Most researchers agree that mental disorders should not have names, as it is difficult or impossible to draw discrete boundaries in this complex and poorly-understood spectrum of symptoms. However, as a broad generalization, researchers are the only group who feel this way:
- Doctors like names because then they can provide a diagnosis and recommend action based on the diagnosis
- Patients and their loved ones (often) like names because it is easier to think/say "I have schizophrenia" than it is to describe their factor scores on a myriad of benchmarks
- Drug companies like names because they can develop drugs for specific disorders rather than for a combinatorially large number of factors
- Regulators like names because they can approve treatments and standards of care for a finite number of situations
- Insurance companies like names because it allows them to approve or deny claims in a more straightforward way.
While names are often times arbitrary, they make many things more convenient. I am not saying that I personally agree or disagree that there should or should not be names, only that this is a complex issue with many complexities besides the underlying science.
We used to get drunk and debate the merits of the DSM as undergrads. Most of my friends who went on to get their PhDs still see it as a imperfect but necessary evil. As a researcher, you need a common language to discuss what you're researching. There is value to studying one particular group of symptoms vs another; different ones have different treatment guideless, medications, and potentially common biomarkers. But people don't always fit neatly in these boxes, as the article shows. It's entirely possible someday that we'll move past specific labels, but we don't have viable alternatives to the DSM right now.
I completely agree with your overall analysis, as well as the main point of the original article. The one thing I would add or clarify is that even the phrase "mental disorder" may not be the best way to refer to this class of symptoms/behaviors. I believe that "mental injury" would be both more accurate, and more conducive to healing.
A substantial portion of the things we refer to as "mental illness" are the after-effects of trauma. When you break your leg and you can't walk for 6 months afterwards, people don't say you have a "leg illness". It's not some unspecified thing which caused your leg to stop performing like most people's legs. It's a fracture. If set properly and given time to heal, it will resume normal functioning. If it's never set, or if it gets reinjured, it may lead to a permanent disability.
Minds can be broken as well. Any one who has ever experienced an abusive relationship knows this. Survivors of child abuse know this. A "mental fracture" isn't primarily physical, like a fracture of the leg, but it has a similar effect in terms of impairing the organ to perform its role correctly.
But mental injuries can be "set" and healed, just like physical ones. Perhaps not 100%, perhaps there will always be scar tissue or some version of impaired mobility where the injury occurred. But injuries heal with time, given proper care.
I am aware that this concept is fairly at odds with the western conception of mental health with its myriad disorders, all of which are unexplained and presumably lifelong diseases. I attribute this entire weird world of DSM pseudoscience with its gargantuan and ever-growing list of labels to the massive social pressure against dealing with the actual problem of trauma and abuse.
Correctly diagnosing someone with a "mental injury resulting from trauma/abuse" would lead to some extremely difficult conversations, which most people (even the ones experiencing the abuse) would prefer not to have.
It's like setting a physical injury, but significantly harder because usually you're not dealing with it at the time of injury, only much later.
You find the original source, some event or series of events that caused the psyche to fracture. By fracture I mean caused the mind to operate according to some models that were necessary to survive at the time of crisis, but are no longer adaptive in the normal/real/adult world. You then update your mental model to one that is more aligned with reality.
In other words: go to the source of the pain, unlearn whatever lesson you learned at the time to deal with the situation, learn a different/healthier way of looking at it, and then practice a lot until the new mental model is firmly in place.
This is hard. But it gets easier with practice. And it's much easier than trying to set an injury by taking lots of pain-killers.
> Most researchers agree that mental disorders should not have names, as it is difficult or impossible to draw discrete boundaries in this complex and poorly-understood spectrum of symptoms.
This is essentially it. The names are a fiction. You let somebody say that you or your dependant is "disordered" or what have you, even if functionally they're doing better than most people, and in exchange you get benefits. Insurance coverage, social assistance, access to specialized programs, certain social privledges.
I do wonder if we're absolutely fucking up the minds of a generation of people by giving more and more people the made up labels. They come hand in hand with stigma and insecurity. We've been loosening diagnostic criteria continually on the dubious grounds that we "better understand" mental illness in the past. When it gets down to brass tacks we just decided as society labelling more people as "different" and treating them differently was for the best. Beyond the concern I have for individuals more and more people are qualifying for disability assistance every year and its unsustainable financially.
I do wish we had a model of mental health that was more focused on addressing more granular individual strengths/weaknesses and one less prone to just saying a broad swathe of people who are nothing alike are part of the same "spectrum".
I do research on the topic of the article. I actually initially clicked on it because the title seems so uncannily similar in content to an article I wrote that I thought they might mention something about it. They did not but it's still really salient to me.
The article is sort of strange in that it brings up these issues and then fails to discuss the huge range of research in this area. The p-factor stuff is sort of hot lately but is just one subtopic in a vast area, somewhat controversial, and more of theoretical interest than clinical utility.
Part of the problem is that there are different purposes for classification systems. I think you're right in that categorical diagnoses have all the appeals you mention at least among some subgroups, but those are a little detached from (1) how many clinicians actually think about a lot of problems, and (2) how many researchers think about these things. Putting aside the "syndrome"-favoring clinicians, a lot of clinicians focus more on behavioral patterns, which tend to be very specific, more targetable, and far removed from broad categorical labels. Many researchers are moving away from these categorical labels also, for many reasons, but mostly generally because the patterns you see in behavior don't map onto the categories in the DSM in reality. Think blood pressure or height as analogies for depression or disorganized thinking, rather than Huntington's disease or malaria.
RDoC is important to mention but it's ending up to be about as controversial as the DSM for various reasons. First, it suffers from the same "names by committee fiat" as the DSM, which is problematic when you are dealing with something like neurobehavioral pathology, which can be examined at many levels and from many directions, which is fuzzy and complex, and about which we know very little. Second, despite its noble intents, was kind of developed by neuroscientists with little connection to actual clinical human behavior. I don't mean any offense to them, but when you get together a bunch of researchers, a substantial number of whom study rodent neurobiology, you're going to start losing touch with what clinicians are actually wrestling with in clinical settings. Look for psychosis or subdimensions of psychosis, for example, and it's missing from RDoC. I like to think of RDoC as "revenge of the neuroscientists," people who got tired of trying to connect their research to human public health, and decided to just redefine problems so it's closer to their own research. A similar initiative is HiTOP, which is more phenotypically focused, and uses statistical/quantitative models for classification rather than committee decisions (I'm not saying HiTOP is better, it just is a similar but different approach from RDoC).
I think the issue is not whether or not mental disorders should have names, it's whether or not there are mental disorders per se, or how to best describe mental-neural-behavioral patterns. You need to be able to quantify to study something scientifically, and quantifying implies labeling; the question is how.
- Doctors like names because then they can provide a diagnosis and recommend action based on the diagnosis
- Patients and their loved ones (often) like names because it is easier to think/say "I have schizophrenia" than it is to describe their factor scores on a myriad of benchmarks
- Drug companies like names because they can develop drugs for specific disorders rather than for a combinatorially large number of factors
- Regulators like names because they can approve treatments and standards of care for a finite number of situations
- Insurance companies like names because it allows them to approve or deny claims in a more straightforward way.
While names are often times arbitrary, they make many things more convenient. I am not saying that I personally agree or disagree that there should or should not be names, only that this is a complex issue with many complexities besides the underlying science.
Also, I see nobody has mentioned RDoC yet, which is the taxonomy researchers are starting to use to classify mental disorders: https://www.nimh.nih.gov/research-priorities/rdoc/constructs...