The legitimacy of depression as an illness. (3 Viewers)

[chelsea girl]

Agreed.

What is people's thoughts on the use of Cognitive Behavioural Therapy in the treatment of depression?

I personally haven't ever found CBT particularly helpful, but that perhaps is due to the fact that I don't suffer Depression on its own. For me, Dialectical Behavioural Therapy has worked far better.

However, I know a lot of people who have been able to overcome their mental illnesses (or at least have them under control enough that they are able to go about their lives in a regular manner) with the aid of medication and CBT. I think it's very important that the patient has a psychologist who really knows what they are doing. I've only ever known one psychologist who I'd consider an expert when it comes to treating Depression with CBT.

 

[KFunk]

We have to be very clear with what we're saying lest it is misconstrued or taken out of context.

People will take your point that it does show there is an interesting moral dimension inherent in psychiatry to mean that it's an everything goes free for all on people who have been diagnosed.

Is misdiagnosis a massive issue? No.

Are the criteria themselves heavily flawed and skewed towards abuse? No.

Are practitioners improperly trained in diagnosing mental illnesses? No.

Where's the problem?

Fair enough. I think gender identity disorder and the various paraphilias are good examples, as is ADHD depending on your perspective on the research (certainly ADHD constitutes a population variant, but the question is whether this difference should be pathologised and to what extent). Psychopathy is potentially problematic in that it seems to be more a problem for society rather than the individual. Some also question the status of personality disorders. There are interesting debates to be had for each of these but I don't have the energy to properly research/argue each case.

I also meant moral dimensions in a broad sense. For example, to label someone as mentally ill has moral consequences in terms of their treatment society, their culpability in the eyes of the law and, more generally, their perceived status as a person. Mental health is tied up with all sorts of concepts like free will, responsibility, personal identity and rationality which are integral to moral discourse.

 

[KFunk]

Nor do I think the majority of these points fall within the scope of this thread, as no one has put forward any real legitimate arguments undermining the current system.

They do insofar as they relate to the project of psychiatry as a whole, which is of great relevance to the legitimacy of depression as an illness (and psychiatric diagnoses in general). Such case studies are often quite instructive.

I don't see why we shouldn't be able to intelligently discuss the issues that come up when examining the legitimacy of psychiatric diagnoses.

 

[KFunk]

Fair enough. I'm not fussed really. Threads go where they please.

If they enter abstract territory I become happy. (Hi - I'm Kieran, and I'm a utility addict <-- warning: colloquial use of a psychiatric category)

 

[Graney]

Certainly, such a shift undermines the categorisation itself. However, it does not thereby undermine the entire DSM, though I feel that it does highlight a very important issue in psychiatry. There are very interesting moral dimensions through much of psychiatry. The research agenda paper for DSM-V explicitly identifies the existence of sociopolitical approaches to defining 'illness'.

I think this is what I was trying to get at before.

I don't doubt the legitimacy of depression at all, but what is the fundamental difference between homosexuality and depression, such that one should be classified as an illness and the other as simply part of the person that should be accepted and embraced?

Both homosexuality and depression have theories of chemical causes and genetic predisposition behind them.

Both homosexuality and depression are correlated with increased incidences of observable, measurable harms. Suicide, particularly teen suicide, is relatively overrepresented among homosexuals.

What is the difference I'm missing?

 

[Graney]

What are the factors behind the increased level of teen suicide within young teens? It's not just about the homosexuality itself, surely? Not an expert in the area, but I'd say it has to do with the way that society responds to homosexauls, the feeling of isolation, etcetera.

Homosexual youth are proportionally overrepresented among suicides among young people.

Obviously other, environmental factors play a strong contributing role (there's a worthwhile study- are elevated suicide rates in homosexuals caused by environmental factors, biological factors, or a combination of the two? If a combination, to what extent does each contribute?). Equally, you could argue that societies approach and attitudes to depression play a role in elevated suicide statistics for that condition.

 

[KFunk]

I don't doubt the legitimacy of depression at all, but what is the fundamental difference between homosexuality and depression, such that one should be classified as an illness and the other as simply part of the person that should be accepted and embraced?

Both homosexuality and depression have theories of chemical causes and genetic predisposition behind them.

Both homosexuality and depression are correlated with increased incidences of observable, measurable harms. Suicide, particularly teen suicide, is relatively overrepresented among homosexuals.

What is the difference I'm missing?

This is where we need a suitable definition of what constitutes an illness. Consider the following candidates (I expect you to spot many flaws - N.B. I don't believe that any one of these models is sufficient to capture the concept):

• Statistical abnormality - something can be considered a disorder/illness if it is statistically uncommon in the population (high intelligence? but not obesity?).
  
  
• Biomedical abnormality - disruption of normal anatomy or physiology (incl. cellular). Note the use of the term 'normal', which itself is in need of definition.
  
  
• Biological disadvantage - things which impair life expectancy and or fertility (ability to reproduce, liklihood of findign a partner, etc)
  
  
• Sociopolitical or moral - the condition in question is judged to be undesirable (skin blemishes?)
  
