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Bipolar support and information

This website is for people affected by mental illness, especially Te Mate Aronganui Pourua (Bipolar Disorder), their families, whanau, friends, support workers, doctors and nurses, and anyone else who cares about their recovery.

Fatal Crash Headline Stigmatising for

people with bipolar

Thursday’s (4th February) Otago Daily Times article about a fatal eight car crash in Auckland was grossly stigmatising for people with mental illness. The headline read "Driver mental patient: Police". It was unnecessary and pointless to headline that the driver in the crash was a “mental patient”. The implication of the headline was clearly that the man’s mental illness had something to do with the crash. That seems to be sensationalist and uninformed speculation.

The article reported police as saying that the man was a “bipolar mental patient on medication”. Thousands of people have a diagnosis of bipolar disorder. They may include your shopkeeper, your lawyer or your school teacher. The article stigmatises those people when they are actually far more likely to be the victims of violence than the perpetrators. As the greatest risk factor for violence in our community is being male, a more useful headline may have been “Fatal crash driver was male”.

Bipolar Disorder in 2012?

DSM-IV, the psychiatrists’ “bible” for diagnosing mental illness, was published in 1994. The book contained a brand new diagnosis, bipolar II, and the following years have seen a huge increase in the numbers of people diagnosed with bipolar disorder. This was partly because the bipolar II category is so broad that any number of irritated individuals with a chip on their shoulder, moody adolescents and naughty children can be conveniently given a diagnosis which absolves them and their parents of responsibility. The brain disease made me do it! The next revision, DSM-V is due out in 2012. Will we see any new varieties of bipolar emerge? Will the old and abused categories like bipolar II be tightened up? The hype in some psychiatric publications gives us hope for some real clarification of bipolar disorder in DSM-V. In the Medical Journal of Australia (2004 vol 181) Mitchell and colleagues tell us: “There have been major advances in clinical understanding and treatment of bipolar disorder over the past decade.” “Advances in genetics, brain imaging and basic pharmacology are starting to provide understanding of the complex causative processes.”

With this wonderful new knowledge we could expect that DSM-V will at last provide clear scientific guidance for labeling people with diagnoses like bipolar. Do these “major advances in clinical understanding” mean we will now have a blood test or scan to back up subjective notions like “mood”? Unfortunately, the reality is that our understanding of mental distress is little further ahead of Asclepiades 2000 years ago (see the summer Enigma front page story). Bipolar in DSM-V will be no more scientifically defined than in DSM-IV and the worst features will be retained. In “Bipolar Disorder in DSM-V: a Sneak Peek” the committee responsible for re-defining bipolar in DSM-V are quoted. One idea they seem likely to introduce is to add structure of some sort to the bipolar NOS diagnosis. People are diagnosed with bipolar NOS (not otherwise specified) when the doctor is sure you have bipolar disorder but your symptoms don’t meet the bipolar definition. Hmmm?

The only other change likely to appear is the idea of “domains of pathology within a syndrome”. So it may be that DSM-V adds some extra descriptors like anxiety or obsessiveness to your basic bipolar diagnosis. These do not sound like the “major advances in clinical understanding” of bipolar disorder we have been promised. I guess people with the disorder are still the real experts. The DSM-V sneak peek article did make some good points. It recognised that there is a tendency for people to think that the categories in DSM are all real and separate diseases rather than groupings of symptoms. This leads to self diagnosis and over-use of drugs. They also make the point that psychiatric diagnoses are metaphors with cultural implications. One panelist said “How we redefine bipolar disorder, if we do, will have cultural impact…” How right he is!