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#1
06-17-2003, 02:39 AM
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Is manic-depression a disease to be cured?
In this thread, bnorton said, regarding the decision to medicate people with manic-depression
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This view doesn't match my reality. While I think anyone who wants treatment should get it, I don't think it is a simple issue or that treatment is the logical next step. I'm manic-depressive. On one hand, I hate it. It makes me pretty darn miserable. It can be unbearable. On the other hand, my manic states are indescribably beautiful. It's the most amazing feeling in the world, and I don't think I could ever part with it. Even my lows have their beauty. It is all so intense that I can't help but think it is wonderful in a horrible way. And the truth that the drugs they give arn't about "correcting a problem", they are about making you able to hold down a full time job. That is pretty much the standard for "treated". In more extreme cases, the main goal is to prevent suicide. I can't figure out why not commiting suicide is seen as preferable to all situations. Why are we so concerned with keeping people alive, but not with their lives as a whole? I've read a lot of psychiatric liturature, especially about lithium, manic-depression, and creativity. The consesus is that there is a strong link between manic-depression and creativity. I can feel this in myself. There is something about that kind of fire- and about knowing the highs and lows of life so well- that gives unique insight into the human condition and lots of energy. Living so richly and so extremely makes for some amazing art. When artists are treated with lithium, the qualty of their work becomes more conventional and their quanitity goes up. When they are untreated, they produce sporatic amounts of edgey and sometimes genius work. So essentially lithium keeps people from killing themselves (which is seen as more important than their art and oddly more important than their satisfaction with their lives) while it makes them mediocre. Many artists decline treatment because they miss their old ways, as hard as they were. And I, for one, have not even started treatment. I don't know if I see what I have as a disease. I see it as more of a tragic mismatch with the world. Whatever it is, it is me. And I don't want to sacrifice it for normalicy. Happiness is not as important to me as satisfaction, rich experiences and adventure. I resent being told that something so fundamental to me is a "disease". It's not. It is something that sucks, and something that can be changed, but not something that should automatically be changed. What do you guys think? Is there some other way of looking at mental illness that acknowledges it's effect on people's lives without shoving it into a medical model that it doesn't really fit into? Is suicide prevention the most important thing for a treatment to do? Is not seeking treatment a valid option? Is happiness really the most important thing in a person's life? There are a lot of questions here, and I look forward to hearing your guy's takes. 
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#2
06-17-2003, 03:48 AM
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I don't know much about manic-depression, but I have seen a similar POV expressed by some schizophrenics who believe they
are having mystical experiences and do not wish to be deprived of them. As to what's most important in a person's life, I think that would vary considerably with the individual. But you have to admit that in order to have something that is important preserved in your life, you have to preserve the life itself. I don't know what the suicide rate is for people with bi-polar disorders. I know that it is high for depression. Generally, I'm a civil libertarian and belief that people should decide for themselves about their own health issues. But I would also think that in some cases the family and other caregivers have to be considered. Quote:
It must be really awful to lose your gifts and talents through a treatment which is meant to relieve pain -- not cause it.
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#3
06-17-2003, 03:51 AM
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Re: Is manic-depression a disease to be cured?
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That seems reasonable to me. Especially in regards to mental conditions that make it nigh impossible for someone to function. Manic Depressive Disorder is suppose to affect around 2,000,000 Americans and I imagine most of them are able to function normally in society. Quote:
Maybe it doesn't match your patricular situation because your disorder isn't one of the more serious cases. On the other hand there's always the possibility that you're in denial about how harmful your condition actually is. Quote:
I don't know anything about you're condition personally. In generally a manic depressive in their manic state has a loss of self-control and is easily agitated. I can see how that would cause some problems in someone's life. On the plus side they have an increase in goal oriented activities but who knows how long that will last? When they're manic they're sluggish, have a lower self-esteem and possibly think about suicide, and they lose interest in things you once enjoyed. Quote:
Part of being a functioning adult in our society is being able to support oneself. Which means being able to hold down a job. Quote:
Who says we aren't? Marc
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#4
06-17-2003, 04:19 AM
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I feel our society as a whole is borderline insane. Einstein said the definition of insanity (and I'm paraphrasing) was repeating the same action over and over and expecting different results.
How many "normal" people do you know go about their lives buying more and more crap, expecting each time that it will make them "happy". Media feeds us impossible physical ideals, and improbably human relationships on a daily basis. Anyone who actually tries to conform to what society says they should be will almost certainly end up with one or more “diseases” that need curing. Take a look at the long term cure rates for mental disorders in the US as compared to the rest of the world. They aren’t good. For me, the single biggest improvement in my mental state has been turning off all the marketing I have control over. TV was first. Then Radio. Then Magazines, Newspapers, Websites with excessive advertising. Any ad I could turn off, I did. It is impossible to turn it all the way off, but with the volume way down, I found I could finally hear myself think. The highs and lows were definitely less pronounced as well. More pleasant waves and less pogo stick. Exercise is another excellent way of keeping a steady supply of the “good” chemicals flowing to your brain. I personally consider drugs to be the last resort. I think any psychiatric process that doesn’t take into consideration outside factors is more a disease than a cure.
