To address further the comparison of clinical depression, as a self-reported condition, with gender identity:

Depression cannot be quantified independently of a sufferer's self-reports. There is no chemical test for it -- this is certainly true. In a broad sense, however, there are cases when someone's self-report can be rejected by an experienced professional.

If a new patient met a psychiatrist, and said that he wasn't enjoying ballroom dancing five nights a week quite as much as he used to, and anyway he felt slightly sad after the orgy on Friday, and he claimed that this makes him clinically depressed and in need of strong medication, the doctor would be justified in doubting the self-diagnosis. We all have ups and downs and not all of the downs count as clinical depression, even if it seems that way to the person doing the reporting.

So there are cases in which a patient could say, "Doc, I have clinical depression," and the doctor could justifiably say, "No, you don't."

And this is a key point in scientific claims, I think: falsifiability. If a doctor can point to reasons why a patient's condition does not qualify as clinical depression, then the claim is potentially falsified. It is not as objective or as quantifiable as some other medical issues, but it is something that a professional could rule out, given certain conditions.

For claims about gender identity to reach the same standard of objectivity, there would need to be some standards by which a patient could be shown to be mistaken. The claim could be falsified. This is why a potential objective test -- chemical or whatever -- would also introduce the possibility of showing that the person making the claim is mistaken. "My true identity is female." "No it isn't." Would become a possible objective empirical conclusion.

So if we feel that we should accept unprovable, unfalsifiable claims as true, this is a choice based on our beliefs about how we want our society to work (i.e. ideology) not on science. I am not arguing that it is a bad choice. But I want to be clear that we have beliefs which are not empirical, objective, or scientific. We believe some truth-claims because it is how we think the world ought to be.

(August 11, 2023 at 8:17 am)Belacqua Wrote: To address further the comparison of clinical depression, as a self-reported condition, with gender identity:

Depression cannot be quantified independently of a sufferer's self-reports. There is no chemical test for it -- this is certainly true. In a broad sense, however, there are cases when someone's self-report can be rejected by an experienced professional.

If a new patient met a psychiatrist, and said that he wasn't enjoying ballroom dancing five nights a week quite as much as he used to, and anyway he felt slightly sad after the orgy on Friday, and he claimed that this makes him clinically depressed and in need of strong medication, the doctor would be justified in doubting the self-diagnosis. We all have ups and downs and not all of the downs count as clinical depression, even if it seems that way to the person doing the reporting.

So there are cases in which a patient could say, "Doc, I have clinical depression," and the doctor could justifiably say, "No, you don't."

And this is a key point in scientific claims, I think: falsifiability. If a doctor can point to reasons why a patient's condition does not qualify as clinical depression, then the claim is potentially falsified. It is not as objective or as quantifiable as some other medical issues, but it is something that a professional could rule out, given certain conditions.

For claims about gender identity to reach the same standard of objectivity, there would need to be some standards by which a patient could be shown to be mistaken. The claim could be falsified. This is why a potential objective test -- chemical or whatever -- would also introduce the possibility of showing that the person making the claim is mistaken. "My true identity is female." "No it isn't." Would become a possible objective empirical conclusion.

So if we feel that we should accept unprovable, unfalsifiable claims as true, this is a choice based on our beliefs about how we want our society to work (i.e. ideology) not on science. I am not arguing that it is a bad choice. But I want to be clear that we have beliefs which are not empirical, objective, or scientific. We believe some truth-claims because it is how we think the world ought to be.

Depression is classified (by psychiatrists) all the time. 
Mild, moderate and severe. Probably even further sub-classified after they get to know and have some experience with their patients. 
There will no doubt, be, and as a matter of fact ARE NOW, tests available when they are looking for possible causes of depression. 

Just one example :
"Oxytocin and vasopressin are regulators of anxiety, stress-coping, and sociality. They are released within hypothalamic and limbic areas from dendrites, axons, and perikarya independently of, or coordinated with, secretion from neurohypophysial terminals. Central oxytocin exerts anxiolytic and antidepressive effects, whereas vasopressin tends to show anxiogenic and depressive actions. Evidence from pharmacological and genetic association studies confirms their involvement in individual variation of emotional traits extending to psychopathology. Based on their opposing effects on emotional behaviors, we propose that a balanced activity of both brain neuropeptide systems is important for appropriate emotional behaviors. Shifting the balance between the neuropeptide systems towards oxytocin, by positive social stimuli and/or psychopharmacotherapy, may help to improve emotional behaviors and reinstate mental health."
https://www.cell.com/trends/neuroscience...12)00152-X

The fact that there are NOW many (drug) treatments available, and tests available for the levels of those drugs in the blood, means yes, a patient undergoing treatment has tests available. And in fact, psychopharmacology is a major and entirely separate sub-specialty at most major medical centers.

