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Bipolar in the eye of the beholder

 

So whom is the joke on here?

I found this video on one of the several blogs I subscribe to.
(Okay, I’ll admit it, I’m a sucker for these Xtranormal videos.)

It seems to be composed from the point of view of the jaded psychiatric consumer patient, disturbed at the fact that her fairly unremarkable complaints are interpreted by her psychiatrist as symptoms of bipolar disorder, and how every problem’s solution seems to be a medication adjustment.

Indeed, most mental health conditions include, among their symptoms, common concerns like insomnia, poor attention/concentration, feelings of sadness, or (my personal favorite) “stress.”  But the truth is that bipolar disorder (the topic of this video) is a serious illness which can, at times, be incapacitating and threaten one’s livelihood or even one’s life.  Sleeplessness and “talking fast,” in and of themselves, do not make a bipolar diagnosis.

Watching the video as a psychiatrist, however, I’m reminded of the other side of the issue; namely, that patients will frequently come in with fairly ordinary complaints and profess that they must be “bipolar” or “depressed” or “anxious” and require medication.  Sometimes this self-assessment is accurate, but other times it’s more appropriate to exercise restraint.

The truth remains that, while in some physician-patient encounters the doctor tries to diagnose and treat on the basis of few symptoms, at other times the patient actually wants the diagnosis and/or the drug.  Which gives rise to the age-old
“slippery slope” in psychiatry, in which we deal with behaviors existing on a spectrum from normal to pathological.  Where does “wellness” end and “illness” begin?  And who makes this decision?

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12 Responses to Bipolar in the eye of the beholder

  1. Kimbriel says:

    I am the person who made the video you are posting. There was more to it than I can show in a video. I do not disagree with the diagnosis. What I went through when I got the diagnosis, is actually very similar to section 296 in the DSM. However, whenever I tried to raise the possibility that perhaps I did not have bipolar disorder, the only two things he could really point to, were talking fast and not sleeping. He would also say I was upset, if you want to count that as a third thing. The main point I was trying to make was not that I disagree with the diagnosis in my case, based on minor complaints. The main point was that the whole process is absurd. I would not have a problem with shrinks if they would conceptualize their practice as being akin to that of anaesthesiologists – pain, after all, is not a disease. It is a symptom of something greviously wrong with the body. However, sometimes it is beneficial to block pain, for the sake of being able to function, or end suffering. Instead, shrinks constantly come up with the diabetes analogy because bipolar disorder is supposedly chronic and needs lifelong management, as diabetes does. This analogy is problematic. It leads the uninformed person to believe that the psychiatric drug is actually correcting something physiological, because insulin DOES do that for diabetes. People should be told the truth about the reasons they should take psychiatric drugs. Sometimes a person does need to be sedated, as I asked for them to do to me, when I sent myself to the psych ward. But that does not mean a disease process has been identified or the "medicine" (drug) is treating something.Honesty is needed in the profession, when what I experienced was more like linguistic game-playing with my shrink. He would not outright lie to me, but he would complicate the issues by using medical sounding jargon, which really were just layers upon layers of self-defining words. I disagree with the entire construct of bipolar disorder. I think the standard of care is severely lacking. People are routinely not given informed consent. It is assumed that we would be willing to take any "side effect" in our ever-constant pursuit of a so-called stable mood. And then, if a person does not achieve a stable mood on the drugs, it is assumed that the problem is the disorder, never the drug itself.By the way, I really love my shrink and have fond memories of him (he moved away). He is a good guy. That does not change the fact, though, that the absurdity of the situation makes me laugh.

  2. The Beholder says:

    Where does "wellness" end and "illness" begin? And who makes this decision? The wellness and illness should begin and end in the eye of the beholder. And the decision should always be made by the beholder. What this cartoon does is illustrate how psychiatrist's well-meaning decisions are actually an abuse of authority. When a patient is an extraordinary amount of pain from trauma the answer is almost always to diagnose and prescribe. Instead of living in a society where people who live through extremes are given the time to grieve and integrate their experiences, psychiatrist's receive our confidence in modern medicine and science and we concede to them as experts. When instead, there is no biologically "balanced brain" that has ever been recorded in any kind of scientific study. Yet when a patient questions why their "disorder" is biological, then they are considered to be missing the point, or worse, jaded. In fact, it is the mental health system and psychiatrists and other professionals and in turn society who perpetuate mental health myths or scientific hypotheses as hard facts. Just because a psychiatrist's heart is in the right place doesn't mean he/she is the beholder. The psychiatrist is dependent upon an industry which has recently surpassed the American Defense Industry in defrauding the federal government. Yet all of these worrisome untruths and outright dangers perpetuated by the mental health system and pharmaceutical companies and other authorities, are seen as alarmist. This is because it brings into question the authority and livelihoods that psychiatrists and other experts are accustomed to.If we are to truly create a compassionate medicine and psychiatric practice it would be available to all regardless of financial circumstances, and it would encourage and treat the beholder as an equal human being.

