The young man jumped up and yelled, “You’re not bipolar! Look at you, you’re fine! My sister is bipolar and right now she’s in the hospital recovering from a suicide attempt!”
If I told him that I spent a day in the ICU after my own suicide attempt and had been hospitalized six times, went through a period when I couldn’t work, emptied every bank account I ever had and wrecked a bunch of relationships it wouldn’t have made any difference.
His experience with his sister’s bipolar disorder was present, and desperate.
It made me think about who has a serious mental illness and where the resources spent to treat mental illness go.
I was a trainer for an agency that had programs for people with developmental disabilities and brain injuries. Since mental illness appeared in many of the people we served, I presented an overview of mental illness and it’s treatment for new hires.
In the segment on bipolar disorder I sometime, if it felt right, revealed my own diagnosis and, maybe, a little bit about my experience.
I thought it could help combat the stigma against those with serious mental illness and illustrate that such illnesses could be well managed and those who suffered from them could recover and thrive.
The young man was in one of my classes and this day his reaction was unexpected.
I spoke to the man after his outburst during a break. He lamented that it was so hard to get help for his sister. People he relied on just didn’t understand.
She was really sick and in danger, but when he looked around he found that it seemed everybody had bipolar disorder or depression or GAD or some other diagnosis. And many of them didn’t seem all that troubled at all.
He told me that these people, the “worried well,” seemed to receive all the resources while programs for those suffering on the street kept getting cut. This was before the ACA and the Medicaid expansion, and the best doctors and private hospitals were only interested in people with insurance or the ability to pay well for services.
I’m afraid that’s still how it is.
Some people, those like his sister, have no insurance and are too disabled to even apply for benefits on their own without assistance. And that assistance is hard to get.
This got me thinking about the increase in the number of people diagnosed with bipolar disorder and the redirection of funds from the most sick to the most able to pay and function well. I discovered I have a chip on my shoulder about this, having been diagnosed so long ago when things were different.
I was diagnosed with bipolar disorder 1 in 1994. I was manic. Upon presentation for my first psychiatric admission I was suicidal, engaging in all sorts of impulsive, dangerous behaviors, and hallucinating. I was also grandiose and full of religiosity, writing incoherent letters to editors of numerous periodicals and devising crazy solutions for problems at work that didn’t really exist. I forced those ideas inappropriately on everyone.
I bought a new Acura with a credit card. I started affairs and ended an eight-year relationship. I used lots of cocaine. Everywhere I looked I saw rotting dead people. A man I knew who shot himself appeared to me from beyond the grave and convinced me to join him.
I was sick.
The criteria for a diagnosis of bipolar disorder 1 or 2 as laid out in the DSM III-R was strict, and lifetime prevalence of the disorder was placed at 0.4 – 1.6% of the population. Some people with bipolar disorder were misdiagnosed as having major depressive disorder or schizophrenia, so this rate may have been a little low.
Soon after I was diagnosed the DSM IV came out. It expanded the diagnostic criteria for hypomania and included cyclothymia, or low grade mood swings, in the definition of bipolar disorder. By 1998 the lifetime prevalence of the disorder had jumped to 5 – 7% of the population.
I was lumped in with people not nearly as sick as I was. The perception of the severity of my disorder seemed diminished. Fewer people understood my suffering then.
Because of possible overdiagnosis and the inclusion of so many with non-debilitating mood swings in the population with bipolar disorder today, the suffering of people like the sister of the man in my training class is being diminished.
Why is bipolar disorder being overdiagnosed?
First, obviously, is the broadening of the diagnostic criteria. This combines with psychiatry’s trend toward medicalizing so many people who are just a little different or situationally challenged.
In 1997 pharmaceutical companies began to advertise directly to the public. Concurrent with that move was the rise of the internet. People began to diagnose themselves and ask their general practioners for a prescription. Many doctors complied.
An NIH report even hints that bipolar disorder may be becoming a fad diagnosis, and pharmaceutical companies that develop and advertise drugs for hypomania and cyclothymia just accelerate that trend.
This is not to say that people with symptoms that fit the looser diagnostic criteria should not be treated. They need and deserve help, too.
But resources for research and treatment follow the money, and there is a lot more money in treating an expanded and more high functioning population than there is in treating only the most impaired. In fact, recent pharmaceutical research has left out the most severely disabled and suicidal individuals in selecting subjects for clinical trials of medicines to treat bipolar disorder.
Better, and more profitable, to develop products for the worried well.
The chip on my shoulder whispers that people with serious mental illness are being ignored, and the market looks rigged against them.
I’ve been fortunate. After years of trying I now have meds that work for me, and adjunct therapies such as meditation, movement and meaningful work keep me well. I have great support from family and friends. I left the job as a trainer and lost touch with the man from my class, so I don’t know what has happened to his sister.
I don’t feel that sick anymore, so I know treatment works. I just hope we don’t lose sight of those challenged as much as I was as the field shifts to treating those more likely to heal and most likely to pay.