Let’s say someone is researching the prevalence of “narcissistic personality disorder.” They administer a self-reported psychological measure of narcissism to a thousand people and then decide that people above a certain cut-off have “narcissistic personality disorder.” This is different from pointing at someone and saying they need treatment, but something similar is happening at an abstract level. What is happening here is that it is being assumed that narcissism above a certain threshold would be “clinically significant,” i.e., it would produce the sort of distress and impairment that brings people to clinical attention. Researchers do something similar with measures of depression or anxiety. They may simply assume that depressive or anxiety symptoms above a threshold constitute disordered states. The assumption is not always correct. This is one major reason why epidemiological surveys generally produce inflated estimates of rates of mental illness. They capture the symptoms necessary for disorder attribution but miss the “clinical significance” part. Someone with anxiety symptoms just above the diagnostic threshold may be doing fine in their life; they may have found productive ways to manage those symptoms, and such people wouldn’t come to clinical attention (View Highlight)
crítica investigación psicopatología síntomas
Put this way, depression doesn’t make you stupid; you’re as clever as you’ve always been, but your intelligence is turned against you.” (View Highlight)
Paul Bloom
I also greatly admire Bloom for writing this:
“I cannot stress this enough—if you are in distress, seek treatment. It works. But, and I can’t stress this enough either, the treatment of mental illness is at a primitive stage.” (p. 361) We absolutely need this kind of honesty. As I said in my conversation with Nicole Rust: “I once heard Kendler say in a lecture, “Psychopathology is an immature, faddish science” and I loved it so much that I try to say it every time I give a public-facing talk because I think we owe the public this sort of clear acknowledgment.” (View Highlight)
What makes psychopathology more moral and political than general medical conditions isn’t dimensionality per se. It’s the tension between changing the individual vs. changing society to relieve distress or disability, and it’s the potential source of error around, “Are we calling this condition abnormal because we are socially prejudiced and have reified social oppression into individual disadvantage?” Medicine isn’t exempt from these considerations, but they are of particular relevance to the science and treatment of psychopathology. (View Highlight)