Not that there's any objective meaning to any dsm label, but still, bipolar I, though listed in the mood disorder section, is already a psychotic disorder. A manic episode requires psychosis. The very idea of a book like the dsm with a section on "psychotic disorders" is offensive.

Also, clinical depression requires psychosis. And of course it's often those with the depressive and bipolar labels who want privileges and feel they have "special gifts" who often look down on the "schizophrenics" as crazy and dangerous. Maybe if all these folks are forced into the same boat, some real reform will happen. While psychiatry and psychology and the "helping industry" harm a lot of people, generally it's those labeled as psychotic that get treating the worst - maybe there's some correlation between crimeless imprisonment, forced isolation, forced drugging and the angry and/or despondent disassociation that often earns the "psychotic" label.

frankly this looked like BS immediately exactly because it would decimate all those people's diagnosis with mood swings...what would we label all those poor lost souls. What would happen to their identity and their doctors credibility...???

I do believe it would take dead bodies to let go of psychiatry's love affair with diagnosing anyone with affect with bipolar disorder.

Sorry, Sally, but neither Bipolar Disorder nor Major Depression require psychosis to be present. Either disorder may present such symptoms but psychosis is not a diagnostic criterion.

All mood disorders are related to stress and/or trauma and trying to differentiate them with a bunch of different names is, as other commenters here have said, offensive. Problems are related to life stories and that's what's important, each and every person's story and how they tell it. So maybe constellations of symptoms help professionals and other supporters deal with suffering people but they should never be an end in themselves. Differentiating constellations of symptoms with fancy names doesn't help the person get on with their life; it just stigmatizes them, makes them feel sick and like there is something wrong with them. All mood problems are on a spectrum and relate to the degree of stress and/or trauma, either real or perceived -- from feeling unhappy to being psychotic. And just because you're one way one day and get the label du jour that day doesn't mean you couldn't be something completely different the next day. I say forget the DSM entirely and don't waste your time fighting over meaningless categories and labels. It's getting your life story straight that's important.

And doesn't it just tell you something that these "disorders" can be eliminated or moved around by fiat? That's the bottom line. This stuff is all made up and arbitrary and doesn't really relate in a meaningful way to the people suffering at all. Imagine latching on to the belief that you "have" schizoaffective disorder and then being told "Oh by the way we were wrong -- it doesn't exist." That's really helpful isn't it? This stuff just makes me weep.

Phillip, psychosis may be present in BP2. It has been in my case.

Maybe if psychosis is a requirement for bipolar disorder doctors will stop slapping the bipolar label on anyone who says they occasionally feel depressed and/or excited. At this point it seems like everyone is bipolar!! WTF! I have never in my life been psychotic and was labeled bipolar and when I described my mothers anxiety to a psych she said, "She was probably bipolar too." when my mother never experienced elevated moods, she was just a worry wort. This doctor wanted to put me on Lithium and Zyprexa, thank god I said no. I also think there's a thing now where chronic drug addicts are being diagnosed as bipolar left and right because substance abuse is a criteria but how can you tell if someone is truly bipolar when they're coming off of an extended meth binge?!

Carpenter's comment that "We hope to get rid of schizoaffective disorder" illustrates precisely why psychiatry remains a pseudo-scientific field. In just what other field of medicine can a committee convene and "vote away" a disease? Hey, let's round up a bunch of oncologists and do away with pancreatic or lung cancer! Let's get rid of diabetes by a committee vote!

Carpenter is right. The DSM people will never change the bipolar status to psychotic. Pharma and the medical community are on a roll right now with the bipolar label. Can't stop a good thing.

Here is an article [in part] from www.SSRIstories.com which shows that 4.8 million additional people were diagnosed with bipolar disorder between 1994 and the year 2005. I am sure the rate is much higher today.

http://www.ssristories.com/show.php?item=1319

Second sentence of second paragraph reads: "Without the need for an episode of hospitalization for mania, estimates of the prevalence of bipolar disorder have increased significantly from 1% in 1994, to 2.6% in 2005."

