Questioning Whether Bipolar Disorder Is An Illness

[David Baxter PhD]

Questioning Whether Bipolar Disorder Is An Illness
Bipolar Beat
August 9, 2011

Several weeks ago, the British Psychological Society published a report online entitled Understanding Bipolar Disorder. (You can download the 88-page report for free; although you must go through the purchase process to ?buy? it, you?re charged nothing for it. According to BPSShop.org.uk, the report will be available for free ?for a limited period.?)

Although the report doesn?t make any groundbreaking revelations, it does contain some important reminders, including the following:

• Everyone?s different. What works for one person with bipolar might not work at all or as well for another.
• Several non-medication therapies are helpful in maintaining mood stability. These therapies include mindfulness training, cognitive behavioral therapy (CBT), interpersonal and social rhythm therapy (IPSRT), family therapy, psychoeducation, family-focused therapy, and other relationship therapies.
• Learning to identify stressors and triggers and reduce or avoid them is sometimes helpful in preventing or mitigating mood episodes.
• A more accurate way of viewing the different types of bipolar disorder may be to imagine a bipolar spectrum that encompasses Bipolar I, Bipolar II, Cyclothymic, Rapid Cycling, and Bipolar NOS (not otherwise specified) and perhaps symptoms of other mental illnesses, including schizo-affective disorders.
• Everyone has the capacity to feel depressed or elated. The difference between those with clinical depression or mania is a matter of degree ? those with bipolar experience extreme depression and/or elation (hypomania or mania).

What we take issue with in the report is that it diminishes the biological basis of bipolar disorder. The authors would probably argue that they did this intentionally to ?restore the balance? that purportedly has been thrown out of whack by the predominant view that bipolar disorder is a medical problem, an illness, but we think it goes too far.
In the big picture, all of these factors are important ? biology, psychology, relationships, work environment, and so on. Furthermore, psychology is biology. Emotional and behavioral responses are rooted in the wiring of and communication between brain cells. These patterns are formed by a combination of genetics and environmental effects that come together to create how a person feels, thinks, and acts.

To maintain an artificial duality, a false dichotomy, seems out of step with modern thinking. Everyone who knows anything about treating bipolar disorder is well aware that both medical and psychological therapies are helpful and often most helpful when used in combination. Psychological therapies still operate at the level of changing brain function ? it is simply a different mechanism than medication.

We object to the view implied in the report that bipolar disorder may not be an illness. It is an illness ? a serious medical condition that requires treatment. Viewing it as merely an extreme on a continuum and not as an illness has the potential of setting back the cause of reducing stigma and getting people to seek treatment and could even be dangerous in influencing people to stop taking their medications.

The idea that because something is part of normal function precludes it from being a symptom is a fallacy. We all breathe, and we all get short of breath sometimes for various reasons, but someone with asthma or emphysema has a lot more serious and frequent problems with breathing that can cause severely impaired function or even death.

Yes, as explained in the report, we all get happy or even very happy, and everyone has sad times, but at the extremes, when mood can?t be regulated adaptively, it becomes a medical condition requiring treatment. The data is increasingly clear that there are consistent and observable brain changes related to mental illness, including depression and bipolar disorder.

Furthermore, if bipolar is seen not as a medical condition, then the general population may see it as a character flaw or something that the person could control if she would just ?try harder.? That can be just as stigmatizing as and perhaps even more so than having a bipolar diagnosis.

The mental health community, patients and practitioners, have worked hard to help clear up the idea that bipolar and other mood disorders are not something that people could just change if they would just try harder. Overemphasizing this idea that bipolar disorder isn?t necessarily a medical issue damages these efforts. Simply because the diagnostics are not always clear cut and the neurologic foundations are turning out to be very complex and difficult to characterize, doesn?t give one license to dismiss the fact that bipolar disorder and other mood disorders are illnesses that typically require medical intervention.

 

[Andy]

Geeez! Well aside from the fact that I am biased as I am diagnosed with bipolar disorder I would have to say that I wouldn't agree that it isn't an illness either. you would think that actually observing some severe Bipolar 1 patients would put that theory to rest quickly IMO. Then where do they draw the line then if Bipolar isn't an illness then what mental illnesses are?

