If there is such a thing as evil, then you've just described it, Phil. The whole business of being denounced as a witch (sorry, that should read "diagnosed as mentally ill") is positively Kafka-esque. Nobody wants you to get better, because then they'd have to look for somebody else to be superior to.

Matt

Phil,

I've a question for you: what makes a certain set of behaviours abnormal, such that it constitutes "mental illness"? It occurs to me that one has to have a norm, in order for something to be abnormal.

The question is, then, who gets to decide what is normal? To a certain extent, society determines that. It is not normal to perform behaviour that amounts to a criminal offence, for example, so I suppose at some point, somebody or other decided that being at risk of violent death (murder) was so unacceptable that it became necessary to bring everybody's attention to that. The same is true of the types of behaviours demonstrated by the mentally ill, and so on.

Now, although there has been a concept of mental illness in place for a very long time, it has only relatively recently become organized, and then medicalized. Moreover, there is only a select group of people who have the right to say what is what. As you point out, a few people have done very well (financially) out of this arrangement.

Do you honestly think that they are going to step aside, just because somebody demonstrates quite unequivocally that they are utterly mistaken? Of course not, they'll fight tooth and nail to maintain their supremacy in this field and demonstrate further that they are correct, when they don't have the speed of thought necessary to come to any kind of proper resolution.

I'll tell you where the error lies: they start from the position that the people they are dealing with are abnormal, and then they prove it. Start from the opposite position: that the person is completely OK, and that maybe there's a couple of things that they could do better, and the result is completely different.

I think it's a shitty trick that when a person goes to somebody for help, they are punished with a denunciation, a label. What kind of quackery is that? Instead of assessing what the issue is, in accordance with the information given by the patient, the quack immediately forces the poor bastard into a box. Fucking halfwits.

Matt

Oh, one last thing. Phil, you're not bipolar, whatever that is. That's my opinion, and it's as valid as the quack's who stuck that label on you, in the first place.

I look at it this way: these people don't have any solutions. As such, you don't have to listen to them. How can they hold themselves out as expert, when they have nothing approaching a fix? Ignore the fuckers: they're halfwits.

Matt

"once-diagnosed, always-diagnosed" This proves psychiatry is not a medical science. If a patient has a real illness like an infection or a broken bone, the patient does not have an infection in remission, or a broken bone in remission. It is broke or it isn't. With no diseased brains/brain chemical imbalances to be found in the real world, I hope/think psychiatries days of legitimacy are numbered.

Phillip,

Don't dispair, there's nothing wrong with your character (whatever that is). You are not morally weak. Cheer up buddy, the problem is that your brain is structurally unsound, doesn't work properly and causes you to think that your thoughts and feeling and impressions have some validity when really they're just symptoms of an illness. Well, uh, I can't prove this, but it seems nicer to tell you your brain is f*cked and you will never get any better than to tell you to cheer up or calm down or work through your issues or get away from the people in your life that think such horrible things about you.

To say someone is bipolar is to say they're not human. It's an atrocity. The same is true of personality disorders, except that personality disorder is actually a crueler, more hateful and limiting diagnosis as it is a diagnosis that says, it's your "personality" not your character or your brain that makes you always to blame for whatever happens in your life and the lives of those around you.

In Georgia, one person labeled has having bipolar disorder was allowed to take the bar exam, and can continue to practice law as long as this person has blood tests to make sure s/he's on meds. http://www.gabaradmissions.org/

Having emotionals and/or a personality is considered a disorder in our society.

As you mention, both true mania and true clinical depression are debilitating, and people have a right to compassion when in these states, not punishment and stigmitization as a life sentence.

Think of it this way, what crime can you commit that will have you forever labeled a criminal, that will make the possibility of having your record sealed impossible...I think murder would be the only one, and maybe sex offender.

And yet a psych diagnosis is a conviction for life. Under today's rules you can never say I used to be bipolar or I was diagnosed with bipolar once, you have to always say I am bipolar. It's bs, barbaric.

There's a history of classifying certain "mood disorders" as we'd call them now as personality disorders, and vice versa ... I found it very interesting, and relevant to your post.

