The latest trend in American psychiatry—re-diagnosing the clinically depressed as victims of bipolar disorder—is on its way to Britain. Patients previously prescribed drugs like Prozac or Seroxat are trading in their antidepressants for mood stabilisers that level out the emotional peaks and troughs that characterise bipolar. Is this a sign of genuine psychiatric progress, or merely the latest diagnostic fad? Annie Maccoby Berglof, who experienced this “diagnostic shift” herself back in the 1970s in the US, explains in the new issue of Prospect.
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Yes, it could indeed be a fad, one that follows many, many others in the diagnostic arena over the years. That said, if people become noticeably more comfortable and functional as a result of the new (and newly reclassified) drugs, then let us welcome their availability for those who find themselves in the most dire of psychological straits. Thank you for this thought-provoking post.
Karen Osterle, MSSA, LICSW
Washington, DC
My suggestion to Ms Berglof if she wants to find meaning in her melancholy is to read the anti freudian freudian (sic) Anne Wilson Schaeff,”When Society Becomes an Addict” and for a deeper analysis try Bertram D. Lewin, “The Psycoanalysis of Elation”.
“But there is a more positive side to theories of bipolar disorder: the link between mood swings and creativity. In several studies, extremes in moods have been tied to the creative output of major figures in the arts, from Schumann to Gauguin. In one study, a high percentage of prizewinning poets were found to have bipolar I; playwrights were more likely to have bipolar II. Aristotle noted that great leaders were prone to extremes in mood”
(PGA att du nu är svensk, skriver jag på svenska) Jag kännde en poet i Sverige, Ylva, som också var på nåt satt ‘psykisksjuk’. När hon medicineras och åt sina tabletter mådde hon ‘bättre’ MEN inte kunde hon då skriva poesi. Dvs att hon inte var det som var henne viktigast. Så väljade hon ‘må dåligt’ och var poet hellre än att vara ‘frisk’ men inte längre den riktiga Ylva. For hennes del var ‘normalt’ och ‘banalt’ samma sak och inte orkade henne vara banal. Allting har nog sitt pris…
Diabetes Catastrophe in Italy
In this article the author quotes Hagop Akiskal, director of the International Mood Centre at the University of California in San Diego as stating that “Fifty per cent of the population of Italy takes drugs for diabetes…”
Surely this cannot be the case. It is not credible that 50% of the Italian population have been diagnosed with, and treated pharmacologically for, diabetes.
According to an article by King, Aubert & Herman in Diabetes Care in April 1999 (Vol. 22(4): p650.) entitled: Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections; the worldwide estimate of diabetes prevalence in “…adults worldwide was estimated [at] 4.0% in 1995 and to rise to 5.4% by the year 2025”.
So there is a growing trend of diabetes worldwide.
And there are serious health and economic costs attached to this growing problem.
However if Italy has reached 50% at treatment levels already then God alone knows what its prevalence rate must be and the much vaunted health aspects of the southern Mediterranean diet may need to be looked at again! A 50% treatment level and the implied underlying prevalence rate would utterly swamp the Italian healthcare system with just the one disease (never mind the rest of the quote which equally inflates the levels of treated hypertension in the Italian population – what a scarily unhealthy and/or over medicated country it must be!).
On a more serious note when any article contains such arrant nonsense the value and truth of the rest of the article become suspect.
John Boyce
Edinburgh
John Boyce has a point - but only if Hagop Akiskal has been misquoted. If he hasn’t then the lable ‘arrant nonsense’ should be applied to him, not to Annie Maccoby Berglof. It is very possible that she provided a source for this quote when sending the article to Prospect but that Prospect edited it out (I have experienced this muself in relation to Prospect but considered it fair enough as we don’t really want footnotes in Prospect)
So the arrant ‘nonsense’ point is valid, but we can’t say whether it weakens or strengthens this article until we know if the quote is accurate or not - perhaps Annie or Prospect could clarify the matter?
