MAID and Mental Illness: An interview with Dr. Jeffrey Kirby

Medical Assistance in Dying (MAID) became legal in Canada in June 2016.

In October 2020, Bill C-7: An Act to amend the Criminal Code (medical assistance in dying) was introduced in Parliament after it was determined that limiting access to MAID to those whose death was ‘reasonably foreseeable’ was unconstitutional. MAID was on its way to becoming an option for those whose only medical condition is a mental illness.

In August 2021 the federal government established an Expert Panel on MAiD and Mental Illness. The Panel was charged with the task of “making recommendations on protocols, guidance and safeguards to requests for MAID by persons who have a mental illness”.

The Expert Panel released their final report, which was tabled in Parliament in May 2022. Dr. Jeffrey Kirby, a bioethicist, was one of the Expert Panel Members (until he resigned in April 2022). On October 2nd I had the pleasure of speaking with Dr. Kirby.

Click here to read the entire interview on Mad in Canada’s website.


  1. “Since a complete description of the underlying pathological processes is not possible for most mental disorders…” this is a precious example how many medical guidelines first state something worrisome or important for then to proceed, for all intents and purposes to do the OPPOSITE of what an average person would DO if the psychiatric WORDS were not LOADED.

    Like in this case one reasonable conclusion would be: “These folks” don’t know how the disease WORKS.

    “In the absences [sic] of clear biological markers or clinically useful measurements of severity for many mental disorders, it has not been POSSIBLE TO SEPARATE NORMAL FROM PATHOLOGICAL symptom expressions contained in diagnostic criteria.” Uppercase mine. To an average person, this might sound like: “these folks” not only DO NOT KNOW what’s normal, they can CONFUSE normal with pathological!.

    Not so average might think: wait a minute, they don’t know what normal looks, they don’t know how the disease works, and they don’t know how the disease is recognized?. Wow, now reading the full TWO paragraphs: but this is the BEST!? they HAVE?.

    And for comedic shock: Imagine that where it says mental disorders WE put “heart attack”. Would anyone go into a $300,000 by-pass surgery on THOSE basis?. Paticularly if one’s symptoms were “mild”?. Would anyone even take aspirin for that if aspirin caused a life shortened by over 20yrs?!

    Or your friend doctor told you: You know, aspirin in some percent of people causes a severy thing that feels like anxiety?! M’Ok?. And that leads some people to violent rampageous muder. M’Ok?. Or, to you know, shorten one’s life deliberately. M’Ok?

    “pathological symptom expressions” is a mind numbing, confusing term that tends to obfuscate the real gravity of the previous part of the paragraph, giving it a flavour of sophistication, so the reader does not get discouraged: embrace it! be learned and sophisticated!. It’s an art!. WeeePeee!.

    Joking aside, it is a good point: how to condone/approve euthanasia for conditions that are not incurable diseases?. And most likely are determined, even caused, by the social, familiar, educational, medical, legal, environment?. And on THOSE “clinical/scientific” bases?.

    Which by the way was one of the strong points against euthanasia: it could be provided overhelmingly against the poor, the discriminated, the persecuted, the different, the hated, and even the rich, etc. Without disease that cause strong enough suffering, mind you.

    And JUST suffering from social, familial, etc., was a NO-NO for euthanasia: beyond criminality, it lead to a callous and cruel society.

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  2. Conclusion 6: Making distinction between disease and disorder in mental illness is irrelevant since both use pathological symptoms. Same for spectrums if they use those. Same for anything that uses pathological symptoms to distinguish normal from pathological/abnormal. Since it has not been possible to do that, despite a LOT of research, muahahaha.

    Conclusions derived if expression of mental disorder were true, that is, if expression were relevant:

    Murky conclusion 2/hypothesis 1: If mental disorder is a brain disorder, then expression of the mental disorder improves the brain, in which case mental disorders are brain therapy not disease. Mental disorders are treatment for the brain.

    As illogical or counterintuitive as that sounds, sadly it has explanatory power: the incomplete pathological process knowledge for mental disorders can be explained because the expression of mental disorders makes the brain more normal, even indistinguisable from normal otherwise, since NO COMPLETE distinction, as stated true in the premises has been achieved. Note: excluded middle.

    Murky corollary 2-1/hypothesis 2: Pathological symptoms are in fact signs of improvement, not disorder. They correlate with hypothesized brain improvement, incompletely distinguisable from normal brain.(!?)

    If true, therefore treating mental disorders might in fact DAMAGE the brain, since it might correct an improving process.