  3. Winston C. Garette says:

    I dont' think the patient is jaded. I think she is traumatized and cannot believe that this is how insensitive and stupid psychiatry is.In reference to diagnosing bipolar disorder, someone told me that one traumatic event causes depression, 2 traumatic events cause bipolar. And by trauma, this means death in the family, divorce, phase of life, childbirth, etc… The patient in the video states that her child has been kidnapped and her mother is dying. What happened to psychoanalysis? It's now the DSM and a prescription pad. If the patient in this video was acting calm about these situations, then they would be insane. Reacting nervously to these traumatic experiences is only natural….but no, it's Bipolar $$$$.Don't forget when an antidepressant causes mania, the patient is then diagnosed bipolar because the mania was just supressed.How come patients come in saying they have bipolar disorder? Perhaps the power of advertising it everywhere???It's so simple.Pharmaceutical companies distribute propaganda. Often disquising withdrawal as "discontinuation symptoms". If they included in their advertisement booklets that this medication causes you to become an accidental addict and you will suffer debilitating withdrawal effects (discontinuation symptoms), then less people would buy it.

  4. Steve Balt says:

    I appreciate all the comments that have been written here.Kimbriel, I like your analogy of the anesthesiologist treating pain. In the mental health field we have effective tools (pharmacologic and otherwise) to treat symptoms of mental illness, but the mere existence of symptoms doesn't always mean that an "illness" exists. Regarding your disagreement with the "construct of bipolar disorder," I will say that I have seen some profound cases of bipolar disorder in my training– cases in which it is clear that there is a longstanding pattern of extreme mood instability and devastating effects in one's personal life, suggesting significant pathology (that we don't yet fully understand)– but I have seen far more cases of patients who have been diagnosed as "bipolar" on the basis of a handful of symptoms which may have arisen from a stressor like a death in the family or an especially traumatic experience. We psychiatrists need to speak to our patients about these events and their role in patients' suffering before jumping to conclusions.Beholder, I agree that the patient is always the beholder (although see below). A patient's experience should always determine the treatment, and as I tell my patients, NO patient improves if he or she distrusts or disagrees with the provider. If my assessment or treatment plan is not something the patient accepts or understands, then it is a foregone conclusion that the patient will "fail" the treatment– because I have "failed" the patient.I agree with all that "jaded" was perhaps the wrong word to use; it implies that the woman in the video is worn out, disillusioned, and has given up, when in fact she is worn out because she is misunderstood, and disillusioned by the absurdity of her experience and by the bogus "explanations" she has received.The reason I wrote this post is because I have, unfortunately, had many patients over the years who come to my office telling me they have a bipolar diagnosis– sometimes from another MD, sometimes because they have "mood swings" and believe they "must" be bipolar– and ask me to treat them. Sometimes they simply want meds, sometimes they want to own the label. While it would be easy to just agree with the diagnosis and prescribe the latest mood stabilizer or atypical, I refuse to do that, especially when I believe there is no neurochemical basis for their complaints (or, at least, no neurochemical defect that a medication will "correct"). In cases like this one, my goal of agreeing with a patient about a diagnosis and treatment plan fails, but for a reason precisely the opposite of what is portrayed in the video. Unfortunately, those patients usually go see the psychiatrist down the street and no one is better off.

  5. kimbriel says:

    Steve – thank you for your perspective. This is what I want to see! REAL dialogue from both sides of the fence. The thing is, that I know my psychiatrist recognized the absurdity of the situation as well. But he is so concerned that I "stick with" the treatment that is the standard of care in psychiatry, that he has to sort of perpetuate myths in order to educate/persuade me, even though he has probably pondered the same myths. If I had been more aware of the actual truth of what we know/don't know about treatment of mental illness, I would not have agreed to take the Abilify for so long, although I WOULD have taken it during the peak of my crisis, because AT THAT TIME, it made me FEEL relief! I just would not have continued to take it for so long after it made me feel crappy.What the video does not/cannot show is that this episode was not my first one. My first one was postpartum psychosis after I had been traumatized by the birthing process and being in a hospital for the first time since I had been in a hospital extensively as a small, disabled child for surgeries. It triggered the Bipolar for me, but it was not labeled Bipolar at that time. I was again, thankful for the help at the peak of the crisis. HOWEVER, after about 6 weeks of Risperdal, I realized it was not realistic to be sleeping 14-16 hours a day (due to the Risperdal) with a newborn to take care of, and it was not helping me live my life/function. I self-weaned (against medical advice) and was fine off of meds for over 4 years while I raised a child and built a high powered, lucrative career. Until the (2nd) episode, which was not a psychotic one, just a mixed manic one… THAT is when my diagnosis became Bipolar (taking into account the prior psychotic episode, which is not mentioned in the video). I brought up the trauma of my son being kidnapped and my grandmother dying, not to illustrate that I may have been misdiagnosed, but rather to illustrate that, even if a person's behavior is way-beyond-the-pale strange, there may be actual reasons for it that are not dealt with or even asked about by hardcore biopsychiatrists.So you see, my psychiatrist is not a quackster shrink. He has plenty of reason to label me Bipolar (I am not one of those "oh-gee-I am-mostly-depressed-and-occasionally-irritable Bipolar cases). My experience DOES match up with that page in the DSM. The issue I have is that it is necessarily a MEDICAL problem, or at least, is it a MEDICAL problem in everyone? And how does one know that it is a medical problem in any given individual without a diagnostic test? It may be a medical problem, I remain open to that possibility. II also do not believe in the kindling hypothesis (in neurology either, but certainly not in psychiatry). So I do not believe the diagnosis of Bipolar disorder to necessitate lifelong medication for the vast majority of people. Is medication useful/helpful to squash a crisis? Absolutely. Will some people with the Bipolar label always be in a crisis? Absolutely. Therefore, is it possible that SOME people with the Bipolar label will always require medication? I do not have a problem with people choosing medication. I have a problem with people "choosing" medication (if they are not educated as to the facts, it is not really a choice) under false pretenses and then constantly being told that, even though they feel shitty, the medication is doing "something".I appreciate all the contributions here. The other two commentators hit the nail on the head as well. I did wince a little at being reduced to "jaded". Thank you, Steve, for being open-minded. Would you please consider passing the video among your colleagues, along with some of the explanation? And if you do, please make sure to let them know that I actually really care for my ex-psychiatrist, and am grateful that, at least when I started to put things together on my own, he was actually really honest about it, though in some ways he always reverted to his talking points. He always acted with my best interests (as he saw them) in mind. I have no doubt about that.

