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Culture War Roundup for the week of February 20, 2023

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The DSM defines various illnesses abut there are problems here. First, everything is based on self reported symptoms. This is not how a science-based medical diagnosis should work, especially now that anyone can simply Google and find out what to report.

I'm not sure this is a tenable position.

If you actually dig deep into the philosophy of disease and disorder in medicine, it's actually very hard to robustly define what an "illness" is, and there are actually lots of cases where the collection of symptoms is more valuable to doctors than the specific cause of what is going wrong in a person.

Consider over-the-counter medicine, which often just treats symptoms like fever, runny nose, or pain. Sure, it might be helpful to know the exact variety of flu or cold virus I'm dealing with, but researching and treating each of them individually would be costly for society, and it far more resource efficient to say, "Use what you can get at the supermarket to deal with the worst symptoms, and if you sickness gets bad enough, then go to the doctor for more specific medicine."

The process of constructing a definition of a "healthy human body" is a partially social one, and has points that are debatable. What's our cut-off for "unhealthy"? Is every measurable trait of the human body that correlates to shorter lifespan, or greater physical or mental distress automatically "unhealthy"? I'm sure I don't need to explain why that would be unworkable - but one example is that would have us saying that being tall is "unhealthy" since men tend to be taller than women, and tend to live shorter lives than women. But these kinds of questions pop up over and over in medicine, and the current medical consensus of what counts as a "disease" and what is merely a normal variation of human traits is going to be highly dependent on what treatments exist, what kind of measurements we can take, and past precedence.

The DSM is very clear in its introduction about the model it uses when thinking about mental disorders. It more or less acknowledges that the diagnostic categories are more practical than ontologically rigorous. They're telling the doctor, "In the past, when we've had patients that report issues x, y and z, we've generally found medicines a, b and c seem to help those patients in controlled studies." They're not telling doctors, "A patient reporting issues x, y and z, has a definitely 'real' disease A, which is mechanistically and reliably caused by b, c and d."