    So, mental disorders, if such, will be “DO NOT TOUCH” disorders, altering them might damage the brain by inhibition of improving processes of the brain!. And doubly saddly, this has LOTS of empirical backing. Irony.

    But the most likely conclusion by reductio is that expression is IRRELEVANT, FALSE. That is:

    Reductio ad absurdum conclusion 1: Mental illness cannot be IDENTIFIED. It’s expression is false, is irrelevant.

    But in attempt at non risory honesty, the WORD expression might be used in equivocation, i.e. it means some thing in the premises and another in this conclusion, but I seriously doubt that, or that it is relevant. Another irony.

    Justification: Pathological symptoms of mental disorders/illness/spectrums may well be INDISTINGUISHABLE from normal. Given the severe lack of progress deduced as TRUE, i.e. necessarily true AND the amount of EFFORT to achieve such distinction, which has not achieved even the first step: distinguising them from normal.


    Conclusion 7: Since there is lack of causality of indistinguishability then it makes a plurality of causes necesary, perhaps sufficient if some aggregate includes them ALL possible causes, for indistinguishability to be explained, as true or false (excluding from the aggreate that which is already known as FALSE: brain pathological processes, symptoms, biological markers, etc):

    Simplifying Corolary from Conclusion 7: It might have been trying to achieve something impossible (distinguishability), OR that cannot be done with the use of LOGIC, OR with the use of symptoms and signs, i.e. modelled as a DISEASE, as opposed, to exemplify, to modelled as suffering. Or mental disorder DOES NOT EXIST OR is SOMETHING ELSE: normal (indistinguishable), suffering, violence, etc.

    Contingent conclusion 1: And if it cannot use logic, then IT CAN’T BE SCIENCE!!!!.

    I just noticed I kinda started to write like the Colossus from Forbin Project.

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    • So-called “mental illnesses” are exactly as “real” as presents from Santa Claus, but NOT MORE REAL. So, “medical assistance in dying”? Good thing that “i” is in the acronym, otherwise it would just be “mad”. And if you’re mad, you’re angry. Or crazy, or insane. MAD. MAID…..
      I wanted to write something clever, but I’m SAD.
      What medical school courses prepares future doctors to both prevent death by healing sick people, and end sick people’s live by helping them die sooner and easier?….
      So now, thanks to MAID laws, doctors literally have the power of life and death in their hands. When will the first case come? And you know it will. Some guy will be in line for a MAID session, but something will go wrong, and the person will SURVIVE that particular medical intervention. Will that doctor be sued for malpractice, because the patient did NOT DIE?…. Idiocracy, here we come….

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      • The problem is, even if not explictly spoken or written, some folks do suffer a lot before dying, sometimes for weeks, months or years. And before suffering, and when suffering strikes did express an honest, congruent, reasoned, mature WISH to die if suffering became unbearable and there was no reprieve in sight.

        People speak of terminal illnessess like cancer or degenerative diseases, where more or less a less or more accurate estimate is available, but read more.

        Top of my head, I saw once a case of a bedridden patient, way too senior, almost impossible to communicate with anyone, except in laments…

        Subjected to painful procedures to try to fight or avoid spreading of a deadly infection that corroded her “to the bone”. Not cancer, not a terminal illness, no degeneratuve self limiting or person exhausting disorder, just a chronic severe, deadly infection. For months in and out of the hospital, precisely because of that infection.

        She might have been so strong, she could have lasted a long time. Antibiotics, surgery, etc.

        It was painful to see, and paniful for me to provide “care”, it was one of the most difficult things I have ever done, and as a trainee nonetheless. And I did it only once. She required it per schedule, hardly, if at all, provided on schedule.

        And yet, in her case, I got the impression somehow, without talking, she wanted to live still. I couldn’t know how, but I did got that impression. She might suffer, but my subjective and probably biased impression, despite me being pro-euthanasia, was she still wanted to live.

        And she was subjected to medical neglect to treat that infection. Precisely because it was painful to provide care on schedule, and I suspect, hoping that by being negligent she might pass away.

        But there she was, fightning, against negligence, against understanding, unable to assert herself, and against the mexican state, and the mexican condition.

        So, there is a need, and if she have expressed a wish in the terms I refered in my fist paragraphs, being legal, I would not have thought of euthanasia as bad nor criminal.

        She did not have a terminal illness, she might pass away in years, and the better care we provided, might have prolongued her life as a painful ordeal. Hence the unspoken, apparent to me, biased, negligence.

