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> Walk through the fMRI and connectivity differences and the genetic differences as currently understood in the medical literature

"Medicine" can not say anything about kids throwing rocks, it can only talk about broken windows and roofs, because all it measures is houses. I did not argue against measuring and fixing houses. I did not claim there are no visible differences in fMRI, nor did I claim there were, nor did I claim there are no genetic differences, or that there were. Straw man. It makes no difference for what I was arguing about, which you decided to ignore and not engage with.

"The high degree of genetic correlation among many of the psychiatric disorders adds further evidence that their current clinical boundaries do not reflect distinct underlying pathogenic processes, at least on the genetic level."

The Brainstorm Consortium; Anttila, V., Bulik-Sullivan, B., Finucane, H. K., Walters, R. K., Bras, J., … (2018). Analysis of shared heritability in common disorders of the brain. Science, 360(6395), eaap8757. https://doi.org/10.1126/science.aap8757

"This empirical evidence of *shared* genetic etiology for psychiatric disorders can inform nosology and encourages the investigation of common pathophysiologies for related disorders."

Lee, S. H., Ripke, S., Neale, B. M., Faraone, S. V., Purcell, S., Perlis, R. H., … Wray, N. R. (2013). Genetic relationship between five psychiatric disorders estimated from genome-wide SNPs. Nature Genetics, 45(9), 984-994. https://doi.org/10.1038/ng.2711

"evidence accumulated over decades of family and twin studies have shown that familial and heritable components commonly overlap between disorders. […] Genetic influences on psychiatric disorders also share genetic determinants with dimensional psychological and neurocognitive traits that transcend diagnostic boundaries."

Lee, P. H., Feng, Y. A., & Smoller, J. W. (2021). Pleiotropy and Cross-Disorder Genetics Among Psychiatric Disorders. Biological psychiatry, 89(1), 20–31. https://doi.org/10.1016/j.biopsych.2020.09.026

"We are so embedded in this structure. We have spent so much time diagnosing mental disorders that we actually believe they are real. But there's no reality. These are just constructs. There's no reality to schizophrenia or depression. We might have to stop using terms like depression and schizophrenia, because they are getting in our way, confusing things." (Thomas R Insel MD, NIMH director 2005-2015)

https://www.madinamerica.com/2022/04/thomas-insel-future-men...

"In the last 2 decades, it has become obvious that child abuse, urbanization, migration, and adverse life events contribute to the etiology of schizophrenia and other psychoses. […] I expect to see the end of the concept of schizophrenia soon." (Murray, R. M. (2016). Mistakes I Have Made in My Research Career. Schizophrenia Bulletin, sbw165. doi:10.1093/schbul/sbw165)

"Clinically, the evidence that symptoms cut across disorders — or that people frequently have more than one disorder — has only grown stronger. […] Even seemingly separate disorders are linked. In 2008, geneticist Angelica Ronald, then at King’s College London Institute of Psychiatry, and her colleagues found that autism and attention deficit hyperactivity disorder (ADHD) overlapped."

Nature: The hidden links between mental disorders (2020) https://doi.org/10.1038/d41586-020-00922-8

"I would say [biomarkers] are potentially highly useful but conceptually and practically incomplete"

Freckelton I., QC (2018). Overdiagnosis in Psychiatry: How Modern Psychiatry Lost Its Way While Creating a Diagnosis for Almost All of Life's Misfortunes, by Paris Joel: Oxford University Press, 2015, xi-xix and 1-181 pp., Psychiatry, Psychology, and Law, 25(2), 325–327. https://doi.org/10.1080/13218719.2018.1463588



Evidence of correlation in genetic studies doesn't answer the questions you were asking. The claim you made was that you don't believe psychological disorders have different causes.

Humans share 98.8% of genetics with chimpanzees. That doesn't tell you humans and chimpanzees are the same. It tells you where to look for the differences between humans and chimpanzees. A similar study to the GWAS study you cite shows that arthritis and type 1 diabetes have significant genetic overlap (https://pmc.ncbi.nlm.nih.gov/articles/PMC10291128/). That makes sense they're both autoimmune disorders where inflamation plays a major role. But arthritis and type 1 diabetes are not the same disorder.

The GWAS studies narrow down the search for genetic markers. They don't establish some sort of continuum for disorders all controlled by a single cause. They don't mean the difference between mental disorders is environmental. They don't mean that medicine or psychological disorders are social constructs or that there is "no reality to them".

The question of whether two things are distinct is determined by any one difference. 1 and 2 are distinct despite differing by only 1. You can list thousands of ways they are similar (both integers, both positive, both less than 500, both written with marks on a page). But those similarities do not make them identical.

That's why I'm saying once again that if you want to focus the conversation we need to talk about the genetic differences, fMRI differences etc between disorders and then you would need to make the case that those differences have the same cause. At any rate, I don't feel like pursuing this any further, but I wish you well.

P.S. I noticed in one of your earlier comments you said something about psychotherapy. Just in case it's not clear, psychotherapy is very different from psychoanalysis, which is what Freud was doing. Freud has a bad reputation as someone whose theories haven't held up well and who engaged in deliberate fraud. Psychotherapy is an evidence-based branch of medicine and is rightfully well regarded. You'll find that I've several times on this site and elsewhere recommended everyone use psychotherapy just like everyone should have a dentist. I just wanted to clarify that in case you were under the impression that my statements about Freud applied to psychotherapy. However, psychotherapy doesn't have anything to do with "attempting to remove internalized violence against self/other."


I get the feeling we're completely talking past each other. I never claimed that psychological disorders cannot have different causes. They may mostly be variants of a living organism's spectrum of maladaptive reactions to various adverse circumstances, yes.

You seem to read what I write, then make assumptions what I might be saying, and then reply to your assumptions, and ignore most of what I write (e.g. about your claims of "heritability"), which makes this a very weird interaction overall.

I agree with your idea of just letting this be, as I don't find it a very productive exchange.

I don't know why you keep coming back to fMRI and genetic markers, because, again, nothing of what I was trying to say has anything to do with whether there are measurable differences on that level or not. You seem to think that "symptoms" are described in the disorder definitions, and anything you measure is the "cause". Again: To me, it is similarly possible that both are symptoms. You can use that for diagnosis if you feel like you need to make this discrimination, but that doesn't say anything about treatment or etiology.

> psychotherapy doesn't have anything to do with "attempting to remove internalized violence against self/other."

I take it you do not consider the EMDR protocol, ACT, CBT, IFS, ego state, Schema, CFT, EFT, SE, DBT, MBSR, DBT, IPT, systemic therapy, gestalt, to be "psychotherapy" then. All of them work with and address internalized violence against self ("inner critic", self-worth, other negative thinking patterns; chronic often suppressed feelings of shame, anger, grief).




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