Abstract
Since we do not know, or more specifically in the past we did not know, how mental disease occurs, symptoms, either behavioral manifestations or verbal reports of internal states, are relied upon to reach a conclusion and a label as to the exact nature of the disorder. To assess, diagnose, and treat a mental illness, it is not required to have a conceptualization of how this particular illness is caused, related to brain architecture or developed. And we do not have to know the physiology that underlies it. We merely must address the symptomology and correct it in any way possible. This situation in and of itself is not problematic. What happens next is. Having made a diagnosis absent an understanding of etiology, we behave, once the diagnosis is established, as though we understand the etiology. We provide all manner of interpretations of causality after essentially saying we don’t know the etiology. This state of affairs is unsettling. This is in part because the continuing reliance on symptomology creates neurophysiologically heterogeneous classes of disorders that do not lend themselves to basic science analysis. In addition, it hopelessly complicates the development of assessment instruments designed to assess the various disease constructs. There is a recognition that the current nosology is necessary, and will be altered when the basic science catches up to what we have intuitively understood for some time. This has begun to happen. There is increasing recognition that a significant amount of what we call mental illness is related to structural and functional changes, secondary to learning and epigenetics, in white matter. As a result, for the preponderance of problems termed as a mental illness, the current constellation of brain structure is essentially a state rather than a trait.
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Wasserman, T., Wasserman, L.D. (2016). Mental Illness. In: Depathologizing Psychopathology. Springer, Cham. https://doi.org/10.1007/978-3-319-30910-1_9
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