[wu-ikkyu]

>Medically speaking a mental illness is no different than a physical illness.

I am a proponent of taking time off for mental health, but I have to nitpick here. Medically speaking, physical illness is different from mental illness. One is diagnosed from objective scientific tests (pathology) while the other is not.

[clfougner]

Afraid that's not true. Around 60-80% of diagnoses in primary care settings are made purely on the basis of the patient history (followed by a brief clinical examination which usually aims at eliciting subjective responses)[1]. In principle it's true that you could find a pathological explanation for all somatic ("physical") diseases which in practice are diagnosed off patient histories (with the exception of diseases for which the pathogenesis is unknown, f.ex. fibromyalgia, IBS, CFS, etc). However - in principle - the same goes for mental illnesses, although the pathogenesis of mental illnesses are generally poorly understood. If you don't think there's a physical basis for mental illnesses though, skim through the figures in this article[2] for a prime example of the ways modern medicine is disproving that. Diagnoses of both mental and somatic illnesses are heavily based off subjective factors, and both mental and somatic illnesses have very real pathophysiological etiologies.

[1] Source: medical school. Not finding a study with exact numbers from a quick search. [2] https://www.nature.com/nm/journal/v23/n1/full/nm.4246.html

[wu-ikkyu]

>fibromyalgia, IBS, CFS

There are objective tests for all of these pathologies, though those tests are often inconclusive in the face of the symptoms.

>If you don't think there's a physical basis for mental illnesses though, skim through the figures in this article[2] for a prime example of the ways modern medicine is disproving that.

There are physical symptoms of mental illness, but as yet there is no proof of physical causes, which is why the chairman of the Department of Psychiatry at Duke University School of Medicine and the DSM-4 stated "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests". You'll find no objective biological tests in the DSM.

https://en.m.wikipedia.org/wiki/Allen_Frances

[alasdair_]

>There are objective tests for all of these pathologies, though those tests are often inconclusive in the face of the symptoms.

Nothing good, sadly.

My wife was in banking for twelve years and worked her way up from a teller to a fairly senior position. Her work ethic was spectacular - she had just two sick days in the previous five years and she was promoted almost yearly, always receiving an excellent review.

A few years ago, she went from having occasional discomfort to waking with fairly severe pain daily. It got so bad that she had to take time off, and eventually took FMLA for a full twelve weeks to see if it would help. It didn't and she was fired soon after.

She filed for disability after being diagnosed with Fybromyalgia. Our lawyer sent her to bother specialist doctors and independent testing labs to get complete documentation. They had her complete various tasks like screwing in a screwdriver, raising a weight above her head for X seconds etc. and then asked her to rate her pain levels and other self-reported things.

In the end, she was denied for disability, mostly because disability is no longer about actually being disabled - it's now about essentially filling the gap between welfare and medicaid. In the written opinion however, the stated reason was that all the evidence was self-reported, implying she could be making it all up (because who wouldn't want to give up a successful and lucrative career for some minimal-level disability payments).

Anyway, I learned two main things:

1. There are no commonly accepted objective tests for pain - it's almost all self-reporting.

2. The disability system in the US is heavily used as supplemental welfare.

[clfougner]

> There are objective tests for all of these pathologies, though those tests are often inconclusive in the face of the symptoms.

No, objective tests are in these cases used to exclude other causes to the symptoms, not to diagnose the mentioned illnesses. These are diagnoses of exclusion[1].

> There are physical symptoms of mental illness, but as yet there is no proof of physical causes, which is why the chairman of the Department of Psychiatry at Duke University School of Medicine and the DSM-4 stated "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests". You'll find no objective biological tests in the DSM.

I'm not disputing the fact that it's not possible to do pathophysiological tests for mental illnesses in current clinical practice, but you're creating a false equivalence by implying that being unable to test for a pathophysiological factor is the same as that factor not existing. There are plenty of pathophysiological changes that occur in mental illnesses [2-4], but for obvious reasons it's not feasible to haphazardly take biopsies of the brain to test for them, especially when the patient history and subjective examinations suffice to make a diagnosis in most cases.

