> I still want to understand underlying causes, or maybe more accurately "What do the symptoms mean? What is producing those symptoms?"

Yep. I think there are a lot of people who would like to know that... And... Theories (still) proliferate. I'm not sure that there is much more consensus on the causal etiology of depression or schizophrenia or whatever than there was before the development of the DSM-III. Of course we have accumulated facts... But what the hell they contribute towards an `explanation' (if anything) is a different matter...

There is also a whole literature (I'm sure you will be pleased to know) on what on earth `explanations' are supposed to be, and what criteria determines a good explanation from a bad one. That makes a difference with respect to whether causal explanations for mental disorders are supposed to be genetic, neurological, cognitive, environmental, evolutionary, psychodynamic or some weird-*** combination of those (however that is supposed to go)...

One way an explanation can go bad is to label something and to think that the thing is thereby explained.

Another way an explanation can go bad is to infer causes from effects.

> Aspirin reduces the pain of headaches, so headaches must be caused by the lack of aspirin in the brain...

Yeah. Might be an `explanation' but seems to be a pretty bad one, huh ;-)

One reason why it is bad is that asprin doesn't naturally occur in the brain. So... There are a lot of people out there in the world without asprin in their brain - and yet only some small subset of them have headaches. Lack of asprin in the brain thus doesn't seem to be a very good explanation of headaches because the majority of people without asprin in the brain don't have headaches.

One theory of ADHD is that it is caused by too little dopamine. The pharma companies are keen to promote that one in particular (and also parents who think the only alternative is 'bad parenting', I guess). The only reason we have to believe that ADHD is caused by too little dopamine is that if you give those people dopamine they are able to focus better*. The trouble is that if you give people without ADHD dopamine they are able to focus better as well. Dopamine helps EVERYONE focus better. Giving a person dopamine and finding they improve their ability to focus is thus not relevant for telling us whether a person has ADHD or not as it fails to differentiate those with ADHD from those without it. So... The dopamine theory of ADHD is problematic.

We think ADHD is a legitimate bona fide disorder because it is due to neurological dysfunction. But what is the nature of the neurological dysfunction? We don't know. At this point in time the dysfunction involved in THE MAJORITY of mental disorders is an ASSUMPTION rather than something that has been discovered / established.

Same goes for the other conditions that are supposed to be explained by too much / too little dopamine / serotonin etc.

* Sometimes it is found that people who improve functioning if given drug x have less x receptors than normal upon autopsy (e.g., in theories of schizophrenia). The problem is whether the lack of receptors was a problem PRIOR to the introduction of the medication or whether the lack of receptors was due to the brain habituating to the presence of the medication. Without autopsy's of people with the same condition who weren't given that medication as a control group we simply don't know. Unfortunately... It is considered `unethical' to with hold medications of `proven effectiveness' in order to see...

There are a lot of bad explanations in psychiatry. Mostly due to the curious blend of information and advertising and the curious blend of science with financial investment...

I think most people would be appalled at the majority of causal reasoning in psychiatry (where we infer causes from effects in the above mentioned highly problematic ways). I think most people would be appalled at how the financial investments infect the quality of the science. I think most people would be appalled at how pharma companies advertising is passed off as `research' and used to `educate' or `inform' psychiatrists and consumers alike.

I'd love to teach a critical reasoning course to training psychiatrists one day :-)

Well... I wouldn't really... But... SOMEONES gotta do it...