For example, I think in the last DSM, and maybe in the last or even current WHO/ICD classification, syndromes such as cyclothymic disorder, dysthmic disorder etc. were classified as personality disorders primarily (dysthmic personality, cyclothymic personality), though now they are seen as mood d/o's. (One of my favorite books, "Symptoms in the Mind," puts these "minor mood disorders" in the chapter on personality).

I also wonder about how anxiety could fit into this paradigm ... would a milder perhaps "sub-syndromic" or "not quite meeting criteria" generalized anxiety disorder, which was pervasive and long-standing, warrant a dx of "generalized anxious personality"?

Cancer-free patients are called being in "remission"; so if anything your doc will just classify you as in remission.

Personally, my doc dx me Bp2, and specifically said, "but I don't want to lose your personality".[with meds] I think that says a lot with regard to personality vs. illness as a topic.

On the other hand, I have no explanation for the wild noise in my head when I had a breakdown that drove myself to go see psychiatrist in the first place.And I never want to feel that awful again.

I am though on low doses of medications, following the thought of not medicating away my personality. I also feel I've gotten worse recently, and don't know why.

I pretty much agree with you that much of what is now termed "bi-polar disorder" amounts to expression of a personality disorder, though even using the term "disorder" there is problematic. Certain patterns of behavior become entrenched and part of a person's character style -- somehow looking at it as a character style makes more sense to me, describing as it does as pattern of relating that developed over years.

A serious problem with the medical model is that once you assume problematic behavior is best treated with medication, because it is a medical problem, then any effort to help the patient develop strategies for dealing with symptoms and problem behaviors is gone.

The need to medicalize behavior and push subjectivity out is fierce right now. Money and turf are the overarching factors, I believe.

Have you read, "Of Two Minds: An Anthroplogist Looks at American Psychiatry" by T.M. Luhrman? It is an illuminating work about the formation of a psychiatrist written by a medical anthropologist following 3 years of research.

in keeping with the cancer parallel - what about the term "remission", philip? are cancer survivors ever deemed "cured"? or are they labeled as "in remission"? (i ask the question because i truly don't know.) i would think a doctor would be loathe to say "you're cured" even though you don't display any symptoms, for either cancer or bipolar disorder. i believe you're in remission - for life i hope!

I believe (from my own experience) that it was not helpful to tell me I had recurrent major depression. How is there any hope in a diagnosis like this? Where is the possibility of being well? The last thing I needed in period of deep despair was to be told that I would go through this again and again and again for the rest of my life. While I do believe that what I experienced was major depression, I do not believe it means I am stuck with this problem for life. I do not experience the deep depression I used to, and I credit this to a great therapist who taught me different ways to cope with pain and loss.

I agree with Matt -- it's positively Kafka-esque. Just why do these guys think they can "play God" and pigeonhole someone for the rest of their lives on the basis of criteria that are arrived at by a fiat of their colleagues (the DSM committee)? That is so damning to say "Once diagnosed, never undiagnosed". Talk about taking away hope and disempowering the patient. Just their way of letting you know you should never stray too far from that little pill bottle. You need it; you're a prisoner of it; you're helpless without it. And you need them -- the docs; they're the powerful, all knowing beings who control your lives. "Never unmedicated" is their goal and this is how they get there. But of course the docs are victims of this way of thinking as much as anyone, because it makes them feel so all important. Thanks for a thought provoking post.

Sally, love your comments and love your adorable dog. I'll take a dog's healing power over medication any day. Cats aren't too bad either.

I've told many people now that I think I have mild personality disorder traits and that my psychiatrist, not knowing what else to do just kept medicating me which did nothing for the personality traits but instead gave me medication side-effects that in turn were medicated, alas, oddly enough, none of those problems went away.

I was of course, first diagnosed because of a true psychosis, but it was drug induced and I've never been psychotic since and like you, it's debatable that I've ever even had a true mania.

And yet, when I was a social worker working with the "severe and persistently mentally ill" I was on more drugs than anyone I have ever met.

In my mind it's a tragedy. And one I have yet to end or come through.

I'd like to add here that "mental illness" in general and "personality disorders" are often born out of trauma. Healing trauma takes the energy of human beings loving us and listening to us, not the heavy dosing of medications.

