Evidence-Based Treatment for Bipolar Disorder: Is the Evidence Based on the Wrong Outcome?
My ankle was broken during a hockey game when I was sixteen. The pain was so intense that by the time I got to the hospital an hour later I couldn’t bear it any longer.
If the doctor had given me a choice between suffering from the pain or cutting my leg off at the knee I would have chosen the amputation. I would still be paying for the mistake if he told me the best evidence calls for amputation and gave me no other option other than suffering for the rest of my life.
This sounds absurd. But, what if the pain was in my head? According to a recent article in the BBC News Magazine (http://www.bbc.co.uk/news/magazine-15629160), they did something even worse in the 1950s – they amputated part of people’s brains.
They lobotomized people with depression and bipolar (and other issues) because it was the best evidence-based treatment at the time. From the article, “But from the mid-1950s, it rapidly fell out of favour, partly because of poor results and partly because of the introduction of the first wave of effective psychiatric drugs.” Chemical lobotomies became the evidence-based treatment of the day.
Today’s evidence-based treatments are so much more humane. Or are they? The tools are more refined, but the goal of treatment is the same: cut off the part that is broken. We are no longer poking ice picks into people’s eye sockets, but are still trying to accomplish similar outcomes.
We cannot imagine cutting off a leg for a broken ankle, but every day another patient hears the false choice between a lifetime of suffering and a diminished life where our capacity to experience high and low states has been cut off. The reason I say it is a false choice is because too many pretend that there are only two choices: remove the highs and lows or not treat it at all. When I challenge the outcomes as unacceptable I often hear that I am advocating the “no treatment” choice, which is a ridiculous assumption. I advocate using the same tools along with new tools while collecting evidence of their efficacy for better outcomes. I believe we need a new paradigm altogether. I call it IN Order-based instead of disorder-based.
Please note that I am fully supportive of the evidence-based model of vigorously studying and debating the efficacy of tools. While corporate interests are skewing studies toward pharmaceutical approaches, I am in full agreement that we need to scientifically assess each tool to make sure the evidence supports its use. My issue is the lack of debate about outcomes. For the most part, the outcome is assumed to be removal of symptoms. It is almost universally assumed that the disorder is that we have highs and lows. There is little willingness to consider that we can have them without them being in disorder.
Perhaps the problem is the pain is so great that we are willing to jump at the solution without considering our options. It may be that people in authority are giving us a false choice comparable to cutting off our leg or suffering from a broken ankle for the rest of our lives. It is funny how the people most advocating evidence-based treatment are the ones unwilling to consider evidence that refutes their claim that we have to cut out our highs and lows to remove the disorder. Worse yet are the doctors mixing multiple drugs with no evidence at all of their efficacy while hypocritically deriding other options as not being evidence-based (http://www.psychiatrist.com/brainstorms/br6510.pdf).
There are a growing number of people who are achieving Bipolar IN Order instead of staying in disorder. We have learned to remove the disorder without cutting a part of ourselves away. We are fully bipolar, but we are not in disorder. We still have highs and lows, but they do not affect our ability to choose how to respond to the increased flow of energy and information associated with the bipolar condition.
We use the same tools that were used to achieve lesser results and have added more advanced tools to the toolbox. We have developed a program of assessments, tools, and realistic plans that have worked for many people, while recognizing that each individual will create their own plans from the template. Evidence is growing that we can achieve results that the “illness” model refuses to consider.
“Since it is believed impossible to thrive in depression, mania, hallucination, and delusion, we are not taught how to thrive. We are instead taught only how to avoid the symptoms and live in fear that they might some day return.”
– Bipolar In Order
If you really believe in science, you need to consider the evidence of our outcomes. IN Order-based does not mean treatment-free; It means that we consider evidence that is based on better outcomes instead of dogmatic belief in removal of highs and lows as the only possible solution. Once you see the outcomes that we are already producing, you will find the argument for cutting out our capacity for a wider range of experience as preposterous as the argument for removing a leg because of a broken ankle.
What evidence can you share of living with Bipolar IN Order?
Wootton, T. (2012). Evidence-Based Treatment for Bipolar Disorder: Is the Evidence Based on the Wrong Outcome?. Psych Central. Retrieved on April 18, 2015, from http://blogs.psychcentral.com/bipolar-advantage/2012/02/evidence-based-treatment-for-bipolar-disorder-is-the-evidence-based-on-the-wrong-outcome/