I just wanted to elaborate on a few items from one of my earlier posts titled: “Are Mental Disorders Diseases?”
1. Concerning the metaphorical use of the term “Disease.”
The metaphorical use of the term “disease” is common to many fields such as sociology. For example, let us consider the disease of racism. In this case, the normal or “ideal” functioning of society (physical structure) is disturbed by an agent called “racism.” Approaching racism from this angle helps us to develop a treatment that targets the agent (racism) and to inoculate the society against future infection.
The same goes for mental disorders. The depression disease (agent) affects the normal functioning of the mind (physical structure). The fact that physical abnormalities are not causally linked to mental disorders is irrelevant because we are using the term disease in a metaphorical sense. Again, this approach helps us to target the agent (depression) and to inoculate the mind against future infection.
2. Sufficient vs. Necessary criterion for verifying diseases.
Diseases are verified using objective criteria such as with lab tests, brain scans, X-rays or chemical imbalance tests – meeting these criterion is sufficient for diagnosis. Once the disease has been identified it can either be cured or controlled considerably and we have proof of this, again, through objective measures.
Mental disorders may be correlated with physical abnormalities, but those abnormalities are not sufficient to diagnose the mental disorder (I don’t even think they’re necessary); rather, a number of subjective criterion, which have a tendency to change and evolve over time (e.g. the DSM criteria), are required for making a complete diagnosis. There is no way of knowing, conclusively, via physiological tests that an individual has a mental disorder. Chemical imbalance does not equal depression, but it does equal “Cha Ching!” for Big Pharma.
3. Disease and dis-empowerment.
If I’m diagnosed with Tuberculosis than I basically have one role in my recovery, i.e., to follow the treatment issued by my physician. However, if I’m diagnosed with depression I have a high degree of involvement with my own recovery. Yes, it is true that different levels of severity require more or less external intervention. But my mental disorder is not a disease – it is not beyond my control.
Now, during a class discussion the Type 1 vs. the Type 2 diabetes example was brought up. Namely, that Type 1 is triggered by certain infections and Type 2 is the result of lifestyle. What I garnered from that discussion is that Type 2 diabetes is similar to many substance disorders in that it results from a combination of genetic predispositions and lifestyle choices. I didn’t know much about this so I perused the infallible world of Wikipedia, which confirmed that Type 1 is primarily inherited or triggered by certain infections whereas Type 2 is the result of lifestyle and genetics. After doing a little more reading I realized that the difference between these two types of diabetes doesn’t change anything in terms of our discussion here on mental disorders vs. diseases because, regardless of the Type, diabetes is an abnormality in sugar metabolism that results in high blood sugar. It’s a disease that can be verified through objective tests, which are sufficient for diagnosis.
There is an argument to made, however, for mental disorders that are strongly associated with physical abnormalities such as some developmental disorders, mental retardation, dementia, amnestic disorders, and some psychotic disorders. Perhaps there is a semantic problem here where neither the word disorder or disease fits the bill – but I don’t even like suggesting that. Regardless, what is clear to me is that in its desire to be effective and efficient, the field of mental health is obsessed with achieving semantic precision. Unfortunately, in a field where the co-morbidity between various disorders is extremely high (e.g. substance related disorders are highly co-morbid with mental disorders), precision will probably be difficult achieve.
4. Medication for Diseases vs. Disorders
When we treat a disease with medication we have targeted the disease “agent” that caused the disease in the first place. With time and research a treatment will eventually be found that can destroy the causative agent, which will, in turn, cure the individual of the disease.
On the other hand, psychiatric medication is prescribed under the assumption that mental disorders involve some type of neurological chemical imbalance. The problem is that there is no science to prove that mental diseases result from bio-chemical imbalances. What is being treated with medication are the symptoms of the disorder such as hallucinations and emotional fluctuations. However, these treatments are only effective as long as they’re being used. The moment the patient is taken off of medication the disorder returns.
As I mentioned before, Dr. Kirsch’s (2009) meta-analysis of the effectiveness of antidepressant drugs demonstrated no significant difference between SSRIs and placebos; specifically, he demonstrated a large placebo effect and a minimal drug effect in the treatment of mood disorders with antidepressants. Further, Kirsch makes a strong argument against the chemical imbalance theory of mood disorders.
Finally, there are some brain diseases that have also been categorized as mental disorders such as Alzheimer’s, which are worth exploring. In the case of Alzheimer’s it is known that as neuritic plaques and neurofibrillary tangles increase so does the cognitive deterioration associated with Alzheimer’s (Tiraboschi, Hansen, Thal, & Corey-Bloom, 2004). However, it is still unknown what agent causes this neurodegeneration (Van Broeck, Van Broekhoven, & Kumar-Singh, 2007). Is it only a matter of time before we find the cause of this disease and, hence, it’s cure? I hope so.
Kirsch, I. (2009). The emperor’s new drugs: Exploding the antidepressant myth. London: The Bodley Head.
Tiraboschi, P., Hansen, L., Thal, L., & Corey-Bloom, J. (2004). The importance of neuritic plaques and tangles to the development and evolution of AD. Neurology, 62(11), 1984-1989. Retrieved from EBSCOhost.
Van Broeck, B., Van Broeckhoven, C., & Kumar-Singh, S. (2007). Current insights into molecular mechanisms of Alzheimer disease and their implications for therapeutic approaches. Neuro-Degenerative Diseases, 4(5), 349-365. Retrieved from EBSCOhost.