        And it does point to what you mention, I for all my biases would not have agreed for her to be put “to sleep”. Not even as an accident.

        Reminding myself, that according to tanatological narratives, some folks seem to be waiting for something, before passing away… quickly, almost painlessly, without struggle. In peace: the “good” death some have call it.

        Hence the importance, regardless of the debate, to write an anticipated order in case such potentially “endless” outcome presents. And for non-endless outcomes one wants shortened.

        See, I don’t believe in waiting for the supernatural to visit, but I can accept some folks do want to wait for that. And for me is good and for them is to me, mandatory, as a former practitioner.

        And also for those who do not want to end their life before nature, medicine and divinity calls the shots. And writing none for those that want to leave up to chance, knowingly.

        To avoid being subjected to the judgement of strangers, and those around you, IF law provides. A big IF.

        As the last freedom of your conscious self, the last way one gets to be who one was, while alive.

        Why leave open the door, when you can tighten it so no one elses values weight more than your honest, congruous, mature, rational, sentient, WILLING self?.

        So you can face the last or whatever comes next as you would have wanted.

        So, to land at the last part of your comment: write it in your living will.

        If failing on the first attempt, then write you want no first attempt or a second one.

        It’s about choice, not about dogma. It’s personal, and anyone can write one, as carefull as one researches and meditates on it, and whom can you count at the end.

        One thing I learned from our ordeal, me and her, is that each one of us is unique, and have different values, and our unique values are to be respected.

        And for that, LAW SHOULD PROVIDE.

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          • Not trying to stir the pot, but without chronic illness, incurable that causes unbearable pain, application of MAID would violate the requirements of it not to be applied “against” victims of violence, deprivation, aisolation, stigma, injustice, crime, fraud, pseudoscience, etc. For non-medical causes.

            But complications of treatment, unjustified or not, like chronic unbearable TD, or tardive dysforia, etc., might, I speculate be valid reasons for MAID. Iatrogenic diseases, not mental ones. Similar to quadriplegy for lumbar spinal stenosis as a surgical complication.

            And my unposted analysis, before “Conclusion 6” kinda proved on logical grounds alone, using just 2, two, paragraphs of the DSM, that arguments using the concepts of the DSM are invalid and therefore false.

            And the DSM says or used to say that it’s not for diagnosis, particularly in court.

            And the logical problem applies to the ICD too when it comes to mental illness, it suffers from the problem the 2, two, quoted paragraphs of the introduction of the DSM claims, in an obfuscated form.

            Precisely because those paragraphs make general claims that apply to ALL mental “disorders”, it’s diagnostics, and more fundamentally: its causes. And are profered by “top” experts in the field.

            So it’s empirical accuracy would be difficult to question, particularly when the opposing camp, even the anti-psychiatrists like me, claim the same thing.

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          • So, ironically both pro and antiP have a common agreement on those 2, two, paragraphs…

            I’ll see if I can repost it with “modifications”.

            Although I could not see what it’s problem was, maybe it’s length.

            But being a logical argument, even refutation, might be difficult to shorten. But I do think it proves mental diagnoses are not illnesses.

            And the stripped argument is that symptoms have to correspond to a known enough “pathological process”, known enough to explain the symptoms. And that addmited by the DSM in obfuscated form is not in the empirical evidence for ALL mental health claims.

            And to clarify: there are no normal process symptoms. Those are called complaints, like growing pains. Pain to be a symptom has to correspond to a disease, a “pathological process”, even if decades later.

            Even a “disease process” on logical grounds can’t be called one if the person dies of old age without symptoms. Otherwise calling it that creeps contradictions that invalidate reasoning with the words disease, symptoms, etc. Simple logical fact.

            And if that sounds illogical, well, prostate cancer and breast cancer can disappear spontaneously. And neither of those 2, two, are responsible for the overwhelming majority of deaths for people above 65yrs of age who have those cancers. “Old” folks with those cancers die mostly of something else, and other than “detecting” it, they cause no symptom.

            So it’s not an abstract argument, my argument has also strong, solid, empirical, worldwide evidence. Clear when “reading” the statististics, and doing some inferences, from the site Our World in Data regarding cancer mortality.

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          • So, to go back to the question, reformulated by me:

            What happens when violence, deprivation, isolation, stigma, injustice, crime, fraud, pseudoscience, etc., are NOW consequences of diseases, pathological process caused by MEDICAL INTERVENTION?, particularly when unjustified, unneeded and harmfull?.

