This year I'm doing a masters in the Philosophy of Mental Disorder, which I have been loving, but I have the most obscene amount of coursework to do. I have 30,000 words to write for June! The good news is, however, that I pretty much finished essay #5 of 9 last night, and I now have 15,000 words. Half way there.

( Essays done so far. )

I'm off back to London today, and I'm moving into my plush new apartment tomorrow. All very exciting. :D My parents are helping me out by bringing up my stuff at the weekend, so I'm sorting out what they can bring from the stuff which I absolutely cannot live without, even for a few days. And, uh, there's quite a lot of it (computer, library books, clothes, comics, food, coffee etc etc etc). I feel like the Cat.

Lister: I said, "Take a few essential basics you couldn't bear to leave behind."
Cat: Right! These are all I'm taking. Just these, and the other ten racks.
Lister: You can take two suits and that's it.
Cat: Two suits? Then I'm staying!
Lister: You can't stay. By the time I come out, you'll be dead.
Cat: Two suits is dead! Hey! If I cut off my leg and leave it behind, can I take three?

I'm not sure when we'll get internet access sorted for our new place (OH, THE WOE!) so I might be offline for a few days. See you soon!

Recently in my studies, I have been looking at the development of the DSM-V (the DSM is the manual used by psychiatrists for diagnosing mental disorders). The next versions of the DSM will be out in 2012, and the new hot topic in the field is biomarkers. The idea is that we could identify a specific gene, or physiological indicator, or particular chemical imbalance which would indicate mental illness, and which could be tested by a doctor. This prospect is certainly attractive, as an objective test of mental disorder would not only make diagnosis easier and more reliable, but it would go a long way to demonstrating psychiatry to be an objective science.

However, this view seems to be based on an extremely limited view of the interaction of mind and brain. It is common knowledge, for example, that depressed patients often show unusual levels of neurotransmitters in their brains, which is often taken to mean that it is this imbalance which is causing the depression. In fact, there are at least three possible interpretations of this data: 1) the imbalance causes the depression, 2) the depression causes the imbalance, or 3) the imbalance is an attempt by the brain to adapt to the depression. This issue is particularly pressing in light of new research indicating that antidepressants may be far less effective then the drug companies would have people believe - in fact, Kirsch & Sapirstein found placebo pills to be almost just as effective as drugs in combating depression. These drugs work on the assumption that if you fix the imbalance in the brain, you will fix the problem in the mind.

My issue with the search for biomarkers is that it massively oversimplifies the nature of mental disorder, assuming the there will be an identifiable and unique physical characteristic which will show the presence of a disorder. In fact, the factors contributing to mental disorders include genetic, environmental, developmental and psychological features, not all of which are identifiable physically. Mental disorders are unlike physical disorders in the complexity of their symptoms, as they are behaviorally based, not physiologically. It's like searching for a specific biological marker for "liking ice-cream" or "being a bit snippy" or "being obsessed with Stargate Atlantis": these are all complex mental processes which cannot simply be reduced to a biological ticky-box.

Much as the medical profession hate to admit it, these sorts of conceptual issues really belong in the realm of philosophy. Admittedly, the philosophers' progress in understanding the relation of mind and body has been somewhat ponderous (!), but the last fifty years have seen remarkable progress. For my part, I find hard-line physicalism to be a surprisingly compelling account of consciousness and mental content. If you're interested in this, I recommend the excellent Sweet Dreams: Philosophical Obstacles to a Science of Consciousness by Dan Dannett and Thinking About Consciousness by David Papineau. I think in the contentious field of mental health, the APA could benefit from considering the philosophical implications of the inclusion of biomarkers in the DSM, however attractive the prospect may be.


Normal service of fangirly squealing on this blog will be resumed shortly. If you found all of that a bit heavy, here's a picture of Michael Shanks covered in chocolate.