Conversely, my point still stands that the vast majority of somatic illnesses are diagnosed off subjective symptoms - doctors don't bother doing objective lab tests for a cold or a sprained ankle when the diagnosis is glaringly obvious based off subjective symptoms.

  [1] https://en.wikipedia.org/wiki/Diagnosis_of_exclusion
  [2] https://en.wikipedia.org/wiki/Mechanisms_of_schizophrenia#Pathophysiology
  [3] https://en.wikipedia.org/wiki/Biology_of_depression
  [4] https://en.wikipedia.org/wiki/Causes_of_schizophrenia

[wu-ikkyu]

>it's not feasible to haphazardly take biopsies of the brain to test for them

It is feasible post mortem but scientists still have no conslusive proof from such examinations.

>Conversely, my point still stands that the vast majority of somatic illnesses are diagnosed off subjective symptoms - doctors don't bother doing objective lab tests for a cold or a sprained ankle when the diagnosis is glaringly obvious based off subjective symptoms.

That is not in dispute because a cold and sprained ankle are objectively diagnosable post mortem. Mental illness is not.

[clfougner]

You're creating the same false equivalence again by stating that an objective post mortem diagnosis not being practically feasible is the same as an objective cause(s) not existing. In my previous post I linked to multiple pages listing objective causes/mechanisms for two mental illnesses. Diagnosing a mental illness post mortem isn't as simple as finding rhinovirus in a person's nasal cavity, but just because the current knowledge of the disease isn't sufficient to create a satisfactory model that can reliably make a diagnosis post mortem doesn't mean that it can't be done. And if you don't think mental illnesses subside in molecules and physical structures in the brain, where exactly do you think they come from?

Oh, and you kind of can diagnose certain mental illnesses post mortem: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181616/

[wu-ikkyu]

>if you don't think mental illnesses subside in molecules and physical structures in the brain, where exactly do you think they come from?

No ones knows for sure because no one can objectively explain the nature of consciousness and the mind in the first place. That is of course not to say that chemicals do not have a strong influence on the mind.

>Oh, and you kind of can diagnose certain mental illnesses post mortem: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181616/

The study has no control group and therefore is not objective. If you read the Methodological Issues section, you'll see that this is essentially a study of the neurochemical effects of antipsychotic drugs.

[0xcde4c3db]

This is partly because when a specific physiological cause for a "mental illness" is confirmed, it usually becomes its own diagnosis in a different specialty. This happened relatively recently with anti-NMDA receptor encephalitis, which is believed to be responsible for some cases diagnosed as schizophrenia (and, historically, as demonic possession).

[rifung]

> Medically speaking, physical illness is different from mental illness. One is diagnosed from objective scientific tests (pathology) while the other is not.

Isn't this just because we don't actually understand medical illnesses nearly as well as we understand physical ones in general? I don't we actually know that there is anything innate about mental illness that makes it different from physical illness in this sense. That being the case, mental illnesses are just like those physical illnesses that we have yet to understand as well no?

Please correct me if I'm misinformed as this is a topic that I am very interested in.

[TheSpiceIsLife]

As a counterpoint, there are no objective scientific tests for, say, back pain or neck pain or nausea or menstrual cramps.

[wu-ikkyu]

That is because pain is not a disease, it is a subjective experience (or symptom) generated by the nervous system.

[gpawl]

So? A disease (or injury) is what causes the pain. Why the specious distinction?

[TheSpiceIsLife]

Fair point. Counterpoint: in the sense that it is dis-ease (the absence of feeling well and easy going) it may still be a sufficient reason to take a day off work.

[wu-ikkyu]

Agreed. You shouldnt need a diagnosis to take a day off work

[calafrax]

A doctor administered evaluation or a patient self-survey is just as objective as any other test.

These tests take a measurement and based on peer-reviewed statistical studies make a determination as to whether or not the measurement falls into a pathological range.

