Posted by greywolf on April 28, 2007, at 0:58:44
In reply to Using Bipolar as a 'fill in the blanks', posted by linkadge on April 27, 2007, at 9:07:10
I am really, really bothered by articles like this. Frankly, instead of reverting to some obscure "mood spectrum" because it is allegedly too difficult to distinguish true bipolar from recurrent depression punctuated occasionally by a sense of normalcy or happiness, maybe pyschiatrists need to be stricter about diagnosing bipolar to begin with. It certainly is a lot easier from a professional perspective to call treatment resistant recurrent depression a form of bipolar rather than what it really is--depression--because throwing depression into bipolar at that point relieves the psychiatrist of the obligation to admit that he doesn't have an effective treatment for your depression.
My case is a perfect example. I have treated with 3 psychiatrists and 3 therapists over the past 12 years. All are unanimous that I am bipolar II--not "soft bipolar", not "bipolar spectrum", not "somewhere near something like bipolar on the 'mood spectrum'." Simply and unequivocally bipolar II. These professionals recognize that hypomania isn't something as generic as "putting real butter on your bread" for excitement; that hypomania is not wholly relative in the sense that its baseline is proportional in some linear fashion to severity of depression.
I mention the "real butter" scenario because the article notes that hypomania may be difficult to discern in people with recurrent depression because for many of them doing something mundane like using real butter is "a walk on the wild side." In my opinion, any mental health professional who thinks this way has no real understanding of hypomania. Hypomania is simply not just a mood surge that can easily be confused with a momentary lifting of crushing depression. It is something completely different, and to suggest otherwise is a complete disservice to both patients who suffer from severe unipolar depression and those who are bipolar II.
Sure, I have learned and believe that bipolar II tends to be weighted toward depression in terms of the dominant feature. I wouldn't expect otherwise. But anyone who has recurrent experiences with hypomania understands that it's a lot more significant than a mood enhancement that appears to be a "walk on the wild side" merely because it's measured against the the person's typical depressed state.
In other words, you can suffer from long-term recurrent depression and have good days, even great days, without being hypomanic. So can people who are bipolar II when they're dealing with long-term depression between hypomanic episodes. But that doesn't mean that recurrent depression sits on the same mood scale as bipolar II.
For instance, both my current psychiatrist and my therapist have seen me in a hypomanic state on a few occasions during regularly scheduled appointments (meaning I didn't call in advance for help with hypomania, so they were expecting the depressed aspect that usually dominates my personality). Both of them have made a point of commenting on my abrupt, significant mood change and how different my presentation is during those times (extremely voluble and talkative; bursting with energy to the point where I look like I'm about to explode; speech mimicking racing thought patterns; much, much stronger personality projection than usual, etc.). Their observations and my affect are always complemented by clearly risk-oriented behavior (spending large sums of money on unnecessary impulse purchases; repeated instances of being "the life of the party"--to the extent that when I'm not hypomanic at social events--which is usually the case--people are actually waiting for the wild 'n crazy Greywolf to appear (like it's something I can turn on and off at will)). This isn't just popping out of a long-term depression for a day to do something "wild" like use real butter, and it diminishes the meaningfulness of the pain experienced by both bipolar II and unipolar depression sufferers to suggest something so flippant.
In my view, bipolar II is bandied about way too indiscriminately, both as a diagnosis and as a self-description. I can't tell you how many people I know claim to be bipolar, but they clearly have no clue what they're talking about. They've never been diagnosed, they've never been in treatment, and, typically, they think being moody means they're bipolar. NOOOOOO--you're not bipolar if you're generally happy, but turn into a complete bastard once in a while. You know what you are? A generally happy person who can be a real bastard at times, and bipolar isn't a handy explanation for rude or bad behavior (likewise, the person who's a complete jerk most of the time, but who occasionally has flashes of decency, is very probably just a jerk who's occasionally nice, and not bipolar).
Blurring the boundary between recurrent/long-term depression and bipolar II just camouflages a professional inability to figure out what's really going on or a simple unwillingness to do the hard work it often takes to make the correct diagnosis. Unfortunately, bipolar II often cannot be diagnosed in one or five or ten 15-minute appointments. In many instances it takes serious interaction with a patient over a long period of time to make a reliable diagnosis, and that just doesn't mesh with the typical "stop in for a few minutes, tell me how you feel today, and I'll send you on your way with a scrip" methodology.
Bipolar II should not be reduced to a euphemism. Those of us who have struggled with it for years know that hypomania's not just a cute "walk on the wild side"; it's a disturbing, destructive phase of the illness that cannot be responsibly equated with a minor mood elevation.
Greywolf
poster:greywolf
thread:753904
URL: http://www.dr-bob.org/babble/20070426/msgs/754105.html