Monday, February 1, 2016

Not Just Up and Down -- A New Map for Bipolar


Last week a friend told me she had just been diagnosed with bipolar.  I remember eight years ago when she told me she was finally getting treatment for depression.  I didn't say it at the time, but for the next several days my brain was screaming it: Really?  In 2016 people are still being misdiagnosed, and mis-treated, mistreated with meds that make them worse.  I mean, 


F*cking Really?!!

Lives are at stake here, people.  Careers, families, credit, and yes, lives. That is what people lose when their doctors get this call wrong.

Nancy Andreasen, world prominent researcher of schizophrenia and former editor of the American Journal of Psychiatry once wrote, Since the publication of DSM-III in 1980, there has been a steady decline in the teaching of careful clinical evaluation that is targeted to the individual's problems and social context and that is enriched by a good general knowledge of psychopathology.

What replaced careful clinical evaluation were the damned symptom lists.  The DSM was supposed to make it easier for researchers to talk with each other and check each other’s work.  But when clinicians, the people who treat patients, got hold of the lists, they stopped listening to patients and started comparing us to what we were supposed to look like.  Count the symptoms; assess severity; assign the diagnostic code.

As a consequence, the lists, which were actually rough drafts until DSM-III carved them in stone, turned into circular arguments.  They could never be significantly improved, because when the researchers wanted to learn more about bipolar, they went out and got a bunch of people who already matched what they thought bipolar was.  Deviations were excluded from studies, and so were not able to provide better data.
Downstream from the lab, patents became chained to lists.  We have to learn the language of the DSM, because that is the only language our doctors speak.  Unless we report what matches the lists, our complaints are not heard and not treated; our suffering is not known, let alone addressed.

How many times have I reported to a doctor that my body doesn’t regulate temperature well?  That might illustrate a pattern of difficulty maintaining homeostatsis, like any number of disregulation issues related to bipolar.  But it’s not on the list, and they really aren’t interested.

Shortly before DSM-5 was published, Thomas Insel, director of NIMH declared that treatments for mental illness were just not good enough.  He announced that NIMH wasn’t going to fund research anymore that depended on the damned lists.  It’s time to stop reading the list of features pasted to the car window and start looking under the hood.

Up steps John McManamy to say:
       Look under my hood!

In Not Just Up andDown, John tells the story of how medicine got to such a distorted view of bipolar – the very name of the disorder confuses doctors, patients, and public alike as to the nature of the beast.  He provides his own careful clinical evaluation.  And he proposes a different map to follow to connect the dots.

He tears up the book, looks at the patient, and finds a new way to explain what is going on, exactly what Insel says we need to do.  Finally!  Here is somebody paying attention.