Thank you for posting this article, I enjoyed reading it

Very interesting read and very relevant. Appreciate the share!

Parricide or regicide? It should tell if it was a Prince... this seem odd

This was a great read. It does seem like most people are under the impression that mental health diagnoses are perfectly concrete; in some cases, that the very act of being diagnosed (of being categorised) is a panacea in itself.

I entered a Canadian university in 1977 to study psychology. Part way into the second year, I realized it was all subjective. In other words bullshit. There is NO way to show that any one diagnosis of disorder is more applicable than any other one. I quit and entered a technical trade.

I've struggled to get a mental health diagnosis for years. My therapist confidently assured me that due to this and that criteria, I was not bipolar. My psychiatrist said that it's possible that I am.

I'm gonna keep trying different treatments until I find one that works, and theres something oddly reassuring about the concept that no one really knows, and the whole system is figuring out how to deal with each individual case by case.

I thought that I was just so fucked up that I was confusing to mental health professionals.

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Paul Verhaeghe has a book presenting the arguments against DSM and claiming that r/Freudwasright and has new proofs [ in the 90s made on on fMRI =neuronal level ] by Peter Fonagy et al [ see Wiki]. Title: On Being Normal and Other Disorders.2004. Exists on PDF.

Clinical psychologist here (UK). In my practice, I avoid the 'rush to diagnosis' as much as possible, prefering to talk to clients about their individual experience of suffering—a more or less direct translation of the Buddhist 'dukkha'. For the majority, this helps them avoid the stigma attached to diagnostic criteria, and it frees me from the onerous task of ascribing a label that may, at best, be only a rough fit.

Maybe the right term, which could describe all those diagnoses, just isn't found yet because we are looking at it the wrong way. Maybe all mental illnesses are a kind of PTSD.

While the point on psychology is nice and fine, the points made in terms of medication are pretty biased and potentially damaging.

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Lets remember that forcing a diagnostic label in mental healt is firstly a requirement from the US insurance system

Victim mentality, macdonald mentality, ready made, easy solution mentality loves diagnosis labels. They are useful but they are a tool for clinicians people think the DSM 5 is a recipe book everyone can use

That's definitely not a new concept

I see “mental health” as more of a religion, or a cult, than a true scientific or medical field. There’s a distinct lack of falsifiable claims for it to meet a certain threshold of objectivity.

! GREAT INSIGHT!

The DSM-V, metaphorically speaking IS something of a “recipe book” for components to an individual’s initial plastic, multivariate psychological construction.

As a patient makes progress to wellness, different aspects may be revealed and treated accordingly.

Hi, I know. I'm so grateful for not being yoked to that system.

UK as well, no longer a patient having been discharged despite needing help. How does that work with how limited to non-existent resources are, are you a private practitioner? What about the patients for whom there is a diagnosis that would be a clearer fit?

I have OCD, and finding out about it, while studying psychology, was an entirely positive experience, suddenly I had an explanation of what was going on with my mental rituals, and there were strategies to cope. My first panic attack, before my mum explained what it was and that she had them too, was an utterly petrifying experience as well. The stigma comes from prejudiced and ignorant people, not the patient themselves (I know I'm not alone in finding getting a diagnosis hugely positive), and the labels can be a way to educate them. The prejudiced also tend to think all mental illnesses are the same, and have an image of violent paranoid schizophrenia. I don't think patients benefit from being lumped together like that.

In a way you’re going into a Buddhist philosophy here. The trauma of everyday life, resulting in dukkha, or suffering. Some folks seems like they tolerate the intolerable better than others for various reasons, others seem to have been more traumatized. For some it seems to have possibly made changes to their brain as a result. Diagnosing, treating, and prescribing will probably remain imperfect due to the highly individual and neural-plastic nature of the brain—people are just too unique. We seem to be moving more and more to seeing qualities as on continuums. One end of the continuum it’s a personality trait or character aspect, too far on the other end of a continuum, and it becomes pathological or a symptom if it interferes with functioning. I think it will keep trending this way.

Isn’t it stressful in your body and mind to keep on trying new medications over and over? You have to ween off the old ones before trying the news ones without knowing if you spent enough time on them before stopping.

More specifically, religion with some degree of double blind randomized control trial.

me and my mam used to laugh about my grandmothers neuroses! yeah, we’re not laughing now, but it’s still funny ¯\_(ツ)_/¯

this made me laugh this morning too

I got diagnosed with autism as an adult and I second your experience. It has been super-helpful to know what is going on. Especially since I am very repressed and an internalizer, so I spent my life struggling in silence, which sometimes made me gaslight myself about whether I even struggle at all.

I personally don't disclose to people who I assume wouldn't understand, but I don't feel ashamed by the label itself at all. I do feel ashamed by some of my autistic personality traits because of the negative feedback I got, but that happened BEFORE anyone, myself including, knew I was autistic. Because the stigma isn't (just) about the label, it is about the manifestations of the differences/struggles I inevitably do present and worked so hard to keep under the lid.