A woman on youtube, SFJane, healed her profound PTSD and so-called bipolar and schizophrenia with meditation.

http://www.youtube.com/profile?user=SFJane

Feeling our pain, confusion, anger, shame, guilt etc and then finding a stillness within are all part of the process of healing and in psychiatry the order of the day is to drug away all those feelings--never never look at them closely.

thanks, Philip. I would tweak your argument about personality disorders a bit here and there--I don't think it's as simple as you put it and there are other dynamics at play too (I imagine you think it's as simple either) in any case I'm tired, very very tired and not up to writing a whole lot to argue or expand upon the small points. I hope I'm motivated to respond to you at length on my site at some point. I think you bring up very important points.

I think I may be confused about the definition of a "personality disorder." Isn't a personality disorder considered to be a non biological incurable flaw in personality? If so, isn't it just a fancy way of saying "character flaw."

I'm sure someone will correct me if I'm wrong. The part of the personality disorder "disease cluster" that I find most improbable is the incurable part.

When I first was diagnosed as being bipolar (right before I turned 23). This was after 2-4 years of pretty bipolar behavior and nearly 10 years of depression. I was angry at my parents for not realizing it when I was younger. I started messing up in school in 11th grade. But I had been seeing a therapist on and off since I was 14 for depression. Like maybe I'd be happier now, and have a college degree and a decent job. Now I am glad that I wasn't "found out" then. Some of these medications are so scary. But I wonder how much of my current behavior and personality are my shitty upbringing or my brain not working right.

I think the diagnosis of Bipolar Disorder is thrown around too loosely, and people who just need help and guidance, and possibly medication but not for long-term, get thrown in with the mix of the people who have a severe deficiency of certain chemicals in the brain with an over-abundance of other chemicals.

I believe the only reason no one can say that BD is curable is because we do not have a fair grasp on what the different medications do, and how they do it. I am aware that some increase serotonin while others work with dopamine. I also understand that not everyone needs medication, but there are people who cannot function properly without having the chemicals altered - On the personal side, you can only feel better if you want to feel better. You will not become better by sitting and focusing on negativity. But on the contrary, as said before, some people honestly need to have the chemicals in their brain changed around in order to appropriately express emotions.

I do not know how I should take the Seroquel comment - Seroquel has done wonders for me, but what does it have to do with reaching for the stars? I reach to the stars by praying, not by not taking/ or taking my prescribed medication. Is that to say that people who do take drugs like Seroquel cannot, "reach for the stars?"

Back on where I was going, I don't think anyone can say you can get, "undiagnosed," because we don't know how the medicines function. Until we see what it is that it is doing, and why and how it works, we won't know.

Kind of like in the 60's? I think it was.. People thought ecstasy was the most wonderful thing, until scientists discovered all the negative side effects and serious health hazards, some of which are permanent.

You'll never know until these medications are fully explored and fully understood what the capabilities of them are. Even for the people who are not on medication, not enough is known if the chemistry can be reversed, or how to do it.

I'm 20. I've been going 'round and 'round with this since 14yrs w/ doctors and everything that comes along with it.

btw, I would have been stunned if my doctor said that to me, and I would have walked out that door and never go back. All comparison to cancer aside--I feel that is ridiculous and very proving of the psychiatric paradigm and defense of the doctor's profession.

I feel anyone open-minded and truly caring regarding patients with an abstract [that's what this is]dx of a psych dx, would have jumped up, clicked the heels, and walked you out the door, shaking your hand and saying, 'Thank God, you have beat this shit, now walk on!'

I hope you drove/walked away and flipped the bird to the Universe on that one.

It really has taken me all day for this to soak into my brain--that a doctor is not happy for a patient and leaves a foot in the door "just in case."

Shit, it's like the doc who told my daughter to her face and mine: "Poor prognosis, send her to Western." Bull Shit.

She just came home and spent the afternoon with her dog and cat. So there!

yes a personality disorder is also sometimes called a characterological disorder---the secret? EVERYONE has some characterological flaws and they are not incurable they are HUMAN.

If you believe people can change and grow then that is all there is to it.

I'm changing and growing and I'm not perfect---heavens---I may even have some flaws!!!

It's the mental health system who have made something like borderline personality disorder into a derogatory hateful term. Most people with this label have been horribly traumatized. I've seen people who have this label flourish. As I've seen people with just about any other psychiatric label flourish.

Sorry about the state of my comments today----I'm so tired I can hardly string a sentence together...but I want to say my bit anyway. I hope I'm making some sense.

