Separating 'this' from 'that'

My apologies for the length of the previous post (Jim van Os and the Salience Dysregulation Syndrome), I do think his ideas are important. He is talking about a major change in the way psychiatry thinks about diagnosis. What is diagnosis anyway but a process of putting a label on an individual condition?

From a Buddhist point of view, putting labels on phenomena is a very fundamental process that we all carry out, instant to instant, throughout our lives. The process of separating ‘this’ from ‘that’ is the root of dualistic thinking. This includes the basic split of ‘me’ and ‘other’ that creates the sense of separate self, the ego. In the Buddha’s first teachings after his own enlightenment, called the Four Noble Truths (suffering, the root of suffering, the cessation of suffering and the path), he identified the sense of separate self as the fundamental source of human suffering.

The idea that ‘I’ am separate from the rest of the phenomenal world is not accurate, from the view point of Buddhism or Western Science. Both systems of thought agree that all phenomena are interconnected and interdependent. There are no separate, independent entities. When we separate ‘this’ from ‘that’ (‘me’ from ‘other’) we are imposing an inaccurate way of thinking upon the actual nature of phenomena. It is not surprising that by starting with a fundamental flaw in our thinking, we end up in constant struggle with the world as it is. We see it as made up of separate independent entities when it actually isn’t that way

Although it is tempting to hope for our own enlightenment, when we could see beyond dualism, that is not our lot, nor our working ground. We are stuck with the way our mind works. We constantly fall into dualistic thinking. We walk around with a strong sense of ‘me’ being separate from everyone and everything else.

This dualistic way of understanding the world is called, by the Buddhist, ‘relative truth’, which sets it off from ‘absolute truth’, the way things actually are. (Of course ‘relative and absolute truth’ are dualistic constructs and so have no inherent existence in reality). In the cognitive world of relative truth it is possible to establish reference points from which judgments can be made, for example, as to how useful or helpful one or another concept (dualistic construct) may be for accomplishing a particular purpose.

In relative truth the idea of diagnosis makes sense. At its best, a diagnostic label can provide useful information to accomplish the goal of reducing suffering. It will still be relative truth (and therefore fundamentally inaccurate), but it can be helpful. (In physics it is agreed that Newtonian physics is highly simplified and inaccurate, but it is very useful in calculating the motion of planets and spaceships).

So a good diagnostic system (set of dualistic constructs) needs to be useful. It should help the person who is being diagnosed to understand what is happening to them and a diagnosis should guide the person and the health care professionals in determining how best to work with the situation.

What I like about the diagnostic system that van Os proposes is that it stays close to simply describing the phenomena (by rating each dimension). As well, by using the construct of a ‘syndrome’, it emphasizes that we are not talking about ‘diseases’ that have some self-existing reality, but we are simply talking about the clustering of phenomena.