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Comment by roland00 | Hacker News Reader

Mental Illness as defined by the DSM as not thriving. You can have the symptoms of a disorder, but if you are thriving then you do not have the disorder.

>It can seriously mess someone's life up.

Treatment to try fix someone who is not thriving, is precisely because someone's life is already messed up. Yes treatment may make it worse, but it often makes it better and there are treatment algorithms where we use best practices of how to go from here, and what signs should we be mindful for often when the meds make things worse the doctor should be asking the right questions for there are warning signs when the med is making things worse.

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The DSM is based off the "top" Psychiatrists at the time voting on the illnesses (literally), without scientific backing.

Treatment's don't fix anything, they might lessen one issue and often give a host of other problems that are often more severe. I think more studying of iatrogenics is in order and more data about what "making it better" means -- as often the patient and doctor have different meanings. Again, because there's no physical symptom, you can't say "levels have returned to normal".

If you were feeling depressed but now you feel nothing, is that better?

The DSM can perhaps be viewed as a field guide to systems we can see the outer manifestations of but have limited deep insight into.

> The DSM is based off the "top" Psychiatrists at the time voting on the illnesses (literally), without scientific backing.

What, precisely, would provide scientific backing here, if a vote by professional scientists doesn't count? A vote by academics? A committee of academics, appointed by a prior generation? A team at Harvard, because Harvard is the oldest? A committee appointed by the government?

I believe their problem was with the structure of the process, and not with the composition of the governing body.

As Talanes mentioned -- the problem is with the decision method not the governing body. Again, comparing to the medical industry, where doctors don't vote on the existence or not of a virus causing a problem.

> Mental Illness as defined by the DSM as not thriving

Isn’t that a two-system measure? The person. And their society.

A gay man in Tehran won’t thrive, but the solution isn’t medicating him into submission.

Yes. From page 20 of the DSM,

> Definition of mental disorder

> A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.

> Isn’t that a two-system measure?

Usually, three, because the specific “not thriving” criteria usually have a degree of subjectivity, so it's patient/society/clinician.

Yes, it is, and that's precisely why the removal of homosexuality from the DSM (in 1974) was not a sign of the DSM's authors giving into cultural pressures - it was a combination of the authors avoiding the cultural pressures that had caused the previous edition to list it, plus a realization (after scientific study) that the problem wasn't with the person, it was with their society.

The nature of the scientific method is that we learn new things over time, and the nature of society is that we are all subject to various kinds of cultural pressures, most of which we don't even recognize. The meta-level goal of the DSM - describing those disorders which prevent someone from thriving and are properly treated by psychiatrists - seems sound, even if each edition always needs to be succeeded by a new one.

Doctors kept thinking I had a mental disorder. Several years of horrible experiences with medications were a waste Turned out it was a blood disorder. Proper treatment actually solved problems.

Depression meds just meant I was cool with my mind not working right.

I get some people are bipolar and such, but I think a lot of people have an underlying disorder they’re unaware of.

Part of the diagnostic process is supposed to be checking for "non-mental" things like blood disorders, by doing blood tests and other evaluations. So it sounds like you went through a flawed diagnostic process. Unfortunately that is far more common than it should be. The best way I have found to mitigate that risk is to have an advocate with you (family member or close friend) whenever you talk to doctors or other medical personnel about diagnosis or treatment--preferably someone who isn't afraid to ask tough questions and be skeptical of what seem like cookbook answers.

That was part of if. I had to bring someone to more or less break down in tears or yell at the doctor to get them to listen.

Had several years of only basic blood work run. Check kidney function and the sort. Mri were always clean.

This was across 20+ doctors. I had one that actually guessed correctly, but wasn’t his specialty. The specialist didn’t believe me.

Later I realized the specialist was using very outdated diagnostic criteria. As it turns out this is very common.

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