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#6
06-17-2003, 05:34 AM
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Manic-depression, as I understand it, is a disorder, not a disease. (Also it's a kickass song.) That means its effects CAN be debilitating, in which case the decision to treat it with medication can be made. That's a choice to be made, ordinarily at least, by the person who has it. I don't think it's unfair to say it's an imbalance, becuase it IS that: it's different from the way most people function, which is how this sort of thing is defined. Doesn't mean you have to do anything you don't want to as far as I can see.
__________________
"Wrong, but eloquent" - twickster
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#7
06-17-2003, 05:34 AM
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Manic-depression, as I understand it, is a disorder, not a disease. (Also it's a kickass song.) That means its effects CAN be debilitating, in which case the decision to treat it with medication can be made. That's a choice to be made, ordinarily at least, by the person who has it. I don't think it's unfair to say it's an imbalance, because it IS that: it's different from the way most people function, which is how this sort of thing is defined. Doesn't mean you have to do anything you don't want to as far as I can see.
__________________
"Wrong, but eloquent" - twickster
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#8
06-17-2003, 06:59 AM
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Re: Is manic-depression a disease to be cured?
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I guess if you want to live as a suffering artist and your condition is mild, I suppose it's up to you to take your medication. On the other hand, if you can't hold down a job (which IS important BTW) and you are unable to maintain personal relationships, you should consider treatment. It's not about making you conform to society. It's about curing an afflcition that many people find dibilitating (and will often get worse). Anyhow, it's pretty obvious that no one here with the possible exception of MGibson knows anything about the mental health field. If you want people to pat you on the back for not conforming to society, come to the SDMB. If you want expert medical advice on a very real condition, talk to a professional. "Take a look at the long term cure rates for mental disorders in the US as compared to the rest of the world. They aren’t good. " -tastycorn Any cites for this?
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#9
06-17-2003, 09:20 AM
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Not a doctor, but I regard bipolar and other depressive disorders as chronic medical conditions to be managed, not acute illnesses to be 'cured'. Management may require medication or not.
As a member of a family riddled with the above-mentioned disorders, I must say that family gatherings are much more rewarding, if less entertaining to the neighbors, since all of us found meds which work. (They tend to take place on the right day, for starters.) Personally, I've happily traded any extra creativity I felt I gained from depression for the stability medication has brought me. And I make my living as an artist, which I was unable to do before; normalcy does not extinguish creativity. I hope you find a solution that works for you. Please note, though, that it can be very difficult to perceive one's real situation, or judge how severe a disorder is, from within the throes of a manic or depressive state.
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#10
06-17-2003, 10:38 AM
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In my experience with poets and with depression, I've found that lots of poets think depression helps their poetry. It rarely does.
I wouldn't claim that there can be no link between various conditions and an increase in good creativity, but I've found lots of people swallowing a myth about depression. Too many seem to think that: a) Depression will make them into good poets, b) Claiming depression will get them more respect, and c) Writing about depression and suicide is deep, man. Deep. I suffer from depression and write poetry. The more depressed I am, the more inward my poetry turns. It becomes incredibly self-involved. It may capture what I was thinking, but that doesn't make it good poetry. It may "speak to" others suffering from depression, but that doesn't make it good poetry either. And in discussion with others, I've found this pattern to be repeated fairly often. This, of course, is purely anecdotal, but it makes sense to me. Depression impairs judgment. Why couldn't it impair artistic judgment as well? Julie
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#11
06-17-2003, 11:40 AM
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My case isn't particularly mild, and manic-depression is progressive. It is pretty likely that I'll end up having to seek help one day. There were some moments that I survived only because I was too lethargic to get out of bed and do something about all the pain. As for my highs, well the only thing I've read that comes close is descriptions of heroin. My manic states are a bit atypical, because they are completly euphoric. Rarely do they degenerate into nervousness and irritabilitiy.
Once again, I want to restate that I believe treatment should be availible to all who want it. What I object to is the medicalization of this "disease". The truth is that we barely know what causes it. We can just barely treat it. I am not an expert on modern treatments, but I know a fair amount about lithium. It is a pretty clumsy hammer. It leaves people feeling stabilized, but it also can leave them wishing for their old life, but too scared to stop their drugs. So they just feel dulled. If thats what they want, all the better for them. But it can hardly be compared to insulen for a diabetic. I guess I view manic-depression as a tragety. It's something that will never fit in neatly to our society. Our medicalization of it is just an attempt to smooth over a part of reality that will never find the kind of resolution we seek. The truth is that it is not a simple issue. It is not something that we can stick in the medical ghetto and never have to think about again. It is painful and unsettling, and as a society we ought to seek to understand that tere are things that will never be resolved, things that will never be fair or sense-making. We should stop pretending that it is oh so easy of an issue.
