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“The beginning of Wisdom is calling things by their right name”

DougT at Gossemer Tapestry has me thinking about taxonomy, and the classification of things.

The categorization of mental illnesses is a continual process. Psychiatric disorders don’t fit (yet) into tidy disease states. On top of this, ‘things that didn’t exist’ become recognized disorders. For example, ADD became a ‘disorder’ in the 20th century when everyone was required to sit still for 12 years in school.

Whenever I meet a new patient, my first task is to establish a diagnosis – what do they have. Having an irritable mood is a symptom like fever; you need to find and treat the origin of the symptom. At this time, psychiatric disorders are primarily made by checklists; if you have 5 of 9 criteria for “X” then you “X”. This is faulty. It is descriptive and doesn’t account for etiology. Lots of symptoms in conditions overlap.

Well, it is a work in progress. The APA is on version #4 of its diagnostic manual, and #5 is on the way.
Recently a colleague wrote in JAMA the modest proposal of putting disorders into ‘families’:

Cluster #1 “What you have”
This group comprises patients with brain diseases that directly disrupt neurology and psychological faculties. This cluster includes Alzheimer’s disease, schizophrenia, and bipolar disorders. They are mostly genetically determined. Those in Cluster #1 have little volitional control of their disease.

Cluster #2 “What you are”
These are the patients vulnerable to mental unrest because of their psychological makeup.

They deviate from the mean to some extreme along one or several dimensions of human disposition, such as extroversion or emotional stability. How their minds and brains matured make them experience distress more poignantly. Some of the anxiety disorders are here. The personality disorders would be in cluster #2.

Cluster #3 “What you do”
These are the patients who adopt behaviors that are fixed or warped. They are patients because of ‘what they are doing’, and how they have become locked into doing it. Primarily their conditions are tied to what they chose, how they respond to that choice. Alcoholism, addictions, anorexia nervosa and some compulsions fall here.

Cluster #4 – “What you encounter”
These are the patients with distressful mental conditions provoked by events. While a lot of genetics/history influences a person’s reaction to a trauma, the main matter is something awful was experienced or witnessed and it continues to effect mood and daily life.

This novel means of categorization has drawbacks that –once again-people don’t fall simply into one type. I’ll be curious to see if this change of paradigm catches on.

I suppose Doug has ongoing controversies as to whether a certain bug or butterfly is in this family or genus, but at least the basic framework is established.

Human mental illness is far from settled.

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June 2007

Spo-Reflections 2006-2018