This is exactly the same as measuring blood pressure or cholesterol. You read a number and decide if there is a statistically valid correlation between that number and an identified disease.

[alasdair_]

This isn't true. These tests are NOT objective if the patient has an incentive to lie about their self-reporting, either in the stoic "it's fine" sense or in the "I want more opiates" or "I want to get some paid sick days" sense.

[wu-ikkyu]

>patient self-survey is just as objective as any other test.

Subjective: based on or influenced by personal feelings, tastes, or opinions.

Objective: (of a person or their judgment) not influenced by personal feelings or opinions in considering and representing facts.

[calafrax]

What is the difference between being depressed and "feeling" depressed?

What is the difference between being schizophrenic and having the "opinion" that Satan speaks to you through your neighbor's cat?

Mental illness is defined by what a person feels and believes.

What you feel and believe is subjective but you can objectively establish that a particular cluster of subjective feelings and beliefs is abnormal vis-a-vis a populate.

Then when you ask people the same questions and their cluster of responses fits the abnormal definition you can objectively say that they have a mental illness.

The objectivity does not come from the doctor observations or patient self-survey, it comes from the study that created the questions and proved that a certain score or cluster of responses is statistically abnormal.

[alasdair_]

> >What is the difference between being depressed and "feeling" depressed? >What is the difference between being schizophrenic and having the "opinion" that Satan speaks to you through your neighbor's cat? >Mental illness is defined by what a person feels and believes.

Honestly, a lot of the time it comes down to observable impact. If a patient comes to a doctor and says that they feel depressed, that's one thing, if they have lost their third job this year because they can't do anything but lie in bed and seem to not care about their own lives (especially if they used to not be like this in the past) that's something else.

[thanatropism]

Not what you asked exactly, but response to drugs sometimes leads to an (objective) differential diagnosis: if someone is depressed and flips out in a manic attack when starting antidepressants... that's not Major Depressive, that's Bipolar.

How do you objectively verify "manic"? You can track hours slept. No one fakes sleeping two hours a day for a month while having, say, good motor skills in the daytime.

This matters because recurring brief hospitalization is necessary for some people to get back on their axis. This is NOT "sanity days" or "mental healing", it's a clear cut medical issue.

[gpawl]

Is "asking a patient how much they sleep" the same as "watching them to measure how much they sleep"?

[dragonwriter]

> Medically speaking, physical illness is different from mental illness. One is diagnosed from objective scientific tests (pathology) while the other is not.

Not all “physical” (the term is not really the correct distinction, since all illness, including mental illness, is physical) illness is diagnosed directly in that manner (not all physical illness can be, because not all is understood well enough to have definitive tests, and it's not always clinical practice to do so even when it is possible in principle.) And, on the other side, some psychiatric conditions have lab tests of the same sort available.

[wu-ikkyu]

>some psychiatric conditions have lab tests of the same sort available.

Which ones?

"psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests" -Allen Frances

https://en.wikipedia.org/wiki/Allen_Frances

[dragonwriter]

Schizophrenia had one on the market briefly, and there is one for bipolar disorder that is (or was, as of last year) in clinical trials.

See, e.g., http://www.thedailybeast.com/can-a-blood-test-diagnose-menta...

[wu-ikkyu]

Do you have a source for these claims? Because the DSM-5 says otherwise

>Diagnosis is based on observed behavior, the person's reported experiences, and reports of others familiar with the person...As of 2013 there is no objective test. [5]

https://en.m.wikipedia.org/wiki/Schizophrenia

Edit: the source you edited in simply states the corollary to what I've been saying all along: that scientists are still searching for a biological test for mental illness but as yet still do not have one

[cbtacy]

wow. ummm... yeah, that's straight mythology. you should read up on brain scans before spreading old falsehoods.

[wu-ikkyu]

>Given how much we've learned about the role of the brain in mental illness, many people are surprised to learn that we can't know what psychiatric diagnosis a person has—or even if the person has any diagnosis—by examining that person's brain.

https://www.scientificamerican.com/article/can-brain-scans-d...