More people are being labelled as BAD! – Bipolar Affective Disorder

Bipolar Affective Disorder = BAD, was created as a new category of ‘mental illness’ in 1980 by its inclusion in the Psychiatrists’ Diagnostic Manual. Prior to 1980 almost no one had heard of bipolar disorder. A story was created saying that this ‘illness’ was simply the renaming of manic depression and gradually more and more people came to believe this story.

Manic Depression was a very rare diagnosis. Bipolar is not just common, it has become an epidemic.

From one person in 10,000 being affected, psychiatry now claims that about 1 in 4 people are now in the bipolar spectrum and the number affected is increasing. Strangely, we are also told it is genetic. The story just does not make sense. A genetic problem does not go from 1 in 10,000 to 1 in 4 in one generation.

What is really going on?

Firstly, Bipolar is not an illness or even a disorder. It is a label given to people who have emotional difficulties. Anyone can have emotional difficulties. These tend to be caused by relationships (e.g. a relative dying), where we live (e.g. having your home repossessed), not knowing how to take care of ourselves (e.g. eating too much carbohydrate or not getting outdoors in daylight) and concerns about the future.

People react to emotional difficulties in different ways. For those who are unable to turn to friends and family a coping mechanism is visiting the GP. In the western world GP’s have been told that emotional difficulties are best treated with sedative drugs and readily prescribe these. Unfortunately, despite many unpleasant side-effects these drugs are addictive. Once started most people find they cannot cope without the drugs. Drugs tend to destabilize moods further, such that:

Emotional difficulties >>> a visit to the GP >>> prescription drugs >>> drug induced emotional difficulties >>> visit to psychiatrist has become the most common route into the ‘bipolar club’.

The last step of labeling used to be exclusively by psychiatrists. With getting on for a quarter of the population believing they need a ‘bipolar label’ the psychiatrists have not been keeping up with the demand they helped to create. An increasingly common route has become via the internet. People are looking at lists of warning signs of emotional difficulties that have been relabeled as ‘bipolar symptoms’ and recognize themselves. Well, really it is not so much themselves they recognize but their recent way of living and coping with emotional difficulties.

Having convinced themselves by reading and often completing an on-line ‘Am I Bipolar?’ quiz, they go to see the GP and present their ‘symptoms’ just as described on-line. This describing our life in terms of symptoms tends to convince GP’s who have been trained to believe bipolar is a brain disorder, that the patient has this disorder. The GP may or may not write, BIPOLAR, but tends to allow the patient to leave with the belief they have a mental illness and that they are bipolar.

The idea of ‘I am bipolar’ has spread around the world. This has further promoted bipolar as a disorder people are being born with and something that stays for life.

There are other ways the disorder is growing. For now though:

Explore the idea that bipolar is more of a label than a diagnosis

Bipolar boom continues

Bipolar is booming!

From a few rare cases of manic depression…

…through to the first ‘antidepressant’ induced manias in the 1950’s…

…through to the boom since the bipolar diagnosis was created in 1980…

…through the proliferation of psychiatric drugs creating more mood instability in those ready to try them…

…and now bipolar being seen in people who were previously viewed as depressed, grieving, mal-nourished or simply exhausted…

…WHY? One answer is: There is a lot of money to be made from bipolar!

However, is it not more ethical to help people recover from emotional difficulties and help them avoid becoming part of this sickly bipolar boom?

Profiting from explaining #moods and #bipolar

If you have alwaysFor most of my life I tried. By this I mean that I mostly believed I improved things for myself and others by working hard. I believed that putting in a lot of effort would lead to good things.

In my 2004 book, ‘Stop Paddling / Start Sailing’ I describe this way of living as paddling. The stop paddling idea does not mean to stop making an effort. It is more about seeing the alternatives and then starting again with a better understanding of why sometimes trying hard works well and sometimes it does not work as expected.

By 2005 I was keen to start my training business, with an associate suggesting, ‘Stop Paddling’ as a unique business name. I wanted to help people understand that there are many alternative mind-sets and to help course participants to have more choice whether to spend their time paddling, drifting or sailing and of course to avoid sinking!

The Stop Paddling business did not go as planned and from 2006 to early 2012 I was mainly training people to understand, live with and recover from being diagnosed with bipolar affective disorder. This led to publishing the handbook on Bipolar Disorder for Nurses and Carers in January 2012.