With the population of the U.S. now at 300 million, the rate of bipolar disorder has increased by 4.8 million people in the U.S. in the last 11 years. It is the opinion of SSRI Stories advocates that the majority of this increase has occurred because of the massive antidepressant use in this country. People are going "manic" on their antidepressants and then being diagnosed as "bipolar".

http://www.pharmaceutical-business-review.com/article_feature.asp?guid=7C5EF4E7-F53F-41C3-BD5A-E637D0211BFD

New hope for manic-depression sufferers comes from unlikely source

21st November 2006
By PBR Staff Writer

I think such a move would be entirely inline with the mainstreaming and renaming of major tranquilizers as antipsychotics. If you reframe bipolar disorder as psychotic disorder, it only stands to reason that the answer must be antipsychotic drugs. As the atypical antipsychotics are now Big Pharma's top money makers, this isn't at all surprising. What a bunch of unethical, greedy morons.

"Hey, let's round up a bunch of oncologists and do away with pancreatic or lung cancer! Let's get rid of diabetes by a committee vote!"

I agree with you, Tom. It's absurd. Their voting out homosexuality in the 1970s tells you everything you need to know about the validity of psychiatric diagnosis.

Unfortunately, it seems to have vanished, but there was a clip of a talk by Ron Unger on CBT for "psychosis" at YT, where he defined the main criterion for "psychosis" to be being out of touch with what commonly is agreed upon as "reality". He then moved on to ask his audience (psychology students, if memory serves me), if anyone present honestly could say of themselves never to have been the slightest out of touch with this commonly agreed upon "reality"...

I have a very hard time accepting the "I've never been psychotic!"-"argument". It won't do. Everybody has at some point in their lives experienced "psychosis". To claim that it only may be called "psychosis" if it lasts long enough, is a pseudo-argument, too. What exactly is "long enough"? Six weeks? What about the person then, who has experienced it for five weeks and six days?...

I'm completely with you, Sally: it's us-and-them-thinking, that desperately seeks to keep "bipolar disorder" as far away from "schizophrenia" as possible.

BUT: I also see the danger in this move, that it will make it even more likely for those labelled with "bipolar disorder" to be prescribed neuroleptics.

Good point Francesca about the reason to reclassify bipolar as a psychotic disorder. Wow -- it's all so we can legitimize its treatment with antipsychotics. Why didn't I think of that? Brilliant. In fact it's probably being classified as a psychotic disorder because antipsychotics are perceived to "work" to treat it. After all this is how they diagnose ADHD. If a stimulant works then you must have ADHD. That's what the ADD guru Hallowell says in his book Driven to Distraction. I kid you not -- after waffling around for most of the book about how to tell whether you "have" ADD or not, he finally ends with the message "Well if a stimulant works then that's the best way to know you do in fact have ADD." Now we can apply that paradigm to bipolar. Pharma is laughing all the way to the bank.

Franceseca,

I understand what you mean about using antipsychotics on bipolars - that the pharma industry would want to change the label but, I believe, that patients wouldn't go for that 'psychotic' label. Bipolar is o.k. by them because so many books have been written about how creative and gifted bipolars are but to be labeled right up there with the so-called schizophrenics would be an insult to patients.

Anyway, so many people have the Bipolar II diagnosis which means that they don't have any kind of psychosis. What would become of that!

Marian, I searched for Ron Unger on YT and found the videos. I actually participated in a similar workshop led by him last week. His presentations are highly recommended!

A psych ward psychiatrist that was in charge of my daughter's "case" told me in the summer of 2007 that the new DSM would remove the SZ dx and that he couldn't tell me what "she is" because the labels would be changing anyway. He said the SZ label was good to have for housing vouchers.