  
• 'Ostensive' definition- definition as illness according to similarity to prototypes of illness, e.g. we may choose schizophrenia, heart attack and cancer, among others.
  
  
• Individual distress - nuff said

Consider the following cases and how they fit into the above (if at all): obesity, short stature, hair loss, small cosmetic blemishes (e.g. a mole), hypomania, ADHD, psychopathy, moderately weak bones, functional polydactyly, ageing (e.g increased DNA degredation and amyloid plaques in the brain), asymmetrical breasts, asymmetrical breasts following partial mastectomy for breast cancer.

How do you think depression and homosexuality fit into all this?

 

[Graney]

I guess, other criteria having been considered, it basically comes down to arbitrary sociopolitical and moral distinctions. A distinction decided by experts, based on what we believe is sufficiently harmful and undesireable to deserve treatment.

Which is completely unsatisfying.

 

[katie tully]

Homosexuality is a biological disadvantage! If we ignore modern technology, you impair your ability to reproduce when you put two penis's together.

 

[KFunk]

I guess, other criteria having been considered, it basically comes down to arbitrary sociopolitical and moral distinctions. A distinction decided by experts, based on what we believe is sufficiently harmful and undesireable to deserve treatment.

Which is completely unsatisfying.

Part of what I wanted you to note is that this also extends to many classically 'medical' illnesses. In other words, the problem of defining illness is not only an issue in mental health (also, read pages 2 - 7 of the attached DSM-V research agenda if you can be bothered).

I think a number of the aforementioned criteria can be considered in the case of depression. For example:

- Research suggests that depression involves statistically abnormal brain physiology and genetics
- Depression confers decreased life expectancy and fertility (i.e. biological disadvantage)
- Depression is deemed an undesirable state by society
- Depression causes personal distress

It will be interesting to see the progression if/when psychiatry starts to move away from descriptive definitions of mental illness towards pathophysiological definitions (neurotransmitters, genes, cognitive models, etc)

 

[Graney]

I undertand what you're saying, and agree with you.

I read the referenced pages of the DSM and it was enlightening.

I have no response beyond this.

I think a number of the aforementioned criteria can be considered in the case of depression.

Definetly. There's no problem fitting any disorder I can recall within a number of those criteria.

The problem lies in establishing the basis on which to exclude a range of behaviours that fit those criteria, but are not considered to be acceptable as mental disorders or illness. The DSM had a number of worthy thoughts.

The sociological model sounds good

"The simplest plausible sociopolitical definition is that a condition
is regarded as a disease if it is agreed to be undesirable (an explicit value judgment) and if it seems on balance that physicians (or health professionals in general) and their technologies are more likely to be able to deal with it effectively than are any of the potential alternatives, such as the criminal justice system (treating it as crime), the church (treating it as a sin), or social work (treating it as a social problem)."​

 

[stolenhotelpen]

I am really finding it difficult to comment on this thread because what could have been a civilised discussion, has transformed into an aggressive and almost unrelated argument. Is it me or are there a bunch of bored, uninterested people on here just trying to spark a fight?

 

[katie tully]

I am really finding it difficult to comment on this thread because what could have been a civilised discussion, has transformed into an aggressive and almost unrelated argument. Is it me or are there a bunch of bored, uninterested people on here just trying to spark a fight?

It's just you.

 

[stolenhotelpen]

It's just you.

Each to their own I suppose. But I'm almost certain that I am not the only one who holds that opinion, and I was most definitely stating a rhetorical question.

 

[Silver Persian]

Um. This thread is of a surprisingly high standard imo. Much rational debate and discussion as opposed to the usual insanity and vitriol.

 

[Graney]

I am really finding it difficult to comment on this thread because what could have been a civilised discussion, has transformed into an aggressive and almost unrelated argument. Is it me or are there a bunch of bored, uninterested people on here just trying to spark a fight?

Did you read the last twenty or so posts in the thread?

 

[stolenhotelpen]

In fact I did. What is your point?

 

[Graney]

In fact I did. What is your point?

Then you would have seen they were exceedingly insightfull, civilised and considerate, particularly from our friend kfunk. There was some rubbish around the place in the early stages, but it was washed away in a tide of reasoned criticism.

If you disagree that they were civilised, I'd be interested to read your criticism.

 

[staticsiscool]

Imo one of the best most civilised threads i have seen.

All hail king graney for bringing peace and prosperity to ncap etc

restoring order lah

 

[KFunk]

I am really finding it difficult to comment on this thread because what could have been a civilised discussion, has transformed into an aggressive and almost unrelated argument. Is it me or are there a bunch of bored, uninterested people on here just trying to spark a fight?

There are trolls and flamers in any BoS thread (/anywhere on the internet). Learn to ignore or otherwise manage them. Perhaps try to be selective in what your read and respond to? I realise that this can be difficult in a topic like this where emotions necessarily run high.

There are interesting discussions taking place here which you are more than welcome to join if you so choose.