Both Philip at Furious Seasons and CL Psych are asking questions about the overdiagnosis of bipolar disorder. (Philip adds more on this topic since I wrote this–the evidence is piling up) CL psych goes as far as to suggest that yesterday mark the beginning of a week commemorating Bipolar Overawareness:
So I propose that we start a Bipolar Overawareness Week, complete with a website linking to a questionnaire that makes statements like:
- Do you know that your symptoms are probably not indicative of bipolar disorder?
- Ask your doctor if you’ve been misdiagnosed with bipolar.
- Find out if you are unnecessarily taking Zyprexa today.
Let’s see if we can get the National Alliance for the Mentally Ill on board. Surely they want to make sure that patients receive the proper diagnosis. Surely drug companies, with their interest in good science and good medical practice, want to help out as well, since they want to make sure that their drugs are prescribed properly.
I think these are very good questions for probably hundreds of thousands of people to be asking. Okay, so I’m a little more radical than Philip when it comes to coming to conclusions. He points out that the research he is reporting on is based on just one large clinic in Rhode Island. (His later post indicate the problem most assuredly goes beyond that) I basically question the label in almost every instance since I’ve seen even the most classically afflicted bipolar patient recover with alternative methods. Also I worked in mental health for 12 years and saw exactly who was being diagnosed. Granted some of those people had very difficult problems and I am in no way minimizing the real suffering people experience.
Philip says of the Zimmerman’s report on overdiagnosis:
For example, Zimmerman uses familial history of bipolar disorder in his paper to rule out bipolar disorder in people in the study who did not meet formal clinical criteria for bipolar disorder according to the Structured Clinical Interview for the DSM-IV (SCID). In other words, if the people didn’t test out as having bipolar disorder and there was no family history of bipolar disorder, then Zimmerman determined that these people had been bad diagnoses if they had previously been given a bipolar disorder diagnosis.
So while we’re looking at Philip’s piece I will take seriously, for myself in any case, the question about family history. I’m not one to buy into the genetics model, instead I say we certainly learn and are nurtured by the people who raise us. We eat what they feed us and learn from their behaviors good and bad. This effects physiology and mental health.
In any case, if I’m to use Zimmerman’s standards, much like Philip I have no family history of bipolar disorder. There is one drunk and one suicide, and aunt and a great uncle respectively. My father was a raging asshole, but he did not have mood swings otherwise—his rages were unpredictable and intermittent. Of course in today’s loose labeling, rage would qualify as mania, but my father displayed absolutely no other symptoms of mania save cheating on my mother. And I agree with Philip that sexual indiscretions are not a good measure of mania. My father was home every day for dinner and was very cautious with money. He was not running around wildly with the women he had affairs with and did not seem depressed in any way. Anyway that’s the family history.
When I was diagnosed as a result of taking hallucinogens and reacting to them with a psychosis that was associated with pre-menstrual syndrome. (I took hallucinogens a few times and the only times I lost it was when I was premenstrual—this I know because each time I was hospitalized I got my period the following day.) I’ve never had anything resembling psychosis without it being drug induced. And I haven’t really had anything strongly resembling real hypomania either, though my energy levels do fluctuate and I’ve suffered from anxiety that has kept me awake at night—also in retrospect adverse reactions to psychiatric drugs. The doctors at the time I was diagnosed did scratch their heads when no family history was revealed but they still saw fit to smack me with a label based solely on the drug induced psychosis which has since greatly diminished the quality of my life. In all the ways Philip says it can:
As a result, hundreds of thousands of people are winding up on meds they don’t need, meds which injure some people (not everyone. Yes, I know some people do derive some benefit from them) and a diagnosis that follows them for life and can lead to discrimination in employment, health and life insurance and personal relationships. That’s serious stuff.
After I accepted the label I fell into accepting drugs without question and now in hindsight I see that I took drugs to get rid of side effects of other drugs. And I took drugs to cope with mild characterogical problems which should have been dealt with in therapy. The drugs never helped and it was my doctors way to simply increase dosages when I complained of irritability or any kind of existential distress. Now I know it was the drugs causing much of the irritability. In fact Risperdal causes irritability in me and my doctor kept raising my Risperdal dose to treat the irritability that very drug was causing. Klonopin causes irritability too and so did the SSRI’s which also caused agitation. I was given Klonopin and Risperdal both to deal with side effects. I did have depression when I was given the SSRI’s but I think it was a result of the neuroleptics they gave me.
I was fine before I took hallucinogens. I did have very severe PMS as a young woman—symptoms that came very clearly only prior to my menstrual cycle— but prior to my illicit drug experimentation I found a nutritional doctor who completely relieved my PMS symptoms through diet and nutrition. I was only 16 when I started work with that doctor and sticking to a difficult diet at that age was something I was not ready for. Once I took the hallucinogens and was convinced by psychiatrists that I was profoundly defective the good nutritional habits went out the window for the next two decades. Why I let psychiatry blind me so deeply, I don’t know. I did give up though on taking care of myself naturally even though I had seen it was a very successful treatment for me.
Like Philip I have questions too. But they are slightly different questions. I tend to believe that most of us whether we fit the classic criteria for bipolar disorder or we are just a bit funky like me can recover. I find the labeling of difficult mental health symptoms destructive and disempowering. Places like Soteria have demonstrated that the severely impaired can and do recover. My own experience in drug withdrawal circles, being involved in Safe Harbor and running this blog have uncovered hundreds of people who have recovered from serious symptoms of mental illness through meditation, diet and nutrition, yoga and other eastern body movement disciplines, neurofeedback etc.
I’d like this to be bipolar unawareness week. Let’s just take care of ourselves and not diminish ourselves with labels that discredit and stigmatize us. Yes, that is not a likely scenario and I know that labels are sometimes practical and we will always use them for better or worse. But I personally no longer use clinical language to explain my well-being and it helps a lot in reclaiming myself as a complicated human being as we all are, mental health diagnosis or not.
For another twist on labeling see what Bipolar Wellness Writer said yesterday:
What if your DSM diagnosis was: Creative Genius, Sensitive Paragon, Thoughtful Humanist? Would you still feel bad, or would you just feel special?
I’ll settle for a mixture of all those labels and feeling special.
For my declaration “Undiagnosising Myself,” see here. It’s a bit angry and rambling and someday I’ll redo it so that it’s more organized, but it’s a decent piece of writing if you like a bit of a rant.