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#12
06-17-2003, 01:16 PM
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Then you're lucky. When I go into a manic phase, all I am is nervous and irritable. It's true that I can get a lot done when I'm manic, but it's because I'm trying to work off the anxiety and irritability, not because I'm having a beautiful experience. I'm not. When I'm off my medication, my life turns into a living hell. Quote:
Then I suggest you educate yourself on bipolar disorder and its treatment. Lithium isn't the only game in town anymore. I'm currently taking Depakote and Serzone, and both of those have been wonderful. I don't feel like I'm constantly on edge anymore, and I can actually relax for a change. The bonus is that I don't feel "drugged" or "dulled". I can live a normal life without worrying about feeling like I'm either coming off a sugar high or too depressed to think straight. Additionally, there are better meds out there than lithium, and it might take some experimentation before you find a combination that works. Psychiatry isn't an exact science; it's more of an art. As for the cause, it's pretty clear that the cause is genetic, and they're identifying specific genes right now, even as we speak. And the closer we get to finding the specific cause of this disorder, the better the treatments will be. Quote:
But let me ask you a question. If you object so strenuously to the "medicalization" of bipolar disorder and its treatment, then what do you suggest should be done about it? Robin
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#13
06-17-2003, 01:20 PM
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even sven, I don't think what you're saying has any logical basis at all. You're contradicting yourself over and over:
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Of course it's a disease. It is a physical condition that debilitates the subject, as you yourself said in your very first paragraph. How else would you propose medicine handle it? Complaining about the "medicalization" of manic depression is no different from complaining about the "medicalization" of cancer. There is no such thing as a "medical ghetto." People are just trying to come up with ways for other people debilitated with an illness to fix it. What's wrong with that? Attempting to solve a problem is not equivalent to minimizing the problem. There's no problem of "medicalization" here, no "ghetto." Nobody is claiming this is an "easy issue." Your entire third paragraph is one strawman argument after another. I'll step on your toes here, but I get the sense you are trying to rationalize your situation and feel better about it by making an argument that there really isn't anything wrong, that rather than being a "disease," it's just a "mismatch" with the world. Not true; it's a disease. Being incapable of regulating emotion is not a "mismatch," it's a medical problem that needs attention. We can argue over the efficacies of various treatments, but why are you denying that you have an illness? Why are you trying to foist the identification of this illness of as "medicalization"? It's an illness, you go to a doctor, they fix it or at least try to. I don't see manic depression as being any different from me going to the doctor after I've injured my knee. Some people have diseases of the colon, some of the liver, some of the heart, some of the ears, you have one of the brain. Don't make the problem worse by pretending it isn't there or that it's somehow noble to have it or that it makes you more creative (as jsgoddess has indicated, it doesn't.) Just handle it. Go to the professionals, let them work on it, get on with life.
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#14
06-17-2003, 01:31 PM
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"The consensus is that there is a strong link between manic-depression and creativity."
You are going to have to some SERIOUS citing if you pull out this old wives tale. The consensus is that there is s strong link between mental illness and ruined lives of misery and despair. Here's a fun way to look at it. It's popular on Oprah and in creative writing classes to count up successful artists who have been "considered" to have one form of mental illness or another by folks who read their works or looked at their paintings and just decided they were suffering from whatever disease is currently in vogue. As a counter to this BS, try this: every time you see or read about a homeless person, consider the possibility that, at one point in that person's life, a mental health professional who actually examined that person diagnosed a mental illness. Sure, some people on the street are just bums, or junkies, but plenty of them have serious, untreated mental illness. Right now, we're tending toward not forcing treatment, so the cycle is Bob the Bum does something really nuts, gets locked up, gets treatment, as the treatment begins to work, Bob the Bum is allowed to decide what he wants, he wants out, he goes back on the street (with a stop-over at a half-way house or with relatives), he stops getting treatment, he does something really nuts, gets locked up.... I don't know if that's better than the old way, when an indigent person who did something really nuts could be locked up in a squalid county hospital for life. Additionally, I don't know what you mean by "shoving it into a medical model" and "pretending it is oh so easy of an issue." The competent professionals I know are very cautious about diagnosis. They tent do say "shows element of x, with some evidence of c" instead of simply slotting patients in to a short list of possible problems. When someone has cancer, there may be a long discussion about the best possible treatment for that cancer, but the decision to treat it is pretty quick and simple. You are spot-on about barely knowing what causes mental illness and barely knowing how to treat it. But that's no reason to throw up our hands and just bear it.
