'You're a practicing psychotherapist. Can you define "mental illness"?

No. Nobody can.

The DSM lists "disorders." How are disorders different from diseases or illnesses?

The difference between disease and disorder is an attempt on the part of psychiatry to evade the problem https://twitter.com/starshinesummer/status/1387010823923580931

they're presented with. Disease is a kind of suffering that's caused by a bio-chemical pathology. Something that can be discovered and targeted with magic bullets. But in many cases our suffering can't be diagnosed that way.

Psychiatry was in a crisis in the 1970s over questions like "what is a mental illness?" and "what mental illnesses exist?" One of the first things they did was try to finesse the problem that no mental illness met that definition of a disease. They had yet to identify what the

pathogen was, what the disease process consisted of, and how to cure it. So they created a category called "disorder." It's a rhetorical device. It's saying "it's sort of like a disease," but not calling it a disease because all the other doctors will jump down their throats

asking, "where's your blood test?" The reason there haven't been any sensible findings tying genetics or any kind of molecular biology to DSM categories is not only that our instruments are crude, but also that the DSM categories aren't real. It's like using a map of the moon

to find your way around Russia.

So would you say that these terms—disorder, disease, illness—are just different names for the same concept?

I would. Psychiatrists wouldn't. Well, psychiatrists would say it sometimes but wouldn't say it other times.

They will say it when it comes to claiming that they belong squarely in the field of medicine. But if you press them and ask if these disorders exist in the same way that cancer and diabetes exist, they'll say no.

It's not that there are no biological correlates to any mental suffering -- of course there are. But the specificity and sensitivity that we require to distinguish pneumonia from lung cancer, even that kind of distinction, it just doesn't exist. [. . .]

What are the dangers of over-diagnosing a population? Are false positives worse than false negatives?

I believe that false positives, people who are diagnosed because there's a diagnosis for them and they show up in a doctor's office, is a much bigger problem.

It changes people's identities, it encourages the use of drugs whose side effects and long-term effects are unknown, and main effects are poorly understood. [. . .]

Al Frances chaired the task force for the DSM-IV and has become one of the biggest critics of the DSM-5.

What do you think of his arguments?

We agree that the DSM does not capture real illnesses, that it's a set of constructs. We disagree over what that means. He believes that that doesn't matter to the overall enterprise of psychiatry

and its authority to diagnose and treat our mental illnesses. I believe it constitutes a flaw at the foundation of psychiatry. If they don't have real diseases, they don't belong in real medicine.

Al's attack is overdone. I think he's really trying to keep scrutiny off of the whole DSM enterprise. That's why he's been so adamant that you don't throw the baby out with the bathwater—he believes that the DSM-IV, for all of its flaws, its still worthwhile. I disagree.

Frances also worries that your criticisms are anti-psychiatry.
It's the universal paranoia of psychiatry that everybody who disagrees with them is pathological. You can't disagree with a psychiatrist without getting a diagnosis.

I've been writing critically about psychiatry for ten years and I've always encountered that. Psychiatry is a defensive profession. They have a lot to protect and they know their weakness.

To repel criticism in the strongest way possible, from their point of view, you diagnose the critic.'

(source: https://www.theatlantic.com/health/archive/2013/05/the-real-problems-with-psychiatry/275371/)

it's interesting which tweets didn't get retweeted