(sigh)

The Diagnostics and Statistical Manual (DSM), the Shrink's bible, has been around for over 50 years. Within this manual, there are now possibly nearly 300 mental disorders.

As a thorough dictionary of suspected mental illnesses, many redefined or recognized diagnoses are added to this manual with each edition.

On occasion, a mental disorder is deleted from the DSM, such as homosexuality in the early 1970s.

Its purpose, this manual, is to assist mental health professionals to diagnose and classify mental disorders.

Published and designed by the American Psychiatric Association (APA), the DSM is also used, I understand, for seeking mental diagnostic criteria to assure reimbursement.

The DSM is organized partially by the following:

I- Mental disorders
II- mental conditions
III- Physical disorders/syndromes, medical conditions (co-morbidity)
IV- Mental disorder suspected etiology
V- Pediatric assessments

The APA has historically directed the creation of each edition of the DSM, and assigns selected task force members to create this manual. This situation has proven to be controversial.

The next DSM involves 27 people. About 80 percent of these individuals are male, and only 4 members are not medical doctors. Most have had relationships with the NIH, and about 25 percent of these task force members have had relationships with the WHO.

Historically, at least a third of task force members have had, or do, have often monetary pharmaceutical industry ties in some way.

This makes sense, as about one third of the APAs total financing is from the pharmaceutical industry.

The APA required this task force for the next DSM edition to sign non-disclosure agreements- which is rather absurd and pointless. Lack of transparency equals lack of credibility because of these agreements of the content of the next DSM. It opposes any recovery model necessary regarding such disorders, I believe.

The DSM should be evaluated by another unrelated task force or a peer review of sorts to assure objectivity. This is particularly of concern presently, as many more are diagnosed with mental dysfunctions presently at a concerning rate- with very young children in particular.

Dan Abshear

________________________________________
New year...new news. Be the first to know what is making headlines.

Marian,

It seems to me the varieties of subjectivity all people experience is a far cry from reality being ripped away from you which is how people I know who experience psychosis describe it.

Whether or not this experience is a problem or requires medication is entirely another matter. Some people might find such mental states helpful and some people find them distressing. But I think to say, "Oh we all experience that" is inaccurate. It may be the extreme of a spectrum of perception we all share but I don't think most people travel that far.

David,

1. I agree, that it may feel like "reality being ripped away from you". On the other hand, I think whether you perceive "psychosis" in this way, or whether you, on the contrary, perceive it as a state where you, finally, get in touch with your own reality, your true self, depends on your background. The more you believe in the existence of an independent, objective reality, the more you'll feel that "psychosis" rips something away from you. The more you believe that reality equals to subjective perception, the more you'll probably feel "psychosis" has to offer you something.

Personally, I came from a place somewhere in between, where cultural conditioning had indoctrinated me to believe in an objective reality, while I also had my doubts. So, the experience itself was both marked by extreme fear and confusion, and at the same time by a feeling of deep connectedness and meaningfulness.

2. It certainly is the extreme of a spectrum of perfectly natural human perception - not the "sick", unnatural opposite of it, as psychiatry wants us to believe. And, right, most people don't travel that far while awake.

Anyhow, which I have a huge problem with is exactly the concept of "psychosis" as opposed to what is accepted as natural: us and them, the real nutcases, the defectives, the freaks, the inferiors, etc. And I wonder whether this urge to judge and label possibly originates in the judges and labellers unconscious knowledge of how close they themselves actually are to which is labelled "psychosis". Whether it originates in their fear of, accidentally, taking that one tiny step, and overstepping the line that separates them from "psychosis". Whether it originates in the il- or delusion, that, if only they can find a strange enough word, like "psychosis" or "schizophrenia", the experience itself becomes so strange, it can never happen to them. - Indeed, I regard the whole DSM normality's desperate attempt to deny and thus protect itself from its very own shadow sides by projecting them onto the other: "Get thee hence, Satan!"