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#15
06-17-2003, 01:37 PM
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I've been manic depressive for little over half my life. My highs are incredible experiences. I can feel the pulse of the Earth, I can sense the electrons within appliances and feel their buzz, language morphs and blends in a verbal tapestry that is beautiful to hear and see. Everything is more alive and vivid. My lows are just as extreme. The world is void, all thought gets routed to /dev/null, I would kill myself but squeezing a trigger is too much work. Neither state is conducive to interacting with society. However, I still "function." At best though I would simply call it survival. When I wasn't in the middle of a manic or a depressive mode, regular emotion was hard to generate. I had been at the extremes emotionally for so long anything less than that was simply not registered.
When I was first diagnosed at 19, I was given lithium. And it worked, fairly rapidly even. I found I could concentrate better, I could manage to get myself to class. Too bad the damage to my grades was already done. I guess I was "better." Lithium clipped the extremes from the sine wave that was my emotion. I can't even say that it lessened the amplitude of the wave, it just plain clipped the ends off. I felt robotic after a while. It was just like being "normal" and I really didn't feel much of anything. So I stopped my medications and started drinking heavily in order to produce some kind of feeling, anything at all. I stopped doing that once I got married knowing that drinking excessivly would be a Bad Thing. But I never got back on my meds either. I kept retreating further and further inside myself in order to shield my wife from my extremes (she did know I was bi-polar before we were married though), but that just isolated her and finally my marriage imploded nearly three years ago. I tried taking paxil about that time in order to deal with things. It worked for the depression, and it didn't ever induce a manic phase. Hey I was cured! So I stopped taking it, and got even worse again. My lows were so low I would get tattos to start feeling something different, to remind me I was alive. My highs left me not sleeping for two or three days and drinking heavily. And all this time I was surviving. The important things were being taken care of, my children were being loved and cared for (they live with my ex should anyone ask), and I was doing my job. Surviving? Sure. But not living. In fact, last week after staring at a wall for literally six hours unable to motivate myself enough to get out of that chair I decided it was time to get back on the medication. So, last week I did. I'm four pills into this and I can already feel that I'm starting to level out. I'm commited to staying on Paxil until at least Christmas and trying to wean myself off of it after that. The literature here at work seems to indicate 6 months of Paxil helps keep recurrance down, so I'm going to try. I love my highs, hate my lows, and feel nothing but apathy when I'm not in either. So why did I get back on the medication? Because it was time to find a way to live the life in the middle and not at the extremes. Medication is not everyone. To finally get around to answering the OP, no it is not a disease to be cured like you can something pathogenic or a metastisi to be be removed. It is a condition that can be managed, and I think it is up to the individual to make that decision when and how to manage it. It is a hard decision to make, I know, it took me seven years and cost me a marriage before I realized that it was something I needed to do. I'm not going to make the decision for anyone else though. I can and will suggest they get help if it seems that they want it, but I've known plenty of people who don't complain about their condition so I don't tell them to get help. The people who love you can suggest all they want you get help, but it's not going to happen until you want it to. And if you can live with the consequences of what happens whether good or ill, congratulations, you've done something I couldn't. Good luck with that. And if you can't, maybe it is time to consider help. Damn, that was rambling.
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#16
06-17-2003, 03:22 PM
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Psychologist checking in here.
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Sven Some of the things you are saying are quite troubling and I would highly suggest you consult a therapist. Not, I repeat, not a psychiatrist for your first visit. They are the ones who will prescribe your disorder away into oblivian. You need someone who is a behaviour therapist. Someone who will talk with you on a weekly basis and guide you out of your depression. Someone who you can confide in and eventually if you need the assistence of medication they can consult on that with you in conjunction with your behaviour therapy. Too many docs these days are prescribing patients medication and not making them adhere to a strict therapy regime. That is what works best Sven. You need a guide. Someone to walk you through the process. Is it money? Is the reason you have not found help a financial one? If it is, there are programs you can be one though your state that will allow you to get the attention you need. E-mail me if you want me to find info in your area. Or if you have more pointed questions. Medication is not the only way out. Trust me I know many people who have beat it for a lifetime after seeing a therapist and being honest in the sessions. Playing with your life is not a matter to take lightly.
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#17
06-17-2003, 03:27 PM
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RickJay:
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#18
06-17-2003, 03:38 PM
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Phlosphr, I'm going to disagree with you. With mood disorders like bipolar and depression, medication can be a useful adjunct because it helps manage the symptoms until the deeper stuff can be worked through, assuming that therapy is even indicated. Unfortunately, while it's true that many psychiatrists will attempt to prescribe into oblivion, many non-MD therapists will dismiss meds altogether, even though their utility has been proven.
