Because his site is no longer I’m cutting and pasting that post below:
Six Months Off-Meds – By Philip Dawdy
Not that anyone cares, but yesterday marked my six-month anniversary of going off-meds for bipolar disorder. After 18 years of taking meds consistently, my psychiatrist figured I might do well off-meds, so he suggested that I give it a whirl. So I have, since I’ve earned the right.
What’s stunning to me is that I remain virtually without symptoms, even of depression–and that’s just not supposed to be happening here, especially since I am under massive amounts of stress, personally and professionally. Not according to the medical literature I’ve read. The course for bipolars who go off-meds is supposed to be highly predictable–they wind up in big trouble and either die or spend time in a psych unit or what have you. And of course they wind up back on meds after wreaking havoc on the Western world. They never get better or do just fine off-meds.
But, then, maybe the unbiased researchers who write the medical literature never talk to or examine people like me. OK, I know they don’t.
So what is going on here? Was I a bad diagnosis back in 1989? Did meds somehow cure me while messing me up at the same time? Did therapy cure me? (Um, no since I haven’t seen a therapist since the early 1990s.) Did I cure me? Or does bipolar disorder just burn out over time? I am leaning towards the latter two possibilities, but I’m not sure how to explain this except to say that’s what seems to be going on.
I just don’t have any reference points to go on. Everyone from Kay Redfield Jamison on down says I am supposed to be a train wreck waiting to happen, but I’m not. That’s both encouraging and disconcerting all at once.
On a positive note, I ran into a friend of mine last night who commented that I was finally losing weight in my face. He’s gay and notices these things I guess, but he’s right. Atypicals and meds in general really puffed my face up and it’s been difficult to lose that puffiness. I’m glad it’s ebbing away. Or at least that my friends think it is.
EDITOR: Today’s post is the following: Psychiatrist calls BS on Bipolar Disorder.
I just wouldn’t ask the question at the end of his piece—Is bipolar disorder as cockeyed and ginned-up as Minot believes? Or are he and I utter fools?
I have no doubt that it’s as cockeyed and ginned-up as Minot believes. Even more so, since I wouldn’t even consider medicating people that Minot still doles out drugs to. Alternatives allow people to avoid the toxic drugs that have ruined my body and so many hundreds of thousands of others.
I’m still doing good. Hanging in there, busting the bipolar paradigm along with Philip.
AND THE POST THAT IS NO LONGER:
January 22, 2008
Psychiatrist Calls BS On Bipolar Disorder – By Philip Dawdy
First, thanks to all of you for your kind thoughts regarding my six-month anniversary of being off-meds. I happened to put the same post up on Daily Kos and got several fascinating replies, including this one from Paul Minot, a psychiatrist from Maine. I’m reproducing his reply, mostly in full, with his permission. You can read the others here.
“Bipolar disorder isn’t actually a disease.”It’s a collection of signs and symptoms lumped together in a diagnostic classification that has no basis or assumption of causation. There is no known neurochemical abnormality associated with “bipolar disorder”, and patients with this diagnosis certainly have a plethora of different problems, all lumped together in one convenient/dumb diagnostic classification.
“The expansion of the definition of bipolar disorder over the past two decades is simply a “rebranding” of post-traumatic stress disorder, impulse control disorders, personality disorders, and other problems into a pseudoscientific trashcan diagnosis, to provide an FDA-approved “indication” for the prescription and marketing of anticonvulsants and other medications to treat this “illness”. I know this because I myself am a psychiatrist, actively treating bipolar disorder and prescribing these medications. I think prescribing these medications is reasonably safe and often helpful, but trumping up fictitious diagnoses and deluding people into thinking that they have a lifelong illness without a firm grounding in scientific fact is ridiculous, and unethical. Your own experience isn’t miraculous, it just verifies that much of contemporary psychiatric diagnosis is a bunch of malarkey.
“You’re very fortunate to have the psychiatrist you do, one that apparently hasn’t fallen for our own bullshit. Good luck to you.
Minot is right that I am fortunate to have the doc I have. Minot authors the Candid Psychiatrist website and has several interesting posts there–for example, one discussing psychiatrists as enforcers of the social order as opposed to being doctors per se.
Anyway, I’ve not encountered this much honesty in the psych world this side of Loren Mosher and David Healy in ages and it was refreshing to hear a psych doc call BS on the huge expansion of the classification of bipolar disorder. This is an expansion of the disorder that continues today what with the new DSM-V on the horizon and much talk in psych circles of expanding bipolar disorder even further into a very soft bipolar disorder type 3 and the creation of an official child bipolar disorder in the DSM. I’ve written about my frustrations with the so-called subthreshold bipolar disorder here. I’ve written about the bipolar child paradigm so much that I won’t bother linking to any one piece.
In fact, I’ll make a prediction: when the DSM-V comes out it will contain a BP3 and a child bipolar disorder. I’ve talked to some in the psych research world who are utterly convinced that this will happen and that it will help people. I think these moves are twin disasters, but that’s my opinion.
