Friday, April 15, 2011

Has the concept of bipolar spectrum been broadened too far?

Catherine Zeta-Jones booked herself into a clinic for 5 days for treatment of her bipolar II disorder (see Guardian story). I don't want to underestimate the emotional impact of dealing with her husband's throat cancer. She has been praised for raising the profile of mental health issues.

One issue that might be worth commenting on further is the way in which the concept of bipolar disorder has been expanded since it became the new name for manic-depressive illness (see my book review for some background). I'm not saying that Catherine Zeta-Jones doesn't have bipolar II disorder, but it might be worth understanding what this diagnosis means.

The expansion in the concept of bipolar spectrum is not dissimilar to what happened to schizophrenia in the 1960s and 70s, particularly in USA, leading to the American Diagnostic and Statistical Manual in its third revision tightening up the definition, so that it was more reliably applied. People may find it helpful to put a label to their mental health problems, but I do have concerns that the diagnosis of bipolar spectrum has become so variable that its validity must be in question.

I've been dismissed as "postmodern" for this sort of questioning of the nosological basis of bipolar depression (see comments following another book review, also previous blog entry). What I am clear about is the need to avoid reification of psychiatric diagnosis. There's always a danger that we tend to assume that a diagnostic concept implies an entity of some kind. But a diagnosis is not a "thing". It's merely an abstract device which is useful for thinking about mental health issues.

I just have concerns that bipolar depression is not as useful as some people make out. And I don't think the argument can be dismissed that one of the reasons people have found the new concept useful is because of the development of so-called mood stabilising medication. There's even been a marketing ploy to develop medication specifically for bipolar depression (see previous blog entry).


SteveBMD said...

A related problem is the labeling of symptoms that, by all rights, comprise a disabling condition, but which don't have a corresponding DSM "diagnosis." By ascribing a label, we may be able to justify (i.e., get paid for) treatment, but we've also implied that there's a particular basis for that person's suffering, and we risk losing the trees for the forest, as it were.

Anonymous said...

You hit the nail on the head in your fourth paragraph…the larger problem is not whether a particular diagnosis seems accurate or appropriate at any one given time, but the fact that they are taken literally/concretely by society rather than metaphorically.

Anonymous said...

Bipolar I is the only true variable mood disorder. The rest is horseshit.

Ellen Biggs said...

This is a very eye opening article. I have had bipolar for many years now and I agree with you that "we tend to assume that a diagnostic concept implies an entity of some kind". I feel that the more information we have, the better we can understand the disorder. I recommend checking out . It offers a lot of great information about bipolar and treatment for it.