponents suggest that essentially everything the brain does works in this way. For example, that the cause of schizophrenic symptoms may be due to them holding a very loose predictive model with weak priors; basically that they don't have pre-existing high-confidence predictions about anything, on every level. You and me likely would predict with very high confidence that we are not and can't be a god, but someone with schizophrenia may not predict that with as much certainty due to a general issue with neural prediction.
I am oversimplifying it and may be partially wrong, but I think that's the general. I'd highly recommend reading that blog's series on predictive processing for a much better explanation. The linked post also discusses schizophrenia.
One challenge here is that there is that a lot of disorders are diagnosed with reference to moods and life experiences.
An ADHDer who repeatedly finds that their distractibility leads to them to fail at obvious tasks and disappoint the people around them can very easily develop symptoms of depression. Would that require having the biological underpinnings of depression?
As far as I'm aware (and from what my doctor has told me), that's different to Clinical Depression/Major Depressive Disorder. One of the key diagnostic criteria of Clinical Depression is a state of depressed mood without clear cause.
The treatment for depression caused by other mental health conditions (e.g. ADHD) and Clinical Depression are very different, although they are often comorbid. Generally successful treatment of the underlying condition also makes the depression go away. Giving antidepressants to someone who has ADHD with depressive symptoms (without treating the ADHD, i.e. it's undiagnosed) generally doesn't alleviate the depressive symptoms.
It isn't strictly depression that's a diagnostic criteria for a lot of disorders/conditions, but rather a negative impact on normal functioning and everyday life. Some people are just rendered incapable due to their mental health, unable to hold a steady job or impulsive to the point of committing assault or other crimes. Some people just take it on the chin without getting depressed about it, but others (those with the biological underpinnings of depression I suppose) get depressed or anxious. There's plenty of chronically underachieving people with ADHD who are perfectly happy, and others who experience significant distress.
> Giving antidepressants to someone who has ADHD with depressive symptoms (without treating the ADHD, i.e. it's undiagnosed) generally doesn't alleviate the depressive symptoms.
You have captured my point exactly.
> Clinical Depression is a state of depressed mood without clear cause.
Sure. It is easy to have a depressed mood without clear cause if you just fail at identifying the cause.
Back when I didn't know how to identify aircraft, I saw unidentified flying objects pretty often.
I wonder about this a lot. I used to be a hopelessly optimistic, positive, happy person despite constant failure. This was of course due to my ADHD, whatever that really is. Over time though, a deep depression, loss of identity, and loss of optimism has really overwhelmed the old me. But where did that begin? Was it there all along? It certainly doesn't seem like it. It isn't rose colored glasses; I had a pretty tough time as a kid. Somehow I was sure everything would be great. Now great things often don't seem as good as they are.
I really struggle to understand where that comes from so I can handle it better. I do believe it developed over time, though. I think it can be reversed. Perhaps that's just a lingering thread of optimism.
I can also relate, but luckily I (hope) that I managed to catch this happening in time and nipped it in the bud. It took a lot of soul searching (plus professional help) to get me back on track.
I started to think that I was a fucking idiot for being incapable of doing what was expected of me, and what I wanted to do. All my grand plans and projects and ideas seemed to just slip through my fingers, despite best efforts I couldn't (and still struggle to) get out of bed in the morning and get to work on time. It was frustrating.
For me it started when I finished university and I realised I had me entire life ahead of me, and no idea what to do with it. As a kid, sure I had plenty of screwups and a tough time, but I always saw the light at the end of the tunnel, I just had to get through my assignments and exams, finish school, finish university, get a job. Once I had done all that I sort of lost all purpose and identity, I had no idea who I was supposed to be. I had grown up with the concept that I was going to get my degree and find a job, then marry some girl, buy a house and have some kids and I'd live happily ever after, like I thought my parents did. Turns out that's not what I wanted in life, and I really struggled to find a purpose.
I think this is incredibly common for all sorts of people with different mental health issues, not just ADHD, I know plenty of people who've experienced the same descent into a hopeless state. Some turn to Jesus, some to drugs, others just say fuck it and kill themselves.
I can relate. I think the daydreams contribute largely to the optimism. When you're young you still have all the opportunity. As you go through life it either does or doesn't match the daydreams. You also get an updated sense of how reality is likely to play out. It can dampen the spirit.
I understand Clinical Depression is more than just feeling down, “depressed”, or demotivated - it’s an actual depression in brain activity (which tends to manifest itself as feelings of sadness, but not necessarily - and people with CD can still laugh, smile, and have a good time... at times).
(I wish they’d change the name of CD to something that avoids the layperson’s concept of “depression” - that alone would help the well-meaning but ignorant people who think it’s just a matter of finding a way to cheer oneself up and certainly nothing to do with serotonin...).
Probably because it has nothing to do with serotonin as far as science has been able to show. If I'm wrong, please provide a link because I've been looking for that link now for well over a decade.
There's a couple related shared factors that cause correlation between diagnosis of various mental disorders.
1. People who are doing okay don't seek out diagnosis. One big example is Bill Gross, the "Bond King" who manages mutual funds - he happened to read the description of Asperger's and realize he had it in his seventies. Psychologists do not see a representative sample of society. If diagnosis A and B are both mild enough to cause some people with it to not seek treatment, but everyone with both to do so, you'll see a correlation between A and B.
