Does Bipolar Disorder Exist?

The popular and worthwhile blog Furious Seasons, written by a guy diagnosed with bipolar disorder, asks the following: Does bipolar disorder exist? Here’s an excerpt, a quote from psychiatrist Paul Minot, from a thought-provoking post well worth reading in its entirety:

Bipolar disorder isn’t actually a disease.

It’s a collection of signs and symptoms lumped together in a diagnostic classification that has no basis or assumption of causation. There is no known neurochemical abnormality associated with “bipolar disorder”, and patients with this diagnosis certainly have a plethora of different problems, all lumped together in one convenient/dumb diagnostic classification.

The expansion of the definition of bipolar disorder over the past two decades is simply a “rebranding” of post-traumatic stress disorder, impulse control disorders, personality disorders, and other problems into a pseudoscientific trashcan diagnosis, to provide an FDA-approved “indication” for the prescription and marketing of anticonvulsants and other medications to treat this “illness”. I know this because I myself am a psychiatrist, actively treating bipolar disorder and prescribing these medications. I think prescribing these medications is reasonably safe and often helpful, but trumping up fictitious diagnoses and deluding people into thinking that they have a lifelong illness without a firm grounding in scientific fact is ridiculous, and unethical. Your own experience isn’t miraculous, it just verifies that much of contemporary psychiatric diagnosis is a bunch of malarkey.

Kalea Chapman, Psy.D.

Confusing Causation and Correlation: Media Distortions of Research

Bugaboos of media science reporting.
PsyBlog has an interesting post from a few weeks ago — a list of eight ways the media distorts research findings. Perhaps the most compelling in the list is the tendency to confuse causation with correlation. Even among the educated there is a confusion about the difference between proving cause and effect (causation) and examining the relationship between two variables (correlation). Probably the most infamous example of two variables is that of smoking and lung disease.

For instance: Smoking and lung cancer.
Despite widespread common belief to the contrary, a link between the two has never been proven. Rather, over the years a compelling body of evidence strongly suggests that there is a strong connection between smoking and lung disease. This is not the same as proving causation. No one has ever observed smoke entering a lung and metastasizing lung tissue. That smoking causes lung cancer is the hypothesis. The large body of research that supports the hypothesis elevates the idea to a theory. It is possible that at some point some new research will disprove this theory, in which case a new hypothesis about the link between lung cancer and smoking would be developed.

Dangerous Psychotherapy Language

A guest post from Alan Karbelnig, Ph.D., past-president of the San Gabriel Valley Psychological Association, among many endeavors. Dr. Karbelnig writes about the hazards of professional jargon.

Perturbed by jargon.
I recently had lunch with two of my illustrious SGVPA colleagues who, in the course of discussing their clinical work, used words such as “attachment,” “affective attunement,” “activation,” and “dysregulation” repeatedly. I understood what they meant. They were describing the phenomena of being close to other persons, of resonating with them, of becoming excited, and of feeling overwhelmed. After lunch I returned to the office perturbed. My fellow practitioners know these words trouble me. Maybe they use them with more vigor when I’m around to demonstrate their attachment or attunement to me. Maybe they want to get me activated. But this time I just felt like shouting. I offer this rant for the SGVPA newsletter instead.

Is your superego corrupted?
In the middle part of the last century, the psychoanalytic lexicon was rife with earlier versions of these words. Had you dined with psychoanalysts in, say, 1955, you would have heard about patients’ cathexis to their analysts, or about their ego weaknesses, or about the corruption of their superegos. If the patients were particularly emotional, perhaps you would have heard them described as overwhelmed by Id impulses that had perforated their repression barriers, over-riding proper ego functioning.

Selective Publication of Research on Selective Re-Uptake Serotonin Inhibitors (SSRIs)

Hindering medical knowledge and public health.
What if you were to find that research into SSRIs discarded negative findings and tended to publish on positive findings? And that negative findings were written up with a positive slant? What if research in this area was found to be actually hindering medical knowledge and public health?

These were the findings of an article in tomorrow’s New England Journal of Medicine (citation below). Thanks to Ken Pope for bringing the article to my attention.

Here’s three exerpts:

Medical decisions are based on an understanding of publicly reported clinical trials. If the evidence base is biased, then decisions based on this evidence may not be the optimal decisions. For example, selective publication of clinical trials, and the outcomes within those trials, can lead to unrealistic estimates of drug effectiveness and alter the apparent risk-benefit ratio.

The Marketing of Bipolar Disorder in Children

Here’s a link to Frontline‘s piece on the medication of what they are calling “pediatric bipolar disorder“. A 2007 article by David Healy and Joanna Le Noury in the International Journal of Risk and Safety in Medicine (citation below) has some sobering and thought-provoking assertions about the marketing and medical treatment of manic depression in general and manic depression in kids specifically. This is an article written by a psychiatrist in a peer reviewed journal. That means a review board of other psychiatrists or researchers reviewed the findings and assertions in the paper and deemed them sound, suitable for publication. Here’s a dirty dozen:

1. manic depression (rechristened bipolar disorder) was not diagnosed in children for over 100 years
2. bipolar disorder in children has markedly different symptoms that in adults
3. we do not know how medications that treat bipolar work
4. children are medicated with the same powerful psychotropics as adults
5. there is “scant research into childhood mental illness and drug treatments to combat them”
6. as recently as 1990 the literature referred to bipolar as manic depression

When Does Therapy End?

They call it termination.
In the field of mental health, some do. So, when should your psychotherapy end? An important question, and some recent research has some pointers to keep in mind. It’s particularly important when you’re in a more “psychoanalytic” or “psychodynamic” psychotherapy. When working this way therapy tends to be less structured. Someone might come in with one complaint, yet unearth a number of other issues. In other words, it’s not always obvious when therapy should end. Here’s the press release issued by the Univerity of Haifa:

Sixty Percent of Psychotherapy Clients Felt Therapy Didn’t End on Time

Sixty percent of private practice dynamically oriented psychotherapy clients felt that their therapy either lasted too long or ended too soon, according to recent research conducted by Prof. David Roe, Head of the Department of Community Mental Health, Faculty of Social Welfare and Health Sciences at the University of Haifa. “While there is widespread agreement that an ideal termination of psychotherapy occurs naturally, with an agreement of the timing between therapist and client, our research reveals that more often than not – this does not happen” said Prof. Roe.

In the study, which was conducted in collaboration with Dr. Rachel Dekel and Galit Harel from Bar Ilan University and Prof. Shmuel Fennig of Tel Aviv University Medical School, 82 people who were in private practice psychodynamically oriented psychotherapy for at least 6 months (and average of 2 years), which had recently ended, were assessed regarding the way they experienced the timing of, reasons for and feelings about their psychotherapy termination.