            I don’t know, I guess it would be a novel case in legal terms, and I guess first the iatrogenic disease as chronic and unbearable would have to be proven, without calling it “mental”.

            But there being no mental disorders, what else could it be?, kind of thing.

            Particuarly when tardive psychosis, TD, tardive dysphoria, etc., do have empirical backing. So not much scientific/technical stretch there, only it goes against the grain of psychiatry. So, it might present a high bar, not on empirical grounds, but on political ones.

            And the non-medical suffering is also present in other degenerative diseases. So that part, the “social” consequences of a disease, a real one, are not that novel.

            Thinking of a disease that causes “deformity”, “smell”, etc., perceived somehow as “ugglyness”?. And therefore a great barrier to “integration”, inducing mocking, isolation and ridicule, and ALL that induces in it’s turn. Top of my head, I’m no expert. But that consideration does not sound new to me.

            And I don’t know HOW that kind of suffering is considered in the MAID process.

            But seems valid for MAID as a now iatrogenic disease, not a long dated “mental disorder”.

            I hope it helps, and I do feel for you…

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          • So my comment tying to answer your question might have sounded offensive.

            But reformulating and admitting I am no lawyer and don’t know anything specific about the MAID laws:

            MAID seems applicable to people diagnosed MI if the request of MAID is made on grounds of complications of psychiatric treatment that are chronic and cause unbearable suffering.

            And in that light, the legal/social/familial/community impact of complications of psychaitric treatment as TD, Tardive psychosis, PSSD, Amnesia, Cognitive/emotional problems, etc., might be reasonable grounds to request MAID.

            They would be explained/justified by a medical condition, a iatrogenic condition, not a mental one.

            Which they would not be grounds if ONLY refered to MI, if MI is not real.

            Similar to full body paralysis, cuadriplegia, caused by “botched” surgery or assault inside a psychiatrical incarceration site, in a person labeled/diagnosed with MI. Or “accidental” cuadriplegia caused by psychiatric medication or its withdrawal.

            Denying MAID in those kind of cases because of the presence of a MI diagnosis sounds like an act of discrimination. Since cuadriplegia very likely is recognized as a valid reason to request and receive MAID.

            So MAID application in a person labeled/diagnosed with MI might proceed if there are complications not of the MI, but of it’s treatment.

            But I imagine the intent of extending MAID to MI had more to do with lack of efficacy, lack of relief by the treatment.

            And then there is the consideration of the harms of the treatment, not of the disease, the burden of the treatment that is supposed to be long term, i.e. chronic.

            And from which, regardless of the MI, is in many cases impossible to withdraw from, even tapering can carry a significant risk of demise and violence to self and others as in Akathisia and suicidality, withdrawal and medication induced.

            But that’s another angle I imagine are currently discussing in Canada: the suffering imposed by the treatment and the impossibility in real terms of withdrawing from it for may people.

            Just the lack of practitioners trying it is a barrier I think addressable by MAID. Heart failure and chronic kidney failure are “solved” by transplants, but the lack of enough donors might make those conditions valid uses of MAID.

            And chronic kidney failure can be treated with dyalisis, but dyalisis in itself is burdensome.

            So, focusing on the burden of treatment and/or it’s complications seem to me valid reasons for MAID in MI. Beyond lack of efficacy which seem valid in cases different from MI.

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  3. So, trying to sum up my thoughts with an unpublished post:

    I guess the problem of using MAID for “mental disorders” is not TECHNICAL, but more fundamental: LOGICAL. It’s not about technicalities but about fallacies.

    Opening the door to using MAID for mental disorders assumes that mental disorders are REAL.

    And when using FALSE premises to reason with them can give circularity, reductio ad absurdum, or more commonly conclusions that under one line of reasoning are TRUE and under another line of arguments are FALSE. In truly technical terms INCONSISTENT.

    And one cannot use experiments to figure out the truth of inconsistent arguments, since experiments ONLY extend the logic, they can’t change it until a real theory, “beyond doubt” facts with enough explanatory power are used to NOW, afterwards, do experiments based on science, not ideology.

    Inconsistent arguments gives rise to inconsistent experimental results.

    Inconsistence is not about not being solid, that’s inconcuse/baseless: not enough convincing evidence, not enough to prove an argument.

    Inconsistency is about being contradictory, say nay and yay at the same time, or under different lines of reasoning.

    And that is prevalent in psychiatry and clinical psychology.

