[fredkbloggs]

> part of why mental health is so terrible in the US is that we do a terrible job empathizing with people who suffer from it

This isn't just a US problem, though it may be worse there in some ways. There's also the problem that "mental health" is not well understood scientifically, yet the medical community acts as though it were. You can thumb through the DSM V and find countless seemingly well-defined "diseases" described using the language of science, yet for few is any underlying cause known and very often the "symptoms" are vague and useless for differential diagnosis. Ultimately all of this is defined by a group of people who have a particular agenda that does not necessarily serve the rights and best interests of the individual being diagnosed as potentially "ill".

That does not mean there is no such thing as a disease of the brain or body that affects behavior, only that anyone who tells you they know what behavior is a sign of disease and what is not, or of which disease it is a sign, or the cause of that disease, much less a proper course of treatment, is usually at best guessing and at worst lying. The psychology and psychiatry communities are roughly where the rest of medicine was in the early 19th century: deeply paternalistic researchers with impressive titles and great big books full of fancy language that amounts to little more than guesswork and superstition, who are nonetheless at least trying to pursue difficult knowledge in what they best understand to be a scientific manner, and a much larger body of clinical practitioners who are for the most part little better than self-serving quacks.

Until that changes in deep and fundamental ways, I'm not ready to condemn anyone to forced treatment, nor to criticize any self-treatment short of criminal injury to others. Medicine couldn't save you from TB in the 19th century (too often, it still cannot), and it may well be that neither can it save you from addiction or myriad other brain diseases today. The solution to that was and is the scientific pursuit of knowledge for the future, not the mockery or damnation of those who decline the usually ineffective (or "heroic", or otherwise horrifying) treatments on offer at the time.

> To engage and promote mental health, it is better to try and see where people are coming from. Admitting that it is a rational option is not necessarily an endorsement. If you think it is, you need to reevaluate why you believe that all things rational are identical with all things good.

Very true. Moreover, people are far too quick to criticize others' decisions as irrational when the other person's value system differs from the critic's. Very often the choices being made are rational in the context of the subject's value system, but the critic cannot or will not understand or accept that the subject does not share his or her values (or indeed that multiple value systems are possible), and so criticizes their choices under their own and concludes that they are irrational. A declaration that someone is irrational says a great deal about the critic but rarely anything much about the subject. Getting past this block is perhaps the most important aspect of useful empathy.

[dragonwriter]

> You can thumb through the DSM V and find countless seemingly well-defined "diseases" described using the language of science, yet for few is any underlying cause known

That's fairly common in medicine even outside of psychiatry: typically, a set of related symptoms are identified and named, then later -- often many years later -- mechanisms that appear to occur with and likely generate the symptoms are identified and then later -- often many years later again -- root causes are identified for what causes those mechanism to begin operating.

And quite a lot of non-psychiatric medicine is at the first or second stage (and even lots that gets portrayed as being at the third stage sees frequent revisions to the ideas of the "root causes", so its only really at the second stage with efforts being made at the third stage.)

The idea that the absence of knowledge of root causes is something that distinguishes psychiatric medicine from the rest of medicine is only possible in complete ignorance of the rest of medicine, even if it is very commonly the basis of politically motivated rants against psychiatry on the internet.

[fredkbloggs]

> typically, a set of related symptoms are identified and named, then later -- often many years later -- mechanisms that appear to occur with and likely generate the symptoms are identified and then later -- often many years later again -- root causes are identified for what causes those mechanism to begin operating

Sure, that's still useful. But then it should be used as a catalogue for further study, not a diagnostic tool and certainly not the basis for prescribing treatments that often do more harm than good. And above all, by no means is such an incomplete catalogue appropriate basis for forcibly detaining someone or otherwise dictating what they must or must not do.

Other physicians have, slowly and with difficulty, come to terms with the limits of their knowledge and sometimes even how to communicate those limits to patients. When diagnosis is uncertain or the effectiveness and side effects of treatments poorly understood, advice is (among the better physicians) tempered by an honest effort to convey the risks and benefits given the unknowns. If nothing else, the guidance of Hippocrates still prevails. I don't see that from psychologists or psychiatrists, and the DSM and its current uses form a perfect case study in their hubris. When in doubt, diagnose; when in doubt, treat, whether the patient wishes to be treated or not, with whatever is handy regardless of whether there is any basis to expect it to work. Again, all traits of pre-modern medicine.

If you think I'm being too hard on these disciplines, consider that medicine as a whole -- while I acknowledge its many faults and would not pretend that its understanding or attitudes are anything resembling perfect or complete -- has at least in principle advanced beyond these particular errors. That should offer hope that someday psychology and psychiatry will advance similarly.

[Lawtonfogle]

> You can thumb through the DSM V and find countless seemingly well-defined "diseases" described using the language of science, yet for few is any underlying cause known and very often the "symptoms" are vague and useless for differential diagnosis.

To say nothing of the political nature of declaring something as being a disorder or not. Read about the decision to remove homosexuality back in the DSM-III and the decision to remove pedophilia in the DSM-V and realize how highly political these moves were (many professionals aren't even aware of that change in the DSM-V and unless you pay close attention, a reader could easily miss the differences between pedophilia in the DSM-IV-TR and pedophilic disorder in the DSM-V).

[drumdance]

DSM V is not perfect by any means, but it's silly to dismiss it entirely.

One may as well dismiss diagnosis of plague during the Black Death because germ theory had not been discovered yet.

[fredkbloggs]

I'm not dismissing it entirely, I'm opposing the manner in which it is used by clinicians, politicians, and the judiciary. A work of its nature should be used with the utmost caution and acceptance of its limitations, primarily by researchers. As it is, it's often treated as holy and unappealable writ by the clinical-political-judicial axis.

[bcabs]

I 100% agree that is problem is most evident in the US. I think that this is a key insight - since a lot of people will argue that the problem is universal and not cultural. It's like the US is the perfect fulfillment of the biopolitical regime.

Someone else commented that our culture is broken - I agreed.