2. All mental health diagnostic criteria share a clause that sounds like "and these symptoms cause a significant amount of distress or ill-functioning to the patient." This is similar to the first factor, but happens after people seek treatment; if you tell a psychologist that you aren't having any problems in your life, they do not diagnose you with depression, anxiety, ADHD, etc. It almost doesn't matter what you have going on, if it doesn't cause problems its not worth using medical care on, so it doesn't get diagnosed. And again, if you only have one kind of thing causing you problems, it's more likely to not be severe enough to warrant some kind of diagnosis.
3. Similar to the previous factor, mental health diagnoses are used to gatekeep medical care and social support. So, people who need more resources than they currently have are going to push more for additional mental health diagnoses, while people who are more okay are going to be fine with the first one proffered. Eg, a young woman who is extremely anxious and whose mom yells at her all the time goes in, gets diagnosed with anxiety and prescribed anxiolytics, things are still bad because her mom keeps yelling, so she goes back and gets a depression diagnosis and anti-depressants. Or a school can offer accommodations for ADHD and not autism, or vice versa, so someone with one goes back and asks the psychologist for the other.
In short, there's a general willingness-to-seek-diagnosis that's an obvious latent variable for mental health diagnoses. I'd be more surprised to not find a positive correlation between two arbitrarily picked mental health diagnoses. If there's an outright negative correlation, that's something that would be actually indicative of a biological link of some sort - either the biochemistry of one complex protects against the other, or they're a pair of under/over-activity of a system, or the like.
As you said in point 3, mental health diagnostic criteria are a tool for diagnosing and treating people who experience distress from their cognitive process. Doctors and psychiatrists exist to give medical advice and treat people who need help, not to tell them how their brain works out of curiosity. On that point though, depression and anxiety are two completely different things, I've experienced both (separately and simultaneously) and they're distinctly different in how they feel and how one would describe the symptoms to a doctor or a friend.
I went to the doctor in my mid-20s to get treated for ADHD, as it was causing me significant problems in my life, having gone through bouts of anxiety, depression, and suicidal ideation for the year or two prior, which the manifested itself in an inability to manage the negative traits of my ADHD. I've had it all my life, but only realised I likely had it a couple of years prior, but it was never something that caused big enough problems to go to a doctor about, mostly just report cards stating "easily distracted and distracters others".
At the same time I was diagnosed with ADHD, the doctor said it was likely I also had high functioning autism. I guess maybe I have it, but it's not something that's ever caused me any particular problems in life, so the doctor basically said not to worry about it and only to seek treatment (therapy or counselling) if I felt like I needed it. Same story for the ADHD too, he said there was no need to continue seeking treatment if I felt like I didn't need it at any point in the future.
On the other hand, being put on medication for ADHD (clonidine and dexamphetamine) has made a world of difference for me, and I've seen vast improvements in quality of life. Most importantly though has been recognising and accounting for the fact that my mind functions in a different way than most people, and making accomodations (and asking others to accomodate) for this.
Interestingly enough, he also mentioned the possibility of having bipolar disorder as well, but said that it was likely the symptoms were actually ADHD masquerading as bipolar and decided to treat the ADHD first and see if the symptoms remain. Diagnosing mental health issues is a difficult task, a lot of people with ADHD are misdiagnosed with bipolar, or people with bipolar diagnosed with clinical depression. If it wasn't for the fact that I was fairly certain that I had ADHD when I went to the doctor, I wonder what I would've been diagnosed with.
I think the language around mental functioning and disorders isn't great.
If you have Asperger's or ADHD and don't experience distress or difficulty in life from it, then it's not really a mental illness or disorder, it's just a different way your mind works. ADHD has a particularly bad name, it's not an attention deficit to begin with, but rather an inability to chose what your attention is on (you should see me if I'm in a hyperfocus/flow state, it's definitely not a deficit of attention), and it's not always hyperactive. I have primarily inattentive-type ADHD, you wouldn't pick me as having it just from looking at me, I display barely any "typical" traits of ADHD, it's mostly mental for me (mood swings, inattentiveness, impulsiveness, poor working memory, no concept of time, rejection sensitivity and a lack of emotional permanence). I don't think it's intrinsically a disorder either, it's been hugely beneficial in parts of my life, and I don't really want to be labelled as disordered or broken for the entirety of my life, it only became a disorder at a certain point in my life, largely due to external factors at the time. Often it's helped me function above and ahead of neurotypical people.
I know plenty of people with ADHD who don't take any medication and don't feel the need to, and get by perfectly fine in life. My father very likely has ADHD (it's hereditary, and he displays a lot of traits), and has never seeked treatment for it, and he's a very successful man. Same for people with bipolar, autism, or other neurodiverse minds.
I wonder how much of this correlation between disorders is just an artefact of inconsistent classification of patients by psychiatrists? What might be being measured here is not the likelihood of getting a second illness, but the probability that person with illness X get diagnosed with illness Y despite the underlying symptoms not changing.
I have always thought that mental disorders are no different to physical disorders. We all know some people who are robustly healthy while others seem to get a bewildering array of different diseases. Illness is not randomly distributed.
