May 11, 2007

We Are All Bipolar Now, Or The Norming Of America

As I noted on Tuesday, a new study claims that 4.5 percent of the American population has bipolar disorder. Bipolar disorder in this study is understood as BP-I, BP-2 and subthreshold bipolar disorder. SBD, as I am calling it, doesn't exist in the DSM. Until recently, prevalence studies estimated bipolar disorder at about 1 percent of the adult population. NIMH bumped its estimate last year to a bit over 2 percent (which seems about right). Meanwhile, pharma companies and some researchers said it was 5 percent and I read one journal article where a researcher pegged it at 11 percent.
My reading of this is that much of that increase is linked to an expanded definition of bipolar disorder as a spectrum disorder (spectrum disorders are all the rage these days) with SBD being the catch basin for all the soft bipolar researchers claim they are detecting in America these days. And so begins the war on the weird, the productive and the agitated of America.
If this strikes you as unimportant, perhaps you don't understand how all the dots connect around bipolar disorder the last few years. Zyprexa, Rebecca Riley, the bipolar child controversy, Seroquel declared the bipolar pill, class action lawsuits, multi-billion dollar settlements, researchers cooking research, black box warnings, calls for more outpatient commitment and so on. All of those bits connect with bipolar disorder in our culture and are evidence of the weaknesses--and dangers--of current treatment paradigms for bipolar disorder. And yet we have researchers, one cabinet level department (HHS), two private foundations and many pharmaceutical companies who would like to double or triple the number of Americans who must be convinced they have bipolar disorder, be instructed that it is a lifetime illness and be pressured to take medications that have a less than 50 percent chance of doing much for you and anywhere from a 30 percent to 50 percent chance of causing you an injury (I'm done with sugar coating it by calling injuries "side effects"). Forget about the usual criticism that this is all a naked land grab by pharma companies and researchers looking to line their pockets.
It's darker than that. What we've got going on here is the norming of America--a big happy party wherein Americans are forced to have their behaviors, thoughts, impulses and expressions grouped around a carefully-controlled norm. That norm is being created--has already been created some would argue--by leading researchers such as the bipolar mafia (adult division) at Harvard and the fine folks at NIMH. Any day, I expect a study proclaiming doctors as the new behavioral norms for American society. No, I am not joking.
To take this new SBD "diagnosis" at face value, then anyone who's experienced a period of insomnia and been more productive than usual at the same time has bipolar disorder. People like artists, entrepreneurs, writers, musicians, Presidents, soldiers, grad students and 4 a.m. poets have bipolar disorder--or are at risk of succumbing to its symptoms!--and must be medicated. Tom Waits, put down that whisky bottle and Marlboros and pick up the Seroquel. We are norming you! Same goes for you, Keith Richards. (CL Psych does a much better job here of poking through the SBD diagnosis. Read it.) I am really surprised that the authors didn't insist upon horniness as an SBD symptom.
I am so not interested in living in this normed world--the one without weirdness of any kind. Because it's all been dopamined to death. And a level flat world is no place I want to live. It will be odorless, tasteless, smooth and uninspiring in the extreme. Kinda like the back wards in "Brave New World."
The press has entirely missed just how important and off-base this study is. Yetserday, the study's lead author, Kathleen Merikangas an epidemiologist
from NIMH, spoke to Reuters in an article titled "Severe impairment common in bipolar disorder:"

"Regardless of the classification, the evidence suggests that impairment is often severe and few patients with bipolar disorder receive appropriate treatment.... "'One criticism we always get is that we're 'medicalizing' everything' and artificially inflating prevalence rates, Merikangas said, instead of recognizing symptoms as 'the normal ups and downs of life.' However, bipolar disorder, including subthreshold bipolar disorder, 'really does impair people,' she stated.
"Study results verify the clinical severity of the disorder, the team maintains, as reflected by the number of episodes, chronicity, symptom severity, impairment and the presence of other illnesses. The observation of increasing symptom severity from one category to the next reinforces 'the validity of the spectrum concept of bipolarity,' the researchers note."

The article doesn't even establish what this vague impairment of SBD might be much less BP-II. Nor does the journal article itself although it lays out something called "role impairment" (yes, we must all conform to our assigned roles in life or we are impaired). In the journal article the authors insist that "Subthreshold BPD is common, clinically significant and undetected in treatment settings."
Most media articles have spoken of only half of all bipolar cases being detected as their news hook. That's laziness. You cannot create a DSM diagnosis out of thin air and then say it's the same thing as the already existing DX and use that as a basis to claim that the problem is twice as bad as it was before. Why some reporters out there are not asking skeptical questions about all the inherent assumptions being made in that kind of thinking is beyond me. Except reporters are trained to always respect doctors--wow, they went to medical school!--and not to question what they say except to spell the Greco-Roman disease names properly. Maybe they are impaired.
Anyhow, I simply love that NIMH's press release on the study appears on the Medical News Today site on a page that features a vague ad about how your depression could really be bipolar disorder. Click on the link and up comes a Seroquel ad where you can take a self-assessment test.
I could go on about this all night, but my back is telling me that I mustn't. Beyond what I see as the darker--and dumber--implications of such research and the press' coverage of the same, it distresses me as an old school manic depressive (back before we got the politically correct bipolar disorder and BP-II) that instead of finding long-promised "cures" for behavioral problems in American society and instead of hammering out efficacious psychological therapies, we now have a medical model of mental illness that is far more interested in finding more patients for a paradigm of diagnosis and treatment that are weak in their conception and weaker in their technology. That's not good. Because soon any agitated, impulsive person who's never had a manic moment in their lives won't have to offer an accounting for their behaviors to themselves or to anyone else.
They'll just say, "Oh, I'm SBD."
Posted by Philip Dawdy at May 11, 2007 12:48 AM