Some people have raised the issue of what defines mental illness, which is made clear in my book, Mental Illness Defined: Continuums, Regulation And Defense (https://bradbowinsbooks.com/mental-illness-defined/). Besides not aligning with the true nature of psychopathology, discrete diagnoses are less humanistic than a continuous characterization, whereby mental health problems range from normal to extreme levels. Take personality disorders, where in clinical practice there is an us versus them orientation. My continuous model of personality disorders views these problems as extreme and enduring expressions of common psychological defense patterns. For instance, avoidance is a normal survival defense when applied to dangerous agents, but when it occurs repeatedly in response to agents offering reward potential it is highly dysfunctional—avoidant personality disorder. We all engage in avoidance but it is the degree that counts, so the client and therapist are not all that different. The same applies to psychosis where based on a continuous model psychotic level cognitions represent the extreme range of thought content, thought form, and sensory perceptual experiences. We all experience psychotic level cognitions during sleep when dreaming, but with psychosis they occur repeatedly in the conscious and awake state, due (from my perspective) to impaired regulation over psychotic level cognitions. Hence, a value of my continuous model of mental illness (aside from aligning with scientific research and not pharmaceutical marketing needs plus our preference for discrete entities to simplify information process) is that it is much more humanistic!
MENTAL ILLNESS DEFINED: CONTINUUMS, REGULATION AND DEFENSE presents a perspective on mental health and illness divorced from financial influence, and one that aligns with scientific evidence. The Diagnostic And Statistical Manual (DSM), which is essentially the diagnostic bible of mental illness, began emphasizing discrete conditions with the third edition (DSM-III). The starting point was Panic Disorder known to those in the pharmaceutical industry as the “Upjohn Illness.” Prior to this newly created discrete entity, panic was viewed as part of anxiety, a more intense expression. In DSM-II it was seen as “anxiety neurosis,”—“This neurosis is characterized by anxious over-concern extending to panic and frequently associated with somatic symptoms.” In 1964 Donald Klein published an article suggesting that panic was a distinct illness, and that these attacks could be forestalled by staying on medication. The study was partially funded by Geigy and Smith & Kline & French suggesting the possibility of bias in his concept. Klein being on the DSM-III task force, apparently persuaded the other members of the anxiety and dissociative disorders subcommittee that his view was correct, and panic disorder became an entity. The following year in 1981 Upjohn marketed alprazolam (Xanax) for this disorder when the market for benzodiazepines was declining. Research funded by Upjohn did not show much support for panic disorder as a distinct entity, but it was a good marketing story. Xanax became one of the hottest drugs in psychiatry by the early 1990’s being prescribed by psychiatrists for this new and widespread disorder.
Industry funded experts establish criteria for discrete disorders as laid out in the Diagnostic And Statistical Manual (DSM), and these experts are often funded by the pharmaceutical industry. Lisa Cosgrove and colleagues (Financial ties between DSM-IV panel members and the pharmaceutical industry) published in Psychotherapy and Psychosomatics in 2006 uncovered some relevant findings. They found that 100% of the “mood disorders” and “schizophrenia and other psychotic disorders” panel members had one or more financial associations with companies in the pharmaceutical industry. As David Healy has stated, “As often happens in medicine, the availability of a treatment leads to an increase in recognition of the disorder that might benefit from that treatment.” Panic disorder is such as example.
Natural entities tend to be continuous and mental illness is no exception. Separate continuums do occur, such as depression, anxiety, hypomania-mania, and psychosis as laid out in the book, but subtypes represent fictions as with discrete categories. Quantitative variation often yields qualitative variation as an emergent property. For example, intense levels of anxiety (quantitative) triggers the fight/flight/freeze response central to panic (qualitative). Likewise, melancholic depression with vegetative features emerges with intense depression. Beyond bias for profit considerations, we are all prone to seeing discreteness to simplify information processing: it is easier on the brain to see distinct items than follow a concept such as quantitative variation yielding qualitative variation as an emergent property. However, if psychiatry and clinical psychology are ever to become true sciences, then fictitious entities to simplify information processing and satisfy marketing needs of pharmaceutical companies must be discarded!
Temperature values for global warming are reported in degrees above pre-industrial levels, with average values dominating. However, it seems far more sensible to report values for regions where global warming is having the most impact, namely the Arctic and Antarctic. On average, we are about 1 degree Celsius over pre-industrial levels, and this frankly does not seem to disturb most people, particularly if defensively downplaying the impacts of global warming. Considering that the Arctic and Antarctic regions are now about 2-4 degrees Celsius over pre-industrial levels, and 3-4 degrees is when runaway negative feedback cycles occur, I suggest that these regions need to be the focus. In researching global warming (see, At The Tipping Point: How To Save Us From Self-Destruction, bradbowinsbooks.com) and understanding how natural entities are highly interconnected, I came to appreciate that it is these negative feedback cycles that will be most telling. They include occurrences such as:
- Open water absorbing more heat, driving more melting of sea ice, more heat absorption.
- Carbon soot on ice absorbing light, melting ice raising temperatures with greater light absorption from open water.
- Melting water from glaciers creating a lubricating surface causing the glacier to slide into the sea, where it melts, leaving less cooling ice.
- Melting permafrost releasing methane, that ramps up temperatures, resulting in more permafrost melting.
Perhaps it is time that we move away from the focus on average temperature increases and emphasis temperature increases in the Arctic and Antarctic where it really counts. Those who spin things to not see an impact of these regions on the overall world and themselves personally, really need to appreciate that all things in nature are connected!