That's been my experience. For decades, I was diagnosed with depression. Eventually, I was prescribed an SSRI. And that became a disaster, over the course of a few years.
But then I saw a psychiatrist who inquired about my use of psychoactive drugs. And based on my love of stimulants, he diagnosed me as having bipolar disorder, manifesting primarily as depression. And so he prescribed modafinil, with lamotrigine to reduce the risk of mania.
So I wonder if bipolar disorder is actually relatively common. I mean, I was self medicating primarily with caffeine, and for many years used nicotine to take the edge off. Maybe that's fundamentally why coffee, tea, etc are so popular.
You probably know this, but for the benefit of other readers, bipolar disorder masquerading as major depression until flushed out into mania by SSRIs is a common (and dangerous) enough misdiagnosis that psychiatrists avoid prescribing SSRIs for depression until they're confident that enough time has passed that they're not dealing with bipolar disorder. It's basically the go to example of one disorder being mistaken for another.
There's a milder form of bipolar disorder called cyclothymia that is rarely diagnosed unless a patient seeks psychiatric care for a different reason. Estimates suggest it's fairly common, potentially up to 1% of the population.
Interesting that you were diagnosed with bipolar, was the possibility of ADHD discussed, and if it was, how did they determine that it was bipolar and not ADHD?
I was diagnosed with ADHD, with the possibility of bipolar, and also have a sweet tooth for stimulants, both legal and not (I'm basically fuelled on caffeine, nicotine, and amphetamines).
I've also never heard of modafinil being prescribed as a treatment for bipolar disorder either, do you happen to have any resources on this?
Lamotrigine has been a life saver for me! Way more effective than snri, ssri for me at least. I wish more people knew about it. Bonus it's like 5 cents a pill unlike so many patented depression meds
There are plenty of psychiatric disorders that are demonstrably structural in nature, such as schizophrenia (likely genetic, lifelong and incurable), but there are plenty of others that seem to be a disorder in the contents of your brain rather than its structure. An example is depression, where people seem to be able to think themselves into depression and think themselves out of it.
Probably 10 or so years ago I had a few episodes that made me think I may be suffering from some form of mental illness (low on the "spectrum", but something nonetheless).
Since then I've thought a fair amount about mental illness in general and have a few theories.
1) Diet. Get the right materials into your body so it can do with them what it needs to. Especially early in life while brain is still forming.
2) Exercise. Make sure your body can get sufficient blood / oxygen to all parts of the body so it can function properly.
3) The brain, IMO, should be viewed as a TOOL Sure it is already part of our body but this is why I think it's so overlooked as a perspective. If I decided to do some landscaping and needed an excavator, I would need to learn how to use it, and practice in order to become efficient and effective with my use of it. I think it's same with the brain. New circumstances come up all the time and sometimes the people who experience them have not trained their brains to deal with them in an effective / efficient way. There should be more focus on this sort of perspective / reflection / learning and perform these generally-applicable exercises early in life. Not just math, science, english, etc.
-- There is no doubt in my mind there are going to be SOME genetically relevant issues. But I would be surprised if, once this stuff gets fleshed out further, we don't come to realize most of it was preventable.
Im sort of half surprised at the down votes and not surprised at the same time.
I think you're probably right to a large degree. To paraphrase you're basically saying yes, there for sure is a very real genetic and environmental component, however if we simulate a reality where everyone runs their bodies and minds in an optimal manner we'd be far less likely to see all forms of disease including mental illness/psychiatric disorders.
The takeaway is if you're struggling with it, they are both important components that ought to be a part of a wholistic treatment plan.
I was watching something on Health Theory the other day and she psychiatrist being interviewed said they start with an elimination diet and the nutritionists have more success than the psychiatrists.
Most people have periods in their life where they're feeling down or anxious, and proper exercise and diet, or a change in life circumstances tends to make it go away.
But there is a percentage of the population that, even with correct diet, exercise, and general mental hygiene, are incapable of surmounting their mental health problems.
Everybody is different, and you can't really apply your personal anecdote to everyone who's suffered from depressive bouts or other mental health issues.
It's incredibly frustrating when people tell me I just need to eat right, or do yoga, or align my chakras and all my mental health problems will go away. It's borderline accusing me of being lazy or stupid for feeling and functioning the way I do.
It is interesting how powerful the meme is which prevents discussion of psychology and psychiatry amongst the laity. Multiple threads started and died on the theme of being a layperson and not an expert, despite the fact that any science should be examinable on its premises, observations, models, and theories.
Meanwhile, the Dodo Bird theory [0] has yet to be disproven, and there are good reasons to suspect that humans are merely smart mammals, rather than special animals who have no peers throughout the rest of the kingdom, which means that psychology and psychiatry are only the tip of a much bigger comparative discipline which handles humanity as a special case rather than as the main system of study.
The Dodo Bird theory may, as it states, be relevant to therapy, but it holds no water for psychiatric treatment. Some mental disorders are known to respond radically differently to certain psychoactive medications. SSRIs are a canonical example. They are an effective treatment for major depression, but in bipolar disorder they cause rapid cycling and increase suicide risk.