When you can afford it, get a new psychiatrist. They don't all think like it. My chart/record now says my bipolar diagnosis was mistaken. I guess that's not the same as saying what you wanted him to say, but still, even Fuller Torrey says 25% of people who experience psychosis more than once will recover fully.

O Philip, this is the sort of post that makes me sorry I don't have any money to send your way right now. Typing jewels and honey here, and the plenitude of your critiques is a rare gift itself. Bless your entire being.

Hey Philip,

I think this is where the paradigm has truly failed Americans (aside from Seroquel for 2 year olds). Yes, that is strong language. The way a diagnosis is reified in our culture is sickening. Reification being the process of making a definition that is merely a constellation of symptoms useful only for treatment purposes a hard-and-fast identity.

I don't think you can be symptom-free for an extended period of time and NOT bipolar. It is especially absurd to think because you were diagnosed as Bipolar I simply before the label Bipolar II came into existence that the label Bipolar I is "what you are".

I feel like the diagnosis your psychiatrist outlined is similar to the way the Alcoholics Anonymous describe Alcoholism: you can never get rid of it. I wholeheartedly disagree that the analogy applies to psychiatric conditions.

The way you talk about "receiving a diagnosis" it has sounded to me like you are talking about a formalized ritual - like being "baptized" in a church!

You have always been such a strong advocate of questioning the paradigm and not listening to the advice of someone with an MD or PsyD behind their name because of their credentials alone.

I've never been "formally diagnosed" with anything, and I am thankful for it.

Phil thanks for this article...

I was diagnosed BP nearly 10 years ago during an extremely stressful time in my life. Granted, it took a while for things to get better, but a retired Psych doc made a quick dx and it has stuck with me in the VA system all of this time.

I can certainly attest to the "once one, always one" phenomena, even when there have been no abnormal mood swings in years.

It's this once diagnosed, never undiagnosed mentality that illustrates the fact that Bipolar Disorder is a label, not an illness. If a doctor thought you had lung cancer and it turned out to be emphysema, the cancer diagnosis wouldn't stay with you. Worse, having the bipolar label forever means you might be forced, when not sick, to take drugs that will make you sick, i.e. manic, suicidal.

Think about how many of the recommendations for "bipolars" are good advice for everyone: get enough sleep, eat right, exercise, don't get too stressed out. This advice could apply to anyone, as could special symptoms of bipolar some people report, things like getting really upset when a relationship ends, not handling stress well....the only symptoms that couldn't apply to anyone are label related, things like not being able to get health insurance, having difficulty maintaining your physical liberty, having difficulty maintaining custody of children.

i blame it all on ted turner and jane pauley. between the two of them (and some no-strings attached funding from jump on oprah's couch boy) there should be enough money to fund an esalen institute of full recovery from mental struggle.

i appoint sfjane http://youtube.com/watch?v=cqgzjq83-dQ as chief taoist dissolver of mental difficulties & sean http://www.youtube.com/watch?v=pt3NYu4Ql9A as chief evangelist of the cause.

that guy tom wootton at bipolaradvantage.com isn't shabby either, but he's got his own gig going already.

& i would sue google for punitive damages of [insert dr. evyl pinky here] 1 trillion dollahz for what they've done to you with adworks.

keep up the struggle!

I dont know if any of you know a child with bp, but I am raising one. I can say that if I thought for one minute all he has dealt with was due to his own "personality" he wouldn't be taking meds. Being different or following your own path is one thing, but to have to suffer to the point of not remembering that you punched yourself in the face or the ridicule of other children from outburst you have not idea how to control in something else entirely. I knew when he was 4 months old that something was going on that I didn't know how to help him with. I was told it was a stage, he will out grow it. 6 years later I finally found what I was looking for, someone who knew what was going on with my son. For some of you it may be a curse to be diagnosed as bp, but for us it was an answer we desperately needed. My son has is symtomatic daily, with meds. He has outburst still, he has good days and bad. He also has friends(which he didnt until he was 7) and he has managed to keep them, they understand as best as kids can that he is dealing with something they cant see and they help him by being understanding and even talking him through some of his tougher moments. He is doing fabulously in school. This is not just because he has accomidations for his bp, but because he has chose to be a willing and active participant in his therapies and add his own ideas to the mix. I had friends that warned me against getting him diagnosed because it would follow him his whole life. This concerns me because people are not as accepting as they like to think and say they are, but I feel that knowing what is going on in his head is the only way to teach him how to function in a world not set up to accmidate people with bp. I dont feel that meds and counseling are the only things he needs, in fact I hope to have him off the meds some day, but right now it gives him the time he needs to learn coping skills, anger management, how to ask for what he needs, take a time out or walk away from a situation when needed,how to funnel the energy of manic moments into productive activities, how to reach out when feeling depressed, not hide which is the usual choice, and a bad habit to get into. There is so much that he can learn about himself and his diagnosis while on meds and in therapy that he would never be able to with out them right now. I have been told by several professionals in various areas that they wish more parents were like me, and would and could teach their children that this is something they have like brown hair or big feet, you can't change it, but it's not who you are and it doesn't have to define you in anyway. So instead of moping or raging at societies take on mental illness take charge of your life and your diagnosis and be who you are with it, in spite of it, and because of it.

