That is pretty simple, actually... the workings of the body are concrete and well defined. The workings of the brain are still a matter of conjecture. In fact, there are many that believe the mind doesn't actually exist. How can you have a mental illness without the mind?

There are no real ways to test the "mind". Most "mental" disorders are diagnosed via interview.

there are many that believe the mind doesn't actually exist. — aserwin

I've never heard of person who believes that minds don't exist.

There are no real ways to test the "mind". Most "mental" disorders are diagnosed via interview. — aserwin

I know that psychiatrists are limited by lack of knowledge of the brain. However, it still doesn't make sense to conflate symptoms with illnesses.

Many psychiatrists (and others, laymen too) view mental illness as diseases of the physical brain which have behavioral or affective symptoms. A person who is bi-polar has something wrong with their brain. The symptoms of bi-polar disease -- mania, psychosis, deep depression, elation, hallucinations, and so on are caused by disorders of the brain. The same can be said for ADHD, schizophrenia, OCD, and so on.

The problem psychiatry has is that the brain can not YET be observed in a sufficiently granular level to identify which neurotransmitters in which neurons are causing the problem.

Many of the complaints which arrive at the psychiatrists doorstep are vague descriptions of unhappiness, dissatisfaction with life, generalized anger, fatigue, poor cognitive function, and so on. The patients are more or less functional -- but not happy. What to do for them to help them feel more upbeat and effective? A relatively small share of patients present with hallucinations, completely irrational cognition, self-destructive behaviors, and so on. They need totally different kinds of treatment than moderately depressed people require.

Since the brain can not be observed so closely as to identify causes, identifying treatments is likewise a fraught problem.

The available drugs that effectively address symptoms like mania, hallucinations... are crude but effective. The drugs that treat depressive conditions are also imprecise but are not quite as crude as the major tranquilizers. They don't work very well quite often.

Many psychiatrists (and others, laymen too) view mental illness as diseases of the physical brain which have behavioral or affective symptoms. — Bitter Crank

Whatever it is they believe they don't call it brain disorders. The DSM doesn't call ADHD an unknown brain disorder with causes such and such symptoms. They cut right straight to the symptoms and say that "this illness is characterized by such and such symptoms".

The available drugs that effectively address symptoms like mania, hallucinations... are crude but effective. — Bitter Crank

True, but isn't there much more to bipolar and schizophrenia than mania and hallucinations? It's very hard to treat all the symptoms when you can't do anything about the disease that's causing the symptoms.

they don't call it brain disorders — Purple Pond

Why do you think they prescribe chemicals that act on brain chemistry? It is to treat disorders of the brain? What is not understood with many drugs is exactly which neurotransmitter in which part of the brain makes the most difference. Thorazine, for instance, or lithium carbonate are effective drugs; we know that they alter aspects of production/uptake of neurotransmitters. Exactly how isn't known, but that's not the same as having no idea of how they work.

Neurologists also treat brain disorders and prescribe medicine. What neurologists treat is generally non-affective, non-cognitive aspects of the brain, such as parkinson's, alzheimers, epilepsy, etc.

A lot of what psychiatrists deal with are disorders of mood, which are generated by the limbic system (the emotional center of the brain). Bi-polar is a mood disorder, as are depression and anxiety. Bi-polar patients swing back and forth between states of elation (can be nice until it turns into the terrors of psychosis) and states of very deep depression, sometimes bordering on catatonia.

Schizophrenia isn't a mood disorder. Neither is delusional thinking.

True, but isn't there much more to bipolar and schizophrenia than mania and hallucinations? It's very hard to treat all the symptoms when you can't do anything about the disease that's causing the symptoms. — Purple Pond

The disease of bi-polar disorder tends to be familial; a set of genes most likely causes the disease. The disease is the abnormal activity of the limbic system, alternately causing elation or depression. Attacks are often triggered by sleep disruption (caused, for instance, by east/west travel across maybe 6 time zones), or other diagnosable sleep disorders. Stress can trigger a bi-polar attack. Sometimes a bi-polar attack isn't triggered by anything. Its the genetic predisposition that makes stress or sleep loss dangerous for bi-polar patients.

Emotions screw up thinking in perfectly healthy individuals. A good share of the history of our species is about people who weren't thinking very clearly when they really needed to have a clear picture of what was going on. They couldn't because they were immersed in the emotion of the moment. For instance, they might have been so madly in love that they just didn't care that their army was ready to fight. Or fear might have caused someone to avoid risks that would have made them rich. blah blah blah.

The thing is, purple pond, we can't just open up the skull and pull out the limbic system to see what the matter with it is. Even if we could put it on a tray, it's still too finely constructed for us to figure out (at this point). You know, there are more possible connections between the 100 billion neurons in the brain than there are atoms in the universe. That makes it very difficult to evaluate what is happening when things go wrong (or right, for that matter).

I'm not clear about what causes schizophrenia or schizoaffective disorders. (NO reason why I would be clear.) Some neurologists/psychiatrists think it is a developmental disorder of the way the brain was put together in utero. A virus or some toxin might cause the abnormality. It just isn't clearly understood. Schizophrenia tends to cause very delusional thinking, like thinking the gas company is controlling your thoughts through the gas pipes in the building -- that sort of thing. (Maybe they are, but that would seem to be above and beyond the average gas company's performance capacity.)

Why do you think they prescribe chemicals that act on brain chemistry? It is to treat disorders of the brain? What is not understood with many drugs is exactly which neurotransmitter in which part of the brain makes the most difference. Thorazine, for instance, or lithium carbonate are effective drugs; we know that they alter aspects of production/uptake of neurotransmitters. — Bitter Crank

The medications that effect the neurotransmitters are not correcting some chemical imbalance as that's a myth Psychoactive medication that are used to treat mental illness are palliative. It's like putting on a band aid. A person has to use a lot of other coping mechanisms to get them back on track. (And let us not forget about the placebo effect.)

