Humans are creatures of meaning!! Brilliant argument from dysfunction (but applicable to normal function too, of course).
And, intuitively, should be very well grounded in some sort of neuropsychological reality via the idea (probably the fact) of specific modules that evolved to manage specific behaviours key for successful survival and reproduction.
**
On the "introspection of own & acquaintance crazy" side, the distinction between different kinds of "anxiety" or "depression" seem very obvious. Even at my very worst of trauma-prompted crazy fears my mind never went towards any form of social anxiety (my hypothesis is that's because of protective effects of slightly psychopathic lack of concern with social validation) and however listless, useless and unable-to I get, I never feel guilt or self loathing shame for that, etc etc.
A thoughtful review of some of the main ways we suffer. Thank you. After reading, it strikes me that perhaps we do in fact know quite a lot about mental illness and its causes (which are not to be confused with knowing all the mechanisms—unless one is a reductionist!).
Another post in which everything you wrote makes perfect sense and it's hard to see how someone would come to a different conclusion... almost:
The section on somatization seems a bit weak - it's clever to start with interoception and hypochondriasis and THEN write about psychosomatization, but "somatic depression" seems to overstate the case. Here a recent systematic review about indications of neuroimmune pathology in fibromyalgia case-control studies (https://www.sciencedirect.com/science/article/pii/S0889159126005210?via%3Dihub), but my favorite study is this clever experiment in which IgG from FM patients was transfused into mice and the mice developed mouse-model FM symtoms (https://www.enzymforschungsgesellschaft.de/downloads/fibromyalgie/Fibro-symptoms-research-2021.pdf). And, setting aside the question of whether or not we've discovered literally every pathophysiology below the brainstem*, isn't it a bit weird how seemingly every syndrome commonly claimed to be psychosomatic has epidemiology and symptoms so similar to known autoimmune disease? If psychosomatization is a manifestation of sick behavior, it wouldn't be surprising for symptoms to be [something] inflammation-mimicking [something], which could result in similar symptoms to autoimmune disease, but why the epidemiology? (I don't mean to imply that syndromes attributed to psychosomatization necessarily ARE autoimmune, just point out that there's a lot of bad epistemology, in this area.) Also, there's IBS, which was previously thought to be psychosomatic - and has the "correct" epidemiology - but is now a recognized GI disorder of debated GI origin! (And some patients are told their identical symptoms are psychosomatic. Is there a good reason for who's diagnosed with IBS and who's diagnosed with psychosomatization, when presentations are seemingly identical? I have no idea.) And then there's "somatic syndrome disorder," in the sense of "distress induced by somatic symptoms," with is very much a mental disorder about a thing! (Ever read the T4 paraplegia memoir "Two Arms and a Head?" https://www.2arms1head.com/)
The big question I have is: How much room do you leave for mental disorders that are NOT about things? While these are certainly not mutually exclusive, as I believe he intended his essay to be read, Thomas Reilly's reminder that symptoms are biologically mediated at SOME point (https://rationalpsychiatry.substack.com/p/im-a-reductionist-maybe-you-are-too) is pretty compelling. Again, these aren't mutually exclusive and we can enjoy both posts in Aftabian dualist bliss, but what about the possibility of a "chemical imbalance" that's JUST a chemical imbalance? (Or a TBI?) Is psychosis about a thing?
*Of course, it could be that a complete-enough understanding of the nervous system(s) would render "organic" and "psychosomatic" a "distinction without a difference!"
I confess I am not well-versed in immune system and psychiatry interactions. I would imagine they can go both ways, though? If systemic inflammation changes your affect and behavior, I would think that the CNS also changes your immune state and inflammation. So causality could run that way too. I'm completely open to the idea that the conditions like FMS/CFS/ME etc have some as yet undetermined "physical" cause. So I think I agree with your final point. I am opposed to mind-body dualism in most cases!
I think the "aboutness" concept works better for some things than others. My interest in this topic is mostly the idea I end with - that we could divide the brain by functional systems based on the "thing" in the world they are adapted to deal with, whether that's bodily health or social status or something trying to eat you.