wildbabe

Wildbabe said "For some of you it may be a curse to be diagnosed as bp, but for us it was an answer we desperately needed."

This is exactly the problem! Who benefits from these moral verdicts? And where is our "appeals court" where we can disagree with the judgement?

Yeah, I was told that and believed it about my daughter way back in 1999. Note that the behavior and symptoms are still there while on medications, wildbabe.

What's going to happen, is the child will grow up, learning coping skills for the explosive side of the personality, and never really have a baseline for "normal".

Could quite possibly end up brain fried on medications that can cause psychosis, --permanent psychosis.

But, one can never know until the time passes. Soon, I predict that your child will have a P.D.D. Asperger's dx, and then you will find out that drugs don't "cure" they "manage" and managing life is learned.

Just my opinion, and I must say it saddens me to know doctors are still pushing that life-long, don't let this run you bullshit on kids.

These are drugs that have NO long term studies done on children. Unless one wants to take a look at my daughter. She appears to be a long term study.

Once a brain is damaged by psych meds and enough time goes by, doctors no longer have answers. Because they never had them in the first place.

I am rolling up my sleeves as I type. I sure as hell hope Philip is too.

I don't see how BP can be a personality disorder if you look at the depressive aspect of the disorder. When people with BP are depressed it is my experience that they lie in bed--but can't sleep, don't want to come out of their room to even eat half the time or do anything--not even go to work or school, even though they're future and even their survival in many cases depends on it. That is not anyone's definition of a personality or "character" disorder, i.e., personality problems that interfere with their getting along with others or being liked by others--this is a definition of depression, which is a "mental" rather than "physical" illness. I'm sorry but BP is NOT a personality disorder by any stretch of the imagination.

Wildbabe, The fact that your "doctors" have told you that bipolar disorder is something you have like big feet or brown eyes actually means if there is a such thing as bipolar disorder, it is not an illness, it is not a disorder, it is a way of being that should be accepted. If a child's parents don't validate him, it's no wonder he goes out into the world rageful.

Bp is a way of being for many people.And people with it should be accepted. It is a disorder, it doesnt mean there is something "wrong" with you, it just means your "normal" is different than most peoples. For my son I feel having him learn about it and understand it gives him the advantage. If he knows what is going on inside of himself then he can find the tools he needs to function in this world. Knowledge is power. Tools can be meds and counseling, but there are other ways to cope as well. Music and water are 2 the things we have found that help him cope with Bp. Both are soothing to him and while in a meltdown his favorite song can bring him down and comfort him. As for validating my son, I do it every day in a multitude of ways. Your right that he will learn to "manage" his life and that there is no cure. If managing his life is what needs to be done than I am all for it. His normal is 12 hour rages that leave him exhausted emotionally and Physically. He is sore from throwing himself into walls and hitting himself. He can't sleep, barely eats and is so wound up that school is an impossible feat. As for being around his friends, that wont happen, they simply dont know how to handle the unpredictability. If there is even a glimmer of happiness in his life that comes out of the treatments that we have found or will find then so be it. He remembers life before treatment and tells me he doesnt want to be like that again. He hates the loss of control and the way people treat him. He knows his friends will disappear and that for him would be hell. I am his biggest advacate and I will do whatever it takes to give him some peace. I come from a family that has several people with Bp, if what they have gone through, undiagnosed and unmedicated until well into adulthood, is what my son has to look forward to then I am willing to take the chance on meds and counseling and letting him know what he has, how to manage it, cope with it, and live with it. I let my son at 10help mke the decisions that affect him. He is informed about his meds, what they are supposed o do and what side affects he can likly expect, we explain what counseling is doing and let him work on what he feels is in need of attention. He is already adding his ideas and opinions to the mix and coming up with ways to help himself. I'd say that if he can do that at 10, he is doing better than most adults with or with out Bp.

