Full transcript of “The source of the problem: what people fail to understand about mental illness”. Click a timestamp to open the video at that moment. Need another video? Use the YouTube transcript generator.
0:00 I'm Dr Orion terban and this is psycha Better Living Through psychology and the topic of today's short talk is what most people don't understand about mental illness the source of the problem so this two-part episode isn't about women or relationships that's okay watch it anyway it may actually be more important for you or someone you know to hear about this so let's get to it right now about one in four American adults are living with mental illness that's 50 million Americans suffering unnecessarily if you're shocked you're not alone because it didn't used to be this way these numbers have only gone up significantly in the past 40 years not only is mental illness extremely
0:47 expensive both to the individuals themselves and to society more broadly but it creates an enormous existential toll on the lives of countless others as well how did it get to be this way and why is it getting worse to answer these questions we have to understand the word reification reification comes from the Latin word re meaning thing so reification kind of means thingification it means to make a thing out of something that isn't actually a thing and if there's one word that will help us understand mental illness it is reification what does this mean this is the the diagnostic and statistical Manual of mental disorders published by
1:33 the American Psychiatric association now in its fifth edition it contains nearly 300 different illnesses this is up from the two mental illnesses first identified by creolin in the early 20th century dementia precox which we might Now call schizophrenia and manic depressive Insanity which we now call bipolar one Disorder so it would certainly seem as though we've made major strides in the diagnosis of mental illness wouldn't it just like chemists 200 years ago didn't know and couldn't know that there were nearly 100 more elements out there Physicians a century ago apparently had no idea that they were missing no fewer than 300 different mental illnesses
2:18 progress but here's the thing none of these nearly 300 mental illnesses can be objectively assessed for all of these illnesses diagnosis is primarily based on self-reported criteria checklists of symptoms this means that you could book a session with a doctor say you've had five of these eight symptoms over the past month which has caused you a lot of distress and boom you now have a mental illness the upshot of this is that in the case of mental illness it's functionally the patient who decides whether and to what extent he is is sick can you imagine a medical system in
3:04 which the patient tells the doctor that he has strep throat or pancreatic cancer or brain aneurysm and that the doctor has no way to objectively confirm that assessment and of course if there were no way to objectively confirm the presence of these diseases then there would also be no way to objectively confirm whether the diseases ever went away with there like pause this episode and briefly consider what medicine would look like if there were no way to trust to test the presence or the absence of any specific disease what do you think would happen well modern Psychiatry provides
3:49 us with a potential vision of what that might look like again there is no genetic or physiological or neuroanatomical or neurochemical or radiological or any objective assessment for any one of these illnesses let's flip through the pages and let the book speak for itself now shall we we can start with attention deficit hyperactivity disorder ADHD that's one that people hear a lot about right ADHD okay here we go Associated laboratory findings there are no laboratory tests neurological assessments or attentional assessments that have been established as Diagnostic in the clinical assessment of attention deficit hyperactivity disorder huh that's odd okay the book continues tests that
4:37 require effortful mental processing have been noted to be abnormal in groups of individuals with attention deficit hyperactivity disorder compared with peers oh really you don't say since often has trouble holding attention on tasks or you know trouble with effortful mental processing is one of the self-professed criteria for ADHD it it's hardly surprising that tests that require effortful mental functioning might be abnormal in groups of individuals already classified as having trouble with effortful mental processing this is because as I'm sure you can appreciate tests don't really have much diagnostic potential if you run them on people who have already been
5:22 diagnosed fortunately the book has the intellectual honesty to admit this circular reasoning and goes on but the tests are not of demonstrated utility when one is trying to determine whether a particular individual has the disorder it is not yet known what fundamental cognitive deficits are responsible for such group differences okay that's fascinating we can't see ADHD on any scan test or assessment but no one today doubts that it exists whereas 40 years ago a boy might be said to be restless probably over the prospect of being forced to sit still 8 hours a day in arbitrary compliance to Scholastic busy work of dubious import