To publish a 350 page book on bipolar disorder and to continue to teach health professionals, the public and of course those who need to recover from the bipolar diagnosis I needed to do a lot of research. I had lots of meetings with experts, read a lot of books, did lots of on-line research and worked for 4 years on mood and recovery research projects.

The authors who I met during this time who most influenced my thinking were Dr Liz Miller and Robert Whitaker (Recommended reading: ‘Mood Mapping’ and ‘An Anatomy of an Epidemic’). If you have time to read both with an open mind you will surely reach the same conclusion I, and I believe everyone else who has read these books comes to: bipolar disorder and other mental health diagnosis are only labels and not medical diagnoses. Bipolar is a label used for people who suffer from stress and anxiety who have periods of higher or lower energy levels.

For earlier generations (prior to bipolar becoming a diagnosable disorder in 1980) most people feeling anxious and stressed with variable energy levels would have been considered to simply be under pressure, in pain, needing change… Now you only need to sit in front of a psychiatrist and say you are feeling troubled for a bipolar disorder diagnosis to be a likely outcome.

This has left me in an odd situation. I continue to research and teach about what is described as a diagnosis that is really no more than a label.

In creating the social enterprise, Rethinking Health (UK) Ltd, my new colleagues helped me find a way to continue with this teaching and research through helping students see both sides of ‘the bipolar coin©’. Part of our courses are delivered using a large coin with each face used for comparison of the main alternative views.

For most who are being labelled as bipolar their biggest challenge becomes the label itself which implies little or no recovery, little hope and on-going stigma that maintains a bleak looking future which in turn maintains the disorder. As well as their original troubles they now have to cope with the stigma that stacks so much against them when wanting to get their lives back on track.

I am reminded of the statement at the top of the page and this quote…

Madness is doing the same thing again and again and expecting a different outcome.” Albert Einstein

Tackling causes:

Whatever it is that is driving people to turn up at doctor’s offices to accept the bipolar diagnosis it will continue to make these people unwell unless something changes. Knowing what to change depends on looking at the causes of our emotional turmoil.

On our recovery courses people have found it easy to identify many possible causes. These are all things that happened in the past that set us up for difficulties with managing our emotions or things in the present that can tip us over the edge.

The likely causes are well-known. It is more challenging, yet essential, to help people to find their personal causes and triggers. Knowing what causes and triggers our troubles allows us to not just to change what we do, but also to have a good chance of making the right changes that will allow us to live a healthier life.

A fresh start:

2012 was a big year for us in figuring out what is going on and how we can help improve the prospects for the next generation.

It was also a time of realisation that we as trainers with experience of mood disorder had become part of the bipolar industry. We were being paid to effectively promote the idea of bipolar as a diagnosis and however much we were explaining that bipolar is just a theory, just using the word was helping the industry around bipolar to keep on growing and drugs to continue to be prescribed.

Although we cannot challenge bipolar without using the word ‘bipolar’, it now seems more ethical not to take a wage from this but rather keep the money we are paid in the social enterprise. This is  allowing our work to expand and so more people can have more hope after bipolar diagnosis.

This is a different kind of profit – if we can do this we can start to feel great about our work again.

BIPOLAR IS BOOMING! #bipolarboom #bipolardisorder

What is causing the BIPOLAR BOOM?

I am increasingly being contacted by young people saying, “I think I am bipolar” and those who have persuaded their doctor to give them bipolar medications based on very common anxiety warning signs.

Several psychiatrists I have met through my work have told me of the increasing demands for bipolar medication from patients who do not seem unwell enough to need them. They also admit to being influenced to prescribe powerful drugs for children when their parents argue strongly that warning signs such as not sleeping enough or sleeping too much are signs of bipolar disorder. Something is going terribly wrong, when so many people are almost enthusiastic about gaining a diagnosis of a severe mental illness, especially one associated with shortened life expectancy.

How did this boom in bipolar diagnosis get going? 

Manic depression was a very rare illness prior to the widespread use of psychiatric drugs. As drug use increased in the 1950’s and 1960’s more people who were suffering occasional periods of anxiety or depression started to be considered to be manic-depressive.

Creation of a new category of mental illness called Bipolar Affective Disorder (BAD) in 1980 expanded the market for psychiatric drugs beyond the still small numbers admitting to being manic depressive.

Very few people understood the meaning of the new label as the word ‘Affective’ was not explained. The meaning being, ‘The mood that is displayed as opposed to anything measurable’, which made it clear for those prescribing that this was not a specific disorder that could be tested for or diagnosed by examining causes. The bipolar label and medication was only to be related to symptoms of anxiety or anxiety avoidance and rather than anything else, such as blood tests or trauma. This allowed patients to be labelled as bipolar and given medication without any need to ask what had happened/what had caused them to become troubled and be in front of the doctor.

