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.

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.

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.

Very interesting read and very relevant. Appreciate the share!

Trash article

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

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.

Thank you for posting this article, I enjoyed reading it

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.

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.

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.

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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.

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

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.

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