Re the "personality disorder" issue: my own view is that bipolar really is a neurological/biochemical disorder at base like they tell us, but this largely manifests itself through our incredibly complex minds as a personality disorder. I can certainly characterise my behaviour/thoughts in hypomanic mode as a distinct personality - it's much more than a "mood". Also, each person's mania is flavored by their personality - religious folks will imagine talking to God, SciFi lovers will detect aliens, etc.

Re recovery/unlabelling: if you make the great achievement to kick the meds, still be healthy, and live well so no one would want to slap a label on you, is it really important to drop the label too?

Though I must admit, when I last visited the US and there was a question on your entry forms about "serious disease or mental illness", I resented the implications of the label then.

i think some people like to be "sick." they embrace their diagnosis b/c it absolves them from any type of personal responsibility for their actions and behavior, and keeps them from ever having any hope. it's a convenient excuse for when things go wrong, "oh i can't help it, i have a chemical disease, something's wrong with my brain." they like to wallow in it and they LOVE the fact that it makes them special. Now, before you bombard me w/ "i wouldn't wish my disease on my worst enemy" take it from me I KNOW. but what if you didn't HAVE a disease? what if you've been mislead all along.

i was terrorized by my parents, my father in particular, who used the mental health system to punish and control me all throughout my late teens and early twenties. this was a man who let my family live in poverty and squalor and frequently choked, hit, threatened, blamed, and even gaslighted my mother ("your mother's crazy...that's where you got it from...all the problems in our family are because of her" ) He violently abused her and myself and my siblings.this was a man i nonetheless had great love for. but he had his own demons which i feel he projected onto me. and it gave him an easy out. "my daughter isn't depressed b/c she grew up neglected and comes from an abusive home, she has a CHEMICAL IMBALANCE-- NOTHING is our fault--we were perfect!" i was so desperate to escape my family life i would sleep with men just to have a safe haven and be in a home that had working plumbing, heat, and air-conditioning and was free of vermin and insects. for this was deemed "manic" (sexual promiscuity) i ran away from home with some fellow musicians to another state, to escape the beatings and constant enforced institutionalization, and of course, this was also deemed "manic." since i was a violinist my father delighted in pointing out that this proved i was crazy b/c everyone knows artistic people suffer from BiPolar disease more frequently. by the time i was 27 i had been locked up seven or eight times and i don't even want to go into what kind of treacherous disturbed insanity i had to witness and endure at those hospitals, i was on verge of being suicidal-- they had taken away my life and there was nothing left. i bore the mark of Kane. no one knows what goes on behind closed doors. my "enforced help" ruined my reputation in my hometown and damn near destroyed my sense of hope and self. but i always knew there was nothing wrong with me. i knew i wasn't BiPolar and i knew they were taking a list of behaviors and categorizing them as a disease, not as a response to circumstances which can only be described as barbaric. my parents finally divorced and my father left my mom to go live by himself on his old family farm, and guess what???? my BiPolar disease miraculously was cured!!! no more institutionalization, no more commitments...nothing! i didn't take any medicine or see any psychiatrists or get any type of lobotomy or shock treatment yet here i eight years later, perfectly FINE. i worked with handicapped adults, i drive, i have a wonderful relationship w/ a kind man who loves me, i take care of my walker-dependent mother and my sister's children, and i continue to perform in my community in theater and in music. so-- WHERE DID MY BIPOLAR DISEASE GO????? i just want to know.

I think we are talking about more than one entity here. I believe there is a disorder called bipolar disorder, and it consists of periods of elation and depression, intermixed with periods of euthymia, or normal mood. I also believe there is an increasing number of individuals with personality traits or disorder who are diagnosed bipolar because the medical community doesn't know what category to put them in. These are people with persistent labile mood, ups and downs that pervade every aspect of their days, all the time, or most of the time. I can see why they get called bipolar but don't believe it is the same illness, and think it has different origins, although some of the neurological changes in the brain may end up being the same.

