Furious Seasons

October 07, 2009

Study: Large Percentage Of Bipolar Disorder Cases "Resolve Spontaneously" By Mid-30s

A fascinating and possibly very important study came out in August in the Journal of Abnormal Psychology (one of the American Psychological Association's journals). It concerns bipolar disorder and its course across human lifespans and the study's conclusion that many cases of bipolar disorder "resolve spontaneously"--the authors' term, not mine--by the latter half of the third decade of life is both startling and not surprising to me because I've been making a similar argument about the disorder's natural course for a long time. It's also not surprising to me that this study has gotten almost zero press attention--its primary finding goes so against the grain of what health reporters think they know about mental disorders and so against the grain of what psychiatry claims about bipolar disorder that it's almost an untouchable subject.

But not for me.

1. The study was NIH-funded and its lead author is Kenneth Sher, a professor of psychology at the University of Missouri-Columbia, and two colleagues. The researchers took the data from two large and very detailed national health surveys (read the paper for more on the surveys and their diagnostic methodology) and examined it for what they call an age gradient (ie, more prevalence of bipolar disorder in one age group versus another age group). They found a significant age gradient with high prevalences of bipolar disorder among late-teens and early to mid-20somethings and much less by the time of the mid-30s--as much as 30 percent less prevalence in the 30s, about 50 percent less in the 40s and 50s and even less in 60s and older (see the graph on page 435 of the study or page 5 of the pdf). This sort of resolving as one gets older holds across both bipolar 1 and bipolar 2 diagnoses.

2. The authors use the term developmentally limited bipolar disorder to describe the phenomenon and argue that it may represent a subtype of bipolar disorder. They also note that some bipolar disorders are still present in 30 and older age groups.

3. This finding is not supposed to be happening, as the authors themselves note:

"This is contradictory to DSM–IV bipolar disorder, which is characterized as chronic, in which a history of mania is sufficient for a bipolar diagnosis. However, we remain cautious in drawing strong conclusions here, because a single follow-up after 3 years [as the underlying surveys have] does not resolve the question of reoccurrence over the life course, and the lack of noncriterial symptoms included in the interview precludes more fine-grained analysis of residual symptomatology.

4. This study is not proof that bipolar disorder fades with time. The authors call for more studies and longitudinal analyses and so on. It's a study just begging for replication and I hope NIH and others in psychiatry get serious about its finding and undertake other research into the natural course of bipolar disorder (or disorders). Maybe Eli Lilly and AstraZeneca would like to help! Um, probably not.

5. That said, the Sher study is an important piece of evidence. Coupled with a study last year by Mark Zimmerman, a Brown University psychiatry professor, asserting that almost 50 percent of diagnoses of bipolar disorder are wrong (they are commonly cases of depression), it argues for some skepticism both within psychiatry and the media on what we think we know about bipolar disorder and what we think we know about people diagnosed with the disorder.

It also argues for doctors, mental health advocates and some in the media to stop describing bipolar disorder as chronic and lifelong.

6. The research state--and here I am paraphrasing--that one possible reason for "chronic and lifelong" tag is that much research is done in settings (commonly around public mental health systems and hospitals) where bipolar patients are more ill, for lack of a better term, than in other settings. In other words, there's a bias built into what researchers in those setting would conclude.

7. So why would bipolar disorder be so heavily weighted towards the late-teens and 20s? Why would it then "resolve spontaneously" in the 30s?

According to emaxhealth.com:

"One possible reason for the shift, according to Kenneth J. Sher, Curators’ Professor in the Department of Psychological Sciences and a coauthor of the study, could be the stress associated with life changes and social expectations experienced by young adults ages 18 to 24. As these individuals reach their late twenties, they have begun to adjust to these changes."

Or as researchers put it in the study:

"With respect to onset processes, late adolescence and emerging adulthood are associated with increased risk for a range of internalizing (e.g., panic disorder; Eaton, Badawi, & Melton, 1995), externalizing (e.g., alcohol use disorders; Kessler et al., 2005), and psychotic (e.g., Riecher- Rossler & Hafner, 2000) disorders, and this increased risk can stem from a range of both developmental stressors (e.g., leaving home transition; Schulenberg, Sameroff, & Cicchetti, 2004) and neurodevelopment (Alloy, Abramson, Walshaw, Keyser, & Gerstei, 2006). Moreover, this period of life is associated with exposure to psychoactive drugs, which can presumably have relatively strong neurodevelopmental effects in vulnerable individuals during this sensitive period of brain development (e.g., Caspi et al., 2005)."

