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Comment by safety1st | Hacker News Reader

Let's leave the diagnoses to the doctors please. The guy was public about being under a lot of stress and that's fine and salient to acknowledge. But it's misleading to use medical terminology unless you're actually his doctor and have evaluated him following the protocols of your profession.

Which we know you are not -- if you were -- you would be bound by patient confidentiality, and not posting a diagnosis here.

So just say his job performance was suffering and he appeared to be stressed. Don't medicalize it.

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I am "evaluating" him as someone who feels he has come unglued in a similarly severe but less public way and recognises a fellow traveller. I'm fully entitled to say this, am I not? It's just my opinion.

I am not "medicalising" it — not least because the medical profession does not recognise burnout as mental illness (because it gets it backward and assumes it is an occupational health issue).

I am saying he is, to me, evidently mentally ill in the way I feel I have been mentally ill. I wouldn't accept a doctor telling me my problems are work stress.

"His job performance was suffering and he appeared to be stressed" is IMO classic American-influenced minimisation of middle-aged male mental ill-health. I would be shocked if what is going on is in any meaningful way limited to his "job performance" and that apart from the job everything else is going fine.

I am only entreating you to be accurate about the terminology used. Due to its historical use by psychologists the term mental illness is generally thought to be synonymous with mental disorder, which is the modern term that refers to a specific illness classified in the DSM-IV which psychiatrists may diagnose. There are only so many of them, and they are defined, and they are diagnosed by name by doctors. To me it is not a matter of sensitivity, and certainly not one of underplaying, but of precision. If you want to diagnose Matt you need to tell us which DSM-IV disorder he is afflicted by and what your authority for the diagnosis is. It sounds like that was not your intent so it would be more clear if you referred to his psychological distress, or sure, "has come unglued"/"lost his mind," or just said he seemed mentally unwell. None of these imply that you're a doctor making a formal diagnosis. They also do not imply that the problem is somehow lessened -- you just aren't mapping it to a definition in the DSM (which ultimately implies some amount of endorsement for treatment, including specific therapies and drugs depending on what you diagnosed). There are unfortunately people out there who will read your comment and take it to mean that a doctor actually diagnosed Matt.

For goodness’ sake, I didn’t “diagnose” him or try to.

If I were to get more specific than “mentally ill” that would be a diagnosis.

But “mentally ill” is not a diagnosis and it wasn’t an attempt at one.

I mean it colloquially based on my own really similar, serious experiences with coming quite unglued due to burnout that eventually rendered me unable to work but before that made me act irrationally against my own interests in a way that has caused me negative consequences.

I consider myself to have been mentally ill. I think it looked like that to people I scared and shocked.

But this wouldn’t be a “diagnosis” either, not least because the healthcare industry doesn’t want to admit or address that it goes further than mere occupational health “thing”.

So would you please fucking stop imagining I did something more specific so you can call me out for doing it.

> There are unfortunately people out there who will read your comment and take it to mean that a doctor actually diagnosed Matt.

No there aren’t. Don’t be silly.

Yes, there are.

Dude, if you use this term, someone out there is going to associate it with "Mullenweg has a diagnosed illness for which therapy or drugs may be appropriate."

You may not like this, but it's a fact. This fact is just a dictionary lookup away.

Please calm your outrage about the world as it is, and accept that there is an established use for this term.

> I am saying he is, to me, evidently mentally ill in the way I feel I have been mentally ill. I wouldn't accept a doctor telling me my problems are work stress.

I'd find it far less acceptable if a doctor told me work stress was mental illness.

You don't know anything about this person, and your case seems to rest on "I know because I've been through it" which assumes your experience is the same as a total stranger's.

> I'd find it far less acceptable if a doctor told me work stress was mental illness.

Goodness me. Sit and think about that for a while.

> Goodness me. Sit and think about that for a while.

You're quite right, let's think further about this.

- A person racing to meet their deadlines.

- Another sweating through a difficult meeting.

- A third using some terrible company software for the first time and feeling his blood temperature rise.

- A fourth softsoaping an angry customer over the phone when all he wants to do is tell him where to do.

By your definition, each of these types are undergoing a spasm of mental illness, since work stress is mental illness.

But then your definition is total bollocks.

I don't know why I get so much hate for saying this and people find it so hard to accept, but I'll say it again.

The term for a formal disease of the mind, as used by the medical practice, is currently "mental disorder."

Not too long ago, the term doctors used was "mental illness."

Therefore when you say someone has a mental illness, you have to think about how the entire medical profession has used that term in the past, and how that may influence perceptions. It is a term that potentially brings in connotations that the individual has been diagnosed with a specific disorder in the DSM-V and this may be leading to doctor prescribed drugs, therapies, different outcomes in court cases, and many other things.

I'm sure many people including OP don't intend to imply that when they use the term. And this is also why you would never call "work stress" a mental illness. Work stress is cause that can absolutely make you unhealthy. It may or may not be exacerbating a mental disorder which a doctor may or may not have formally diagnosed yet. We can have compassion for somebody who's suffering without jumping to the conclusion that they've been diagnosed with a DSM-V disorder. As non-doctors, we should!

These distinctions matter. It's merely paying respect to the facts on the ground, as well as the person in question when we describe their situation accurately.

I think these responses show how much stigma is attached to mental illness, that people abhor someone placing the label on someone else. Despite the fact that, for anyone familiar with it themselves or in loved ones, it's a lot more prevalent and in many more shades and gradients than probably most people realize.

It is not just stigmatized. It is criminalized. A diagnoses can strip you of numerous rights.

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