Assuming mental disorders exist, sure. But there is also evidence that a sufficiently technocratic government will use psychoactive drugs indiscriminately on its population in order to coerce and control them [0][1][2][3]. We must demonstrate somehow that mental disorders not only exist, but that their classification is due to science, and not due to bigotry and a lack of understanding [4][5].
Your example of SSRIs is an especially poor one, as SSRIs are well-understood to have been developed by the pharmaceutical industry as part of a panpsychic wellness package which is meant to be sold pill-by-pill to the public [6][7]. SSRIs today are like sugar in the past [8], with a corporate army of compensated scientists ready to study the noise and find useful results from harmful chemicals.
Readit News
- This article reveals the folly of viewing a complex system (the mind) through a mechanistic lens. We want to be able to look at the mind the way we look at a malfunctioning car ("ah, the timing belt's out") or computer ("one of the memory sticks died"), repair/replace that component and expect it to carry on as "normal". This can never work. The mind is an organic, emergent phenomenon, not something that has been "designed" to work in any "normal" way; it has evolved to adapt to circumstances that can change and differ dramatically for all kinds of reasons. So, trying to categorise "disorders" into discrete definitions with distinct "causes" in order to restore the mind to some "normal" state cannot possibly work.
- I realised after a few years of researching this stuff that the notion that psychiatric "disorders" manifest due to "bad genes" doesn't make sense. The whole point of evolution is that only genes that promote survival and replication can make it through. Sure, you can get random mutations, but that doesn't explain why so many people have the same kinds of "disorders". So whatever are the genes that "cause psychiatric disorders" in big enough clusters that they can even be attempted to be named and described in the DSM, those genes must be there for a reason that has aided our survival - even if they have some negative aspects too (nature is all about tradeoffs after all). Realising this changed the way I view mental "illness". I realised that my depression was my mind's way of telling me that something was wrong in my life (relationships, career, physiological health) and I needed time out to examine it, understand it and correct it. Schizophrenia can be seen as an alteration of your perceptions to numb you from a stressful/traumatic situation, a trigger of extreme creative thinking to help solve serious life problems, or a display of aberrant behaviour to signal to outsiders that you are in need of help (see studies of how often schizophrenia manifests after a period of severe stress or trauma). Bipolar can be seen as a pattern of swinging between a high energy/creativity state in order to get important things achieved quickly, and a low-energy state for recovery.
- The discussion in this article seems astonishingly simplistic and naïve to anyone who has read/heard any of the many researchers who have spent years examining mental "illness" from the perspective of trauma, and who have found success treating all kinds of conditions through trauma healing techniques. Such figures include Stan Grof, Ram Dass, Iain McGilchrist, Peter Levine and Gabor Maté.
- My own experience: I'm one of those who has fit the diagnosis for several conditions at times in my life; depression and anxiety most clearly, but also (at least mildly) bipolar, borderline PD, ADHD, some addiction. I tried all the conventional things (pharmaceuticals, mainstream psychiatric talk therapy) and didn't get much relief. About 8 years ago I discovered unconventional approaches to subconscious trauma healing, and have undertaken these consistently ever since, and my "disorders" have steadily resolved. All that's left is some latent anxiety, but that continues to improve too.
There are plenty of inheritable genetic physical diseases. The evolution is not machine to make us perfect not God. You can't treat it this way.
While this has been true in our past, we as a species have completely diverged from this. We do everything in our power to save every life no matter what the disorder or weakness. So it is no longer survival of the fittest in the traditional sense.
Whereas in the past someone with schizophrenia or major depression would not likely live a “normal” life and have children, now obviously it is very likely.
So I can respond to something solid, can you name some?
Dead Comment
So my theory is that some of our evolution is not at the individual level but the societal.
It specifically mentions co-morbidities and such. It mentions that hundreds if not thousands of genes are involved and that this was pointed out by a study which contrasted the obviously genetic conditions of epilepsy and multiple sclerosis with disorders like bipolar or schizophrenia.
> This article reveals the folly of viewing a complex system (the mind) through a mechanistic lens.
Nobody is saying that current research views the mind through a mechanistic lens. The article is explicitly saying, "hey, this is a complex problem – let's observe and analyse the phenomena"
> We want to be able to look at the mind the way we look at a malfunctioning car ("ah, the timing belt's out") or computer ("one of the memory sticks died"), repair/replace that component and expect it to carry on as "normal".
Says who? The article is not saying this. The argument that researchers have an unsophisticated model of the brain/mind and its corresponding disorders is frequently put forward to justify a rejection of conventional therapy – which is what you end up doing, surprise surprise.
> The discussion in this article seems astonishingly simplistic and naïve to anyone who has read/heard any of the many researchers who have spent years examining mental "illness"
That's a gross mischaracterization of the article, which says:
“Researchers are also drastically rethinking theories of how our brains go wrong. The idea that mental illness can be classified into distinct, discrete categories such as ‘anxiety’ or ‘psychosis’ has been disproved to a large extent. Instead, disorders shade into each other, and there are no hard dividing lines — as Plana-Ripoll’s study so clearly demonstrated”
So when you say
> So, trying to categorise "disorders" into discrete definitions with distinct "causes" in order to restore the mind to some "normal" state cannot possibly work.
Yeah, nobody's trying to do that. Researchers are clearly aware of that.