  6. peter says:

    diabetes management is different in the sense that the managed patient actually gets to the agreement that he is feeling well. Physicians and scientists behind them adjust themselves towards gaining higher tiers of knowledge through that feedback. You see that in half a century management of diabetes is approaching to its definite treatment. In psychiatry treatments, complaint of the patient from the management is being considered as part of his disease. Hence, a good trained ideal psychiatrist never gain from his experience with patients. He never observes anything. In the cartoon shown, the patient have to say that she is all right and conform if she does not want to live the remaining of her life in incarceration. Psychiatrists have to figure-out just random ideas morphologically analogue and parallel in appearance similar to practice of physicians without considering its consequences. A disastrous consequence is for patient, interpreted as part of his disease.PJ

  7. moviedoc says:

    I'm embarrassed to have to say that the animation may accurately portray the perseverative approach of some of our colleagues, especially with regard to overdiagnosis of bipolar disorder and polypharmacy (as manifested by addressing every complaint by increasing or adding a drug). Of course this psychiatrist is a caricature, but the animation so clearly emphasizes his failure to appreciate that mood disturbance is the essence of a mood disorder as well as his failure to communicate this to the patient, not to mention his refusal to provide the patient with direct answers to very legitimate questions.

  8. This is a very well done video! Does it caricaturize? Yes, a little, but it should. And to be honest, my experiences with undifferentiated psychosis have been very similar. Whenever one starts to question, the doc becomes a repeating machine?! But I'm happy a psychiatrist has the guts to comment about the video. I'm sure most of us aren't here to make you look bad. I know there are skillful psychiatrists out there, like Peter Breggin, Grace Jones and Thomas Szazz among others. We are here to comment because we feel we didn't get proper information concerning the long-term use of psychiatric drugs. Absolutism in either way is always an obstacle. And yes, there's money involved too…But I see something is definitely happening, maybe we have a change coming. It doesn't mean psychiatrist will be left without jobs. No way. It means there will be new ways of treating those with mental problems.

  9. What to do? says:

    I know this is off topic, but I have a family doctor that is quite "old-school" when it comes to mental health. He belongs to the class that believes if you "break your leg", just walk it off and because of this refuses to take my complaints seriously. I have been contemplating suicide lately, I'm not planning just looking at it as an option because of the way i feel and the lack of help I'm finding in my community. I'm not in a financial position to visit a psychiatrist on my own and my doc refuses to refer me because of missed appointments to his preferred psychiatrist in the past (during a major depressive event which i didn't leave the bed for around 1 month). Anyway, what should I do? I can't go to the psych hospital and admit myself because I have no one to take care of my cat but my doc refuses to help me.P.S. I have been hospitalized for about 12 years of my early life due to mental health problems, mostly bipolar and depression. My doc doesn't believe bipolar exists in me because when I visit him it's only during normal or manic periods, which I appear a little hyper but mostly normal.

  10. Steve Balt says:

    what to do:If you and your doc don't see eye-to-eye, treatment will never be effective. The question is, who's seeing things more accurately? Only you know what is happening in your own mind & body, but he may have a better sense of how your symptoms compare to others and their histories, their response to treatment, etc. Nevertheless, at this point you owe it to yourself to get a second opinion, preferably by someone with knowledge of mood disorders. Look for a community mental health clinic, a crisis clinic, or– if you're in a metropolitan area– a psychology training program where you might be able to see a trainee therapist for a nominal fee. The internet is also a surprisingly good place to find some peer support… look around for some discussion groups, Facebook pages, etc where you can share your concerns, questions, etc., and you may get some great advice.

  11. geezer840 says:

    Excellent web site. It is refreshing to read what is obviously very complex material presented in a manner understandable by non medical audiences. I look forward to more.

  12. bipolar symptoms tests…

    […]Bipolar in the eye of the beholder « Thought Broadcast[…]…

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