More on So-called Bipolar Disorder

A few days ago, I received the following email:

Hi Phil,

I would like to hear from you how we can survive the bipolar disorder, as I understand bipolar is a very serious disease.

Regards,

[Name]

The question seems important enough to warrant a more public response, though I have omitted the writer’s name to safeguard confidentiality.

So here’s my reply.

Firstly, the condition known as “bipolar disorder” is emphatically NOT a disease.  Rather, it is a loose cluster of behaviors which psychiatrists – in concert with the pharmaceutical companies – have called an illness with the purpose of selling drugs.

The DSM criteria for this so-called diagnosis are set out in my earlier post on this subject.

In practice, the behaviors likely to attract a “diagnosis” of bipolar are:

  • Hyperactivity of any kind for an extended period
  • Marked irritability; grouchiness; snapping at family, co-workers, etc.
  • Marked boastfulness; expressions of grandiosity
  • Pronounced sleeplessness
  • Excessive talk; rapid shifting from topic to topic
  • Temper tantrums
  • Behavior that would normally be called “irresponsible,” e.g. sexually reckless activity; buying sprees; gambling; risky ventures; etc.

Traditional psychiatry says that if you’re functioning in this fashion, you have an illness called “bipolar disorder.”  The formal criteria call for a certain number of behaviors within certain time frames.  Also, a measure of oscillation is required – i.e. the “symptoms” abate periodically, then resurge.  And so on.  In practice, any of the behaviors listed above will attract this “diagnosis.”  And the “treatment,” of course, is: drugs.  Usually lithium carbonate – but in the past decade or so other drugs are being used to impact these behaviors.  Especially worrying in this regard is the prescription of these drugs to very young children to treat tempter tantrums.  (I am aware that temper tantrums as such are not included in the DSM criteria list, but over the past decade or two, proneness to temper tantrums has been conceptualized as “mood swings,” and has become a kind of backdoor feature of this so-called mental illness.)

But, back to the question in the email.  What should one do?

Well the answer, of course, depends on what kind of problem behavior we are talking about.

Let’s say that the problem behavior is irritability and temper tantrums.

The first requirement is to describe the problem clearly and completely.  “Temper tantrum” can mean different things – everything from stomping one’s foot and saying “drat,” to throwing the furniture out the window.  So if a person feels that he/she has problems with anger control, the first thing is to write down exactly what kind of behaviors are occurring and with what frequency (Daily? Weekly? Monthly? etc..)

Duration is important.  Has it been going on for years or just in the past few days?

Context is also critical.  Where does the problem behavior occur?  At home?  Work?  When visiting in-laws? etc..  Or perhaps everywhere?

And triggers.  What kind of situations seem to “trigger” the anger response?  Other people’s driving?  People talking on cell phones?  Outbursts of anger usually occur when we feel frustrated or attacked.  Frustration arises when we are trying to do something but can’t manage to do it.  And attacks may be real or imaginary.

And substance abuse.  Is there a problem with alcohol or other drugs?

And so on.  The point being that a simple phrase like “temper tantrums’ or “bipolar disorder” tells us nothing.  What’s needed is a detailed written statement of the problem.

I do not know the enquirer personally, so it would not be proper for me to give him/her specific advice.  And I don’t know if temper tantrums is the issue or what – but the point is this:  specify the problem as honestly as possible and with as much detail as possible.

Often at this point the solutions start to suggest themselves.  For instance, if a person is routinely throwing temper tantrums when the car breaks down, then maybe it’s time to get some repairs done or get a new car – or even just decide to get stoical about it – try to let it wash over one.

The point here is that finding solutions to behavioral problems is not quantum physics – usually if one has done a thorough and honest job identifying the problem, then the solutions are forthcoming.

In this regard it is often helpful to break problems down into components and tackle them one at a time.  Or to set intermediate goals.  A person who identified over-talkativeness as a problem might initially aim to sit silent for one minute, then two, and so on.

I have mentioned elsewhere in this blog the importance – indeed I would say the necessity – of having at least one good friend – someone with whom one can be completely honest.  Often the kinds of problems we are talking about here benefit from a second perspective.  Other people often see us more accurately than we see ourselves.  A best friend can be a spouse, a brother, sister, or just the guy who lives next door.  The point is that if I have a significant behavioral problem and if I genuinely want to change this, then asking for help is clearly a positive step.

Some other pointers:

  • Try to find and pursue an activity that is incompatible with the target activity.  For instance if you feel a temper tantrum coming on, start singing or whistling.  It’s difficult to have a temper tantrum while singing a happy tune.
  • Acknowledge successes. If you had been having daily temper tantrums and you’ve got it down to one per week – that’s great – acknowledge the gain, but keep working.
  • Avoid triggers as much as possible.  If a person finds that he has temper tantrums whenever the dog starts barking, then maybe it’s time to get rid of the dog – or get one of those bark suppression collars.