Personally I would feel so patronized for not getting the truth because my diagnostician decided I couldn't handle it. A friend got diagnosed with borderline personality disorder recently, or so she thought - turns out her former psychiatrist had already diagnosed or strongly suspected, without informing her. She scrutinized her after receiving the diagnosis from the new person, found out that former provider had known all along, was understandably upset and only now got to access specialized group therapy, which it turns out, helps her tremendously - more than any other form of treatment she had received. Because these labels make you eligible for more targeted support and allow you to connect with people in similar situations. And especially finding community has proven helpful in almost all documented cases.

Adhd in women is commonly misdiagnosed as bpd. Maybe read about inattentive type adhd.

A lot of women dont find the correct treatment until they treat their undiagnosed adhd.

Absolutely. But it's a lot harder on my body to deal with where I am without medication -- random bouts of insomnia, constant anxiety, bouts of depression where I don't exercise or eat right, and self-destructive patterns of drug use.

I do feel that I've spent enough time on each different med before stopping. The side effects in the first two weeks were enough to know that some weren't right for me.

And what I'm on now worked great on the lowest dose for a few months, then seemed less effective, so the dose was increased, and now it helps again. So I've been on the same medication for several months now.

No such thing as a true control sample when it comes to human beings, at least for the conditions wrapped up under the “mental health” umbrella.

Yep, that's another potential diagnosis that's been considered for me. And it's not clear which symptoms are PTSD and which ones are different illnesses.

And then you throw in the confusion of hormonal birth control.

Buproprion has worked really well for me for a while, which seems like a good indication that it's an adhd/depression combination.

My mother was abusive. She is also a doctor, and when teenage me started fighting back, she had me put on mood stabilizers for bipolar. I didn't take them for long, but when I left home that question always lingered for me - am I dealing with trauma or mental illness? Both? Which illness? My ups and downs are extreme and self-destructive.

I did talk therapy for a long time and despite improvements, it wasn't fixing things in a significant way. I was resistant to medication for lots of reasons. Having a hard time trusting doctors, worrying about the effects of trying different medications, seeing my sister use adhd meds to support her anorexia. And also, being worried about the label.

But antidepressants have turned my life around. I can think straight again. I get up in the morning and I want to do things. I can focus and prioritize. Some days I wake up happy just because.

This was a very long-winded response that you did not ask for, but it's all to say: at this point, I don't care what they say I have. I'm just happy that the treatment works.

I’m on cymbalta and vyvanse now, and I’m doing pretty well. I found an amazing doctor on circle medical. Getting actual therapy is my next step. I’m pretty sure i have cptsd from my mom too.

Congrats on getting out. It takes a lot to take care of yourself and advocate for yourself the way you are.

It's not. You are giving them far too much faith and attributing what you wanted to hear from them. I've heard that from every single uncle lost to Fox News and Limbaugh and the hosts themselves for years. It isn't that nuanced, though everyone takes different things from texts.

bpd is borderline personality disorder ... bipolar affective disorder is BPAD

This is a fact. My girlfriend is going to school at northwestern to be a counselor and she said they only get paid if they diagnose a client. So basically if you see a counselor you’re gonna get diagnosed with something.

Idk, seems off to me.

One of the things the scientific method has done to us is that it has conditioned us to think in prescribed ways, largely based on empirical evidence of cause and effect which leads us to seek categories of states and a presumed standard biochemical basis to treat those categories.

The mind ... I use the term mind vs brain to steer away from it as an object ... is much more complex than that. It's states are probably not as discreet as science would want them to be. So, continuum is probably more realistic way of viewing states that be one problematic for individuals and society.

Yes, society! Let's not forget that there is a whole field of social psychology that attempts to understand states of masses of people using psychological approaches.

Makes me wonder, how many dysfunctional states are self-perpetuating and self-reenforcing. The extent to which we see a range of behaviors or continuum.

The question seems to come, how does one break these cycles of dysfunctional states, either in individuals or societies. The soukutiin would seem to be to fundamentally alter the state so that it realigns to a more harmonious one. Whether this be done internally, as in cultivation in an eastern sense, or externally by imposing a set of treatments that alter or reset the state of mind, such approaches might be more helpful.

In any event, the permutations of mind are as many as there are minds. Scientific categorization have not been very successful.

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Oh thanks! I’ve seen them both use bpd, but that would lessen the confusion.

Well I didn’t mean in diagnosis, but randomized control trial in psychiatric drugs/indications.

It's funny, PTSD is the one diagnosis that every mental health professional I've seen has agreed on, and it's the one that I still feel like an imposter when I say it. Some of my coworkers are veterans and the shit they've been through...it's really hard to see myself in the same category.

But from the time I was born til the time I left home, I got up every day not knowing if I would be safe. I didn't know what stability felt like til I made it for myself as an adult. And I'm still training myself to accept that I deserve it, that I'm allowed to set boundaries with people who disrupt it, and that it's perfectly OK to not make everyone around me happy. If you think your childhood was traumatic, then it probably was. Part of the abuse is being conditioned to believe that it's not abuse.

I didn't expect this, but the antidepressants cleared my head in a way that made the things I was learning in therapy click. Like I understood them rationally beforehand, but I had a really hard time practicing them or feeling them. Now I'm able to catch things in the moment, rather than hours or days later.

