Tuesday, April 13, 2021

Draft Attempt - What Are Mental Health Disorders

 Do Mental Health Disorders Exist?

Define exist. Yes, for some that may become too abstract. But the goal here is an operational definition. We're taking on the subject of what's "real", and there's no getting past that being a complicated question. Will try to be as pragmatic as possible and avoid the deep philosophical weeds.

To start with, I want to state my position that emotional distress is absolutely and unquestionably real.

This is not a story about distress itself, but about how society thinks about distress. A prominent concept is that of mental health disorders. We have concepts of post-traumatic stress (PTSD), schizophrenia, clinical depression, autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and more. And a question arises with all these disorders. A very divisive and controversial question. How real are these disorders? Do they exist?

Again, define exist.

These concepts are, in essence, classifications. And a classification system is a weird thing that is both real and not real, depending on what's meant by real. Let's start with a less high-stakes bit of subject matter - color classification.

Are pinks, scarlets, burgundies all kinds of red? Is teal a blue? Is orange a kind of brown or is it it's own thing? What seems uncontroversial is that each individual shade of color, in and of itself, most definitely exists.

Color is physically based in light. Our eyes have rods and cones to pick up that light. Light has different wavelengths, and the interaction of those wavelengths, combined with rods and cones, is what gives rise to color.

But, how to classify all those shades of colored light coming into our eyes? Colors, especially the broader categories, have a great deal of subjectivity to it. In can vary from culture to culture and vary over time. One example is how, in ancient Japan, blue and green had the exact same word- "ao". Blue is shade of "ao" and green is a shade of "ao". If you travel to Japan, traffic lights are blue instead of green, and the reason traces back to ao.

Now, getting back to classification and the tricky nature of reality, we have a question. Does "ao" exist?

In ancient Japan, "ao" meaning a singular color that covered blue and green? It's real. In modern English though, there is no such concept as "blue and green are one thing". They are two things - two separate colors. So, is an American sense of "blue" real or not? The answer might be yes or might be no. It's a cultural definition. The underlying entities being grouped - individual color shades - are objectively real. The classification words though. They are cultural conventions. There’s not a physical, mechanistic underpinning for “ao” specifically. There’s not a physical, mechanistic underpinning for the English word “blue”.

But there is one classification system that is objectively supported by quantifiable physics and biology. Most (not all) human eyes have three kinds of cones. One is sensitive to blue light, one is sensitive to red, one is sensitive to green (that is a slight oversimplification). Three kinds of cones gives rise to three primary colors - red, green, and blue. All other colors can be created as mixes of red, green, and blue, which corresponds to sensitivity of the three cones in our eyes.

In addition, there are three secondary colors. Red + blue is pink. Green plus red is yellow. And blue plus green is teal.

So we have three “real” primary colors and three “real” secondary colors. Six main colors.

But in ancient Japan, there were “colors”of blue, teal, and green. Only “shades of ao”.In modern English, there is no primary blue and teal, only “shades of blue”. Green is not a shade of English blue, but is a shade of Japanese “ao”.

But we treat teal and blue and shades of blue, while we treat yellow as a separate color from green. Even though pink is, in color theory, equal parts blue and red. And teal is equal parts blue and green.

And while Americans treat teal as a shade of blue, a segment of Russians up to modern times consider teal to be a "not blue". In Russian the word "sinij" refers to dark, primary color blue. While "sinij" refers to teal as a separate, distinct color, in the same way that pink is not red in English (though this is currently changing in modern Russian semantics, as the language moves to a more Americanized conception of teal as a shade of blue and not it's own separate color).

So we have distinct, mechanistic meaning for... Blue - primary color Green - primary color Teal - secondary color

And culturally defined conventions of ...

"ao" - a single color comprising of blue, green, and teal shades "blue" - a single color comprising of blue and teal shades "sinij - a single color comprising of primary blue

All that to arrive at the illustrative question - Is "ao" real? Is "blue" real? In ancient Japan, there is no such thing as American "blue". It's not real for them, not expressed in that form of classification. The term "blue" doesn't exist, only "shade of ao" exists.

Bringing this back to mental health diagnoses, the point to make is that every diagnosis is of the same level of existence as "ao", "sinij", and "blue". It's a culturally-based classification of a set of actually real things. And, with that understanding, we arrive at something critical to understand about diagnosis...

With main colors in a culture, the underlying items being grouped are all the shades of colors. Those shades certainty exist. And those shades have a very high level of physics-based and biology-based mechanistic understanding. One that supports a very objective, measurable theory of color. There are three primary colors - blue, red, and green - that correspond to three types of cones in most human eyes (some humans have fewer or more kinds of cones). There are three secondary colors - pink, teal, and yellow. And that's our objective color system.

With diagnoses - we have this collection of disorders. The disorders attempt to group the experiences of human thoughts and feelings. The thoughts and feelings are very much real. What we don't yet have is a fully defined objective, physics-based and biology-based mechanistic understanding of human disorders or personalities.

That's the point trying to be made about diagnosis. The experiences are real. The classification has subjective elements. And, moreover, the direct link to a physical cause is often unknown. We simply do not have enough of an understanding of the human mind to say, in specific and perfect detail, what gives rises to certain thought styles or behavior patterns. Nor how much is "born with" versus "could happen to anyone through environment".

And that fact does not mean that underlying biological factors exist or don't exist. We simply can't fully say one way or the other.

Also problematic - the experience of pain is subjective. We can't experience the direct thoughts or emotions of another. Sometimes it's so obvious and relatable that we almost assuredly get pretty darn close. But we can never directly measure it in the same way we can, for example, measure weight or temperature or light levels.

It not being measurable does not mean it's not real. But it's fundamentally different phenomenon to study and try to understand.

So that's two huge challenges for studying mental distress...

1) Can't directly, objectively measure subjective experience

2) Don't have a direct, mechanistic understanding of what gives rise to thoughts and feelings

Those two issues are a contributing factor to a third challenge...

3) Fuzzy and imperfect classification systems for the experiences of human thought/emotion patterns

What happens with diagnosis is it can sometimes be misunderstood or implied to be linked to a direct and known biological cause. Language like "you have ADHD" rather than "your behavior patterns fall into certain broad, fuzzy bucket of others who seem to behave somewhat similar. One such bucket for you is the ADHD bucket".

And even then, it's worth questioning how useful those buckets are since so many have so many co-occurring traits. Going back to the color analogy, it's like if we decided everyone is either blue or yellow. And green from color to color doctor. And one says "you're a blue" and the other says "you're a yellow", and neither of those are wholly correct or incorrect. It's just that having only three colors would be a somewhat useful but very flawed classification system.