I'm happy for you that whatever mental disorders you were suffering from seem to be receding but the attitude that mental health researchers are stuck is a conventional rut needs to be put to bed. If you're going to refute an article at least refute what the article says and not what you claim it says.
My point is that they're still largely making the same mistakes; yes they're blurring the distinctions between "disorders", but they're not going back to first principles, nor giving due consideration to the coherent and compelling work of other eminent figures in their field.
> > So, trying to categorise "disorders" into discrete definitions with distinct "causes" in order to restore the mind to some "normal" state cannot possibly work.
> Yeah, nobody's trying to do that. Researchers are clearly aware of that.
They are still focused on identifying biological causes for disorders, rather than seeing variations in behaviour – even extreme ones – as adaptations that have been selected for by evolution.
It's articulated here:
> They have a few theories. Perhaps there are several dimensions of mental illness — so, depending on how a person scores on each dimension, they might be more prone to some disorders than to others. An alternative, more radical idea is that there is a single factor that makes people prone to mental illness in general: which disorder they develop is then determined by other factors. Both ideas are being taken seriously, although the concept of multiple dimensions is more widely accepted by researchers.
I sigh at that statement, when several prominent figures in the field, all with advanced qualifications in mainstream medicine or psychology, have been offering coherent explanations and effective treatment approaches for years or decades.
I recently finished Hidden Valley Road and one of the interesting things mentioned was the use of nicotine/anabaseine to improve attentional gating. Apparently due to the acetylcholine release in the PFC. Similar effect to modafinil for attentional switching and alertness.
Philosophically, I think it is true that noone can save someone from the torments of a wayward mind. The trick is to overcome this "powerful elephant" with the intelligent use of the mind in the first place, and tranquilize it by studying scripture, satsanga, and renouncing desire/hope. We must identify not with the mind or thoughts, but with what Kant called the noumenal world, the solar existence, pure consciousness.
Evolution is not proactive. It's passive. Genes introduce possibilities, so are beneficial, so are not.
The mind is plastic. Human "conform" to the world around them. Perhaps the commonness of disorders are the result in common patterns in the human condition, as well as a finite number of genetic contributions?
And of course, there's gut bacteria. A wonky gut often leads to a wonky mind. Perhaps diseases of the mind are actually symptoms of other abnormalities?
Point being... what appears to be a major weakness sometimes turns into a significant advantage.
This paragraph in the article says it all:
As a result, the world’s largest funder of mental-health science, the US National Institute of Mental Health, changed the way it funded research.
Like so much in medical research, efforts are governed by what research will be funded, and ideally what will lead to the discovery of a drug or intervention that can generate billions of dollars of revenues. Those researchers who figured this stuff out decades ago don't need to be considered.
Beginning in 2011, it began demanding more studies of the biological basis of disorders, instead of their symptoms, under a programme called the Research Domain Criteria. There has since been an explosion of research into the biological basis of psychopathology, with studies focusing on genetics and neuroanatomy, among other fields.
"Focusing on genetics and neuroanatomy" is the perfect way to miss the forest for the trees.
But if researchers hoped to demystify psychopathology, they still have a long way to go: the key finding has been just how complex psychopathology really is.
Complexity doesn't have be difficult to understand.
Sigh.
What are those unconventional approaches ?
Having hit my head quite a few times over the past years, I've dug into cutting-edge mTBI (concussion) research pretty hard.
What I learned was that the long-term effects of concussion are now fundamentally thought of as neurometabolic in nature. That is, the loss of metabolic homeostasis within the brain due to an initial trauma. Unless this process arrests, what you're left with is neurodegeneration. How much really depends on the circumstance and patient.
The most striking takeaway I had, was that much of the latest research is suggesting that different etiologies lead to the same pathology in many instances. For example, it may be that you can acquire Alzheimer's Disease, or Parkinson's Disease, or even ALS via way of: chronic poor sleep quality (poor glymhpatic performance), history of frequent subconcussive head trauma (CTE), history of concussive or severe head truama (mTBI/TBI), neuroimmune factors, and of course genetic factors. Often times a combination thereof. That example isn't even remotely comprehensive on either the etiology or pathology side.
Point being, your brain is like a washing machine. If it goes out of balance, sometimes it will only oscillate further out of balance unless the process is arrested.
Psychiatric disorders are much the same way. I suspect it is for this reason that comorbidity is so commonplace.
The interesting part about psychiatric disorders however, is to a degree they can self-reinforce in a unique way. Your behavior and thought literally influence your brain's neurochemical state. Likewise, your brain's neurochemical state influences behavior and thought. I suspect this is why behavioral intervention in conjunction with medication generally works better than medication alone in treating psychiatric disorders.
Of course, it's not as simple as brain chemistry affecting thought and vice versa. You brain chemistry (and as such your behavior and thought) is still subject to effects of neurodegeneration, neurostructural changes, neuroinflammation, immune activation, and so forth.
So what we have is a very, very complex puzzle wherein you have many different factors—often vastly different in mechanism—each affecting the other.
If it's acute (TBI), then almost certainly yes.[1] It's no longer considered a concussion at that point however.
[0] https://www.neuroskills.com/brain-injury/mtbi-and-concussion...
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057689/
Turbofan engines are a far more dramatic example.