That ought to make the blood of all genetic determinists and neuropsychopharmacologists boil over. Good.

It also ought to be a positive challenge--and perhaps ray of hope--for each and every person diagnosed with bipolar disorder.

Posted by Philip Dawdy at October 7, 2009 12:03 AM

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Comments

I am not sure if the illness "spontaneously resolves" itself or rather by the time you are in your mid-thirties (like me), you wise up that the meds are the source of your problems.

Good Post Philip!!!

Posted by: Angie at October 7, 2009 03:22 AM

This makes a lot of intuitive sense to me, by which I mean it speaks to my own personal biases, but just to play devil's advocate I have to ask: could some of the age difference be accounted for by differential rates of diagnosis, seeking treatment, etc, among age groups? For instance, I'd guess that if you looked at something like autism you'd find that it also appears to be much more common in the young than the old--but this doesn't mean that it spontaneously resolves when you hit 50. Maybe (I stress maybe, since I have no idea) there's something similar going on here.

Posted by: Evelyn at October 7, 2009 04:07 AM

The flaw of this and pretty much every research study in psychiatry is that it depends on self report data. We are to believe that just because some people who are asked endorse 6 of 9 symptoms they are therefore Bipolar? In no other field but psychiatry does such an approach for the gathering of data pass as scientific method. If they told us they had wings would we classify them as birds? This study tells us nothing more than there is little support for the overall consistency of the Bipolar construct currently as it depends on self report. I have seen dozens of pts with manic psychosis who years later would flatly deny having ever had ANY such symptoms on interview and those with chronic and enduring symptoms of personality and no documented hx of manic psychosis endorse every single symptom worthy of an official DSM Dx of BAD. I am glad people are getting better but this certainly does not prove they are recovering from "BAD" whatever that even means. This study says far more about the folly of psychiatric research than it does about "BAD". At least its better than one of those idiotic fMRI studies.

Posted by: John Sorboro MD at October 7, 2009 05:09 AM

...or maybe we are simply too eager to assign the term "bipolar" to plain old foolishness and irresponsibility. great portions of young people -- now at two generations' worth -- have been raised in the "progressive" manner, with parents and teachers holding high regard for not hurting kids' feelings, for not imposing rules, chores, or expectations, of dumbing-down education so no one gets their feelings hurt, of single moms treating their children gently to "make up for" the lack of dad, lack of money that would come from a 2-parent family, or just not being as rule-and-discipline oriented as dads tend to be. Two generations of allowing kids to "find themselves" by having low expectations of them, and allowing them to find themselves in junk food, junk tv, junk video games, and junk culture. two generations of kids being told they can do anything and achieve anything, but no requirement that they perform hard work and fulfill obligations and commitments, so we fail to teach the tenacity that translates into success. two geenrations of kids that grow up believing that success is deserved, not earned. appreciation is deserved, not earned. now, we all accept that a person should not "grow up," settle down, and be a breadwinning parent until at least mid-30s. couples used to marry around high-school-grad time. this is normal across time and cultures, up to our current/recent two generations - now, if you get married straight out of high school, you are judged as "odd." Two generations of a belief that alcohol abuse is a normal behavior each weekend, and believing that illegal drug use is normal. two generations of parents rescuing teens from alcohol-related charges, instead of letting kids stew in jail to think it over. two generations of parents on the side of the child when the child is doing poorly at school, instead of being on the school's side. two generations of believing that you are entitled, and it is normal, to have the newest consumer goods, even if you have no job and are in credit card debt. two generations of "social promotion" despite failing grades. NOW when these indulged children hit the real world, they cannot cope. They cannot delay gratification. they cannot even read and write! --go volunteer at your local college and see for yourself. They have learned that rules will be bent for them. when you drive your car, you have to keep turning the wheel, making minor corrections to stay on path. this is how children should be raised. but we don't correct anymore. we think the car will go straight because we gave it a pep talk about how it can achieve anything. the car will go off-track without regular, little corrections. these people are undersocialized. has anyone ever seen a "bipolar" study perform a deliberate rule-out for kids raised in excessively lenient or permissive, or absent-parent homes? No. Has anyone ever seen a study rule out those who should be dx with "312.1 Undersocialized conduct disorder" from a bipolar study? No. If you have, post the citation here. I dare you. many people out there are simply undersocialized. there is a code for that. but no one would accept a pill as a remedy for that. No, we just label everything "bipolar." That is why we are seeing increasingly greater prevalance of "bipolar" in increasingly younger age groups. It is becoming increasingly common for children to be raised in this permissive, neglectful style, and they are not prepared for teen or adult life. if the parents are firm, the schools are not. kids get "completion" grades - fill in the blank with the wrong answer, and you get a good grade because at least you completed the worksheet. you think i am kidding. ask anyone from the older generations what routine, regular responsibilities they had at different ages: at what age did they watch younger siblings? cook? take out the trash? clean the kitchen living room whatever, mow the lawn, etc. MOST teenagers i know nowadays - i talk to a bunch - have NO single chore - if they do, it is for their own stuff: clean my own room, clean my own bathroom, earn my gas money. this is practically unheard-of from anyone over the age of 50. go ask. ask the older generations if they got "completion" grades, or got "social promotion" when failing a school year. responsibilities in youth make you responsible in adulthood. no responsibilities in youth make you irresponsible in adulthood, until you hopefully "catch on" and shape up.