With the changes to the DSM, what I want to know is are psychopaths/sociopaths going to exist? There is no such diagnosis under the current nomenclature, only antisocial personality disorder. This is something that puts the thinking of American mental health out of alignment with the rest of the world.

If you want to have reason for concern, go to page 273 in the dsm-IV and note there is no definition of psychosis. Here's a line, first sentence, second paragraph:

"The term psychotic has historically received a number of different definitions, none of which has achieved universal acceptance."

Huh, there's no consensus on what a definition of psychosis is so how can we tell if someone is psychotic or not?

Oh, here's how the DSM-IV handles that issue later in the same paragraph:

"The different disorders in this section emphasize different aspects of the various definitions of psychotic."

So in other words, the term psychotic doesn't always mean the same thing even in the DSM-IV!!!! For you biopsych enthusiasts, I think the word diabetes always means the same thing as does the word arm and the word leg. These guys don't even pretend like this sh*t is science so why do any of us?

Oh and those of you who feel so confident about pre DSM-IV "scientific" diagnosis of "psychosis" here we go, same paragraph:

"...the definition used in earlier classifications (e.g., DSM-III and ICD-9) was probably far too inclusive and focused on the severity of functional impairment, so that a mental disorder was termed "psychotic" if it resulted in "impairment that grossly impairs the capacity to meet the ordinary demands of life."

Since the DSM-IV came out in 1994, I guess that means lots of folks labeled as psychotic prior to that were informed of this change and reevaluated and their treatment and records corrected and received financial restitution. Uh, no, but some may have been relabeled as depressed and bipolar...

With words like that from the text itself, it's shocking anyone takes this document, less reliable than a bedside astrologer, seriously.

wow, that's full on. Can see you've done a great deal of research into the differences. I saw a really powerful book on depression at www.iambruce.weebly.com Worth checking out.

Marian,

I really like your take on this topic, you've clearly done some deep experiencing and thinking around it. It's very hard for me to talk about without relying on loaded notions of reality that ultimately may not be helpful to the person experiencing these states of being. Do you insist on a consensus reality and say, "No, the floor is not melting, that's not happening." to help calm and ground them and get them to "return" or say, "Okay, the floor is melting... and...?"

It may be different for different people. I have no clue as I'm just a witness on the outside. But I'm trying to be helpful to my friends and at times this issue can seem very urgent.

Typical psychiatric spin in that article posted: "The elimination of homosexuality as a mental illness in the third DSM edition issued in the 1970s, for example, is now widely viewed as a watershed development in changing society's view from outright hostility to varying degrees of acceptance."

No mention of how much suffering they caused by including homosexuality in the DSM in the first place, just taking credit for removing it.

And Francesca, did you hear the news? Ketchup is not a vegetable!

David: Good question! My own personal experience was that it was extremely helpful whenever people accepted my perception of reality as just as valid as anyone else's, that is, when they didn't dismiss it as "crazy" (that both made me mistrust them and really pissed me off), and at least tried to understand. It didn't even matter then, if they said they weren't able to understand.

So, the "Okay, the floor is melting... and...?"-approach was definitely the most helpful one, with emphasis on the "and...?" which caused me to contemplate the deeper meaning of the floor melting, in context with my life story. Therapeutic :)

BUT: there are limits to how much of this therapeutic stuff a person in "psychosis" can take at a time. What was helpful and grounding whenever my limits were reached wasn't a "No, the floor is not melting, that's not happening." though. It was a "Hey, what did you say, your horse's name was?" For instance. It happens very, very rarely, that you can't reach someone and get them at least somewhat grounded, using this kind of "neutral" type of conversation.

I've heard two very interesting presentations make the case for Bipolar I to return to where it was in DSM-II - i.e. as Manic-Depressive Psychosis. There is more in common with Schizophrenia than with usual depressive disorders in genetics, course of illness, response to medication etc.