That's a great metaphor. Thanks :)
I'd naively think we're more likely to get a useful theory by trying to push a Predictive Processing approach too far for a while and then find a way to incorporate the signaling impact of hormones & ambient levels of neurotransmitters on various feedback loops.
I certainly found https://slatestarcodex.com/2017/09/12/toward-a-predictive-th... useful for overcoming my writing anxiety and issues with motivation.
One thing to understand about this is that they're not making up these dimensions from thin air. The dimensions are found in a data-driven manner using one of several techniques, most of which fall under the umbrella of factor analysis[1]. If you're familiar with principal component analysis or singular value decomposition, it's a pretty similar idea: you find the dimensions that explain as much variance as possible.
Then, once you have the dimensions, you try to make sense of them in some way. You may do something called factor rotation, which will change what these dimensions are, but you always have the same information among those five factors. Next, you have to give the factors arbitrary names. The names are usually given for the purpose of making it easy to discuss the factors. (This is the same way that the "Big 5" personality scale [2] was developed.)
For instance, if you had a factor which included the survey questions "Do you have trouble sleeping at night?" "Does it take you a long time to fall asleep?" and "Do you wake up not feeling refreshed?", you might name this an "insomnia" dimension. Really, it's just making it easier to discuss the math and data (though the names do end up having a big impact on how people think about the factors).
You can do this with survey data, brain imaging data, genetic data, etc. There are many different ways to find these. That means you can look at how they line up with each other. There are many theories and structures, but a popular one is about the "p factor" mentioned in the article which boils it down to a single dimension. I haven't read the literature for a few years, though, so I can't comment on current thinking about factor structures beyond what the article discusses.
But in the end, the idea is trying to find statistics which are useful and meaningful, either in the clinic or else for guiding future basic research. So when they say "how many dimensions are there?", what they really mean is "how many dimensions can we find that are useful?". It's not a perfect solution, but it is a good start.
[1] https://en.wikipedia.org/wiki/Factor_analysis
[2] https://en.wikipedia.org/wiki/Big_Five_personality_traits
The point of models such at this isn't to 'cleave reality at its joints', it's to provide useful frameworks to reason about disease (or politics).
High level concepts such as schizophrenia attempt to given a human understandable account of what Schizophrenia is, why it emerges, and what treatments we may form.
Reductionism of the sort of, "we've looked at every neuron and figured out that 12301231723 of your 3782328372832 brain cells are out of whack" has no explanatory power. The goal of inquiry into mental illness is not to give some physical account of what is wrong with the brain, it is to give an account of what is wrong with the mind.
These brain chemistry accounts of psychological illness really have glaring problems. By definition they exclude all ecological or cultural factors by focussing on some individual's brain. But this is almost tautological, all psychological illness manifests in some sense in the brain.
When some local company pours lead into the river and everyone loses 20 IQ points then that manifests in the brain, like anything else does. However the right framework in that case is ecological.
> All such sweeping hypotheses are premature, says Hyman. “I think it’s a time for much more empirical research rather than grand theorization
So I think it is best to consider this a theory that we all hope is true, which has a slight chance of being true.
Although this may not seem like a crazy idea, some proponents suggest that essentially everything the brain does works in this way. For example, that the cause of schizophrenic symptoms may be due to them holding a very loose predictive model with weak priors; basically that they don't have pre-existing high-confidence predictions about anything, on every level. You and me likely would predict with very high confidence that we are not and can't be a god, but someone with schizophrenia may not predict that with as much certainty due to a general issue with neural prediction.
I am oversimplifying it and may be partially wrong, but I think that's the general. I'd highly recommend reading that blog's series on predictive processing for a much better explanation. The linked post also discusses schizophrenia.
Dead Comment
An ADHDer who repeatedly finds that their distractibility leads to them to fail at obvious tasks and disappoint the people around them can very easily develop symptoms of depression. Would that require having the biological underpinnings of depression?
The treatment for depression caused by other mental health conditions (e.g. ADHD) and Clinical Depression are very different, although they are often comorbid. Generally successful treatment of the underlying condition also makes the depression go away. Giving antidepressants to someone who has ADHD with depressive symptoms (without treating the ADHD, i.e. it's undiagnosed) generally doesn't alleviate the depressive symptoms.
It isn't strictly depression that's a diagnostic criteria for a lot of disorders/conditions, but rather a negative impact on normal functioning and everyday life. Some people are just rendered incapable due to their mental health, unable to hold a steady job or impulsive to the point of committing assault or other crimes. Some people just take it on the chin without getting depressed about it, but others (those with the biological underpinnings of depression I suppose) get depressed or anxious. There's plenty of chronically underachieving people with ADHD who are perfectly happy, and others who experience significant distress.
You have captured my point exactly.
> Clinical Depression is a state of depressed mood without clear cause.
Sure. It is easy to have a depressed mood without clear cause if you just fail at identifying the cause.
Back when I didn't know how to identify aircraft, I saw unidentified flying objects pretty often.
I really struggle to understand where that comes from so I can handle it better. I do believe it developed over time, though. I think it can be reversed. Perhaps that's just a lingering thread of optimism.