Posted by: medsvstherapy at October 7, 2009 06:43 AM

People using common sense have always known that adolescents and young 20's people are more moody and inclined to depression, irritability and euphoria [now called mania]. It has mostly been noted in great works of literature, however, rather than in psychiatric journals.

Perhaps, too, as people get older they get smarter. Here is a story of a man who was started on antidepressants as a teen, was later diagnosed as bipolar and finally became medication free after 23 years. Hopefully, this is happening all over the country. This fellow even wrote a book about his experience.

http://www.ssristories.com/show.php?item=2066

The first paragraph of this article states: "Doctors ignored various causes for his depression and prescribed drug after drug to "cure" him. Eventually the side effects of the drugs caused him to be diagnosed with ADD and Bipolar Disorder. He then discovered the truth about psychiatric drugs and found a way to get out of his 23 year pharmaceutical coma."

http://www.emediawire.com/releases/2004/11/emw176441.htm

If Antidepressants Really Work Why Did The FDA Issue The Strongest Warning Possible For Teenagers
The truth about the effectiveness of psychiatric drugs and the crisis in the making.

(PRWEB) November 10, 2004 -- Jeffrey Wilson is the premier expert at recovering from depression. His new book Irrational Medicine (Gracia Publishing, November 4, 2004)

Posted by: Rosie at October 7, 2009 10:14 AM

Firstly, thanks for snagging this study, Philip. I'd be missing a whole lot were it not for the one-stop-shopping of mental health data your blog provides. Kudos to you.

Second, as someone who follows psychiatric research and politics pretty closely, and as someone who suffers on the depression side of the emotional continuum, I've long held that the biopsych model (biological/genetic reductionism) is completely bogus, unfounded and indefensible.

In his long, rambling rant above, medsvstherapy does make some good points that have some merit in psychological research. There's been some great research (link to follow at bottom) on Generation-Y (those born after 1970), and the diet of self-esteem they've been force-fed. These cultural changes happened around the same time we began to see youth depression and ADHD emerge out of seemingly nowhere. This lends powerful evidence to the argument that much of the psychiatric ailments suffered by young people is, for the most part, situation or cultural. As such, the Sher study hints at the tail end of this hypothesis as we begin to see Generation-Me "grow out of" their diagnoses as they enter adulthood.

Dr Jean Twenge from San Diego State University wrote a very entertaining, but equally well researched book on the topic, which you can learn more about on her site: http://www.generationme.org/

To me, the links between socialization-based depression (as opposed to biological-based) seems painfully obvious. And the only reason this theory hasn't garnered more attention is because it has been drowned out by a Goliath of big pharma propaganda, lobbying and marketing efforts.

Posted by: The Skeptic at October 7, 2009 10:32 AM

It sounds a great deal like criminal/anti-social behavior. Criminology has a very large body of research which shows that once criminals get to age 40, a great many of them tend to chill out.

