On Mental Disorders, Part One

One of the major errors that people make when thinking of DSM mental disorders and the like is to think of them as diseases. While this is undoubtedly true for some diagnoses in the DSM, the fact of the matter is that "mental disorder" and "disease" are really very different concepts.

While disease categories are abstractions based on etiology, mental disorders... well, aren't. That isn't even the ideal anymore.

As I discussed in an earlier post, certain conditions must be met for something to be called a disease:

• It must be an impairment of the normal state of the living animal or plant body or one of its parts.
• It must interrupt or modify the performance of the organism's vital functions.
• It must be typically manifested by distinguishing signs and symptoms.
• It must have a distinguishing etiology (which may be simple or complex).
  

The conditions for something being called a mental disorder, however, are very different. Unlike with the concept of "disease", however, these are anything but straightforward.

Going to MedLine Plus, for instance, yields the following definition: "a mental or bodily condition marked primarily by sufficient disorganization of personality, mind, and emotions to seriously impair the normal psychological functioning of the individual—called also mental illness."

In other words, while a disease is an abstraction based on etiology, a mental disorder is an abstraction based on symptoms. While a disease is a process which causes its symptoms, a mental disorder is a label which describes them or a description of them. Classification of mental disorders makes no reference to the why, only to the what. They have no explanatory value whatsoever; to say that a psychiatric diagnosis has any explanatory value whatsoever is to commit nominal fallacy.

Even this, however, isn't really satisfying. What, for instance, does "disorganization" mean? How do you decide whether or not something "impair[s] the normal psychological functioning of the individual"? Heck, just what does "normal psychological functioning" mean?

These questions are important because of the "wiggle room" built into these terms. In the DSM-I and II, for instance, homosexuality was considered a mental disorder -- homosexuals were considered "broken" heterosexuals whose attraction to members of their own sex represented an impairment to their functioning qua members of their gender. Another infamous example of this problem featured a doctor who pathologized the desire of slaves to flee their masters (he considered whipping to be curative).

My abnormal psychology textbook provides a somewhat more clear answer: it defines one as "a psychological dysfunction within an individual that is associated with distress or impairment in functioning and a response that is not typical or culturally expected." (p. 2)

This, in turn, breaks down into four parts. To qualify as a mental disorder, a set of symptoms must:

• Constitute a "psychological dysfunction".
• Be within the individual.
• Be associated with distress and/or impairment in functioning.
• Be associated with (at least one) response that is not typical or culturally expected.

Unfortunately, none of these is quite what it seems. I'll write more on this later, but for now... just keep in mind: a mental disorder is not a disease.

Edit: Corrected an embarassing typo.

On Stereotypes

One of the kindest, most generous people I know is a homosexual, atheistic skeptic. I mention this not because I'm an atheist (I'm not, certain people's claims to the contrary aside) nor because I'm gay (I'm not), nor because I'm a skeptic (this, at least, I am). I mention this because "kind" and "generous" are very much not part of the stereotypes surrounding atheists, homosexuals, or skeptics.

Despite the stereotypes, however, he is all of these things. In fact, the entire list of traits works together quite well: his skepticism, for instance, means that he investigates charities before he gives to them and tries to make sure that his donations actually go to the people he's supposed to be helping. He's skeptical about the charities he donates to precisely because he genuinely cares. I cannot say the same for many people who donate to religious charities, who often care more about appearances or ideology than genuinely helping.

The prevalent stereotypes, however, would pidgeonhole him as the exact opposite of who he is: atheists are often seen as prototypical sinners, untrustworthy and criminal. Skeptics are seen as cynics at best (true skeptics are anything but). Homosexuals... let's not even go there.

Many of the people who know me will know precisely who I am talking about. There is even a possibility that the person I wrote about will read this blog entry some day. I am not, however, writing this to flatter him.

I am writing this to illustrate the point that stereotypes are often misleading. Worse, they are often wrong -- that is, they very often don't even have a genuine basis in fact, but rather are based solely on prejudice or incomprehension.

If this is the case, why do we persist in stereotyping? Especially now, as we're becoming increasingly aware of the manifold harms and errors perpetuated by this sort of thing -- why do it?

The sad truth of the matter is that, as best we can figure it out, stereotyping is the result of normal, adaptive cognitive mechanisms being used in ways that just don't make sense. People, in general, categorize other people in ways that just don't make sense... and then use these categories to reach conclusions that make even less sense.

While I sadly know the answer to why we do it (it's tied up into the normally-adaptive cognitive processes most people rely on to function), the fact of the matter is that we should be smarter than this. We can be smarter than this.

Just question yourself -- repeatedly. Be careful of over-generalization. Realize that in-group differences almost always exceed between-group differences. Keep in mind that people are people, regardless of anything else. Understand that you can misunderstand. Question yourself -- it bears repeating. Understand that statistical significance and practical significance are very different. Realize that "groups" of people -- however they're defined -- are almost always "fuzzy" statistical constructs. Watch out for logical fallacies. Don't expect perfection, mind... but always try to be right.

On Donald T

As part of my studies in autism, I've read Kanner's original article multiple times. The case that I've paid the most attention to -- and studied across multiple articles -- is that of "Donald T"... in large part because it was the first. I've followed it across multiple papers, and even spent a while last year looking for any and all available information regarding him in the literature. The most recent information, however, was in a 1971 followup -- after this, there was no real information on what happened to the first person to ever be diagnosed as autistic.

That changed recently. As I found out this morning, reporters for the editorial and literary magazine The Atlantic (which has a really long and interesting history) managed to track Donald T down and wrote a genuinely fascinating article about him.

Go. Read. Then come back.

Finished? Good.

The article's nowhere near perfect. It gets some things wrong. It has some bad information.

Still, Donald himself is the main point... and I don't think that needs any further remark. The main takeaway message remains: At the age of 77, Donald Gray Triplett, the first person to ever be diagnosed as autistic, is doing just fine.