6:09 he is today thought to be suffering from ADHD that is reification now before we go any further if you're liking what you're hearing please consider sending this episode to someone who might benefit from its message because it's Word of Mouth referrals like this that really helped to make the channel grow I'm also proud to announce that I'll soon be publishing my book the value of other so if you'd like to learn more about that then you can go to my website and sign up for my Weekly Newsletter finally please fill out an inquiry form on my website if you're interested in booking a paid consultation link is in the description okay let's get back to it all right but maybe that's just because ADHD is usually diagnosed in children who can't really advocate for themselves effectively what about something like major depressive disorder
6:57 that that affects a lot of adults right okay here we go associate laboratory findings no laboratory findings that are diagnostic of a major depressive episode have been identified H that's weird I mean we give people chemicals to treat that Disorder so shouldn't we be able to see that the chemicals are out of whack before we applied the intervention guess not all right right but that's probably because that's a mood disorder and everyone knows that mood is hazy and subjective right what about schizophrenia H everyone knows that that is the exception it's the gold standard for the biological basis of
7:42 mental illness genetics brain anatomy and all the rest here we go Associated laboratory findings no laboratory findings have been identified that are diagnostic of schizophrenia okay all right so I'm not going to bore you by going through the other 297 disorders they're all more or less the same so are you saying that these are fake problems Orion are you saying that people are just making this up and lying about their suffering no I'm not while malingerers exist I believe the vast majority of people are accurately reporting their subjective experience and that they are actually suffering however I also believe that a lot of this suffering is [Music] unnecessary which is one way to approach Neurosis like my personal definition of
8:28 neurosis is taking a fake problem into a real problem which then absolutely becomes a real problem for instance worrying about the straightness of your picture frames a fake problem while your house is on fire a real problem is actually a real problem both for the worrier and for the people around him now it's actually hard to overstate the importance of this issue as the inability to objectively diagnose mental illness opens the door to a lot of potential squirl one of the most important consequences is that it kind of makes the individual less responsible for the problem he is suffering from and this is kind of by design it was part of the intention behind medicalizing mental
9:13 illness it's cruel to hold people responsible for things outside of their control sometimes people might look strange or act strange through no fault of their own however this does not necessarily mean that they brought this condition on themselves or that they can do anything about it now that it's here so persecuting or ostracizing these individuals just because they're different is heartless and inhumane and it's a big part of why we've collectively come so far from the stigan insane asylums of the 19th century however most mental illnesses are not like congenital or genetically determined most of the symptoms that constitute most mental illnesses are brought on at least in part by the indiv
9:59 idual themselves and these people generally can do something about them now that they're here but reification can obscure this responsibility for many people they believe that being depressed or anxious is kind of like being colorblind or congenitally diabetic there's an issue inside of them that kind of has nothing to do with them that they just kind of have to learn to live with and you can see this understanding reflected in the language that people use to describe these issues for instance as you'll recall has trouble holding attention is one of the symptom criteria of ADHD so when someone tells me H you know I'm sorry Orion I'm having trouble concentrating because of my ADHD what I actually hear is H I'm sorry
10:44 Orion I'm having trouble concentrating because of my trouble concentrating right I mean after all as far as we can tell the symptom is the disorder so you can't really blame the symptom on anything other than itself but reification kind of creates a thing a disorder inside of people that they can blame in lie of assuming personal responsibility over at least that proportion of the variance of the issue that resides within their domain of control now maybe we do have this thing inside of us that for whatever reason we just can't see with all of our Advanced Technologies like that's certainly possible I mean the strong nuclear force wasn't discovered until the 1930s and it
11:30 certainly existed before then so it's very likely that we still can't see many things that in the future will seem manifest in obvious but right now we can't but we act like we can and it's this acting like that in my opinion is creating a lot more problems than it's solving and the biggest problem that it's creating is an inappropriate dependence on a privileged class of Specialists who enjoy a monopoly on the indic at treatment I'll talk more about this in the second part of this episode for now what do you think does this fit with your own experience let me know in the comments below and as always I appreciate your support and thank you for your understanding and now a word about
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