Tuesday, February 24, 2009

Maniac-depressive psychosis - Bipolarity 1, 2 and 3 - Say What?

A very close person to me went into manic after one year being depressed and had to be hospitalized. The diagnoses was manic-depressive psychosis known today as bipolarity.When I first heard it I thought it was a good word and it was better to say it than the old stigmatized label.
But the concept has evolved. Now there is bipolarity 1, 2 and there will be coming soon to a theater near to you bipolarity 3.
So when a person tells you that he/she is bipolar without the numbers you don't know what is really going on.
Philip Dawdy, who has been trying hard to make sense on the accuracy of these diagnoses, has published a great article on this issue at Furious Seasons and he says?

"My frustration with the bipolar disorder label, be it type 1 or 2 (or the possibly forthcoming type 3) is that people outside the clinical world of well-informed researchers and well-read patients--and that would be the general public--do not understand the distinction between subtypes of bipolar disorder and what those distinctions mean. So saying to someone that you are diagnosed with bipolar disorder type 2, especially a cautious employer, is tantamount to saying you have full-blown manic-depression because that's all the general public knows. You'll lose your job, or not get it in the first place, and that date you've got tonight will run for the hills. Some family members will make the same kinds of assumptions. So will the police, insurance companies and society as a whole.

The instant assumption people will make is that you are just like the manic guy they read about in the paper who went off his nut and shot a cop or stripped and ran naked down the street until the cops dragged him off to a psych unit. I don't care how many awareness-raising campaigns you or NAMI National or DBSA or whoever want to do on bipolar disorder. They simply won't cut ice with the public.

The sad fact is that people in America lose jobs, careers and their own little society each day due to being slapped with a diagnosis of bipolar disorder type 2 that should more properly be understood as "mixed depression," as the above author notes. It's time for psychiatrists, and especially those drawing up the forthcoming DSM-V, to realize that their diagnoses exist as much in a social context as in a medical context and that they need to be damn careful and extremely precise about labeling anyone with bipolar disorder (and some other disorders as well). It's time for these blasted 15-minute interview, first-visit diagnoses to go away.

I've had a flurry of emails involving others' experiences with this dynamic lately and I'm sick and tired of seeing this go on in our culture.

To the degree that this mixed depression diagnosis might help clear some of that up--let's face it, it'll be understood by most people as "depression"--I'm all in favor. I doubt that it would change much the treatments doctors would recommend, but you can only fight one war at a time, as it were. It would appear from the two other papers that treating someone with mixed depression with anti-depressants is a recipe for disaster and human suffering.

For those of you who think I am attacking you and your diagnosis of bipolar disorder type 2, I'm not. If you are comfortable with your diagnosis, then roll with it. I'm simply putting some things out into the Netosphere that must be asked and making points that must be made, or nothing will ever change.

Besides, where do you or anyone think all those false-positive diagnoses of bipolar disorder are coming from?

No matter where you stand on any of these issues, this is a pressing matter that demands sorting out and promptly."

It's getting harder and harder to understand it all and I believe it's intentional. When you don't understand your diagnosis the use off-label of psych-drugs is easier.


andrew said...

I really wonder about all of these labels and whether they are helpful or not. I can understand that the health professionals need to closely identify different types of illness in order to better target the appropriate treatment. The problem seems to come as you identify in your post, from ignorance among the wider population. As an example, my son has been diagnosed with Asperger's Syndrome, which is not a medical condition, but rather is a personality type. However I have encountered many people who believe as a result that there is 'something wrong' with him. I even heard on the BBC a reference to someone suffering from 'Asperger's disease'. And to cap it all, we have been charged extra on our holiday insurance because of his diagnosis.
All the best,

Ana said...

Disease awareness campaigns don't help explaining about it all.
They should but their aim is to scare people.
Health is not their concern.
All the best,