Back from the country! Here we go.
If illness is biological by definition, then if mental illnesses don't correspond to neural dysfunction then they can't be illnesses.
Unless you're a very strong type of dualist, then you must believe that mental states supervene on neural states, so the only way to argue that mental illnesses aren't real illnesses is to make a kind of argument about the transitivity of "pathological" from the behavioral to the neural level. Is this what you're trying to do?
You could use a transitive argument, but I wasn't trying to and wouldn't suggest that it be used in the OP's paper, at least.
😛 I think you're mistaken about something when you say "neural states," which I'll mention shortly, since you mention it again (fifth comment down I think).
(re: social definition of disease)
Hey, this is not a very strong point. All it means is that psychiatric illnesses are defined syndromally instead of etiologically. This is for a good reason, because we don't know the etiology of any mental illness.
I disagree. I think it's vitally important. Since mental illnesses are defined by a small group of people according to what's deemed to be "right" or "wrong" within a society, you can't help but get flawed definitions. And that's happened over and over. If we don't know the etiology of the diseases, I would argue that we should reserve judgment on the topic until we have enough information to make real decisions. That doesn't preclude using some sort of diagnostic system as a guide, but it does stand in opposition to using a system like the DSM as it frequently is now. Also, I agree with your last comment that "we don't know the etiology of any mental illness," and think it's telling that decades upon decades of research has never succedded in producing this.
But all medical disorders used to be defined in the same way before we knew about their etiology. Ancient physicians used to talk about a syndrome called "stomach ache", in which the patient had a stomach ache. Now we know that this syndrome has more than one etiology, and since etiology is what is relevant for treatment plans, we categorize the disorders etiologically. "stomach ache" could come from the flu, or it could come from bowel cancer, so there would be two radically different treatments for the same symptoms.
Right, so the accurate definition of the problem helped to guide treatment, which was different depending on the specific cause of the disease. As you correctly state, moving away from a broad, symptom-based treatment plan onto treatments based on etiology was a good move. I'm not clear on how this helps your case, but I see how it helps mine....
In psychiatry we have a situation in which depression sometimes responds to one pharmacological treatment, and sometimes to another... this is probably due to differences in etiology within the same syndromally defined disorder, which why the goal for psychiatry in the future is to come up with mechanisms for the disorders.
If this is the future goal, we shouldn't be applying diagnostic tools as if this goal has already been attained. I think this speaks to more accurately finding biological correlates of disorders in order to alleviate symptoms, but I'm not catching how this relates to the original comments.
Hey, this goes back to the concept of "harmful". Obviously there is something biologically different in homosexuals that makes them homosexual. This is kind of a truism since every difference in behavior corresponds to a difference in brain state. Let's also assume that this difference is some kind of dysfunction... well it is on evolutionary grounds, at least. Whether or not it is an illness depends on whether or not it is harmful. If I were a homosexual in a society in which homosexuals were executed, I would be justified in trying to find a treatment to make me heterosexual. In America I would probably be fine. The same thing could be said for any trait, though, including diabetes, provided we cook up some imaginary society in which diabetics are worshipped or whatever, so having diabetes isn't harmful. This just goes to show that the very idea of "disease" has a normative component, but this is obvious, because in order for something to be a disease, it has to be "bad", which is a normative term.
Now things can get interesting. "Something biologically different in homosexuals makes them homosexual." You seem to be holding a sort of binary belief here: That there are "homosexual" and "not-homosexual," and that there's some reliable difference between the two. Does this stance also apply to your beliefs about, say, depression or ADD? That a person either has ADD or doesn't have ADD? If so, I'd say that belief is flawed.
Using sexuality: First off, the idea that there's some sort of binary state for sexuality is just incorrect, and studies on that are not hard to come by. Rather, sexuality exists on a wide, bidimensional continuum. You could contend that there are seperate brain states for each degree of sexual attraction to each sex, but I'd seriously doubt that neuronal differences between people with similar sexual attractions are especially similar, meaning that even if a difference exists I'm not sure how useful that would be. I don't actually think it would mean anything particularly interesting anyway.