Humans are creatures of meaning!! Brilliant argument from dysfunction (but applicable to normal function too, of course).
And, intuitively, should be very well grounded in some sort of neuropsychological reality via the idea (probably the fact) of specific modules that evolved to manage specific behaviours key for successful survival and reproduction.
**
On the "introspection of own & acquaintance crazy" side, the distinction between different kinds of "anxiety" or "depression" seem very obvious. Even at my very worst of trauma-prompted crazy fears my mind never went towards any form of social anxiety (my hypothesis is that's because of protective effects of slightly psychopathic lack of concern with social validation) and however listless, useless and unable-to I get, I never feel guilt or self loathing shame for that, etc etc.
"Content" seems to matter, functionally, indeed.
A thoughtful review of some of the main ways we suffer. Thank you. After reading, it strikes me that perhaps we do in fact know quite a lot about mental illness and its causes (which are not to be confused with knowing all the mechanisms—unless one is a reductionist!).
Another post in which everything you wrote makes perfect sense and it's hard to see how someone would come to a different conclusion... almost:
The section on somatization seems a bit weak - it's clever to start with interoception and hypochondriasis and THEN write about psychosomatization, but "somatic depression" seems to overstate the case. Here a recent systematic review about indications of neuroimmune pathology in fibromyalgia case-control studies (https://www.sciencedirect.com/science/article/pii/S0889159126005210?via%3Dihub), but my favorite study is this clever experiment in which IgG from FM patients was transfused into mice and the mice developed mouse-model FM symtoms (https://www.enzymforschungsgesellschaft.de/downloads/fibromyalgie/Fibro-symptoms-research-2021.pdf). And, setting aside the question of whether or not we've discovered literally every pathophysiology below the brainstem*, isn't it a bit weird how seemingly every syndrome commonly claimed to be psychosomatic has epidemiology and symptoms so similar to known autoimmune disease? If psychosomatization is a manifestation of sick behavior, it wouldn't be surprising for symptoms to be [something] inflammation-mimicking [something], which could result in similar symptoms to autoimmune disease, but why the epidemiology? (I don't mean to imply that syndromes attributed to psychosomatization necessarily ARE autoimmune, just point out that there's a lot of bad epistemology, in this area.) Also, there's IBS, which was previously thought to be psychosomatic - and has the "correct" epidemiology - but is now a recognized GI disorder of debated GI origin! (And some patients are told their identical symptoms are psychosomatic. Is there a good reason for who's diagnosed with IBS and who's diagnosed with psychosomatization, when presentations are seemingly identical? I have no idea.) And then there's "somatic syndrome disorder," in the sense of "distress induced by somatic symptoms," with is very much a mental disorder about a thing! (Ever read the T4 paraplegia memoir "Two Arms and a Head?" https://www.2arms1head.com/)
The big question I have is: How much room do you leave for mental disorders that are NOT about things? While these are certainly not mutually exclusive, as I believe he intended his essay to be read, Thomas Reilly's reminder that symptoms are biologically mediated at SOME point (https://rationalpsychiatry.substack.com/p/im-a-reductionist-maybe-you-are-too) is pretty compelling. Again, these aren't mutually exclusive and we can enjoy both posts in Aftabian dualist bliss, but what about the possibility of a "chemical imbalance" that's JUST a chemical imbalance? (Or a TBI?) Is psychosis about a thing?
*Of course, it could be that a complete-enough understanding of the nervous system(s) would render "organic" and "psychosomatic" a "distinction without a difference!"
I confess I am not well-versed in immune system and psychiatry interactions. I would imagine they can go both ways, though? If systemic inflammation changes your affect and behavior, I would think that the CNS also changes your immune state and inflammation. So causality could run that way too. I'm completely open to the idea that the conditions like FMS/CFS/ME etc have some as yet undetermined "physical" cause. So I think I agree with your final point. I am opposed to mind-body dualism in most cases!
I think the "aboutness" concept works better for some things than others. My interest in this topic is mostly the idea I end with - that we could divide the brain by functional systems based on the "thing" in the world they are adapted to deal with, whether that's bodily health or social status or something trying to eat you.