Right from the start (1980), the media chose not to abbreviate Bipolar Affective Disorder to B.A.D. instead preferring to simply describe almost anyone with erratic moods as bipolar. Popularity of the new label grew and drug companies thrived without any complaint that the label was being misinterpreted.

Bipolar caught the public’s imagination as those labelled with it seemed to so often have extraordinary talents. This for many fixed the idea that people could be ‘born bipolar’. The idea of an illness that can be both a gift and a curse was popularized. However, in all the autobiographies of famous ‘bipolar people’ I have read the authors write about life events leading to their variable mood and influencing what they achieved rather than any in-built special abilities.

In the 1990’s bipolar was increasingly ‘promoted’ (wittingly or unwittingly) by celebrities who either claimed to have, or were said to have, a mood disorder. The idea of, ‘the disorder is part of who I am’, helped promote the belief that it was something they were born with. These stories from or about celebrities often gave the impression that bipolar was something ‘special’ that could give musicians, actors and authors ‘an edge’ or even an advantage over non-bipolar artists and performers.

For the bipolar handbook I co-authored I needed to check the origins of many of the stories about ‘bipolar celebrities’. It was amazing to find how flimsy the evidence was, such as Sting (the song writing and lead singer with the group The Police) had been labelled as bipolar simply because he wrote a song that mentioned a chemical associated with bipolar that was being used by a friend of his. [It would be interesting to hear from Sting at this point with his version of how people started to talk about him being bipolar.]

Proliferation of psychiatric drugs that cause the symptoms of bipolar, allowed drug companies and psychiatry to create more definitions of bipolar mood disorders. The range of options for people being labelled bipolar grew with options such as ‘bipolar lite’ and ‘cyclothymia’ for those not experiencing traditional manic-depressive symptoms. This variety has allowed me to facilitate regular workshops since 2006 instructing nurses about the many possible diagnosis.

I have worked in one of the fastest growing industries on the planet… The bipolar industry! Yes, bipolar has been booming. It has been lucrative for many. There is a lot of money to be made from bipolar.

It is time for change

As mentioned above, bipolar is classed as a severe mental illness associated with shortened life expectancy. It is very serious and detrimental to health to even be labelled as bipolar as the drugs that go with the label tend to be prescribed indefinitely with serious consequences. If such a label is to exist at all it needs to be reserved for people who are very unwell and who can benefit from being singled out for specialist treatments.

Is it not more ethical to help people avoid the diagnosis even if we in the bipolar industry earn less money by doing so?

– – –

The bipolar industry has continued to grow

An interesting discussion of how bipolar diagnosis has increased and how maybe there is over-diagnosis and over-prescribing…

The bipolar explosion

Censorship may prolong bipolar suffering

A few years ago I only knew a few people with a bipolar diagnosis who were living well without medication.

big pharma censorship

censorship by big pharma?

Access to good recovery training and explanations of the effects of the various medications have changed so much for so many. Increasingly I am meeting people who, like me, were diagnosed and told to stay on medication for life and then found that it was possible to responsibly come of the medication and stay well.

This week, I met a newly diagnosed person with a forward-thinking-psychiatrist who showed a list of medications, what they were said to do and the side-effects for each. They asked the patient which they thought would be best for slowing their thinking and making them sleep more during the night. The patient selected one and although they told me it was giving some horrible side-effects such as blurred vision, they were happy with their choice. They felt it better than one of the antipsychotics known to cause permanent brain damage.

Censorship? If the censorship laws being considered today go through, will this lead to more restrictive laws in the future that will stop us talking about bipolar recovery. Big business supports the medical model, which says that recovery is not possible. They say that we are sick people who cannot learn from our mistakes. They say that our emotions (that cause us to write about these things) have to be kept under control by medication.

The trend is for more people who have discovered they were not mentally ill after all to come on-line and talk about their horrendous  experiences on drugs. This is beginning to threaten all the big drug companies and their share prices/value on the stock market. Yes, what we are doing is starting to unsettle and is likely to make the global economy more unstable. This is a shame.

It has to be said though. The only alternative is greater censorship and increased use of drugs to stop people talking.

Bipolar is big business – originally written in April 2011

Why is almost everyone talking about a bipolar diagnosis as something that can never ever be eliminated?

