Posted by Larry Hoover on February 18, 2007, at 9:48:11
In reply to Re: Everything I believe may be wrong, posted by munificentexegete on February 15, 2007, at 20:36:50
> Mental Illness has been the source of much confusion and debate specifically over the last 100 years in particular.
>
> In my view Mental Illness can only be a synonym for neurological disease:
>
> Mental = Neurological
> Illness = Disease
>
> it is a term of the vernacular, a layman's version of a medical term, nothing further.
>
> As such Mental Illness exists only when neurological disease is identified in a patient.... Illness of any sort can only be defined by its detectable presence in an individual.I much prefer the original Old French meaning for disease, in any case.... from "diseasu", not at peace.
I think you've gone astray from your premise. Detectability is not restricted to e.g. instrumental observations. Illness/disease is still most often detected behaviourally. We "rule out" various potential disorders, rather than verifying one in particular. Moreover, instrumental findings are often found to have provided both false positive and false negative assignments. Neither one precludes disease, but merely our understanding of what disease exists, if any. You are substituting interpretation for raw data observations. It is the difference between knowing something is wrong and what is wrong. There is no a priori requirement to know what is wrong before one can take steps to remedy the discomfort. The nature of the "something wrong" is often enough.
> Parkinson's disease is a Mental Illness, it has a pathophysiology being the decay of the dopaminergic system.
Parkinson's Disease existed, both as a human experience and as a concept, long before we had any knowledge of the pathophysiology. Did it suddenly spring into existence when we discovered the decay in the subtantia negra?
> If we define schizophrenia as an overactivity in the dopaminergic system, then it too would be a Mental Illness. If we define bipolar as the overactivity followed by the under activity of the serotogenic system, then it too becomes a Mental Illness. However, without any pathophysiology schizophrenia and bipolar are meaningless, not mental illness at all, nothing more than metaphoric terms allowing doctors to define the well as diseased.
I don't think a lay person needs to think "dopaminergic" to understand that a schizophrenic is having a different experience of the common reality than they themselves are having. Meanings of words have social components quite apart from their more technical definitions. It is true, most psychological diagnoses are behavioural. That does not invalidate the diagnoses themselves. The absence of evidence is not evidence of absence.
> Redefine them as illnesses by all means, but don't insult our intelligence and expect us to admire the counterfeit.
I am indeed concerned about redefinition going on.
I am always struck by one key element in the diagnostic assessment of psychological illness, such as defined in the DSM. It is the presence of phrasing such as "causing marked impairment/distress"....
Now, I know that diagnoses can be imposed upon the unwilling; distress and impairment are subjective. I prefer to see the psych diagnoses as working hypotheses, rather than as constructs with perfect validation. As hypotheses, the existence of exceptions serves to suggest a boundary condition not yet understood very well.
Consider diabetes. There are boundary blood sugar concentrations arbitrarily setting an exclusion/inclusion decision on the exocrine gland disease. Yet, I have no doubt there are people with lower blood sugar concentrations with undoubtable symptoms of the disease, and those above the threshold absolutely oblivious to the condition. And as to treatment, the dose of insulin required, even the type of it, is not found by a priori criteria. It is found by experiment.
I agree with you that we have only a weak and preliminary conceptualization of the relationship between brain tissue and biochemistry and the resultant cognition and behaviour. I also agree that it is unpleasant to be experimented on (a thesis that I infer from your arguments), yet that is all we have. It is all we have ever had.
Lar
poster:Larry Hoover
thread:732492
URL: http://www.dr-bob.org/babble/20070213/msgs/733786.html