I’ve picked the example of temper tantrums and used it in this reply.  But I’m conscious of the fact that this might not be the issue of the enquirer.  That’s one of the problems with the term “bipolar disorder.”  It simply is not specific enough.  But the essential point here is that whatever the behavior is that attracted the diagnosis of bipolar disorder, this behavior can be identified, specified clearly, and remediated.  And in this regard you have to do what we all have to do with life’s problems – exploit your strengths to counter your weaknesses.  In other words – use your ingenuity.  Find solutions to the problem.  Don’t give in.  Don’t go on doing things the same.  Break patterns, etc..

If your problem behavior, in fact, lies in some other direction and you would like further thoughts, don’t hesitate to come back and let me know the specific behaviors that are causing concern.

Now, of course, having said all this, I should add that you can take the conventional step:  go see a psychiatrist and take the “happy pills.”  I’m not recommending this course of action, but I’m sure you realize that it is an option.  Drugs can be effective in suppressing certain kinds of behavior.  However, they always have negative side effects, and although they may suppress the worst aspects of the problem behavior, the result is a far cry from normal human existence.

  • Wow. This is a long way from what’s really happening in psychiatry and mental health care. And the new drugs are remarkable effective for some people. I suspect somewhere in this complex set of issues are some serious mental illness that takes more than trying harder and smarter.

  • Anon

    Hi Phil ,

    Can you please suggest any readings, practise to combat bipolar syndrome.

    Regards,
    Anon

  • Anon,

    Most literature on the so-called bipolar disorder simply restates the “official” nonsense, i.e.: This is a disease and you must take these pills for the rest of your life.

    The way forward is to identify the specific behavioral problem as honestly and as accurately as possible, and take corrective action. There is an abundance of self-help literature on the market. I’m not sufficiently familiar with this genre to recommend specific books, but browse around and find one that fits your perspective.

    What’s essential is to develop the habit of critical self-appraisal – taking an honest and realistic look at one’s own performance across a wide range of dimensions. Am I being pleasant to those around me? Am I pulling my weight at home, at work, in the community? Am I being honest in my relationships and with myself?

    In my post More on So-called Bipolar Disorder I outlined how one might tackle an anger control problem. And the same general tactics and considerations apply to other habits that attract the label “bipolar.” It is useful, I think, to set aside a particular time each day to work on an issue. And keep notes – make a written note of what you’re trying to change and how you’re doing from day to day. And ask for help – identify someone in your circle of friends/acquaintances with whom you feel you could share your concerns and who would give you honest feedback.

    As a general principle, I would suggest avoiding programs that stress prayer and religion. In my view prayer and religion – though widely touted as the answers to life’s problems – tend rather to act as barriers to change and personal growth. But here, as in all these matters, flexibility is critical. If prayer and religion are indispensible for you, then use these tools, but be honest in your self-scrutiny.

    If there is a specific area of personal change that concerns you, please feel free to come back, and I will try to provide more specific ideas and suggestions.

    Best wishes.

  • Medical blog,

    Thanks for your interesting and thought-provoking comment. Because this comment goes to the heart of what this blog is about, I have decided to write a complete post in response. I am calling it Diagnosis. For my regular readers (all six of you) it will involve some repetition, but perhaps it’s a good idea to pull these threads together from time to time.

  • Thank you so much for doing this for Bipolar Illness…However I disagree with you. I don’t honestly know if medications are managing my bipolar but I don’t want to go off of them to find out. The bipolar depression is very traumatic and irregardless of where it is coming from I have learned many coping skills. However they still aren’t enough to get me safely through a severe depressive episode.

  • Patty,

    Thanks for your comment.

    The central point of my blog is that the so-called mental illnesses (including bipolar disorder) are not illnesses in any normal sense of the term, but rather are habitually dysfunctional ways of dealing with the normal problems and vicissitudes of life.

    It is also my position that psychiatry has degenerated into drug-pushing, and has forged an alliance with the pharmaceutical companies with the objective of selling as much product as possible to as many people as possible.

    So I guess we’ll just have to agree to differ.

    Incidentally, I do not encourage people to stop taking drugs. Some people like to take drugs, others don’t. It’s a personal decision. I just like to point out that they are drugs, not medications. And the so-called bipolar disorder is not “just like diabetes.”

    I think that psychiatry’s spurious philosophy of life has done untold damage to our society. They have persuaded millions of people that they can’t manage without the product. How is this different from the street drug vendor?