(August 11, 2023 at 8:17 am)Belacqua Wrote: To address further the comparison of clinical depression, as a self-reported condition, with gender identity:

Depression cannot be quantified independently of a sufferer's self-reports. There is no chemical test for it -- this is certainly true. In a broad sense, however, there are cases when someone's self-report can be rejected by an experienced professional.

If a new patient met a psychiatrist, and said that he wasn't enjoying ballroom dancing five nights a week quite as much as he used to, and anyway he felt slightly sad after the orgy on Friday, and he claimed that this makes him clinically depressed and in need of strong medication, the doctor would be justified in doubting the self-diagnosis. We all have ups and downs and not all of the downs count as clinical depression, even if it seems that way to the person doing the reporting.

So there are cases in which a patient could say, "Doc, I have clinical depression," and the doctor could justifiably say, "No, you don't."

And this is a key point in scientific claims, I think: falsifiability. If a doctor can point to reasons why a patient's condition does not qualify as clinical depression, then the claim is potentially falsified. It is not as objective or as quantifiable as some other medical issues, but it is something that a professional could rule out, given certain conditions.

For claims about gender identity to reach the same standard of objectivity, there would need to be some standards by which a patient could be shown to be mistaken. The claim could be falsified. This is why a potential objective test -- chemical or whatever -- would also introduce the possibility of showing that the person making the claim is mistaken. "My true identity is female." "No it isn't." Would become a possible objective empirical conclusion.

So if we feel that we should accept unprovable, unfalsifiable claims as true, this is a choice based on our beliefs about how we want our society to work (i.e. ideology) not on science. I am not arguing that it is a bad choice. But I want to be clear that we have beliefs which are not empirical, objective, or scientific. We believe some truth-claims because it is how we think the world ought to be.

Any doctor that asserted such would be looking to get sued. The standard clinical tool for assessing depression relies entirely on self-reporting. Are you familiar with the concept of opposite action? In DBT therapy it is often advised to act opposite to the way that the person feels. Thus your hypothetical doctor would be making a false diagnosis if someone was engaged in opposite action. And depression like any psychiatric disorder is highly individual. What counts as a symptom for one individual does not count as a symptom for another. I don't believe you know what you are talking about with respect to clinical depression. It certainly doesn't reflect what I know of the subject. It's not anywhere as clear cut as you seem to think it is such that a doctor could say that a person isn't clinically depressed. I'm not going to belabor the point other than to share an anecdote with you. Back in 2008 I went to my practitioner and shared with her that I had psychotic delusions. She dismissed what I was saying because in her opinion, my mental state and behavior weren't consistent with what she understood about psychotic delusions. Less than two weeks later I tried to kill myself by hypothermia on account of these delusions and lost 9 of 10 fingers due to this person's faulty clinical judgment. I don't know what your experience with mental illness is but you don't sound like you have much experience in this area.

There are many levels of depression.  Obviously Bel wants it to be an either/or situation.  It is not.

I have been treated over the years with different meds due to different things.  What I needed when my dad died and my breast cancer diagnosis followed closely thereafter was something quite different than what works for me now.  Those two traumatic events were what my doctor called situational depression.  

What I take now on a daily basis keeps me from curling up in the fetal position.  I know now when I get to that point and we need to step up treatment and I also know when it's something that will pass and I can work my way through it.  It's not one size fits all.

I must say I wish they had known more about post-partum depression back in the day because if they did, I probably wouldn't have scars on my wrists.

Doctors aren't walking around looking for people who appear to be sad.  A person has to self-report or have someone step in for them. And the doctor needs to listen to what's being said and what's not being said.

(August 11, 2023 at 10:19 am)arewethereyet Wrote: There are many levels of depression.  Obviously Bel wants it to be an either/or situation.  It is not.

I have been treated over the years with different meds due to different things.  What I needed when my dad died and my breast cancer diagnosis followed closely thereafter was something quite different than what works for me now.  Those two traumatic events were what my doctor called situational depression.  

What I take now on a daily basis keeps me from curling up in the fetal position.  I know now when I get to that point and we need to step up treatment and I also know when it's something that will pass and I can work my way through it.  It's not one size fits all.

I must say I wish they had known more about post-partum depression back in the day because if they did, I probably wouldn't have scars on my wrists.

Doctors aren't walking around looking for people who appear to be sad.  A person has to self-report or have someone step in for them. And the doctor needs to listen to what's being said and what's not being said.