I started to think that I was a fucking idiot for being incapable of doing what was expected of me, and what I wanted to do. All my grand plans and projects and ideas seemed to just slip through my fingers, despite best efforts I couldn't (and still struggle to) get out of bed in the morning and get to work on time. It was frustrating.
For me it started when I finished university and I realised I had me entire life ahead of me, and no idea what to do with it. As a kid, sure I had plenty of screwups and a tough time, but I always saw the light at the end of the tunnel, I just had to get through my assignments and exams, finish school, finish university, get a job. Once I had done all that I sort of lost all purpose and identity, I had no idea who I was supposed to be. I had grown up with the concept that I was going to get my degree and find a job, then marry some girl, buy a house and have some kids and I'd live happily ever after, like I thought my parents did. Turns out that's not what I wanted in life, and I really struggled to find a purpose.
I think this is incredibly common for all sorts of people with different mental health issues, not just ADHD, I know plenty of people who've experienced the same descent into a hopeless state. Some turn to Jesus, some to drugs, others just say fuck it and kill themselves.
(I wish they’d change the name of CD to something that avoids the layperson’s concept of “depression” - that alone would help the well-meaning but ignorant people who think it’s just a matter of finding a way to cheer oneself up and certainly nothing to do with serotonin...).
https://www.webmd.com/add-adhd/depression-adhd-link
1. People who are doing okay don't seek out diagnosis. One big example is Bill Gross, the "Bond King" who manages mutual funds - he happened to read the description of Asperger's and realize he had it in his seventies. Psychologists do not see a representative sample of society. If diagnosis A and B are both mild enough to cause some people with it to not seek treatment, but everyone with both to do so, you'll see a correlation between A and B.
2. All mental health diagnostic criteria share a clause that sounds like "and these symptoms cause a significant amount of distress or ill-functioning to the patient." This is similar to the first factor, but happens after people seek treatment; if you tell a psychologist that you aren't having any problems in your life, they do not diagnose you with depression, anxiety, ADHD, etc. It almost doesn't matter what you have going on, if it doesn't cause problems its not worth using medical care on, so it doesn't get diagnosed. And again, if you only have one kind of thing causing you problems, it's more likely to not be severe enough to warrant some kind of diagnosis.
3. Similar to the previous factor, mental health diagnoses are used to gatekeep medical care and social support. So, people who need more resources than they currently have are going to push more for additional mental health diagnoses, while people who are more okay are going to be fine with the first one proffered. Eg, a young woman who is extremely anxious and whose mom yells at her all the time goes in, gets diagnosed with anxiety and prescribed anxiolytics, things are still bad because her mom keeps yelling, so she goes back and gets a depression diagnosis and anti-depressants. Or a school can offer accommodations for ADHD and not autism, or vice versa, so someone with one goes back and asks the psychologist for the other.
In short, there's a general willingness-to-seek-diagnosis that's an obvious latent variable for mental health diagnoses. I'd be more surprised to not find a positive correlation between two arbitrarily picked mental health diagnoses. If there's an outright negative correlation, that's something that would be actually indicative of a biological link of some sort - either the biochemistry of one complex protects against the other, or they're a pair of under/over-activity of a system, or the like.
I went to the doctor in my mid-20s to get treated for ADHD, as it was causing me significant problems in my life, having gone through bouts of anxiety, depression, and suicidal ideation for the year or two prior, which the manifested itself in an inability to manage the negative traits of my ADHD. I've had it all my life, but only realised I likely had it a couple of years prior, but it was never something that caused big enough problems to go to a doctor about, mostly just report cards stating "easily distracted and distracters others".
At the same time I was diagnosed with ADHD, the doctor said it was likely I also had high functioning autism. I guess maybe I have it, but it's not something that's ever caused me any particular problems in life, so the doctor basically said not to worry about it and only to seek treatment (therapy or counselling) if I felt like I needed it. Same story for the ADHD too, he said there was no need to continue seeking treatment if I felt like I didn't need it at any point in the future.
On the other hand, being put on medication for ADHD (clonidine and dexamphetamine) has made a world of difference for me, and I've seen vast improvements in quality of life. Most importantly though has been recognising and accounting for the fact that my mind functions in a different way than most people, and making accomodations (and asking others to accomodate) for this.
Interestingly enough, he also mentioned the possibility of having bipolar disorder as well, but said that it was likely the symptoms were actually ADHD masquerading as bipolar and decided to treat the ADHD first and see if the symptoms remain. Diagnosing mental health issues is a difficult task, a lot of people with ADHD are misdiagnosed with bipolar, or people with bipolar diagnosed with clinical depression. If it wasn't for the fact that I was fairly certain that I had ADHD when I went to the doctor, I wonder what I would've been diagnosed with.
I think the language around mental functioning and disorders isn't great.
If you have Asperger's or ADHD and don't experience distress or difficulty in life from it, then it's not really a mental illness or disorder, it's just a different way your mind works. ADHD has a particularly bad name, it's not an attention deficit to begin with, but rather an inability to chose what your attention is on (you should see me if I'm in a hyperfocus/flow state, it's definitely not a deficit of attention), and it's not always hyperactive. I have primarily inattentive-type ADHD, you wouldn't pick me as having it just from looking at me, I display barely any "typical" traits of ADHD, it's mostly mental for me (mood swings, inattentiveness, impulsiveness, poor working memory, no concept of time, rejection sensitivity and a lack of emotional permanence). I don't think it's intrinsically a disorder either, it's been hugely beneficial in parts of my life, and I don't really want to be labelled as disordered or broken for the entirety of my life, it only became a disorder at a certain point in my life, largely due to external factors at the time. Often it's helped me function above and ahead of neurotypical people.