In any event, talking therapy may not always be an option for people with bipolar disorder. It's listed in the "Promising (But Unproven" treatments for depression section of this site. (Do a search for "bipolar"; I couldn't get a direct link to that page. I know that for me, anyway, it's useless for me to talk to a therapist about my problems. It doesn't do anything but waste my time and money. YMMV, of course. Robin
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#19
06-17-2003, 03:55 PM
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I beg your pardon MsRobyn but I said:
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#20
06-17-2003, 04:10 PM
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I'm not trying to pick a fight, but IME, many therapists will not recommend medication. I think I've had two out of about a dozen who gave their blessing to medication. The other ten were so convinced they could "cure" me without it that I was talked out of it. Therapy was then made a waste of time because I was spending so much time and emotional and mental energy trying to control my symptoms myself, when medication could've helped. In short, I was miserable, and all it did was feed the shrink's ego.
Robin
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#21
06-17-2003, 04:17 PM
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Oh no MsRobyn, no fights being picked here. How could anyone pick a fight with you anyway, always posting such good stuff/advice. I understand your POV completely. I'm sad you saw such inept therapists. There are a fair number of us out there that are good at what we do. I am merely a psychologist. IANA Therapist. In fact I'm an instructor at a college - clinical psych never agreed with me. However, I do have a lot of professional collegues who are good therapists. The gap between PhD'd therapists being able to prescribe meds in shortening I must say.
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#22
06-17-2003, 05:37 PM
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What bothers me most about this whole post is the use of the word "cured." That seems to me that there is an end, a surcease to the condition, and there isn't one. Maybe longer frequency between moods, or different coping strategies for when you are up or down, but that's no more a cure than you can cure MS or diabetes.
I've done lots of therapy in the past. It hasn't been useful to me. I seem to find all the burned out therapists that can do little more than say, "So, what I'm hearing you say is that you are depressed." Seemed to be the therapy du jour when I went looking for help. It wasn't very helpful, so that stopped quickly. But I'm not discounting it entirely either. I can recognize that I'm in no state of mind to pay any attention to what a therapist says no matter how helpful or valuable the advice might be. Hence returning to medication to at least get me on a keel even enough to listen to them. And then perhaps I could learn different coping stategies. I might even be able to get off of the medication some day once I've learned better methods. But it still won't be a cure. I know that sounds pessemistic, but it has taken me a long time to come to grips with this being something I cannot take care of myself and I need help in some shape or form, whether it is medication or therapy. It is no longer a condition I can let slide. This is something that I'm going to have to monitor and get help for. Since I'm not going to be "cured," I can at least keep it in check.
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#23
06-17-2003, 05:48 PM
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even sven-have you ever even had just THERAPY? What you are describing is NOT just "the way you are", it's a disorder.
If you're so depressed you want to die at times, but you can't even muster the strength to move-then you are ill. You need help. I'm not saying this to be nasty. I'm not bipolar, but I AM Obsessive Compulsive. And you know what? It does have its advantages (like organizational skills, and being extra thurough), but I'd give it all up in a heartbeat NOT to have to deal with crippling depression. And in case anyone is wondering, I normally saw both a therapist AND a psychiatrist.
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#24
06-17-2003, 06:10 PM
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Quote:
I've had people with psych degrees or counseling backgrounds express concern when I've told them that my MHNP thinks I should be on meds for life. I think there is a certain amount of competition and even enmity between pyschologists and psychiatrists, and the way in which the psychologists tend to come at it (I believe) is to be scornful of the use of psychopharmeceuticals for all but the most psychotic. I was never helped by a LCSW; it took until I received the medical care I needed as well as the therapy before I started to have improvement in my life.
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#25
06-17-2003, 06:13 PM
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My mother is manic-depressive. When I was younger, it could be fun when she was manic, as she'd buy me lots of presents. But it was also confusing, as she would start crying for no reason, or sleep in really late and not spend much time with me (my parents were divorced and I lived with my dad, so I didn't have a whole lot of time to spend with her as it was).
Now that I'm older and have studied the disorder more, I can definitely where she is in her mood cycle. She has meds, but has frequently gone off them. Whether because she couldn't afford them, she thought she was getting better, or because of side effects (IIRC, one of the side effects of depakote is diarrhea). This frustrates me, because I don't think she realizes what an effect it has on my life. I'm her only child, and she's not remarried, so she will call me when she's feeling depressed, and there's not much I can do about it. She complains about us not being as close as we used to, but when she's feeling manic, she always interrupts me and never listens to me. She disappeared for about 6 weeks when I was in high school (this was when I was first realizing what it meant for her to be M.D.), shortly after she started dating a new guy, and it worried me terribly. She was actually in the hospital for her M.D., but wouldn't let anyone tell me what was going on. Okay, I'm rambling a bit and getting a bit too personal. To bring things back on track, I know it can't be cured, but I think it can be treated. But the treatment usually has to be ongoing. This is another stumbling block with my relationship with my mother, because sometimes I think she doesn't want to be treated, because as long as she's showing obvious symptoms, she can use her disorder to excuse her behavior. Even if you regard manic-depressive disorder as a "tragic mismatch with the world," it is important to recognize that your actions, choices, and behaviors (including whether to seek treatment or not) can and do affect your loved ones. If medication and therapy can improve your functioning in society, I think that that is a good thing. I don't know about creativity levels on and off treatment, so I can't comment on that.