    And my argument is that happens because ANY non-trivial claim that something is explained by mental disorders is FALSE. DSM, ICD, clinical psychology, approaches, frameworks, etc., will suffer the same fatal LOGICAL flaw.

    In short, because mental disorders are not REAL.

    And that explains a lot of psychiatrical practice, it’s now “techinical” problems with MAID, and some and some. Except no amount of empiricism can overcome arguing with false premises.

    My argument has MORE explanatory power and less attack surface than the WHOLE aggregate and combinations of psychology, sociological and psychiatrical evidence and arguments. Simple: they use faulty, incorrect logic. Bye, bye, “hasta la vista Babies”…

    That is probably in the first pages of many, if not all books of informal logic for high-school and college: to construct an argument you have, by necessity to start from TRUE PREMISES.

    Except for reductio, but that does not give you a TRUE conclusion, it gives you a FALSE premise, that by excluded middle does not give you a TRUE conclusion, but ironically a TRUE premise.

    Reductio gives a conclusion that it’s obviously FALSE, clearly false, patently false, it’s a requirement to use reductio. And other premises being true, and the “technicalities” of the argument construction being impeachable implies a FALSE premise.

    Not clearly stated for mental disorders, but, hey, it’s logic. it applies to ALL arguments. Even moral ones…

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  4. The case for autism NOT being a disease.

    Inspired by:

    And the articles it quotes in the piece.

    tl,dr: Behaviours considered autistic might provide an evolutionary advantage in children from older male fathers.

    I am assuming that autistic behaviours actually mean something, that they are not an example, they don’t belong to the class, of meaningless behaviours like motivational deficiency disorder.


    I am not assuming they have evolutionary benefit, that’s what I am trying to prove.

    My case:

    Mutations and epigenetic changes that occur in the sperm of older fathers cluster 30% of the time around genes that control neurodevelopment AND are associated with behaviours classified as autistic, without proving autism is a disease. That’s outside and unnecessary for my argument.

    My statement is a minimum that could be accepted as truth: behaviours can be autistic, can be identified AND that means something. The last is the big IF assumption I am making.

    Now, that suggests those changes, mutations and epigenetic, are selected in the sperm of older men, because they don’t occur randomly, they cluster. They seem to be favored by the evolution of sperm development.

    But, atlernatively, they might cluster because those pieces of genome are more suspectible to accumulate changes. They might occur randomly but be seen more often because they are more susceptible to be seen, more evident, so to speak. Like rain more visible in lakes and ravines, because of their shape prone to accumulate water.

    There seems to be a cluster too around a gene imputed as causal in epilepsy. But, alas!, it does not seem, seem, to increase the risk of epilepsy probably because it comes from the father!. In the sense, that correlation of age and epilepsy are not reported yet, per the paper:

    “An example of sperm aging HyperDMR (chr2:166900333–166900544) is overlapping exon 11 of SCN1A, MOST COMMON GENETIC CAUSE OF EPILEPSY, intriguingly most de novo mutations arise in the paternal chromosome [37], BUT PATERNAL AGE HAS NOT YET BEEN ASSOCIATED WITH OCCURRENCE OF MUTATIONS.” Uppercase mine.

    So, my conclusion is, at the minimum, autistic behaviours confers an evolutionary advantage at least in children from older fathers.

    The why, is not in those papers. And yes, I am biased saying “at least”. But that is a hypothesis, not just a bias.

    Similar case seems to apply to “schizophrenic” behaviours. By analogy suggesting those behaviours might, might, confer an evolutionary advantage of similar STRENTGH, around fivefold, in children of older fathers.

    That does not mean it confers an advantage greater than sperm from younger fathers, caveat, but in older fathers it probably does. For some reason…

    And that means, generalizing, that at least autistic behaviours in some circumstances are not part of disease, but beneficial adaptations. And it suggests “schizophrenic” behaviours might be too.

    As a corollary, autism, assuming it’s a disease, invalid assumption but accepting without conceeding, occurs in 1 in 1205 individuals. And increases to 1 in 200 for children of men over 40yrs of age at conception. That seems as a STRONG selection, not a disease inducing mechanism.

    And btw, does not lead anyone to conclude that autism, asumming it is a disease, occurs in more that 1% of the population. It occurs around 1 in 1205 individuals, among israelis:

    Note: the explanation of “selfish selection” assumes mutations are pathogenic, which is not only not a given, but FALSE. As per my previous comments in this MIA piece. And it refers to sperm growth, “clonal expansion”, not to growth and development of the offspring, the childen, the descendants. Which is actually what evolution is trying to select for, not “just” the sperm. But “selfish selection” does seem to explain the higher frequency of cancers in children of older fathers, they are gowth promotion genes, not merely developmental ones.

