Tea at Trianon: The Future of Mental Health Diagnosis

John Wilson Croker on Marie-Antoinette

"We have followed the history of Marie Antoinette with the greatest diligence and scrupulosity. We have lived in those times. We have talked with some of her friends and some of her enemies; we have read, certainly not all, but hundreds of the libels written against her; and we have, in short, examined her life with– if we may be allowed to say so of ourselves– something of the accuracy of contemporaries, the diligence of inquirers, and the impartiality of historians, all combined; and we feel it our duty to declare, in as a solemn a manner as literature admits of, our well-matured opinion that every reproach against the morals of the queen was a gross calumny– that she was, as we have said, one of the purest of human beings."

~from History of the Guillotine by John Wilson Croker, 1844

Edmund Burke on Marie-Antoinette

"It is now sixteen or seventeen years since I saw the queen of France, then dauphiness, at Versailles; and surely there never lighted on this orb, which she hardly seemed to touch, a more delightful vision. I saw her just above the horizon, decorating and cheering the elevated sphere she had just begun to move in, glittering like a morning star full of life and splendor and joy. Oh, what a revolution....Little did I dream that I should have lived to see such disasters fall upon her, in a nation of gallant men, in a nation of men of honor and of cavaliers! I thought ten thousand swords must have leaped from their scabbards, to avenge even a look which threatened her with insult. But the age of chivalry is gone; that of sophisters, economists, and calculators has succeeded...."

~Edmund Burke, October 1790

Thursday, March 17, 2022

The Future of Mental Health Diagnosis

From Wired:

DO YOU HAVE five or more symptoms of inattentiveness, including trouble staying organized, difficulty paying attention, and feeling easily distracted? What about five or more symptoms of hyperactivity or impulsivity? Have your symptoms been present for six or more months? Do they interfere with school, work, or your social life?

If you answered “yes” to these questions, a mental health professional in the United States may diagnose you with attention deficit/hyperactivity disorder, or ADHD, a neurodevelopmental disorder that’s often treated with cognitive behavioral therapy and stimulants.

But what if the conversation went a different way—less Buzzfeed quiz, more detailed character study? Perhaps, instead of a specific label, you should be grouped with other people who struggle to prioritize long-term consequences over short-term gratification—a big tent that includes not only ADHD but also those with substance use problems and even some personality disorders. Or maybe you don’t need to be labeled at all. Instead of selecting a diagnosis from a big book, a therapist could help you see how what might feel like an internal struggle is really a response to your life circumstances and the power structures that surround you.

These are just two of the visions of psychiatry proposed by renegade psychologists and philosophers working to imagine a different future, free from the unscientific and often-stigmatizing diagnostic labels plaguing the field today.

They face an uphill battle. Psychiatry in the United States and in many places around the world has been dominated by the Diagnostic and Statistical Manual of Mental Disorders, or DSM, for 70 years. The so-called Bible of psychiatry, published by the American Psychiatric Association, is used in prisons, hospitals, and outpatient clinics to diagnose patients, prescribe medications, dictate future treatment, and get it paid for.

Despite its prevalence, the APA has faced consistent criticism for its manual, including its failure to incorporate new scientific evidence, tendency to pathologize “normal” human experience, and the outsized financial influence of the pharmaceutical industry on its formulation. (Read more.)

From Neuroscience:

The study appeared in the journal Translational Psychiatry. Chronically stressed people often show abnormalities in their motor skills, such as poorer fine motor control. However, how these symptoms occur has hardly been studied so far. “We investigated this question in our study,” explains Prof. Dr. Valentin Stein from the Institute of Physiology II at the University of Bonn.

The researchers used mice as experimental animals, some of which they exposed to a stressful situation for a few days. Meanwhile, they used a special microscopy method to take pictures of the rodents’ brains. They focused on parts of the cerebral cortex responsible for motor control and learning new movements. (Read more.)

Also from Neuroscience:

For the first time, researchers looked at the entire duration of such a situation. They found not only changes in the communication of brain regions, but also a dynamic process: Different networks behaved differently during acute stress.

From this, the scientists were able to determine how susceptible a person is to negative mood and how much this increased their risk of mental illness.

Until now, experts knew little about the dynamic processes in the brain during acute stress. Research has usually focused on the brain areas that are active at a given time. Now, however, scientists from the Max Planck Institute of Psychiatry (MPI) and the Department of Psychiatry and Psychotherapy at Tübingen University Hospital have observed what happens in the brain over the entire period of a stressful situation, such as while solving a tricky math problem.

“Our study shows not only where changes occur, but how different brain regions interact and how their communication changes over the course of the situation,” summarizes first author Anne Kühnel from the MPI. (Read more.)