I know plenty of people with ADHD who don't take any medication and don't feel the need to, and get by perfectly fine in life. My father very likely has ADHD (it's hereditary, and he displays a lot of traits), and has never seeked treatment for it, and he's a very successful man. Same for people with bipolar, autism, or other neurodiverse minds.
I have always thought that mental disorders are no different to physical disorders. We all know some people who are robustly healthy while others seem to get a bewildering array of different diseases. Illness is not randomly distributed.
But then I saw a psychiatrist who inquired about my use of psychoactive drugs. And based on my love of stimulants, he diagnosed me as having bipolar disorder, manifesting primarily as depression. And so he prescribed modafinil, with lamotrigine to reduce the risk of mania.
So I wonder if bipolar disorder is actually relatively common. I mean, I was self medicating primarily with caffeine, and for many years used nicotine to take the edge off. Maybe that's fundamentally why coffee, tea, etc are so popular.
Edit: typo
There's a milder form of bipolar disorder called cyclothymia that is rarely diagnosed unless a patient seeks psychiatric care for a different reason. Estimates suggest it's fairly common, potentially up to 1% of the population.
I was diagnosed with ADHD, with the possibility of bipolar, and also have a sweet tooth for stimulants, both legal and not (I'm basically fuelled on caffeine, nicotine, and amphetamines).
I've also never heard of modafinil being prescribed as a treatment for bipolar disorder either, do you happen to have any resources on this?
Since then I've thought a fair amount about mental illness in general and have a few theories.
1) Diet. Get the right materials into your body so it can do with them what it needs to. Especially early in life while brain is still forming.
2) Exercise. Make sure your body can get sufficient blood / oxygen to all parts of the body so it can function properly.
3) The brain, IMO, should be viewed as a TOOL Sure it is already part of our body but this is why I think it's so overlooked as a perspective. If I decided to do some landscaping and needed an excavator, I would need to learn how to use it, and practice in order to become efficient and effective with my use of it. I think it's same with the brain. New circumstances come up all the time and sometimes the people who experience them have not trained their brains to deal with them in an effective / efficient way. There should be more focus on this sort of perspective / reflection / learning and perform these generally-applicable exercises early in life. Not just math, science, english, etc.
-- There is no doubt in my mind there are going to be SOME genetically relevant issues. But I would be surprised if, once this stuff gets fleshed out further, we don't come to realize most of it was preventable.
I think you're probably right to a large degree. To paraphrase you're basically saying yes, there for sure is a very real genetic and environmental component, however if we simulate a reality where everyone runs their bodies and minds in an optimal manner we'd be far less likely to see all forms of disease including mental illness/psychiatric disorders.
The takeaway is if you're struggling with it, they are both important components that ought to be a part of a wholistic treatment plan.
I was watching something on Health Theory the other day and she psychiatrist being interviewed said they start with an elimination diet and the nutritionists have more success than the psychiatrists.
Food for thought.
Reducing the complexity of the bio-psycho-social model down to "exercise" and "eat better" isn't great.
But there is a percentage of the population that, even with correct diet, exercise, and general mental hygiene, are incapable of surmounting their mental health problems.
Everybody is different, and you can't really apply your personal anecdote to everyone who's suffered from depressive bouts or other mental health issues.
It's incredibly frustrating when people tell me I just need to eat right, or do yoga, or align my chakras and all my mental health problems will go away. It's borderline accusing me of being lazy or stupid for feeling and functioning the way I do.
Meanwhile, the Dodo Bird theory [0] has yet to be disproven, and there are good reasons to suspect that humans are merely smart mammals, rather than special animals who have no peers throughout the rest of the kingdom, which means that psychology and psychiatry are only the tip of a much bigger comparative discipline which handles humanity as a special case rather than as the main system of study.
[0] https://en.wikipedia.org/wiki/Dodo_bird_verdict
Your example of SSRIs is an especially poor one, as SSRIs are well-understood to have been developed by the pharmaceutical industry as part of a panpsychic wellness package which is meant to be sold pill-by-pill to the public [6][7]. SSRIs today are like sugar in the past [8], with a corporate army of compensated scientists ready to study the noise and find useful results from harmful chemicals.
[0] https://en.wikipedia.org/wiki/Project_MKUltra
[1] https://en.wikipedia.org/wiki/Edgewood_Arsenal_human_experim...
[2] https://en.wikipedia.org/wiki/Crack_epidemic_in_the_United_S...
[3] https://en.wikipedia.org/wiki/CIA_involvement_in_Contra_coca...
[4] https://en.wikipedia.org/wiki/Homosexuality_and_psychology
[5] https://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Man...
[6] https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_i...
[7] https://twitter.com/jcbonthedl/status/1159823784242753537
[8] https://en.wikipedia.org/wiki/Sugar_marketing#Influence_on_h...