Is manic-depression a disease to be cured?

In this thread, bnorton said, regarding the decision to medicate people with manic-depression

Frequently, we hear mental disorders compared to diabetes or pneumonia- a disease which is to be cured. It is a matter of chemicals in the brain being “wrong” which can be “corrected” in a very staightforward and medically sound way, just like any other disease or disorder.

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.

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.

And I understand that your view of reality needs to be respected. Just remember that your reality isn’t the reality of many people who suffer needlessly from chemical imbalances in the brain. There is no way that I can say that you are a person with a disease. I’m not a professional. But I know that I do have a mental illness that is a disease just as much as any other illness that has a physical cause.

It must be really awful to lose your gifts and talents through a treatment which is meant to relieve pain – not cause it.

**

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.

**

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.

**

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.

**

Part of being a functioning adult in our society is being able to support oneself. Which means being able to hold down a job.

**

Who says we aren’t?

Marc

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.

Hmmm, probably should have been improbable, not improbably.:smack:

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.

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.

Well isn’t that basically the definition of “manic-depressive”? One minute you are incredibly happy - manicly painting the house for the third time, cranking out works of art and being the life of the party - the next minute life is unbearable and you can’t get out of bed for a week. I heard this before. M/D describe how “wonderful” things are during the manic stage that they forget about the “depressed” stage.

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?

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.

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

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.

**

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.

**

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.

It’s not an easy issue, and no one said it was. As I said, it can take quite a while to get it under control. But it can be managed. I manage it quite well, and so do a lot of other people.

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

even sven, I don’t think what you’re saying has any logical basis at all. You’re contradicting yourself over and over:

So let me get thsi straight; this condition has driven you to suicidal thoughts, you admit in another post it would rpevent someone from holding down a job. It has a physical pathology. It has demonstrable, objective negative effects. It’s bad for your physical health. If it’s not a disease, just what is it??

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.

“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.

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.

Psychologist checking in here.

It is not a disease Rick it’s an imbalance with-in your neural transmitters caused by a variety of environmental factors, diet, mores etc…etc… Furthermore unless you have it and/or can be a little more sympathetic towards those who do, I’d suggest your scraping for logicalities should stop.

This statement essentially makes you unable to understand an provide any sort of meaningful advice to Even Sven.

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.

RickJay:

I do think there is one difference that is important. Your brain helps you to determine that your knee, colon, liver, heart and ears are diseased or injured. With mental illness, the brain is often not able to function well enough to know that it is ill. And then the brain doesn’t realize that it is not able to function well enough to know that it is ill – and so on.

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

I beg your pardon MsRobyn but I said:

In Conjunction with. Meds should be used in conjunction with. This is a proven therapy MsRobyn. Meds are only a tool. Therapists guide patients through the process of healing, sometimes with meds sometimes without. I would not say they are useless, especially to someone who is in need of one. Some people handle medication much better than others. What if someone on Klonopin feels wonderful after the first two weeks whereas another starts having seizures. I don’t think anyone could convince me therapists are a waste of time, especially with serious depressive disorders.

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