Eli5 If Mental Illnesses can be categorised with certain symptoms then surely they can’t be psychological?


If mental illnesses can be categorised according to certain symptoms, for example, Schizophrenia and hearing voices, seeing things etc… then surely certain part(s) of the brain are not working correctly / damaged / underdeveloped etc in all sufferers… just as a broken arm for me is the same as someone 3000 miles away. So why do we say that often say Mental Illness’s are Psychological rather Psychiatric?

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Presumably because the same types of thought pattern appear in different people with the condition

It’s more that our understanding of the human brain is lacking so we can’t look at a brain and go “yup, that’s the problem right here”

In short, we understand the symptoms but don’t understand the physical cause. And even if we can look at a brain scan and go “well….that person definitely has Schizophrenia” we *definitely* don’t know what physical changes we can make to fix that.

There may come a time where our understanding is good enough that it’s treated the same as other physical problems, or it may forever be unknowable.

To describe this weird predicment we use the term “psychological”

It sounds more like your understanding of all of the words and concepts you’re using is not correct, and your misunderstanding of the nature of mental illness stems from that.

Schizophrenia is a poorly understood brain disease that presents itself as psychological symptoms such as dissociated, confused speech, unpredictable changes of affect (emotion), inability to meaningfully relate to other people, etc. Many people even today mistakenly believe that it is “only” psychological. It is a biological brain disorder.

I mean you’re thinking correctly, particularly with society and even doctors needing to get away from the idea that mental illness is “all in your head”. I think especially as neuroscience and neuropsychology advances we’re going to see how even thoughts are quite physical, not only in measurement, but in impetus; thus a physical/mental disorder may have a more physical cause rather than behavioral or an error in mindset, not only in the more obvious “brain disorder” such as schizophrenia, but also in the case of treatment resistant/difficult to treat depression. For example, I’ve talked to countless people who have great lives and are not depressed situationally; some didn’t even experience a trigger event: they just truly don’t enjoy life. This also becomes more compelling when mental illness overlaps with something like fibromyalgia or a chronic pain disorder/central sensitization, as their may be overlapping causes as well. It’s been shown how experiencing emotional loss works alongside the same neural pathways as physical/bodily pain. I have likened this before to a sort of “wound in the brain”.

Some of this may be genetic; some of it my be epigenetic or even an early-natal (like newborn) caused disorder, as suggested with the HPA Axis theory for mental illness.

I know personally that finding the right or decent antidepressant made my whole world different and better. Like suddenly all the things I was doing right suddenly actually *seemed* right to me again, as they hadn’t in years. And I could enjoy things I previously enjoyed again. My depression was like the immediate period following a serious breakup, or after a loved one died: I was in a constant state of grief except there was no determinable cause (at least not any longer). In this light, all the most cutting edge therapy in the world or lifestyle/diet changes aren’t going to make a goddamn difference: especially with anhedonia, you cannot force someone to *feel*.

We need to correct whatever brain error (or perhaps error elsewhere in the body) to actually achieve remission as would be the case with strep throat and antibiotics. Of course good therapy, support system and healthy lifestyle choices are all helpful in giving someone a fighting chance, but they are adjunctive, and controlling symptoms rather than curative. And there is no reason to think treatments cannot at least sometimes be curative in some cases of mental illness given the astounding improvements we’ve already been able to achieve and what we know if its (dys)function.

And then there’s the whole matter of poverty, discrimination, other poorly controlled physical disorder, isolation, and PTSD or chronic trauma. In those cases, it’s less a “physical” depression or mental illness to me than it is an unfortunately somewhat *correct* psychosocial response to your life basically being particularly shitty. In this way, a lot of mental illness could more easily be treated by improving socioeconomic status. It’s also a glaringly infuriating fact considering how many fucking yokels give lip service to saying we need more mental health services. Like no, we need to prescribe these “patients” enough money to fucking not be a constant state of fight or flight (or freeze).

Yeah there’s the matter of resiliency, but even that is at least somewhat genetic of early-natal. Like if your mom was too stressed/traumatized breastfeeding or even couldn’t do it, she might have inadvertently reduced your potential quality of life by 50% or made it harder to cope. Like we’ve all heard of stories of early trauma and poverty crushing a person or turning them into a monster, but we’ve also heard of rare cases of someone breaking through. Foolishly, the upper class heralds that as reason we all just need to “try harder”.

It all goes to say that while we’ve made significant progress, we’re still in the Bronze Age of mental illness understanding and treatment. Like another user noted, we can’t even accurately measure mental illness most times. We have semi-silly questionnaires and crude behavioral observations – which also suck because many with depression simply are good “actors” – hence why so many suicides are preceded by otherwise “normal” behavior. In the case of MDD, you’d think that a fundamental lack of pleasure or will to live in an individual would be enough to clue society and medical professionals to there being arguably one of the worst disorders with which someone could be afflicted. All thought and behavior stems from those features, and in turn an error somewhere in the cycle becomes a positive feedback loop.

Look up Prof. Robert Sapolsky’s lectures on mental illness. He’s surprisingly easy to understand despite being exceptionally brilliant.