I was diagnosed “manic-depressive” (the old name for “bipolar”) in 1980 before being diagnosed schizophrenic in 1982. Over the long haul of decades, bipolar is probably a more accurate descrip, but:
• Both diagnoses, like all psychiatric diagnoses, are made on the basis of observed and reported behaviors. They don’t do labs. Therefore it’s significantly more subjective than diagnoses made w/regards to medical conditions that can be lab-tested for.
• To be charitable to a profession I dislike: I think psychiatry has, over the last century, observed the general catchall category " people whose behavior is weird or disturbing to us or themselves", subtracting from that category phenomena such as tertiary syphilis or epilepsy once we understood those things, and the behavior they’ve observed does tend to fall into nichelike categories – it isn’t just “any weirdass behavior that need not resemble any other weirdass behavior”, although [charitability momentarily off] if you disturb people with weirdass behavior that doesn’t smoothly fit these niches you’ll still run a heavy risk of acquiring a psychiatric diagnosis [/charitability momentarily off]. Whatever else I could say about them, I will acknowledge that they’ve tried to make sense of the phenomenon of disturbing behavior, their field was born in an era where ambitious and optimistic faith in scientific medicine yielding cures and answers was waxing strong, and their generalizations, as reflected in their diagnostic categories, have a lot of validity as generalizations, i.e, these patterns, as opposed to random weirdnesses, do exist.
• Slapping a label on something is not the same as understanding it. This is a gripe I have with medical practice in general but it’s particularly pervasive in psychiatry. A pattern is noticed. Good, patterns are how we start to understand things. Creating categories. And categories require names. “Schizophrenic”. “Bipolar”. “Paranoid”. “Depressive”. But doctors know damn good and well that the general public thinks of a diagnosis as an explanation for the symptoms: I have ulcers and that’s why my stomach hurts sometimes. Psychiatric diagnoses are like saying to someone who comes in complaining of their stomach hurting, “You have gastritis”. Gastritis is not why your tummy hurts, it’s a restatement of the fact that your tummy hurts. Bipolar means that your moods swing from elation to depression. It’s not an explanation. They don’t know why. They wish they did. They are immersed in research. They have a better idea of the mechanism than they used to (i.e., what changes in neurochemistry correspond to and are necessary for the bipolar experience to occur). Cause? Nope, not yet.
• [/charitability]. They are reductionistic. They have for a long time now assumed that all of these constellations of behavior-and-feelings patterns are caused by something physiologically wrong with the brain in the medical sense: neurochemistry, neurostructure, congenital defects in the brain due to genetics, whatever. They have no evidence for this. They are doctors, not sociologists, not philosphers, not counselors – body-based pathology is what they do. But heck, the box of behavioral/feelings disorders was full of stuff in 1900 and the patterns that were observed and eventually traced to body-based problems (e.g., syphilis and epilepsy as I mentioned before; hypothyroidism; vitamin deficiencies; etc) have generally been removed from the box, leaving them with “that which is not yet understood”. (A latter-day nominee, Alzheimer’s Disease, is still often dealt with as a psychiatric disorder – no telling whether or not it will continue to be categorized as such if a solid pharmaceutical cure is found or not). Bipolar doesn’t have the same astonishlingly long history that schizophrenia has as an Unsolved Phenomenon, but it’s been in the box for awhile. You should question the premise that the often-observed feeling-and-behavior pattern called “bipolar disorder” has jack shit to do with the brain or nervous system being messed up. All they know is that there are some correlations. (Of course there are. The brain is where you feel and think things and it’s made of neurons. But saying that’s an explanation is like saying the local condition of your neurons is why you like to read the Straight Dope).
• Their pills tend, in general, to be somewhere between “less than entirely benign” and “brain poison”, although for some folks there are positive tradeoffs. The general experience of mental patients seems to range from “wow, this saved my life, I can cope with things again” to “I’d rather be dead and I’ll either kill you or kill myself if you try to force me to take that shit ever again”. Lithium carbonate does very little permanent brain damage but does have a high propensity for screwing up your liver and possibly your kidneys – the therapeutic dose is very close to the toxic dose. Other psych drugs to which bipolar folks are exposed are more likely to do various kinds of brain damage. The pharma companies that do psych meds constantly come out with new ones, and every generation of new meds is touted as free from nasty side effects, permanent and otherwise, and then a few years down the pike it turns out it just ain’t so. All of them are designed to intervene in neurobiochemistry, and all of it is geared towards research on symptoms since there is no real understanding of underlying cause. Some of us think that the pills muffle the symptoms therefore extending the cause by virtue of the fact that you are given less reason to make changes that might ameliorate the causes, whatever they may be.
• Some bipolar people do function without psych meds. You wil hear otherwise. You will hear that bipolar folks in their “manic” phase want to go off their meds and soon get into trouble. You will be told that it’s always a mistake for bipolar people to go off their meds. Well, you made it this far, didn’t you? There are others who have chosen to do life without psych meds despite the roller-coaster careening. They feel more “authentically who they are” unmedicated and learn to cope (a support group of other folks who know what it’s like REALLY helps).
• It’s your body, your brain, your life, and ultimately YOUR RIGHT TO DECIDE these things, an unalienable right even if not sufficiently recognized and protected in most places. If we’re intrinsically biologically different, we have the right to be respected in our difference, including the right to be proud of it and the right to go untreated. If we’re handicapped or disabled by it, we have the right to choose the least restrictive accomodations and to be granted access to societal participation based not on the extent to which our disability can be hidden away but rather the extent to which we can nevertheless participate. If we have a medical condition, we have the right to make informed decisions as adults, meaning that the decisions rest in our hands until and unless we commit crimes or are found to lack fundamental decision-making capacity, and that we have the right to make decisions that are not necessarily the ones our doctors, relatives, or other concerned folk think are the ones we ought to be making.
• Coercion still exists. Learn up on it. You’ve been officially called one of us now. Forced psychiatric incarceration and treatment is still a reality in most of the world and changes are you’re vulnerable to the possibility of it. Make contact with your local mental hygiene legal services organizations in case you ever need to contest forced treatment/incarceration. Find out what you do and do not have to report about yourself on forms and applications if and when they ask if you’ve ever been a recipient of mental health services or received a mental illness diagnosis.
