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Wednesday 17 August 2011

THE MYTH OF BIPOLAR DISORDER - courtesy of the Psychminded website

You might be interested in this, our latest piece, on the ‘myth of bipolar disorder’. Perhaps you would consider forwarding the link around your colleagues.


2. What an insight! Everybody has ups and downs and we’re all bipolar. The real advance is mood stabilisers. In private practice, we now have an inexhaustible supply of clients for so-called mood stabilisers to give us a fee. They don’t work which can lead to more fees and an accolade for NHS up-to-dateness ….and you don’t need to beat you brains out trying to untangle what in God’s name has brought them to a psychiatrist in the first place.

3. The phenomenological difference, of mood and affective states demonstrated by large numbers of people who seek psychiatric help, in comparison to what we could, with understandable trepidation, call normative mood states. These difference have been written about since antiquity, through medieval times, across the renaissance and to this day (and not in a way coloured by mythology, religion or any other archaic system of thought). Yes it is difficult to define a normal range, but clearly when a dramatic alteration of affective range and depth and loss of tight control of harmony between affect and environmental stimuli occurs, people are fully in their right both to posit that there has been a fundamental change in biological and psychological function and to seek help for this. Obviously more recent research with functional MRI has shown measurable differences in brain activity between those seeking psychiatric help with affective difficulties and carefully matched controls. This of course does not comment on the difficulty of grouping people with these affective disturbances into disorders. Many people have long-ago come to acceptance (unhappily) the inevitable intrusion of some degree of arbitrariness into diagnostic formulations. What is far more important than affixing labels to people is developing ways to help them through their difficulties, utilizing evidence where appropriate and human compassion when not.

4. Conflating of terms like ‘ups and downs’ with the kind of affective disturbance people can suffer with is just ridiculous. The Royal College of psychiatrists / Mind / The Depression Alliance and many other groups have been trying to highlight the very difficult but important distinction between very transient and mild alteration in mood and affect and more prolonged, debilitating disturbances, often associated with changes in thinking, appetite, sleep, sensation, perception etc. To not recognize these differences, I find is neglectful and irresponsible. To highlight people visiting psychiatrists merely to be given a diagnosis and therefore benefits is unnecessarily cynical, and neglectful of people who are truly suffering. Millions across the world have experienced and recovered from mental ill health and not just chavs! Isaac Newton, Samuel Johnson, William James, Albert Camus, Winston Churchill, Sylvia Plath, Kelly Holmes, Antonin Artaud etc Humbly, and I’m sure you would agree, some of these people possessed intellects that we could only dream of.

5. Certainly an interesting set of points. Taking the idea of famous intellectuals, Socrates found his voice to be rather helpful, and didn’t consider it to be an impairment – rather, his contemporaries considered it to be problematic, an example which indicates ‘difference’ and ‘illness’ are not necessarily the same. I appreciate contemporary thought does not consider him to be ‘bipolar’, but then, not all of the above examples are considered bipolar.

The extreme psychological states written about in literature (e.g Hamlet) are often taken to illustrate the depth and breadth of human experience, realms we can all reach, if placed in extreme social and emotional circumstances. Research does consistently show that understandings which normalize psychological distress minimise public prejudice and is the understanding of choice for the general public. This also probably minimises feelings of fear about their condition in people experiencing psychological distress, and maximises self-efficacy to find ways of living with their challenges, which are probably rather helpful!

Talking of MMR studies, a study comparing actors to ‘acting’ depression and depressed people found no significant differences.

I don’t think that approaching extreme states and psychological distress seriously and with compassion is not incompatible with looking at the social environment or a critical consideration of psychopharmaceuticals.

6. Before getting too heated, remember the epidemiological perspective. if you work in an office and people come with money and ask for a diagnosis, you will see a different population of people from the ones you will see in an emergency department or catchment area service. you will inevitably disagree about the nature of the ‘bipolar’ label because you are seeing completely different people and using them to confirm different prejudices
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