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#26
06-17-2003, 06:50 PM
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Quote:
If addiction is considered a disease why wouldn't an imbalance of your neural transmitters also be a disease? Maybe you could tell us why because it doesn't make any sense to me. Marc
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#27
06-17-2003, 07:18 PM
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MGibson - Addiction is a disease when you are in an Alcoholics Anonymous meeting, or a NA meeting. When you get down to it, an imbalance in your neural-transmitters is a laymans way of saying your brain doesn't produce enough of a certain chemical needed to keep your brain functioning correctly. Many times it is environmental factors affecting the chemical imbalance. Essentially a disease is something that impairs normal functioning. That can be a result of any of a thousand environmental or elemental reasonings.
Take someone with Crohns Disease. Crohn's disease is a disorder of the gastrointestinal tract that is characterized by inflammation and deep ulcer formation in the lining of any region of the tract from the mouth to the anus. My example is only to illustrate that disease has many different definitions. Calling manic depression a disease just doesn't do it justice for one who is out to cure it through non-medicinal or light medicinal pathways. Crohns disease can be cured through medicinal needs only. Put it this way would you council someone to get rid of their crohns disease? No, you'd medicate them. Would you council someone who has depression? Yes, it can have visible verifiable results. I'll check back in tomorrow, I'm off to get a cat...Check IMHO for reasoning.
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#28
06-17-2003, 08:06 PM
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Phlosphr, I honestly don't understand a damned word you're saying. Perhaps you could help me by defining what you use the word "disease" for, because every definition in English would define bipolar disorder as a disease. It's a disease. There's no debate to be had here.
The fact that it can be partially treated through counselling doesn't mean it isn't a disease. Counselling is a valid medical treatment for bipolar disorder. What's unusual about that? Lots of diseases involve more types of treatment than just taking drugs. Counselling is just... physiotherapy for the brain, to put it one way. The fact that you have particularly strong opinions about what type of treatment should be adopted does not change the central fact that bipolar disorder is a disease.
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#29
06-17-2003, 10:37 PM
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First of all, even sven, as of this moment there is no "cure" for diabetes, either type 1 or 2. If insulin were a "cure" then I would only have to take one or two courses of it, like I do antibiotics when I get, say, a sinus infection.
However, your comparison between diabetes and bipolar disorder were right on the money, in my opinion. I have to take insulin for the rest of my life becuase it is merely a treatment, not a cure. However, without it, I would be dead in a matter of days. So you have to take medication the rest of your life - that's undesirable simply becuase it is not a cure? You have to take it forever instead of just a little while, so skip it altogether? Or maybe I'm missing one of your many points. Phlosphr, I, too, am confused about how you differentiate between a "disorder" and a "disease". By your reasoning, my diabetes is not a disease but instead a disorder, because it's simply my body not producing a chemical it needs to function. In that respect, dopamine = insulin, no?
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#30
06-17-2003, 10:49 PM
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I think she's saying that she feels her manic states are worth it. Or that perhaps instead of a disorder, it's merely a personality feature some people have.
And I worry about her, reading this.
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#31
06-18-2003, 01:50 AM
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Okay, now I'm confused. I zeroed in on the term "behavior therapist" in phlosphrsfirst post:
Quote:
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#32
06-18-2003, 01:50 AM
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Phlosphr
Quote:
I have considered my illness to be a disease, but I am willing to listen to whatever distinctions that you make. Maybe I am mistaken. I do know that like manic-depression, it is a mood disorder. Can disorders be diseases? I know that there are several different kinds of depression and that what is appropriate treatment for one may not be appropriate for someone else. In the early years, my access to counselling was limited. I had to travel 200 miles round trip. But even the little bit of counselling that I got was helpful. I took medications that weren't terribly helpful and I had a lot of electrical shock therapy. (I don't remember the latest term for that.) That was forty years ago. The shock treatments then were much different from the shock treatments of today. It took away my symptoms but left me with a lot of memory problems. When I moved to the city, I saw both psychologists and psychiatrists (though not at the same time). These sessions were for about fifty minutes once a week. The counselling was helpful to me because in addition to depression, I had a lot of childhood issues to be resolved and I needed to learn how to parent myself. For the last fourteen years I have seen my psychiatrist once a month for twenty-thirty minutes. We focus on the present and not the past. It is usually a check up on how I am handling stress, family and relationships, my medications and symptoms related to the illness. My understanding is that these short once a month sessions are being used more and more often in the treatment of depression. Someone else with depression may need intense counselling.
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#33
06-18-2003, 02:04 AM
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Well, if we are going to bicker about the symantics of disease and disorder now, in my opinion, a disease has some sort of pathogen whether it is a virus, bacteria, parasite, prion, whatever. If it invokes an immunine resonse, it's a disease. If it's genetic, it's a disorder. Bi-polar is a disorder and so is diabetes. In my opinion. I like that reasoning better, because in my mind calling bi-polar a disease is like pointing and yelling "unclean!" I'm being oversenstive, I know. In any case, disease seems to have an external source whether curable or not.
