The Trouble with Mental Illness

  • The “patient” has an incentive to overestimate the extent of his illness, since he can “get away” with certain things by claiming to be more sick than he is
  • People around the patient have an incentive to underestimate the extent of illness. They think the person is claiming illness only to extract sympathy and get away with things that would be otherwise not permissible
  • The second point here leads to internal conflict in the patient, as he can’t express himself fully (since others tend to underestimate). Feelings of self-doubt begin to creep in, and only make the problem worse
  • There are no laboratory tests in order to detect most kinds of “mental illness”. Diagnosis is “clinical” (eg. if 8 out of following 10 check boxes are ticked, patient suffers from XYZ). This leads to errors in diagnosis
  • The method of diagnosis also leads to a lot of people in believing that psychiatry is unscientific and some reduce it to quackery. So there is little the medical profession can do to help either the patient or people around him
  • That diagnosis is subjective means patients have incentive to claim they’re under-diagnosed and people around are incentivized to say they’re over-diagnosed
  • I don’t think the effect of a lot of medicines to cure mental illness have been studied very rigorously. There are various side effects (some cause you to sleep more, others cause you to sleep less, some cause impotence, others increase your mojo, and so on ), and these medicines are slow to act making it tough to figure out their efficacy.
  • There is a sort of stigma associated with admitting to mental illness. Even if one were to “come out” to people close to him/her, those people might dissuade the patient from “coming out” to a larger section of people
  • If you were to be brave and admit to mental illness, people are likely to regard you as a loser, and someone who gives up too soon. That’s the last thing you need! And again, the underestimate-overestimate bias kicks in.
  • Some recent studies, though, show a positive correlation between mental illness and leadership and being able to see the big picture. So there is some hope, at least.

2 thoughts on “The Trouble with Mental Illness”

  1. Psychiatric diagnosis is primarily based on case history. It starts with the patient’s version of symptoms, but is quickly dominated by the doctor’s impression of what the patient is going through. The case history of the patient is a document of observations and conclusions, and any gaming by the patient is usually obvious to the doctor.
    Treatment is a little tricky because people respond to the same meds differently, mainly because the etiology of many mental diseases is not well understood. Treatment usually consists of gradually ramping up the drug dosage while observing how the patient responds to the drug. This way, the dosage ends up being empirical. If the patient sticks to the drug regiment (this is frequently a problem), the drugs today have been very effective in 1) alleviating symptoms and 2) having few to zero ‘side-effects’.
    The social stigma attached to mental illness creates a fair amount of stress for the patient. Maybe the best option is to keep this information private, keeping only a few close friends/relatives in the know. Many people see mental illness as an extrapolation of laziness ( even you say patients have an incentive to overestimate their illness… this is extremely shortsighted, for the patient should then have to lie to his dear ones, and take a general negative hit to the quality of life), but such barbaric social beliefs can can only be corrected by education.

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