I do think that a lot of doctors are labeling people with the diagnosis prematurely. Back when I was diagnosed it was a handful of doctors observing and talking to you over a long period of time (unless it's blatant of course), now it seems that some doctors label people with it in a few short visits.

And that does make you think, what the hell am I taking all this stuff for then?

I think this is kind of ridiculous. Undoing everything that has been discovered about all mental illnesses not just Bipolar. Just my opinion.

 

[David Baxter PhD]

I agree with the article. I see other documents like this coming out of the UK in recent years and from my viewpoint they appear to be motivated more by political cost-saving interests and anti-psychiatry factors than by evidence-based medicine. Frankly, I find it quite worrisome, especially since it's released under the name of an organization that most people would consider to be authoritative.

 

[Missed Link]

I have bipolar disorder as well. I've read various reports and most seem to uphold the idea that it is caused, at least in part, by neurological and biochemical imbalances or misfires in the brain. That being said, epilepsy is also caused by neurological misfires in the brain. A psychiatrist explained to me that both bipolar and epilepsy are similar in that they are both due to biochemical & neurological miss-firings but the pathways affected are different for each resulting in different malfunctions in our bodies. So, my question to the writers of the report is, if this is so, why is epilepsy categorized as an illness and not bipolar and I'd like to hear their reasons spelled out.

Just my opinion.

Thanks for all your hard work. You give me much to think about.

 

[Jesse910]

While I think bipolar disorder is an illness of sorts, "illness" is not a word I use because that implies being sick. And, I refuse to be anything but. I believe that being diagnosed with bipolar should not be viewed as a death sentence. Once treatment is sought, we can live as normal a life as the next person. Ultimately, everyone who is diagnosed needs to learn as much as possible about bipolar, ask questions, figure out with the assistance of medical personnel what type of treatment to utilize, and incorporate other support systems, if necessary, to allow us to thrive. Additionally, we also need to figure out, if we haven't already, what triggers our moods and learn alternative ways of dealing. Over the years, I've taught myself that how I feel about myself makes a huge impact in how others view me. Each day, I decide, to the best of my ability, how I'm going to feel. And, on the days that I cannot function well, I may need to call my therapist, family member, or a friend for support. This doesn't make me weak/sick. It simply means that I'm strong enough to realize that this so-called illness doesn't have to determine how I live my life.

 

[Daniel E.]

BTW, from Wikipedia:

In many cases, the terms disease, disorder, morbidity and illness are used interchangeably. In some situations, specific terms are considered preferable.

Disease
The term disease broadly refers to any condition that impairs normal function. Commonly, this term is used to refer specifically to infectious diseases, which are clinically evident diseases that result from the presence of pathogenic microbial agents, including viruses, bacteria, fungi, protozoa, multicellular organisms, and aberrant proteins known as prions. An infection that does not and will not produce clinically evident impairment of normal functioning, such as the presence of the normal bacteria and yeasts in the gut, is not considered a disease; by contrast, an infection that is asymptomatic during its incubation period, but expected to produce symptoms later, is usually considered a disease. Non-infectious diseases are all other diseases, including most forms of cancer, heart disease, and genetic disease.

Illness
Illness and sickness are generally used as synonyms for disease.[4] However, this term is occasionally used to refer specifically to the patient's personal experience of their disease.[5][6] In this model, it is possible for a person to be diseased without being ill (to have an objectively definable, but asymptomatic, medical condition), and to be ill without being diseased (such as when a person perceives a normal experience as a medical condition, or medicalizes a non-disease situation in his or her life). Illness is often not due to infection but a collection of evolved responses, sickness behavior, by the body which aids the clearing of infection. Such aspects of illness can include lethargy, depression, anorexia, sleepiness, hyperalgesia, and inability to concentrate.

Disorder
In medicine, a disorder is a functional abnormality or disturbance.[10] Medical disorders can be categorized into mental disorders, physical disorders, genetic disorders, emotional and behavioral disorders, and functional disorders.

The term disorder is often considered more value-neutral and less stigmatizing than the terms disease or illness, and therefore is preferred terminology in some circumstances. In mental health, the term mental disorder is used as a way of acknowledging the complex interaction of biological, social, and psychological factors in psychiatric conditions. However, the term disorder is also used in many other areas of medicine, primarily to identify physical disorders that are not caused by infectious organisms, such as metabolic disorders.

http://en.wikipedia.org/wiki/Disease