However, according to the 2nd edition of Springhouse's Handbook of Diseases that while bi-polar and alcoholism are "disorders," diabetes is a "disease." How even the book of disease makes the distinction is unclear. Perhaps disease is a general term, while disorder is more specific subset. Quote:
However, I don't think bi-polar's can be treated by therapy alone. The meds are a foot in the door while the therapy is there to help keep you on them and understand what is going on and how to deal best with it. More effective survival skills in essence.
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#34
06-18-2003, 02:24 AM
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even sven, maybe you can find some helpful suggestions at this site:
http://www.dbsalliance.org/PDF/Dealing_Effectively2.pdf
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#35
06-18-2003, 02:33 AM
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Bishamon:
Quote:
I do see "mental illness" and "mental disease" used interchangeably on other websites, but that doesn't mean they are necessarily correct. I wasn't asking for an opinion on what a disease is. I was asking for factual information.
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#36
06-18-2003, 09:33 AM
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Quote:
As Zoe said, I do not intend on bickering either. Anyway you cut the cake even sven needs some help. I don't want to grapple with whether or not he needs medication, or the efficacy therein of any particular drug. Someone said that psychologists and Psychiatrists have had their differences throughout the years. This is some what accurate. Psychiatry and psychology vary between individuals. They may have the credentials but any joe can run into a dumbass psychiatrist or therapist. I'm also not going to speak anymore about what the definition of a disease is. Thats just a hijack to what we are supposed to be talking about here. For some interesting reading on the subject I will provide a good link to the National Center for Biotechnology. They have great definitions of what a disease is at the genetic level. Even Sven my best to you. I do wish you good health and luck with your future Endeavor...
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#37
06-18-2003, 11:10 AM
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Even Sven , have you ever read Touched with Fire or An Unquiet Mind by Kay Redfild Jaminson? She is a psychologist who writes about her own manic depression and the relationship between manic depression and creativity. I've not made it all the way through both books yet but so far they are fairly interesting.
Personally I've had four serious bouts of depression -- we're talking psychotic level at some points (I don't want to get too much into that here) and have had an occasional hypomanic spell. I know that I have almost a 100% chance of recurrence at this point even with my medication (8 pills per day!). I see it as a part of me now -- a part that I can manage with meds and therapy but something that my identity will never let go of. As to whether someone should take medication for bipolar disorder, it is pretty much up to the individual unless the patient is involuntarily hospitalized and as a result must take medication.
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#38
06-18-2003, 11:27 AM
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Even Sven , could you give us some examples of the "many artists" who produce their best work during manic periods, but get dull after treatment? Say we put depressive disorders out of a medical model, and I'll concede that various mental imbalances can give unique insights.
However, art--writing, painting, composing, or any other form--involves a lot of sheer hard work and self-criticism. Inspiration may come in a brilliant flood, but you might need to spend an amazing chunk of time and energy, not to mention planning, realizing that inspiration. Some coherence is needed. Few I have known are really capable of that in a manic state. Perhaps you're luckier than most. I think the 'lone genius' image is more of an archetype than a reality, today or in the past. An artist has to be able to deal with the 'real world' on at least a basic level, even if it's writing up a grant application so you can continue to be divinely mismatched.  Is it really such a good thing when your brain chemistry prevents you from accomplishing the most basic work?It was easier to romanticize my disorder, and those of others, when I was 20 or so. Not nearly so much time had been lost to the low periods, and the idiosyncrasies of college life buffered it. As MsRobyn notes, if a medication makes someone feel like he's lost an essential part of his personality, it's the wrong med. The proper one won't do that.
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#39
06-18-2003, 11:53 AM
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Interesting OP, and I agree that people should be able to decide for themselves when and if to get treatment for bi-polar disorders. That said, your experiences are very different from mine (I am bi-polar as well). I do not have any desire to hang onto this condition, if it could be wiped away with a wand I would do it. The highs can be nice, and they really do inspire me to be artistic. Still, I don't find the balance to work out in my favor, the lows dominate most of the time. So while in your case perhaps you spend more of your time riding the crest of the wave, lots of us are being dragged along the bottom for the majority of the experience. This is the very reason I agree that everyone should get to choose for themselves based upon the very different experiences individuals have.
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#40
06-18-2003, 12:05 PM
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I suffer from bipolar disease.
I thank the gods everyday for lamictal, topomax, and wellbutrin, as they have literally given me my life back over the past year. If I have to take 10 seconds out of my day for the rest of my life taking these meds so be it. I'd NEVER want to go back to feeling the way I did before. Added creativity unmedicated? I was either too tired to move or too ansty to concentrate. Now I'm actually starting to write again, and the feeling is indescribable. I am a walking, talking, example of just how much good the right meds can do for a manic depressive. Therapy? YMMV, but it never did diddle for me. I'm not disputing it works wonders for some people, but I'm not one of them. Even Sven, good luck.
