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Can we draw a line between people with psychiatric disorders and those without? If we zoom in on a single individual, can we draw a line between that which is them or their self, and that which is the psychiatric condition? Well, in a sense it’s always possible to draw a line; all you need is pen and paper. But does the line track a real distinction, a truth which is out there for us to find? Or is it a construct? In short, is the line between people with psychiatric disorders and those without, and the line between a single person’s self and their condition, more like a shoreline or like a country border? I argue for the latter.
Some people have a psychiatric diagnosis, whereas others don’t. This is an either-or-thing – either you have gotten diagnosed, or you haven’t. But what about the underlying reality that diagnoses are meant to track? Research indicates that things are less black and white if we look at people’s psychology. Most, or even all, psychiatric conditions exist on a spectrum.
This is, of course, not unique for psychiatry – we often find the same phenomenon if we look at the physical side of medicine. We might confidently say that Billy’s blood pressure of 105/70 is perfectly fine and normal, whereas Abby’s blood pressure of 170/95 is dangerously high. It would clearly be wrong to say that blood pressure is too high as soon as it exceeds 100/65, and also wrong to say that it only becomes too high if it exceeds Abby’s numbers. Still, the cutoff point of 120/80 is somewhat arbitrary. The difference between having 119 or 121 in systolic pressure is no more dramatic than the difference between having 117 or 119.
Psychiatric diagnoses are made by talking to people rather than measuring anything in their bodies, and the diagnostic criteria typically contain lots of vague words. However, there is no reason to assume that we would find sharp cut-off points even if we found reliable “bio-markers” for various conditions. Suppose that scientists were to prove that people with ADHD have less dopamine in their brains than others, and we subsequently began diagnosing ADHD through some kind of dopamine-measuring brain scan. We would likely find a continuous spectrum of dopamine levels, and would have to draw a somewhat arbitrary line to distinguish those qualifying for a diagnosis from those who don’t, much like with blood pressure.
It might seem obvious that a condition like ADHD, with symptoms such as forgetfulness, restlessness, impatience and so on exists on a spectrum – all people can struggle with …
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