Here is one controversial answer: Bipolar is big business.

bipolar business

'Bipolar ensures reliable profit'

It is said that 5.7 million adults have a bipolar disorder diagnosis in the USA[1]. I am going to guess that about 5 million of these people are taking an average of two tablets per day. So that is 10 million tablets. Even if those tablets only cost $1 each that is $3.65 billion per year just in the USA. As bipolar is said to affect every race and every country, the worldwide bill for medication must be enormous.

Any kind of therapy after a bipolar diagnosis is likely to be expensive. The clinic Kathryn Zeta Jones stayed in recently was said to charge $750/day [2]. Yes, that is an exception, but even ordinary beds on psychiatric wards cost the tax payer a lot of money.

In the UK it costs £1 billion/year for 9,220 NHS psychiatrists [3]. OK, they work on a lot more than just bipolar, but there is no doubt that bipolar is a fast growing sector for psychiatrists. In 1998 the average age of diagnosis in the UK was 39, now it is just 19. Younger diagnosis, with no hope of ever eliminating the diagnosis means more work for the health services and more medication needed over a lifetime.

The controversial idea here is nothing to do with anyone being evil or even particularly bad, it is just that there is money to be made and many jobs depending on the growth of the bipolar industry.

I cannot claim to be whiter than white here having been paid to deliver training that included phrases like, “Bipolar is a life-long illness” and “Medication is important”. Of course both phrases may be true, but how do we know that they apply to everyone all the time?

I am ready to be paid less, if that is what happens when fewer people are diagnosed and a few more people eliminate their bipolar diagnosis.

[1] Bipolar disorder statistics

[2] Silver Hill mental health hospital in Connecticut in a daily mail article 

[3] Mental Health Today Journal – March 2011 – Pavilion Publishing UK

Since 1955 #bipolarboom

Has there been an increase in people disabled by depression?

It is difficult to say for sure as there are so many ways of measuring disabled. Certainly mental health disability payments as a percentage of national income are increasing around the world. Organisations that support people with mental health difficulties are struggling with the numbers of people seeking help.

One way to look at the increase is by comparing figures for two years a long way apart as in this graph…

bipolar boom

Disabled by depression

I showed this as part of a presentation to 35 college staff.  I was surprised by the ferocity of response. I was told that the figures ‘do not compare like with like’. It is true. Ways of recording impairment have changed, yet don’t government agencies usually change the way they describe and measure things so that it looks like they are doing well? Here clearly things are not going well.

The second response was, “That is in USA and they have had a lot of wars in recent years.” I was a bit stunned by this then I remembered reading that there is a widespread belief that Americans for some unknown reason cannot cope with seeing and hearing about violent acts compared with the rest of the world. I feel the argument falls down when we consider America was heavily involved with the Korean war (25 June 1950 – armistice signed 27 July 1953), yet depression rates were low immediately after this war USA could not even claim to have won.

The third response was, “Why 1955?”. The top title on the graph explains this. It was just before the first drugs called ‘energizers’ became available to doctors. These powerful mood altering drugs had adverse effects. The boom in depression got under way. This was followed by the boom in bipolar disorder which is continuing worldwide today.

This recent article also uses 1955 as a reference point for the same reason. It is well worth reading. There are links to the scientific papers that prove depression is enhanced by drugs and bipolar is often caused mainly by taking drugs.

In researching for our book, (Bipolar Disorder: A guide for mental health professionals, carers and those who live with it’), I was surprised to find that doctors are still able to prescribe some of the very first 1958 style energizers , even though they were proved to be ineffective. Would you recognised these drugs if you were offered them?

When a diagnosis rate doubles…

When a diagnosis rate doubles, health professionals get concerned.

After a talk I gave on ‘recovery from mood disorders’ a psychiatrist asked my opinion on the bipolar diagnosis rate reaching a new alarming high for young women in their city .

I remembered this conversation when I read “…the number of disabled mentally ill in the United states tripled over the past two decades…”

No one knows for sure why rates for diagnosing bipolar are increasing in so many countries.

Could the answer to far higher diagnosis of young women than the young men (in that city in 2010) be linked to medication? The young men certainly had alcohol as their drug of choice while the young women were more likely to tell their doctor about their troubles and be given antidepressants. Both drugs can make bipolar diagnosis more likely just that the more powerful drugs may take people to this place quicker?


Have you read…

Whitaker, Robert, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. 2010, Crown (Random House). ISBN 978-0-307-45241-2.