Another example : 

What chemical causes anhedonia?
Anhedonia Causes: What Leads to Emotional Flatlining?
Bad Dopamine Reception: There's a shortage of receptors that process existing dopamine. Your brain has thousands of different receptors for specific transmitters, including dopamine. If there aren't enough dopamine receptors then you can experience anhedonia symptoms simply because your body can't use dopamine.

"Runners High" is also a well-know psychological (temporary) state. Endorphins are testable,  (in a sense the opposite of depression). 
"As you hit your stride, your body releases hormones called endorphins. Popular culture identifies these as the chemicals behind “runner’s high,” a short-lasting, deeply euphoric state following intense exercise." https://www.hopkinsmedicine.org/health/w...20exercise.

You probably heard this week that the FDA has approved an oral Post Partum Depression med. 
https://www.fda.gov/news-events/press-an...depression

(August 11, 2023 at 10:27 am)Bucky Ball Wrote:

(August 11, 2023 at 10:19 am)arewethereyet Wrote: There are many levels of depression.  Obviously Bel wants it to be an either/or situation.  It is not.

I have been treated over the years with different meds due to different things.  What I needed when my dad died and my breast cancer diagnosis followed closely thereafter was something quite different than what works for me now.  Those two traumatic events were what my doctor called situational depression.  

What I take now on a daily basis keeps me from curling up in the fetal position.  I know now when I get to that point and we need to step up treatment and I also know when it's something that will pass and I can work my way through it.  It's not one size fits all.

I must say I wish they had known more about post-partum depression back in the day because if they did, I probably wouldn't have scars on my wrists.

Doctors aren't walking around looking for people who appear to be sad.  A person has to self-report or have someone step in for them. And the doctor needs to listen to what's being said and what's not being said.

Another example : 

What chemical causes anhedonia?
Anhedonia Causes: What Leads to Emotional Flatlining?
Bad Dopamine Reception: There's a shortage of receptors that process existing dopamine. Your brain has thousands of different receptors for specific transmitters, including dopamine. If there aren't enough dopamine receptors then you can experience anhedonia symptoms simply because your body can't use dopamine.

"Runners High" is also a well-know psychological (temporary) state. Endorphins are testable,  (in a sense the opposite of depression). 
"As you hit your stride, your body releases hormones called endorphins. Popular culture identifies these as the chemicals behind “runner’s high,” a short-lasting, deeply euphoric state following intense exercise." https://www.hopkinsmedicine.org/health/w...20exercise.

You probably heard this week that the FDA has approved an oral Post Partum Depression med. 
https://www.fda.gov/news-events/press-an...depression

I did not hear about the Post Partum med, thank you for sharing.

That is a bitch that people used to call 'Baby Blues' and that was crap.  It's so much worse than that.  I had three kids and only experienced the shattering effects of PP with the middle one...part of the reason that I didn't know what the heck was wrong.  I just hope that more women take their symptoms seriously and that their doctors do as well.

While I understand that childbirth throws the body into a whirlwind of hormonal flux, PP is a step beyond that.

Quote:To address further the comparison of clinical depression, as a self-reported condition, with gender identity:

Depression cannot be quantified independently of a sufferer's self-reports. There is no chemical test for it -- this is certainly true. In a broad sense, however, there are cases when someone's self-report can be rejected by an experienced professional.

If a new patient met a psychiatrist, and said that he wasn't enjoying ballroom dancing five nights a week quite as much as he used to, and anyway he felt slightly sad after the orgy on Friday, and he claimed that this makes him clinically depressed and in need of strong medication, the doctor would be justified in doubting the self-diagnosis. We all have ups and downs and not all of the downs count as clinical depression, even if it seems that way to the person doing the reporting.

So there are cases in which a patient could say, "Doc, I have clinical depression," and the doctor could justifiably say, "No, you don't."

And this is a key point in scientific claims, I think: falsifiability. If a doctor can point to reasons why a patient's condition does not qualify as clinical depression, then the claim is potentially falsified. It is not as objective or as quantifiable as some other medical issues, but it is something that a professional could rule out, given certain conditions.

For claims about gender identity to reach the same standard of objectivity, there would need to be some standards by which a patient could be shown to be mistaken. The claim could be falsified. This is why a potential objective test -- chemical or whatever -- would also introduce the possibility of showing that the person making the claim is mistaken. "My true identity is female." "No it isn't." Would become a possible objective empirical conclusion.

So if we feel that we should accept unprovable, unfalsifiable claims as true, this is a choice based on our beliefs about how we want our society to work (i.e. ideology) not on science. I am not arguing that it is a bad choice. But I want to be clear that we have beliefs which are not empirical, objective, or scientific. We believe some truth-claims because it is how we think the world ought to be.