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#41
06-18-2003, 12:47 PM
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Quote:
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#42
06-18-2003, 03:30 PM
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If any of you see a person in full manic mode, going on about the Bible (and getting it all wrong), then you'll see it's not a joke.
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#43
06-18-2003, 05:51 PM
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Phlosphr:
Quote:
The thread title: Is manic-depression a disease to be cured? Isn't that what we are supposed to be talking about here? In answer to the OP's question, the link that Phlosphr provided indicates that genetic illnesses can also be considered diseases. Quote:
I am not a physician.
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#44
06-18-2003, 09:02 PM
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Anecdote -- my partner was diagnosed with bipolar last year. He's a writer, well-published and shortlisted for awards and has received fellowships etc. So he's not a creative wanna-be, he really was already successful.
Last year things got impossible for him and with him. He trialled depakote with grave misgivings about the (possibly mythical) effects on his creativity. His normal output was 2 books in a good year with lots of time off for depression and inability to deal with life. In the past year he's written 6 books, one of them the best he's ever written. Without the cycling of bipolar, he's more productive, more happy in himself and a damned sight easier to live with. I don't view bipolar as this romantic condition where the price of genius is suffering. Neither does he any more.
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#45
06-18-2003, 09:35 PM
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Quote:
I do not, of course, claim this is true of everyone. But it seems to be true more often than not. Julie
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#46
06-19-2003, 09:32 AM
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And really, what is the rate of successful untreated manics, with the unsuccessful?
For every Van Gogh, you probably have about 100 who aren't successful.
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#47
06-19-2003, 03:47 PM
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I am not manic-depressive, but I can share some of the concerns expressed here.
I have always felt cynicism, a grim outlook, and a curmudgeonly demeanor to be a part of my identity, my personality. It is who I am. When my dissertation coach told me she thought I might be getting depressed, I started wondering what my doctor was going to want to do if that diagnosis panned out. I had a grave concern about the effect of pharmaceuticals. I worried that they wouldn't just "fix" my dysfunctions, they would also strip away that delightfully bitchy outlook which is the hallmark of who I am. I would imagine some artists feel something analagous to this--that the more tortured parts of their souls are a font of genius and creativity. It is who they are. They don't want to lose that. I think such concerns are valid. However, in my understanding of how medication and other therapies work--and in my own personal experience--it turns out that the fears are unnecessary. The goal of therapy and of drug treatment is not to erase the extremes of human emotion. I'm still a bitch. I'm just a functional bitch. What is gone are the negative thoughts which were irrational, such as assuming my boss loathed me. The general negative thoughts (grumble, grumble; damn, that singing bird is annoying) stay with me. I presume that an artist who uses strong emotions as a wellspring of material doesn't have to be clinically and constantly depressed to succeed. You can improve the depressive (and manic) symptoms but the essense of the person will still be the same.
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#48
06-20-2003, 11:23 PM
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I just met with a group of psychiatric inmates' liberation / "consumers-survivors-expatients" movement people and we talked about public perception of us and public education and how we wish to be perceived.
Is it a "disease"? Some of us do believe there is a difference and that at least under some circumstances this difference is the reason we have received psychiatric diagnoses, although we don't tend to attach much credibility to the medical model of mental illness. But a difference only becomes a disability (let alone a disease) when we, on an individual basis, determine that we find that difference disabling -- and not all of us do. And the bottom line is this: no coercion. No forced treatment. We have the right to be untreated uncured crazy people. (As with noncrazy people, nondiagnosed people, etc., we are subject to laws that govern behavior and if we violate them we can be charged and arrested like anyone else). And it is our right to choose to remain untreated and uncured that we are fighting for.
__________________
Disable Similes in this Post
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#49
06-21-2003, 05:10 PM
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That's all well and good-but when "untreated crazy people" become a danger to themselves and others, then their right to remain untreated ends.
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#50
06-21-2003, 05:47 PM
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AHunter3, I don't disagree with you, but I would like your view on this sort of situation:
A patient of my acquaintance is bipolar, rapidly cycling (4 or 5 full cycles a year), and completely psychotic during both the severe depression and severe mania (catatonia, hallucinations). When not on medication, these cycles are devastating to the family, especially the young children. The patient is unreliable as a parent during these extremes, yet breaks no laws. Spouse, family and friends are always on high alert to mitigate risk and damage to the children and to the patients, but things do slip thru. The patient agrees the behavior is a problem, but only wants medications during exacerbations. However, during the exacerbations, the patient then refuses medications. Clear and present danger is difficult to demonstrate to the courts, and they have declined to intervene. What should the family do? What should society do?
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