    It is in confronting and overcoming life’s problems that we achieve our potential. Routinely insulating ourselves from life’s challenges by taking drugs may help us stay “stable,” but in my view it is a poor substitute for successful and adaptive living.

    As I said earlier, I have no quibble with you taking drugs. (We all do what we have to do.) My quibble is with the practitioner who is selling you the lie that you have an illness.

    Once again, thanks for the comment. If you would care to tell you story, click on the Tell Your Story tab above.

  • Sam

    Hi Phil,

    I think that Patty raises an issue that could use more coverage. In some ways, taking pills is the easy way out. Now, I’m not saying that it’s the thing for cowards or the weak-willed. Rather, a proper behavioral solution to these debilitating behavior habits is *hard*. From what I understand, it requires intensive, frequent, personal intervention by a highly-skilled specialist. Probably, it’s expensive, too. Correct? Yes. Easy? No.

  • Sam,

    Thanks for your comment.

    I don’t agree that behavioral change has to be all that difficult, or necessarily requires intensive or prolonged outside assistance. Behaviorism is infinitely flexible, and solutions to problems are as variable as humanity itself.

    In my experience almost all the problems catalogued in DSM are amenable to self-help with little more than encouragement and support from outside sources. What militates against this is the mindset, created and fostered by the psychiatric-pharma syndicate, that people are incapable of dealing with their problems, and that they must enter the seductively comforting mental health world to be “diagnosed” and “treated.”

    For example, if a person hates his job, then he’s probably going to be pretty miserable, and these negative feelings will spill over into other aspects of his life. The solution is: firstly, face the facts; secondly, get a different job. Or, of course, one could go to the mental health center; be diagnosed as dysthymic, and eat drugs for the rest of one’s life. Now changing careers might not be easy, but is there a realistic alternative?

    Similar considerations apply to virtually all the depressive contexts in which people find themselves. Once a problem has been identified and put into words, the solution is usually fairly obvious. The barriers to this process are: firstly, denial (“I don’t have a problem.”), and secondly, learned helplessness (“I can’t do anything about it.”) The mental health philosophy encompasses both of these stances with its spurious disease message.

    Within mental health circles little or no attempt is made to explore why people are feeling down. I knew a person one time who had great difficulty getting out of bed in the morning, was always tired, and would sometimes fall asleep at work. He consulted a psychiatrist at a mental health center, was diagnosed with depression, and given pills. But his situation didn’t improve much. I happened to meet this individual in a social context, and after a very brief discussion he told me that he routinely stayed up until 2:00-3:00a.m. watching TV. I suggested he get rid of the TV. He did, and the chronic weariness ceased, more or less overnight. What’s truly staggering here is that no one in the mental health system had even bothered to ask about these matters.

    So it doesn’t have to be intensive or expensive!

    Once again, thanks for your comment.

    Best wishes.

  • Neil

    If bipolar is not a real illness, why do I have delusions and hallucinations with my bipolar disorder? That’s conveniently missing from this arguement!

  • Phil_Hickey

    Neil,

    I have discussed delusions and hallucinations at length in my posts Schizophrenia is Not an Illness Parts 1, 2 and 3.

    The APA’s own criteria for a manic episode include this: “the symptoms are not due to the direct physiological effects of…a general medical condition…” In other words, it’s not a real illness. You can’t have your cake and eat it too.

    Thanks for coming in.

  • Dr. Doctor

    Science will be proving you wrong very shortly that it is indeed a disease caused by the synthesis of rogue proteins that prevent proper glutamine transfer in the brain.

  • Phil_Hickey

    Dr. Doctor,

    Thanks for coming in. If this position is ever proven, then I will be the first to retract and to apologize profusely.

    Best wishes.

  • Adam Martin

    I looked this up, but I found no literature on it. It’s been 9 months and no announcement of this discovery yet. When will they make the announcement? If it really is a disease, why didn’t my therapist, psychiatrist, or doctor examine that part of my brain before they made a diagnosis?

  • Francesca Allan

    They’ll never make the announcement. Bipolar disorder is too vast a category to correlate.

  • Adam Martin

    So the only evidence for bipolar’s existence is a list of vague symptoms?

  • cannotsay

    That is true for every DSM label, not only bipolar. That is the core criticism against psychiatry. Phil wrote a very poignant post about his recently http://www.behaviorismandmentalhealth.com/2014/01/09/psychiatry-is-not-based-on-valid-science/ .

  • Francesca Allan

    Even if there were a reliable test that distinguished bipolar disorder from normal, we wouldn’t know if it was a brain disorder or just what the brain looks like when it’s bipolar. Psychiatry has of course assumed the former in spite of staggering evidence to the contrary. There is no other “neurological disorder” that can be entirely cured through effective counseling and lifestyle changes.