The problem is symptoms and diseases are two different things, the former is caused by the latter. Why has the field of psychiatry conflated the two? — Purple Pond

This is a comparatively weak criticism of psychiatry. It is part of the process of medial science that one begins with a group of symptoms, that used to be called a 'complaint' (now a 'syndrome') and looks for a causal mechanism. Sometimes, in finding causal agents, one finds that classifications need to be refined, for example distinguishing between CJD and Alzheimers.

You expect a disease to be a pathogen, or a gene mutation or some such, but if you consider the root meaning, it is whatever leads to a 'complaint', in other words the disease is more so the symptoms, not their cause. So one fairly well established causal mechanism is psychological trauma - not a gene or a pathogen, but an experience that distorts the operation of the brain.

As a nice mechanist analogy one might liken it to a power surge, that causes a computer to crash, without actually burning out the circuits. Or perhaps only one program crashes, and the others continue to function, but poorly because the wifi is down, or whatever. As might be expected per analogy, the effects of psychological trauma are fairly variable and unpredictable, and unfortunately the wizz-kid's standard cure-alls of turning it off and on again, or restoring from back-up are not available for brains.

What is problematic about mental illness in my experience is that it is socially disruptive. If someone breaks a wrist it can be placed in a cast and the individual can return to their roles in the world.

A person with severe mental illness posses a problem to both mind and body, the social and the physical. As someone with depression I know crying in the workplace because my father offed himself when I was young is different than having a broken finger. Many psychiatrists and psychologists emphasize the physical aspects of stress.

Sapolsky on Depression

What psychology often overlooks, in my experience, is the social elements of mental illness. An example that could overlooks a social aspect of mental illness is where the DSM has frivolous spending with negative financial consequences as a criteria. If this is the primary symptom in an up and the person is rich enough where it has no financial consequence, is it a symptom? If the person makes ten thousand a year, shouldn't this be considered in the writing if symptoms in the DSM? Perhaps it is, it's been a long time since my days off wanting to be a psychologist.

Furthermore behavior which may reflect the inner workings of our brain is often a site of meaning making and the interpretations of the other. How a person acts in the world is interpreted! (Symbolic Interaction, Existentialism too many books to list) An example of this in my own life was my co-workers giving me nudges about staying up late drinking alcohol, and someone mentioned that others at Target we're addicts. My behavioral signs caused by depression indicated similar acts associated with excessive drinking not to mention living with four roommates who played loud music past midnight. How can we simply stop at the biological components without considering "the mind" is indeed an imperative ledge to jump from! The mind here is for me undoubtedly social!

If I'm not sleeping well, have 80k in debt, am stuck on a lease for the next six months, ( thank God that's over) and know I have to teach an English class 5 hours and push carts 8, because it is morally right to pay off loans, not to condemn my cosigners to the debt, etc, this social situation must have some effect on the lymbic system! Thus what happens when our minds say, " I need to go to the grocery store and pay bills" or "should I take a risk and gamble" is overwhelmingly more complicated than looking at the lymbic system and saying, "looks like a bad storm coming". Adding some electrical flare or some happy chemicals and leaving mental illness only up to psychology and its biological bias will get us nowhere! Even with biology being as complicated as it is, I think even if we had a comprehensive understanding of the brain we could not manage to appropriately make sense of human behavior, including mental illness, without considering social components. Even if my biology is condemned to it's annual dip in mood because of early life trauma, this biological ontology omits the operations of masculinity which most likely lead my father to the grave.

So sarcastically, yes oh yes, I am physically depressed because genetics caused it, not just another generation of broken men who met the ultimatem, "it's either the booze or the family" and because he could not go to counseling for fear of breaking social bonds with his manly booze buddies because seeking help would make him weak, thus unmanly, he took a gun to his head, and well is condemned to pushing up daisies in a grave built in a swamp somewhere in the sticks where another generation of boys are learning to shoot guns and drink booze to avoid all feelings but anger!

The medications that effect the neurotransmitters are not correcting some chemical imbalance as that's a myth Psychoactive medication that are used to treat mental illness are palliative. It's like putting on a band aid. A person has to use a lot of other coping mechanisms to get them back on track. (And let us not forget about the placebo effect.) — Purple Pond

Ordinary depression presents a number of problems. For one, "a bad life" -- too much stress, debt, drinking, drugs, lack of exercise, bad environment, traumatic stuff, lots of anger, rage, and so on -- is not going to be relieved by any drug on earth. One's overall function will be quite adversely affected. What lots of people need who are diagnosed with depression (and they do have the required markers) is a "new life" where they have the skills and resources needed to change their circumstances.

I can attest to the inadequacy of antidepressants -- having taken various pills for some 30 years. Most of them did not work very well. Some of them had pretty unpleasant side effects.

But the major psychiatric conditions -- psychosis, bi-polar, schizophrenia, psychopathy, and severe depression -- often hell on wheels -- don't seem all that comparable to run-of-the-mill depression. A cure of these conditions is not around the corner. While the brain is at least somewhat plastic, it isn't clay that can be re-formed at will.

So, chemical "imbalances" in the brain is maybe not the case. (Thanks for the link to the SA article.) And there are other places things could go wrong: a nerve impulse is chemical between neurons, then electrical within the neuron, and back to chemical again. Maybe the problem is within neurons, rather than between neurons -- damned if I know which.

Great insight here.