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    • For comparison:

      Some mutations in the APO-E gene, Apolipoprotein E, variants ε2 and ε3 REDUCE the risk of Alzheimer from 2.5 to 8 times.

      Very similar in the magnitude of the EFFECT of sperm aging changes and risk of displaying “autistic” or “schizophrenic” behaviour.

      Sperm changes on aging, that as I argued above seem to be select for, not a side-effect of trying to increase sperm numbers when aging.

      “…Klotho-VS reduces AD risk by 1.3 times in APOE-ε4 carriers…” and APOE-ε4 increases risk of Alzheimer. And 1.3 times is significantly less than 5 fold, or 500%.

      “…APOE-ε4 homozygotes carrying a common loss-of-function variant in CASP7 (rs10553596) had roughly 2-fold reduced risk of AD compared to noncarriers…” That’s a twofold reduction.

      “…higher levels of peripheral BDNF decreased AD risk, with the highest levels reducing risk by up to two-fold.” Two-fold.

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    • For another very vivid, even bloody, comparison:

      There is a relative risk reduction from severe malaria, depending on the genome of the parasite between 99% and about a 33%. Which gives the equivalent of an “effect” of 3 times and 99 times. The 99 reduction occurs in parasites that do not have mutations that increase resistance to the falciform gene. The wild-type variety of parasites. The unevolved parasites regarding the falciform gene.

      A single copy of the falciform gene occurs in around 15% of the population in Kenya and Gambia. And although a 99% risk reduction is a lot, around 60% of the parasites in East Africa carry protective mutations against the falciform gene, that for the patients with faciform gene gives a risk reduction in reality, in those cases and in those places, from 1 in 4 to around 1 in 50.

      I cant shake the parallel between the evolution of the malaria parasite and evolution of psychiatry, at least in it’s looser as time goes by, diagnostic criteria.

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    • “An example of sperm aging HyperDMR (chr2:166900333–166900544) is overlapping exon 11 of SCN1A, MOST COMMON GENETIC CAUSE OF EPILEPSY, intriguingly most de novo mutations arise in the paternal chromosome [37], BUT PATERNAL AGE HAS NOT YET BEEN ASSOCIATED WITH OCCURRENCE OF MUTATIONS.” Uppercase mine.

      That suggests the novo mutations and “mutations” caused by sperm development in older fathers is under different rules, under different pressures.

      Adding weight, if corroborated, to my argument: sperm development seems to avoid clinical epilepsy even when touching the SCN1A gene that otherwise causes epilepsy.

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  5. There are 4, four, common ways to see a symptom without a pathological process does not exist, it can’t be called a symptom nor a disease, disorder, spectrum, etc.:

    1.- A symptom that is not explained by a pathological process is most likely explained by another disease. Otherwise symptoms are useless if any pathological process can be caused by any disease. It has to be specific to it AND explained by it.

    A symptom caused by another disease is indistinguishable from a symptom that is NOT explained by a GIVEN pathological process.

    2.- A symptom that has no pathological process to explain it, it never will have one for instance, for whatever reason, is indistinguishable of one WITHOUT a KNOWN pathological process that explains it.

    So why try to make a distinction of something conceptually and experimentally indistinguishable?.

    Apparent severity of the symptom by itself does not grant a disease process being present: childbirth can be extremely painfull, as first time intercouse, losing a tooth in the course of normal development, loosing a pet, a parent, a partner, etc. There are caveats, but then again the other indistinguishabilities will still be there.

    3.- A symptom, called in the DSM pathological symptom, without a pathological process that explains it, is indistinguishable from a normal symptom, a non-patological symptom. From a symptom that is part of living, growing, maturing, developing, multiplying, dying, etc.

    4.- As many legislators: senators, congrespeople, judges, some physicians AND supreme court justices might explain very thoroughly: old age comes with a lot of complaints, and old age is NOT a disease and is NOT a disability.

    It is in the law of many countries that old age can’t be called a disease NOR a disability. And that does not make it complaintless by itself. But I imagine it does help some, at least some of the time, in some way.

    commonsensely QED.

    And pathological process is SYNONYMOUS with disease process. Not of disordered or spectrumalized process…

    [Duplicate comment]

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