I'm a physician with bipolar disorder who gets frustrated when everyone who has labile mood or who does something "crazy" gets labeled with the same illness I have. I think it blurs a lot of things to do that. However, in the end, it is less about what diagnosis you have and more about what it takes to get you well and functioning in the world. That is the real question.

well, you're always pitting it into some little category, aren't you, Dr. ? "labile" or "manic" or "depressed" or "cyclothymic" -- same decoy, different coat of paint. you are who you are as a result of the circumstances you were born into, the people who raised you, your personal belief system, and your environment and your reactions to it. use medication if you like it or need it, but know and understand that a. it won't always work and b. it won't always be available to you.

you have to eventually be able to control yourself and recognize what is triggering your "episodes" and how your thoughts influence your behavior. i feel sad that you think you have a biological disease for which there is no cure and your faulty brain chemistry is responsible for all your black moods, manic highs, poor choices and irresponsible actions. believe what you want, and take your pills if you really think they help, but i'm telling you, there's a better life out there waiting for you. a life where you are no different than anyone else, one where all you need is a loving home, a happy and grateful heart, and a healthy lifestyle to heal your wounds and help you recover... and to eventually function remarkably well, drug and diagnosis/label free. i know this is hard for someone in the medical community to swallow and for parents that like to have defective kids to believe, but it's true. at least it's true to me.

Elizabeth
How dare you call kids with serious mental health issues defective! When something is defective, its thown out like the trash. Its people who think like you that had those who suffered from mental health issues locked away, I thought we had moved passed thinking its best to treat people in barbarric ways. Over time, knowledge, understanding, and acceptance has started to overcome the stigma associated with mental illness. We are not all the way there, but our society has made huge strides in realizing that people who have a mental illness can be just as capable and productive as those who dont have mental health issues. Many are or will be helped with treatments, therapies, and medications, but that really should not have much barring on the issue. A lot of other people suffer from things like diabetes, high blood pressure, eplilepsie, and a multitude of other medical issues and must take meds, go to counseling or have therapy of some sort in order to get through a day.

My son is surrounded by family and friends and has a good home with love, attention, and care. He is fed, clothed, and bathed well. He is given encouragemnet, talked to, listened to, and accepted for who he is. He is being taught to know his triggers, and how to handle situations that may set him off. He is a happy, active, intelligent, curious, artistic, warm and loving child. I resent the fact that you think parents who have children like mine "like having defective kids." My child is not defective in any way. I wouldn't trade him for anything. I admit that some days are better than others and that the road to "recovery", if there is such a thing for people like my son, will be long and hard, but I know that my son will be a wonderful man capable of functioning in society because he was given a "Label". That gave me what I needed to help him. He will achive many things because spmeone showed me how to see through all the symptoms and find my little boy. I will forever be greatful for his "LABEL"

um, you called him defective not me. i don't recall anyone being locked up for diabetes or heart disease. it's not the same and you know it. let's see how grateful and gracious sonny-boy is in a few years when it's not so easy to lug him around to shrinks and push pills down his throat. when he gets beyond kool aid and cookies. oh, and with a mom who goes by "wildbabe" why am i not surprised at your situation? you are missing the entire point of what i am trying to say. there is NOTHING MEDICALLY wrong with your son, that is my point. if it makes you feel better to think there is, go ahead. you are dooming your child to a lifetime of social ostracization, potential institutionalization, serious community stigma, and drugs. this is the REALITY of having been daignosed mentally ill, not the FANTASY. but have at it w/ YOUR label YOU out on him b/c you have seemed to found your all purpose solution to all that ails. i am suspicous that all is not so hunky dory in your family. i question the environment that produces a CHILD diagnosed w/ a bipolar diagnosis, i SERIOUSLY QUESTION it. are you with his father? have you ever been abused as a child ? is there instability in the home? no child should be diagnosed bipolar. what a crock. i stand by what i say. and i feel sorry for you but i feel sorrier for your little boy.

What? Is someone really serious when they define personality disorders saying "personality or "character" disorder, i.e., personality problems that interfere with their getting along with others or being liked by others"? Excuse me but that is not a good definition of a "personality" disorder.