As I noted last May:
“If this strikes you as unimportant, perhaps you don’t understand how all the dots connect around bipolar disorder the last few years. Zyprexa, Rebecca Riley, the bipolar child controversy, Seroquel declared the bipolar pill, class action lawsuits, multi-billion dollar settlements, researchers cooking research, black box warnings, calls for more outpatient commitment and so on. All of those bits connect with bipolar disorder in our culture and are evidence of the weaknesses–and dangers–of current treatment paradigms for bipolar disorder. And yet we have researchers, one cabinet level department (HHS), two private foundations and many pharmaceutical companies who would like to double or triple the number of Americans who must be convinced they have bipolar disorder, be instructed that it is a lifetime illness and be pressured to take medications that have a less than 50 percent chance of doing much for you and anywhere from a 30 percent to 50 percent chance of causing you an injury (I’m done with sugar coating it by calling injuries “side effects”). Forget about the usual criticism that this is all a naked land grab by pharma companies and researchers looking to line their pockets.”It’s darker than that. What we’ve got going on here is the norming of America–a big happy party wherein Americans are forced to have their behaviors, thoughts, impulses and expressions grouped around a carefully-controlled norm.”
Which brings me to Minot’s point of just how wildly expansive definitions of bipolar disorder have become. I cannot offer you quite the comprehensive overview of how manic-depression–aka bipolar disorder–had softened pre-DSM-IV (1994) that I’d like to. My understanding is that what we now call bipolar disorder was well understood in the medical literature going back to the 1800s (and further of course to the Greeks) and all the way through DSM-III (in effect from 1980 to 1994) had as its central underpinning that a patient had to be wildly out of touch with reality (ie, delusional) and manic off their butts for an entire week in order for a diagnosis to be made. That changed in 1994 with the introduction of bipolar disorder type 2, which allowed for a diagnosis to be made when only hypomanic symptoms were present (there was no change to the requirements for depressive symptoms as I recall).
I was diagnosed under the DSM-III (technically, DSM-III-R after 1987) in 1989. As I recall, I was not manic off my butt, but instead was dealing with something that, in retrospect, smelled more like BP2 than BP1. So how I ended up with a diagnosis of manic-depression (later to become bipolar disorder type 1) is a bit beyond me. I cannot account for this and it troubles me greatly because what if I were simply dealing with a mess of PTSD and impulse control problems, as Minot suggests, as opposed to a full-blown case of mania and depression? How would I explain the last two decades or so of my life to myself? How would I understand my future? How can I shake the label of bipolar disorder when the psychiatric profession refuses to undiagnose people who do well? How do I apologize to my body for all the years of psych meds?
It’s because of questions such as these that linger 18 years later that I think the psychiatric profession needs to do a fair amount of soul searching when it comes to bipolar disorder. I doubt that too many researchers who shape the DSM and clinical research will bother. But i think this continual softening of bipolar disorder is out of line. Can the profession show replicated evidence of how BP3 (or SBD, as it’s now called) patients have their lives dramatically improved by being diagnosed with the disorder and medicated? I’m not talking about these meaningless three-week studies that the industry favors (that’s meaningful for talking about treating acute mania but not about much else in the context of bipolar disorder), but long-term naturalistic studies. I think we already know from the results of STEP-BD what the answers will be (hint: not really good). Absent positive real world evidence (as opposed to anecdote), why would docs continue to demand that bipolar disorder be expanded? Can some researcher delineate the impairment caused by BP3? Can they establish that this cannot be more effectively treated through therapy or by a short term course (ie, a few days) of benzos?
I also think the profession needs to be careful what it asks for when it comes to the bipolar child. The psych industry is fairly well divided on the question of whether the diagnosis even truly exists in kids (but the power centers at Harvard and Columbia think that it does), so it would seem appropriate that the writers of the DSM and the alleged key opinion leaders of psychiatry create a mechanism whereby someone diagnosed with child bipolar disorder at say five-years-old could later be undiagnosed at, say, 15-years-old. That seems like a sensible trade-off. It would also make sense to apply undiagnosing criteria to teen and adult flavors of the disorder, especially if the industry is going to push for this continual softening.
And, I think my own case ought to be a bit of a nudge to them as well. Because if their diagnostic criteria were as locked down and scientific as they claim then I wouldn’t have so many questions and they would have far more answers that worked for large numbers of people. And I have questions.
What if I was basically just going through a bad patch of life with personality issues run amok? Must I pay for it forever? Why do doctors get to decide that I will never be well or never be redemmed? Isn’t that my business and not theirs? It’s my life after all, not theirs, and last time I checked I wasn’t violating the social order in any way. So what gives?
Is bipolar disorder as cockeyed and ginned-up as Minot believes? Or are he and I utter fools?
I don’t have an answer. Do you?