Mental Illness, The Redefinition

I got that “oh, no” feeling when I came across this very short piece in The Atlantic entitled What is mental illness? It was alluding to a blog post about efforts among the American Psychiatry Association committee revising the DSM to redefine “mental illness”. That’s right, these guys want to take the mental out of “mental illness”. The current view is that there is a physiological basis, if undetected, behind what is commonly referred to as “mental illness”. Webster’s Dictionary is still way too good for them. I see serious semantic complications arising from redefining something as something other than what it is defined as being. It’s sort of like we must be dealing with a secret code here. The fact that we are getting an entirely theoretical argument presented in this snippet is not dealt with at all. I know that such notables as Dr. Thomas Insel, the current director of the National Institute of Mental Health, are pushing for this kind of view. I take the contrary view; I don’t think the evidence supports the brain disease hypothesis. The crevasse between the psychiatrist and the neurologist is still broader than these psychiatrists would choose to admit it is. I had to go to the original blog post, A Consensus Emerges, in Seed Magazine to see what was actually up.

Last week, psychology graduate student (and Research Blogging Psychology / Neuroscience Editor) Jason Goldman held a mini-carnival, an online forum inviting some of the top psychology and neuroscience bloggers to weigh in on the question “What Is Mental Illness?”

British psychologist and editor Christian Jarrett answered the question by citing an editorial published in January in Psychological Medicine. The editorial’s writers, led by Dan Stein, argued that a “mental disorder” has five primary factors: It’s a behavior or pattern occurring in an individual, causing clinically significant distress or impairment, reflecting an underlying physical dysfunction, and is not primarily the result of social deviance or conflicts with society. It’s also not just a response to a stressful event like a friend or family member’s death, where it’s normal to expect someone to appear “depressed” or otherwise disturbed for a period of time. Stein’s team is part of the working group for the DSM-V, so clearly their arguments will carry significant weight in forming the new definition.

Dan Stein’s 5 primary factors of “mental disorder”

1. behavior or pattern occurring in an individual
2. causing significant distress or impairment
3. reflecting underlying physical dysfunction
4. not primarily the result of social deviance or conflicts
5. not a response to a stressful event

The idea is to take any strictly unmedical factor out of the equation, and to assume that by so doing psychiatry has become a legitimate branch of the medical sciences way up there with cardiology and endocrinology. The problem with this view is that it is primarily an abstract fabrication based entirely upon bias. We haven’t ruled out, in other words, social deviance and conflicts, or reacting to some traumatic happening, merely by stating that this has nothing to do with that. Proof is called for, and it is not forthcoming.

Looking for a mad gene does not make genes the source of madness. When the source of what some people call “mental illness” is still up for grabs, we can’t say for certain that madness is biological. The psycho in psychobiological, in fact, indicates that all is not of a biological origin. The extent of the biological cause is still, and will continue to be, a matter of depute for some time to come. Social and environmental factors cannot be ruled out entirely, until they can be ruled out, after the evidense comes in, even if theory has blinded researchers researching the subject regarding this matter. If it’s a “brain disease”, find the “brain disease”. This is something researchers have simply not been successful at doing. Alright, if you have not been successful at proving your hypothesis, perhaps it is because your initial premises were just plain wrong.