This would put the spotlight on Bipolar II and BD-NOS which stretches over far too many people with trauma or early insecure attachment history (and that is many of us in modern society) and encompass temperament and personality traits when hit by stress and/or grief.

Some Bipolar II presumably may still relate to Bipolar I but much may not and simply "Mood Dysregulation" may be safer to say and look for underlying individual causative factors in each case to address.

Marian,

I like what you are saying. Your example about the horse works with anyone extremely upset and we are best to treat people who have perceptions we don't understand that are frightening them not as freaks to be "treated" but as frightened humans. Loren Mosher's work bears this out.

A couple of points. As I mentioned previously, even the DSM doesn't have a definition of "psychosis." The word has no real meaning, and yet we all use it. What I think is particularly bad about the "science" of psychiatry is that it teaches us that not all minds are capable of "psychosis," only minds structurally and chemically different from normal minds. This belief is counter to science. All minds, not sick or defective minds, are capable of questioning the consensus of what reality is, which is what I sort of think the word psychosis denotes at least in this thread.

There is a constant back and forth about whether there is a such thing as mental illness. I don't think there is thus I don't get bogged down in whether mental illness is trauma based or biologically based.

I think the things we call mental illness are more analogous to taste and vision than to diabetes and heart disease.

With vision, there can be injuries to the eyes so that one can't see, will be blind, and there can be injuries to the brain so that one's perceptions are limited, i.e. the way they think or feel is changed. This doesn't mean the thoughts and feelings of a stroke patient are wrong, these are in fact a correct perception of their changed situation.

And this doesn't mean people go around using the fact that some people are blind to label people who have a different favorite color from them as visually ill. There are all different colors and shapes and designs and such of every thing from shirts to paintings to soup ladles. The preference for blue over green is not treated as an illness and people who persecute others for having different tastes than them are considered criminal and immoral, or just rude, morally flawed.

In the same way psychiatry and the helping industry are flawed. Similarly, people who perceive events differently are not wrong but different. Just as there's no one correct color there's no one correct feeling to have, no one correct and "sane" way to react to the death of a loved one, a traumatic experience, or simply viewing the world around one.

If "psychosis" were viewed as a perception, valid in its own right and the feelings coming from it as reasonable and deserving of compassion, there would be no need for psych hospitals or dsms or therapy. Human decency would do the trick.

Hmm, I don't like this. And yes, as others have already pointed out, the fact that they have to "vote in" or "vote out" diagnoses just proves how ridiculous psychiatry is-- not a field of medicine at all.

My husband become very disturbed about a year ago. He started telling me of problems he was having at work and thought "things" were going on at work, then he wasn't able to work and started doing the odd and strange "things" at home. I couldn't get him to go to the doctor, he didn't think anything was wrong with him. So after going through this whole year with him like this, after him thinking he had a microchip implanted in him and me being a part of it and knowing about it. He slipped into a final psycosis and I had to call 911 at 4:00am, take a mental hygene warrant out on him. After being committed, he spent 30 days in and was diagnosed with Severe Bipolar Disorder with Psychotic Disorder. He is home and off meds, joined church because he feels it all was all spiritual and is doing good. He is everything I ever wanted him to be in a husband and father but I still see him struggling and he isn't on any meds, he stopped them and says all he needs is God and Jesus. When admitted into the hospital he was "Pre-religiously occupied", I worry that he still is and don't know what to do. Please help my family.

Diagnoses are subjective. DSM serves to label, discredit, and stigmatize. However, many well meaning mental health professionals use it as a guide to "treat" people who are experiencing psychological issues living in our very unhealthy society. Primarily the former, in my opinion. I am sadly disappointed at the lack of understanding of the mind in the DSM, such a simplistic reductionist approach to narrow down human experience, contributing to the "us and them" crap that is the very nature of the pathology!

Like others have mentioned, it probably boils down to big pharma and their desire for profit.