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Comment by lazide | Hacker News Reader

That is definitely not how it is defined through - it seems to be a straw man?

The criteria is essentially ‘you meet these criteria AND it causes clear problems with your ability to live your life’.

It doesn’t mean you have a bad job and X, therefore you have ADHD. Rather, you show ADHD traits and they get in the way (and cause you distress) in doing a job you otherwise would be entirely capable of doing. Or consistently fail (and have distress) on social environments you’d otherwise be perfectly fine in, etc.

If you don’t have a criteria like that, there is no useful criteria at all, since practically all medicine is oriented towards fixing things that aren’t working correctly/causing problems.

It’s the same type of criteria used for evaluating everything from heart disease to stroke to a broken bone. Or in other words ‘if it ain’t broken, then it isn’t broken.’

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That is absolutely not how strokes and broken bones are diagnosed. If one of your bones breaks, you have a broken bone. Whether it hurts, or stops you from doing things you'd like to do, is an unrelated question.

I think you're missing the point. Let me be concrete.

I'm diagnosed with bipolar disorder. Sometimes I feel axnious and euphoric, other times depressed and lethargic, both at extremes noticably deviant from the average person. This has caused all sorts of turbulence and distress in my personal and academic life. Being diagnosed allowed me access to therapy and prescriptions.

There exist plenty of people who oscillate between distinctively high and low moods, but have never found themselves in serious distress because of it. Thus, they have not been diagnosed with bipolar disorder. Whether or not they "are bipolar" is a subjective question that mainstream psychiatry doesn't seem to have an opinion on.

But also if you have schizophrenia, but all the people around you -for some reason- have chosen you at random to aggressively reward your schizophrenia and lavish you while also threatening that if the illusions stop, they will kill you, then schizophrenia really isn't a problem, in fact it's the best thing that ever happened to you. Saves your life every day.

But it's still a thing. Maybe you can't refer to it as a disorder, but you are hallucinating stuff. It's a set of material facts about your mental state.

Some of Donald Trump's various disorders have objectively rewarded him, generously. But he has those conditions. He doesn't not have narcissism just because his narcissism is good for his bottom line.

I think the issue is that medical criteria are functional- what should doctors do about this. If it's not even bad, they shouldn't do anything! And this gets translated as "nothing is there to treat" but shouldn't be translated as "nothing is there to notice"

So when you find a person whose highs are higher than yours, and whose lows are lower than yours, and whose life is better than yours, that person doesn't have bipolar disorder, because they're not experiencing problems.

Which makes the idea of "bipolar disorder" meaningless. That person demonstrates that your problems are not caused by bipolar disorder. But the disorder is defined by you having problems, even though the problems come from somewhere else.

> whose life is better than yours, that person doesn't have bipolar disorder, because they're not experiencing problems

Your argument seems to hinge on this idea that a good life => no distress, which, if you've interacted with anyone diagnosed with a mental disorder, is obviously not true.

My life is great. If I didn't take a mood stabilizer, it'd probably still be good, but not as good. Regardless, my mood swings can negatively affect me and those around me.

If one day I reach a point where I can live without meds or therapy and reap no negative consequences, then yes, it would be fair at that point to say that I no longer had bipolar disorder.

> That person demonstrates that your problems are not caused by bipolar disorder. But the disorder is defined by you having problems, even though the problems come from somewhere else.

Bingo. My symptoms (mood swings) + my problems ARE the cause my bipolar disorder diagnosis. Until I had problems, I had no disorder.

What causes the mood swings, then? Genetics, upbringing, life experiences, diet, idk. Nobody knows for sure. It's an active area of research, but there is no one known cause. For all we know, there may be five independent and unrelated risk factors that lead to someone developing bipolar disorder.

It's like you get it, but you're still dismissing it for some reason. I'm curious what ulterior point you're trying to make.

Mental disorders are an interaction of a person's characteristics and the environment they are in. That doesn't make them meaningless.

Someone close to me broke their arm, and had to have it pinned. As it healed the bone rotated and shifted slightly.

In discussing whether they'd need to try to correct this movement via surgery, the doctor very much said "it's a problem if it's a problem". When it fully healed the person had full use of their arm, so the doctor was satisfied with the outcome.

The doctor did also say that different countries had different philosophies on what they expected a healed bone to look like. In their experience Canadians were more likely to be OK with an imperfect solution, but Australians were more likely to want the break healed in a "like new" condition.

This is akin to totalling out a car for cosmetic damage - are you trying to fix it back to as it were (may be impossible or exceeding costly or risky) - or is it working to get it back to good enough?

And circumstances make this different - a sports star is going to want to do everything to improve performance, whereas an office worker may just want functionality.

But it is absolutely how broken bones are diagnosed! We don’t run around randomly x-raying the population. We have ERs and similar places where those who are hurting go and there we try to answer what is the cause of their pain. If you have a bone broken but its not causing pain and not affecting you in any way how would we even know it? Now this is vanishingly unlikely with broken bones, thus not something we have to worry about much consciously.

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