That's absurd we rely on  self-reporting to huge degree and there are no universal symptoms of depression there are guidelines but those are not gospel. One mans depression is not another mans depression. Also when comes to gender i doubt any such test can exist there are to many factors to gender to make such test reliable or meaningful gender identity is a personnel  identity that is based on the individual and their definitions of what they mean when they use it and their is noting in science that contradicts this. 

(August 10, 2023 at 9:31 pm)Belacqua Wrote:

(August 10, 2023 at 8:04 pm)Angrboda Wrote: It's been my understanding that no test is diagnostic for clinical depression and that as a result, self-reporting is the primary tool.

As far as I know there's no definitive test. Most diagnosing takes place through interviews, as I said. 

The fMRI differences are detected in patients who have already been diagnosed, but in practice this is far more than self-reported feelings. Severe cases exhibit certain kinds of behavior which can be observed independent of self-reporting. 

The kind of severe withdrawal and anhedonia one sees don't seem like choices that one would make. They do allow experienced diagnosticians to say that a person self-reporting as severely depressed does not show the indications of depression, and the doctors should consider treatment accordingly. It would be bad to misdiagnose something and give it the wrong treatment. 

Quote:There's evidence that there are objective markers for gender and while we don't currently have the ability to determine gender scientifically, that doesn't mean that it isn't objective; that would be an appeal to ignorance.

It will be interesting to see what gets discovered in the future. I remember when they started mapping the genome a lot of people were talking about a "gay gene," and of course things turned out to be not so simple. 

Maybe there will be objective tests which will allow doctors in the future to tell self-reporting individuals "no you're wrong." I wonder what people who are confident in their self-report will do when the objective test tells them that their gender identification is incorrect. Will we continue to support their choices? Or will we tell them that they will not be allowed to transition based on these tests?

Not sure how this would work if it seems like gender is partly determined by how one identifies themselves as in relation to the society that they're in. Both science and observation have ruled out genitals or sex chromosomes as being the absolute definitive markers for gender. Clearly, there is something else beyond genitals or sex chromosomes, even if we don't know definitively what the exact criteria for being a man or woman are.

Also, since I see depression is being brought up here, this brings me to a very pertinent point here. There is very often no one sole combination of criteria that dictates whether one warrants a diagnosis of a particular psychiatric disorder. Often times, you only need to meet a minimum number of symptoms listed in the DSM (or whatever other official source of diagnoses being used) to then be diagnosed with that disorder. And this means two different individuals could meet different criteria for a depressive disorder and still both be rightly diagnosed with the same thing.

I suspect it's like that with gender as well. Someone who identifies as a man might not have a penis, but if they meet enough of the other criteria for being a man (whatever these criteria may be), then they shouldn't be precluded from being considered by society as a man.

(August 11, 2023 at 10:42 am)Helios Wrote: That's absurd we rely on  self-reporting to huge degree and there are no universal symptoms of depression there are guidelines but those are not gospel. One mans depression is not another mans depression. Also when comes to gender i doubt any such test can exist there are to many factors to gender to make such test reliable or meaningful gender identity is a personnel  identity that is based on the individual and their definitions of what they mean when they use it and their is noting in science that contradicts this. 

There is a fairly standard self-reporting tool that in many states is required for Family Practice preventive visits and others I'm sure I don't know about, (probably Post Partum visits).
Many clinical research studies track the use of this tool, along with all the data the actual study is about. 
It's called the PHQ-9. For established patients known to the providers, the scoring system is known to be useful. 
I'd have to look up the research on it, but, just an example of a known, useful tool in wide use. 
https://www.hiv.uw.edu/page/mental-healt...ning/phq-9

(August 11, 2023 at 10:52 am)Bucky Ball Wrote:

(August 11, 2023 at 10:42 am)Helios Wrote: That's absurd we rely on  self-reporting to huge degree and there are no universal symptoms of depression there are guidelines but those are not gospel. One mans depression is not another mans depression. Also when comes to gender i doubt any such test can exist there are to many factors to gender to make such test reliable or meaningful gender identity is a personnel  identity that is based on the individual and their definitions of what they mean when they use it and their is noting in science that contradicts this. 

There is a fairly standard self-reporting tool that in many states is required for Family Practice preventive visits and others I'm sure I don't know about, (probably Post Partum visits).
Many clinical research studies track the use of this tool, along with all the data the actual study is about. 
It's called the PHQ-9. For established patients known to the providers, the scoring system is known to be useful. 
I'd have to look up the research on it, but, just an example of a known, useful tool in wide use. 
https://www.hiv.uw.edu/page/mental-healt...ning/phq-9

Really their standard in name only because peoples minds are rarely standard