Turning to, say depression, if you continue this line of thought things also don't work out especially well. Given that most illnesses can manifest in a variety of different ways, I doubt that the brain state in a person who fills the depression criteria in one way is the same as the brain state of a person who fills it in another way. I'm also not convinced that the brain state of someone who has depression for less than 6 months is different from that of someone who's had it more than 6 months. So, again diagnostic criteria aren't especaiily useful and are completely arbitrary. Even if we could find a specific brain state and "correct" it, that too is essentially meaningless. Conceivably I could find the brain state that causes people to like the color yellow and inhibit it; that doesn't mean that liking yellow was a disorder.
So, you write that homosexuality would be a disorder in one society and not another. It's clear to me that this means that the society is disordered and not the individual. People with the flu aren't sick in one society and not another. You make a hypothetical example of holy diabetics, but I'm not clear on how that pertains. It seems clear to me that even in that society they would still need some form of treatment or die prematurely....
Incidently, homosexuality is not biologically maladaptive. Males aren't in particularly high evolutionary demand. Also, in some animal species, male homosexuals are important to genetic variety--in lion prides, a male lion will sometimes go off and have intercourse with the alpha, at which time all the betas run in and mate with the females. Very useful.
Hey, I'm not sure what you're trying to argue here. Are you saying that there are some mental states that don't correspond to brain states? Because if you are, I think you're wrong. "Biological determinism" just means that everything we think or do is based upon a biological state... which is necessarily true unless you believe in dualist interactionism. Do you agree with that?
The argument is very simple: Let's decide that "douchbaggery" is a mental illness. DB is characterized by people wearing pink polo shorts and popped collars. That's not really so bizarre; let's just assume we convinced some people and got enough votes on committee. The argument is simply that it's stupid to then go look for a DB gene or brain structure and call that a "cause." Even if there is some reliable brain difference in DB patients, say when they see a sale at Abercrombie & Fitch (and, really, there probabaly would be), it doesn't mean anything. Of course there's going to be some biological correlate--there can't not be. I think I covered why a biological correlate isn't particularly important in my first post, last paragraph.
Hi, the current diagnostic system is useful. If we diagnose someone with bipolar disorder, then we know they can be treated with lithium. If we diagnose them with schizophrenia, then we know they can be treated with antipsychotics. If there are a pair disorders whose treatment or prognosis don't differ in anyway, then differentiating between them is kind of useless. There are a ton of reasons a person might get a rash, but if they're all treated by the same skin ointment, and none of them have any difference in outcome, then who cares which one they have?
If that's the way things actually worked, that would be great. But it's not. The DSM is treated as if the arbitrary distinctions are real and meaningful. Earlier you mentioned treatments that work for some people and not others. You also mentioned how much better it was when treatments for stomach aches were based on etiology and not symptoms. Again, I agree, but it's really not that important to the argument.
Hi, in a society in which ADD is no impediment, or is somehow a benefit, then it wouldn't be a disease in that society... but that's irrelevant. It's just like sickle cell trait. In Africa it protects people from malaria, so it's not really a disease... at least we wouldn't want to cure it if we could. In the US its health problems outweigh this malaria protection, so we consider it a disease and would cure it if we could... All this means is that the term "disease" isn't a purely objective one, it doesn't have any special ramifications for mental disease over any other type of disease.
I'm not sure what you mean by "In Africa it protects people from malaria, so it's not really a disease." It does something benificial but it also causes problems, so I'm not clear how anemia is "not a disease" in one part of the world. But, anyway, that's not at all what I was saying. Malaria is a problem because it causes people to sicken and die through infection. Anemia causes people to weaken (and then die, usually, in Sub-Saharan Africa). ADD on the other hand is a problem only because we make it one, and for no other reason at all. Nothing we could do would stop Malaria from being an infection, or anemia from weakening people. There are plenty of things we can do, however, that would make being hyper and figity in a classroom nonproblematic.
So, just so it's clear: the argument isn't "meds don't do anything" or "people don't really get depressed" or even "we shouldn't give people meds" (even though some people believe those arguments to naturally follow this one). The argument is that these disorders are socially defined and so are inextricably linked to what's thought of as right or wrong in society, as opposed to being based on some objective criteria, and that this definition can change based on social changes (which shouldn't be able to happen with a real disease).