I'm glad you're doing well!

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Jesus Christ what an abuse of power by a doctor I’m so sorry

There's some interesting science going on around regulation and the brain. My therapist specializes in infra slow fluctuation neurofeedback and his colleagues are finding our brains have a "set point" that the ISFN helps the brain learn to get back to and regulate around. Trauma disrupts the brain's ability to regulate itself optimally.

It also seems that secure attachment throughout our lifetime is a huge component of mental health. There is a lot of data on attachment theory that's replicable and solid. The issue is people not putting that science into practice.

There are categories called other than or not otherwise specified type which basically means we are calling it X but also labeling that you don't me the normal criteria for the diagnosis. I have some diagnosis like that. I tend to smile and get chatty when meeting people and I am also well spoken, polite and with good manners so I don't present as someone with chronic Major Depression amongst some other stuff. Its basically a combination of long time masking of my mood and how my anxiety presents itself. I smile a lot and get very talkative and "social" but its anxiety. I also isolate a lot so I get fairly lonely and when I am in a situation I have to interact with people all the above happens.

I find myself leaning towards the constructivist approach more and more. Not only are diagnostic criteria far from perfect (ADHD criteria for example has been mostly created using only white men) but there are also biases in society that bleed into diagnosis processes. I‘ve heard multiple times that ADHD is such a trend diagnosis right now, from psychiatrists who should know it‘s the most common neurodevelopmental disorder. I‘ve had one certified expert tell me that women almost never experience ADHD and that I can‘t have it, because I could sit still in a chair. The overdiagnosis myth has also made its way to many professionals, resulting in more stigma being put onto patients when they ask for an evaluation.

As someone who studies social sciences it never seized to amaze me with how much confidence these doctors proclaim you can or can‘t have X,Y,Z before even taking tests. I know that this results from their positivistic education but as a patient, it‘s hurtful to be seen as needing a box to fit rather than looking specifically at your individual symptoms and the best treatment for them.

I guess some practitioners don’t put that into practice, but as a practitioner myself, I certainly do. I’m glad you’re working with someone you feel can assist you, and is giving you a helpful treatment.

yea but that NS categories are even more of a clinician thing, because its too easy to put everything into that "non specified" bag

This categorization and atomization problem is pervasive throughout society right now.

I think this boils down to the relationship between duality and reality, and is best viewed through the lens of Tarski's undefinability theorem or Gödel's incompleteness theorems.

TLDR: to create meaning out of the abstract, we have to define things in increasingly atomistic ways, and then separate those definitions into various categories. But this process is also inherently, foundational, false. It’s an approximation.

And yet, there is something of objective reality. Things do exist. It’s a phase change problem where language (and even thoughts) are always going to be a step down from truth.

Dogma —around philosophies, gender, etc— tends to come from believing in the platonic reality of a concept on its own rather than letting that concept exist as a proxy for the bigger gestalt truth.

In relation to this article, mental illness designations are proxies. They are only useful insofar as they keep pointing us to better truth. Few or even none of them represent discreet things that we will still consider true in 100 years. And everyone knows that. Which leaves us with an entire academic discipline that is somehow both our best attempt so far at understanding a lot of really complex truths, and justifiably able to be second guessed at every turn by even moderately educated lay persons.

Seriously?!

capitalism at its finest

Very interesting read but I think it mischaracterizes how academic psychologists/neuroscientists understand the problem. Our system is like Beccaria's because it has to be given the current state of knowledge. We have to define mental illnesses in terms of syndrome (behavioral effects), rather than underlying pathology (causal biological mechanisms), because we don't understand the underlying pathology yet. People need help, SSRI's save lives, and if you're a clinician it doesn't matter if you know why they work or not—they work often enough. And we have to apply general diagnostic labels because our understanding of individual differences is not nearly precise enough (yet) for idiopathic tailoring of interventions.

I cannot wait for the day when we can understand the mechanisms that produce depression or OCD well enough to target our interventions more precisely (or understand why current treatments work and in whom). But we're not there yet. The root of the problem is scientific, not philosophical. I grant that while we wait for better scientific understanding (which could be a long time), we need to be clear-eyed about what these diagnostic categories actually represent. I don't love the DSM either. But I wouldn't go so far as the author, suggesting that "scientists appear to be confused" and are trying to solve the problem by "aimlessly throwing data at the wall." That is not my experience of clinical neuroscience at all.

Trash article

What a joke… I am currently a second year undergrad. I am over half way through my major, and I’ve yet to learn a single thing about diagnosing mental disorders. And that’s the thing, I’m not going to. Clinical psychology is a graduate school specialization, so I don’t expect to learn anything beyond the general basics, let alone the specifics that are taught to graduate students. So you thinking you somehow know everything enough to critique the ENTIRE field of psychology just because you were a second year student is laughable.

The whole thing is a massive joke.

You are correct; I know nothing about psychology! LoL!

Dont diagnose.

Perverse incentives. I wonder how much of worlds problems could be solved just by adjusting incentives a little bit…

Is not a certain amount of mental illness inevitable in the human species?