You are both right. In the editing process, the correct quote was cut and then mistakenly changed. Here are Hagop Akiskal’s exact words, in context: “The controversy to medicate or not medicate bipolar patients–I’ll say this: Today at least 50% of the population above the age of 40 in many countries is receiving medications to treat hypertension, which is now defined as BP (blood pressure) above 110/80, diabetes which is defined by fasting blood sugar of above 99, and cholesterol levels which have been lowered significantly as well. Most of these individuals are asymptomatic and have no disease. When it comes to psychiatric illness, there is a double standard: We need to research ad nauseum and still those who object to medications would raise the same questions, but not so with physical illness.”
The quote, I hope, will be corrected on-line by tomorrow.
Thank you for your thoughtful comments.
ABM
I can assure you that in my case this is no fad, but a long overdue development, I was wrongly diagnosed with chronic, treatment-resistant depression for many years. All the while, dysphoric hypomania in the form of uncontrollable attacks of rage continuted to cut a swathe through my professional and personal life.
Bipolar II is nothing to scoff at. Studies show 2s have higher suicide rates. Equally as important, some of us do not have euphoric hypomania, but only or sometimes just the dysphoric variety, and so there is no “upside” to it. I find that nearly all fellow bipolar 2s I know take an antidepressant and a mood stabilizer, and often a spot medication for their rage attacks. The dangers of antidepressants are in my experience more for bipolar I patients.
The next DSM contemplates a fuller discussion of dysphoric hypomania, and it is to be hoped that an all-too-frequent dismissive attitude toward bipolar II will be dispelled as a result.
I could use the advice of the B.A.D. sufferers out there. I am new to the effects of this disorder and could use an opinion or two on whether some behavior is possibly related or if it just “is”.
I work with a woman who has been diagnosed and is under medical care (pharmaceutically and psychologically), but there are days in the workplace when something (I’m guessing stress) causes her to be unusually mean-spirited or competitive in a One-upmanship kind of way. When this isn’t happening, she is serious, quiet, smart and has a good, kind heart–the kind of person with whom I would like to be friends. The trust issue is not knowing when the “mean” one is going to emerge.
I would so appreciate a little BAD 101 from someone out there. I think I have the ability to ignore the negative because the positive seems worth the effort. Help?
The “sudden” appearance of bipolar disorder can be traced to drug companies’ releases of antipsychotic drugs and their subsequent marketing campaigns. It is that simple. These companies are blitzing the airwaves with ads to convince the public they are bipolar, and therefore need these drugs. Sadly, millions of Americans over the last decade have fallen for this claptrap, which does not say much for the IQ of the average citizen. Furthermore, just because the DSM says something is this way or that, does not mean it is true. This text has done more harm than good than any other book besides the bible itself in disseminating mistruths. The DSM has now tailored what was once a severe mental disorder (formerly known as manic depressive disorder) into a tiered disorder now with the flowery name of bipolar disorder. What is totally sad is that so many doctors, who we used to think of as guardians, are now in the pockets of the drug companies and are complicit in this debilitating farce.
The DSM is primarily driven and controlled by psychiatrists, insurance companies and the psychopharmacological industry. Each group has a direct financial interest in focusing on individual pathology (rather than familial or societal), inevitably leading to medication-based solutions and shorter periods of treatment. The DSM has been referred to as the pharmaceutical companies’ “bible,” because without its coded diseases there would be no drug trials. Without medications psychiatrists stand to lose their place in the treatment hierarchy, and the DSM would loose its legitimacy as a necessary biological-medical tool.
This blog information about “Bipolar disorder comes to Britain” is really very informative. New research from the European neuroscience meeting explores the burden of symptoms in bipolar disorder: manic vs depressive, controlling bipolar depression, and cognitive functioning in bipolar I patients.
Bipolar Disorder, Bipolar Patients, Bipolar Symptoms, Bipolar Community, Manic-Depressive, Mania, Mood Swings, Mood Stabilizers, Mental Health Evaluations, Episodes