The boundaries of mental illness

Seed Magazine has an excellent piece on ‘redefining mental illness’ that discusses the limits of labelling mental disorders and whether we can understand disability purely in terms of the mind.

The piece captures the highlights from a recent online blog discussion on the topic and is inspired in part by the ongoing update to the American Psychiatric Association’s diagnostic manual, the DSM-5, due to be released in May 2013.

One of the big changes to the manual is likely to be the introduction of dimensions, so instead of just having to decide whether “you have it or you don’t” psychiatrists will be able to rate symptoms on a sliding scale.

This has been inspired evidence that hallucination-like experiences or unlikely magical beliefs are not restricted to people with schizophrenia or other psychotic disorders, but are also present, albeit to varying degrees, in everyone.

This has led some to argue that we should abandon diagnoses for mental disorders as they’re just arbitrary cut-off points that have no scientific basis.

But if everyone has their own ‘unique dose’ of unusual experiences, like everyone has their ‘unique dose’ of typical daily anxiety, we should see a nice smooth curve when we measure it in the population. Some people have a little, some people have lots, and we should find everyone else in between.

It turns out, that this is not the case with hallucinations, delusions, reality distortions and unusual magical beliefs.

A recent over-arching meta-analysis of all the data from past research suggests that some people show a qualitative difference in the type of psychosis-like experiences they have – in other words, there is a natural break – but this doesn’t match up with who is likely to be diagnosed with schizophrenia.

Here are the authors in their own words:

The weight of evidence suggests there is a nonarbitrary boundary between those with and without schizophrenia. Certainly, the prevalence estimates of the psychometric risk categories indicate that this nonarbitrary boundary is well below the threshold for schizophrenia, capturing approximately 11% of the population.

In other words, there is not a smooth continuum between normality and schizophrenia. In fact, there seems to be clear difference in 11% of the population, but this happens in most cases in people who never become mentally ill.

Less than 1% of the population will qualify for a diagnosis of schizophrenia and only 3% for any type of psychotic disorder involving hallucinations and delusions.

That leaves 8% who have, perhaps what we could call ‘schizophrenia-like’ unusual experiences (as opposed to ‘regular’ unusual experiences), but who don’t ever seem to become disabled.

What this may mean is that defining mental disorders like schizophrenia largely on the basis of certain experiences may be missing the point, because they don’t in themselves cause a problem for most people.

But what this also means, is that the diagnostic manuals will remain very rough guesses until the publishers decided to draw their diagnoses from science, rather than doing science to try and justify their diagnoses.

Link to Seed on ‘Redefining Mental Illness’.
Link to ‘What is Mental Illness’ blog carnival.
Link to PubMed entry for meta-analysis of psychosis-like experiences.

7 thoughts on “The boundaries of mental illness”

  1. That Seed article makes a common but totally false claim – that if abnormal neurological functioning is involved, then that means:

    “there is nothing truly “mental” about these disorders—the disorders are a result of physical problems in the brain. This is a huge acknowledgment for a field that once thrived on such vacuous concepts as the “id” and the “superego.” ”

    The problem with concepts like ‘id’ and ‘superego’ (i notice he doesn’t include the more commonly accepted and intuitive ‘ego’ or any other everyday mentalistic terms, let alone any concepts from clinical psychology or phenomenology) is they are part of a speculative cultish psychoanalytic framework that purported to be based on biological/evolutionary science but wasn’t, not surprisingly since it was dreamed up before the discovery of DNA and the modern Darwinian synthesis, let alone modern cognitive neuroscience.

    I’m mentally sick of people using the failings of psychoanalysis to prop up a failed biopsychiatry!

  2. I had emailed psychologist Nicholas Humphrey in 2006 when he reported in his last book that it is impossible to “flex” your brain. I told him that indeed, via nonwestern energy practice, it is not only possible but I was doing it as I wrote him.

    Humphrey has a new book out “Soul Dust: The Magic of Consciousness” which is about how consciousness is sort of the spiritual connection to science — how it’s a subjective hallucination of sorts that lead individuals to a sense of unshakable transcendence. I haven’t read the book yet but he’s asking Mary Midgley to review it, in light of her critiquing Humphrey for scientism. The book is released for sale in early 2011.

    Now I bring all this up because of this “false paradigm” in psychiatry about hallucinations — how they might not be dysfunctional but rather just part of a spectrum based on brain illusions, so to speak.

    Jim Schnabel who authored a book on military remote viewing has a new response to Jonah Lehrer acknowledging a recent mainstream psychology study published on precognition. Schnabel points out that, as usual, Jonah Lehrer has a patronizing acceptance of this paranormal research. In other words Lehrer pigeonholes parapsychology. On the contrary there’s a vast history of science suppressing paranormal anomalies which are also part of a well-established tradition of study in nonwestern countries — Japan, Korea, China, India all have numerous recent paranormal studies published in their science journals.

    Science is “so close but yet so far” when it comes to paranormal research results. Paranormal psychologist George P. Hansen, author of the “Trickster and the Paranormal,” argues that there is an inherent, structural, subversion of science via the all too true reality of paranormal phenomenon.

  3. Alternative review of the ‘mainstream psychology study’, breaking down what they call the “Bem Statistical Method” which they say reflects flaws in much of psychology pratice today

    Click to access Bem6.pdf

    The alleged phenomena wouldn’t even begin to explain most hallucinations anyway.

  4. The public needs some of this wikileaks information to protect itself. Current light has been shed on some of the relationships that people did not know existed, like the pharma companies being “vital” to the US feds. This relationship goes a long way to explain seemingly bizarre and dangerous decisions made by the FDA in regards to Avandia and psych meds and the explosion of the mental health industry and drugs. People need to know that the approval process for these drugs is heavily tainted by DOD & DOJ interests and the FDA is merely a puppet organization when deciding whether or not to take or give psych meds to their children.

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