All that people like Philip and Elizabeth are saying is that causes of all mental "disorders" are a blurred mix of biology and environment.

Too many bigoted souls revel in the idea that biological is "Axis I" and environmental is "Axis II" as if the two could be separated so as to make sure that the first is "good" while the second is "evil". For these people to find ways of describing all mental disorders in terms of a continuum would take too much effort, to admit that the brain is a sensitive organ that is damaged by life events and may be fragile through an unlucky genetic lot, but it is also a marvelous instrument that can use thoughts to influence chemistry - this would take up too much time, human resources and demand an empathy that they do not want to wear themselves out with. What amazes me most - these are so often the same "professionals" that are the first to accuse others of thinking in black and white.

Many people with BPD (I assume that's what the doc means by "labile") have long enduring friendships and marriages, many people with "bipolar" find that their ups and downs last so long that no one can deal with them anymore. Just as it's wrong to think that people with bipolar disorders do NOT have any problems getting along with others, it's wrong to assume that those with "BPD" ALWAYS do.

Gianna's comment is right on. Actually "personality disorders" have evolved into a hatefully moralizing way of describing people that even most medical professionals would rather be seen as being much further off the deep end - bipolar I, even schizophrenic, than narcissistic or borderline.

The reality is that the terribly painful dysphoric ups and downs of those dx BPD are just as environmentally and biologically linked, and can be just as debilitating (or more, they lack the "highs" of those dx "bipolar") as manic/depression.
How is it that we strip people of their dignity, humiliate them by belittling their pain and "their" reasons to explain it, give them a thousand subtle (and not so subtle) hints that the world would be a better place without them, and then we accuse them of self-centered narcissism when they kill themselves out of despair or desperation?

It's a noble cause to help people see through their defenses and maladaptive traits when they are suffering and to try to find meds that may help. And sometimes people do need to be hospitalized to keep from hurting themselves or others. But it's high time to find different ways of talking about people - stop clustering them, labeling them; for God's sake, stop the power games. And it's certainly not so noble to say "for you no meds - suffer baby, you've got personality problems, and for you mister, don't tell me your problems, take this pill and everything will be just fine..."

Certain genuinely caring people hope to make "borderline" PD a recognized "serious mental illness" thinking it will reduce the stigma! The sad reality is that until the human race learns to accept the full complexity of their fellow beings none of these labels will rarely ever do more good than harm.

The problem with comparing bipolar to a broken bone is that a broken bone has clear pathogenesis, therefore recovery - cure - is evident when the pathology is resolved (the bone is healed).

Bipolar, like all mental illness, has a MYSTERIOUS BLACK BOX in place of pathogenesis, and diagnosis is based on symptoms (and all too often, report of symptoms, which is subjective and prone to error). It is assumed this MYSTERIOUS BLACK BOX is always there, even if it is 20 years after the last observance (or report) of symptoms.

A doctor can xray a leg to see if it is healed. If it is healed, the patient has no broken leg.

A doctor can not scan a brain to see if it is still vulnerable to mania or depression. It is therefore by default assumed a person who has had bipolar disorder will always be vulnerable to bipolar disorder, because it is unknown at this time whether or not it is possible to heal that. Doctors assume by default that it is not possible as this is the most professionally safe and financially profitable assumption to make.

My suspicion is that it is not truly possible to recover form bipolar disorder, it is only possible to learn to control it and prevent manic episdoes with drugs or perhaps behavioral modification and stress reduction techniques (e.g. meditation like SFJane uses). People who claim to recover from bipolar disorder probably never had it to begin with; they probably never had mania or even hypomania, and if they did, it was probably drug induced therefore not true mania.

Absolutes have no place in medical care issues, except for providing appropriate care.

Illnesses are more likely to go into remission once they have been treated. I just want to know which of you would like to go to an accredited site for issues like Depression, Schizophrenia, or Post Traumatic Stress Disorder and tell the readers there these diagnoses do not exist, or "you'll be cured" if you at least acknowledge some legitimacy to these disorders.

And some people I meet, who have been given a diagnosis, I conclude may not seem to have such a disorder or diagnosis. And believe me, if they agree with my opinion, more often than not they are happy. But that is the point, it is a professional OPINION.

I won't be holding my breath waiting for a response, not with this crowd.