  • Phil_Hickey

    Francesca,

    Good point.

  • Heidi

    You obviously don’t know any people with Bipolar disorder. It’s insulting to be so flip when you don’t know of what you speak. Some people see a very different world at times as they are looking through a chemically dependent organ.

  • Anonymous

    Without a doubt, the “you obviously don’t know any people with…”, is one of my favorite psychiatry true believer sayings. At this point I’ve seen it a thousand times. It’s actually fascinating how many people think this argument has the potential to get off the ground. Yep. Phil Hickey, retired psychologist, blogger of fine psychiatric critique, “obviously doesn’t know any people with…”. Because it’s the “knowing people with”, that “proves” something’s a bona fide biological disease, we all know that cancer and diabetes were merely just demonstrable diseases with predictable disease courses, objective diagnoses, clear biomarkers, well understood etiologies, yeah they were just these pathetic poorly defined pseudomedical concepts, until the day of course, that someone first could say they “knew somebody with cancer”. It’s really the “knowing somebody with…” that brings a disease officially into the realm of objective medical pathology… yep…. but what would you know? “Have you ever known anybody…” that was a skeptic of psychiatry?

    You obviously don’t even know any people with skeptical views about psychiatry. IF YOU DID, you’d know. IF YOU DID, THEN you’d be able to talk. If you’d ever known someone who [fill in the blank], then you wouldn’t be saying that. It’s all in the knowing somebody. Writing hundreds of articles critiquing psychiatry over a number of years is “flip” because you only read two of them I see.

    19th Century

    “You obviously don’t know any slaves with Drapetomania”

    20th Century

    “You obviously don’t know any women with hysteria”
    “You obviously don’t have a son with sexual orientation disorder, if you did…”

    21st Century

    “You’ve obviously never seen a kid with oppositional defiant disorder, if you had, then the simple act of seeing it, would utterly convince you, that this kid who has never had his brain examined or proven diseased in any way, is a walking, talking, misbehaving brain disease of a kid”.

    YOU OBVIOUSLY.
    YOU OBVIOUSLY.
    YOU OBVIOUSLY.
    YOU OBVIOUSLY.

    YOU OBVIOUSLY.

    JUST LIKE DIABETES.
    JUST LIKE DIABETES.

    IT’S A REAL DISORDER.
    THE APA SAYS SO ARE YOU GOING TO DISAGREE WITH THE ACCEPTED WORLD AUTHORITY ON MENTAL DISORDERS?

    SCIENTOLOGIST.

    DENIER.

    JUST LIKE DIABETES.

    JUST LIKE DIABETES.

    OH WAIT I JUST GOT DIABETES BECAUSE I TOOK PSYCH DRUGS NOW I HAVE DIABETES AND THE REAL BRAIN DISEASE THAT IS JUST LIKE DIABETES THAT I TOOK THE DIABETES CAUSING DRUGS FOR AND NOW I AM GOING TO DIE 20 YEARS YOUNGER BUT THAT’S A SMALL PRICE TO PAY TO HAVE MY HORRIBLE REAL PROVEN UNDENIABLE BRAIN DISEASE STABLIZED.

    JUST LIKE DIABETES.

    BRAIN DISEASE.

    BRAIIN DISORDER.

    IT’S GENETIC.

    YOU OBVIOUSLY NEVER MET ANYONE WHO WAS REALLY GENUINELY JUST LIKE DIABETES MENTALLY ILL, IF YOU HAD, YOU WOULDN’T SAY THAT.

    IT’S A CHEMICAL IMBALANCE.

    IT’S JUST LIKE DIABETES.

    PSYCHIATRY IS A YOUNG SCIENCE, GIVE IT TIME. IT’S ONLY BEEN AROUND 200 YEARS.

    THE PROOF IS JUST AROUND THE CORNER, ONE MORE DECADE OF RESEARCH IS ALL THAT’S NEEDED.

    THERE’S SHINY PICTURES OF BRAINS IN THE RESEARCH PAPERS.

    JUST LIKE DIABETES.

    THEY ARE REAL MEDICAL DOCTORS.

    YOU’RE A DENIER.

    You’ve clearly never met anybody who…

  • Anonymous

    Then there’s my second favorite… “You’ve obviously ever visited a psych ward or worked in one, I have, therefore… proven”.

  • Francesca Allan

    I’m not being flip. I have bipolar disorder, a very severe case if my doctors are to be believed. And, you’re right, some people see the world as if through a chemical haze. That’s because they’re taking chemicals aka psychiatric medications.