Posted by: marlborojones at October 7, 2009 12:05 PM

The results of this study don't surprise me. My own experience doesn't fit the timeline (recovery in late 30s) but certainly confirms that the standard mantras don't always apply. I was very ill between the ages of 21 and 26, fine for a decade, and then ill again between 36 and 42.

The notion that psychiatric disorders are lifelong and chronic is pushed pretty hard. When presented with evidence to the contrary (like my own experience), most psychiatrists respond by trying to belittle my intervening decade of health.

Most patients accept chronicity because that's what they're groomed for. It's simply not true. You can successfully recover from psychiatric disorders. It happens frequently and mainstream psychiatry needs to address that. Even E. Fuller Torrey acknowledges that a signficant percentage of schizophrenics spontaneously recover.

Psychiatric disorders are chronic because patients are taught they are chronic and their expectations are lowered accordingly. Chronic illness is good news for the psychiatric machine.

Robert Whitaker's work suggests that it's treatment that makes patients chronic. Psychotropic drugs, while they can help alleviate symptoms in the short term, are contraindicated over the long term. The usual experience is to be given one drug and then another. Once you're on two, you're well on your way to a lifetime of chronic disability.

If any other branch of medicine had results like psychiatry does, it would be shut down.

Posted by: Francesca Allan at October 7, 2009 12:23 PM

Forgot to add in my post above that the problem with chronic medication is that spontaneous remission wouldn't be noticed. The assumption would be that the patient is stabilized and doing well solely due to the drugs. The truth may very well be that the patient would be doing fine without the drugs. And, with the kind of side effect profiles these drugs have, that's something that shouldn't be ignored.

Posted by: Francesca Allan at October 7, 2009 12:37 PM

"The flaw of this and pretty much every research study in psychiatry is that it depends on self report data."

I didn't understand that Mr. M.D. Sorboro

"We are to believe that just because some people who are asked endorse 6 of 9 symptoms they are therefore Bipolar?"
Isn't it the way diagnoses are done? The "patient" reports symptoms and the physician have a diagnose, so why would a research like that flaw because the patient is doing the same s/he does during any consult?

I don't understand psychiatric logics but my main concern now is: "Do psychiatrists park their car anywhere even when they are not working?"

I would really like to have the answer.

Posted by: Ana at October 7, 2009 12:48 PM

Ana you ask a very good question. Research in physics or biology or even most areas of medicine does not depend on what someone says.If I dx someone with a urinary infection I do not do so based on the fact they tell me it hurts when they urinate. I do not diagnose a heart attack based on a complaint of chest pain. Other areas of medicine have objective tests to measure pathology that do not depend on what a person says. The problem with almost all psychiatric dx is it depends COMPLETELY on the way a persons wishes to interpret their symptoms. You may see yourself as being ill and in need of a psychiatrist. I may see myself as just in need of some prayer or philosophy or meditation and we may feel exactly the same way.Self report is important as a start in medical science but if it ends there well there is very little that science can say about the matter.Science depends on objective observation. This is almost totally devoid in psychiatric research.

Posted by: John Sorboro MD at October 7, 2009 02:29 PM

@Dr. Sorboro 2:29

In all due respect, I think you've made some errors. Allow me to fix them for you:

...The problem with almost all psychiatric dx is it depends COMPLETELY on the way a psychiatrist wishes to interpret [the patient's] symptoms...

I and a great many people that read this blog have learned that with psychiatrists, self-report is looked at as an inconvenience and something to be dismissed.

...Science depends on objective observation. This is almost totally devoid in psychiatry...

And that's why it's correctly called a pseudo-science.

Posted by: marlborojones at October 7, 2009 05:37 PM

This research finding reminds me of other data which indicate that antisocial personality disorder tends to "burn out" by the decade of the 40's. There is similar research regarding borderline personality disorder. The irritable, aggressive, and "acting-out" aspects to these personality disorders tend to quite down or disappear over the course of the second half of adulthood. Maybe bipolar disorder, with its mood lability, irritability, and impulsiveness is part of this overall spectrum of human traits and dispositions that wane with age.

Posted by: Tom at October 7, 2009 05:54 PM

I think it's fascinating that this study doesn't mention treatment AT ALL. Not psychotherapy, not medication ... nothing. Actually, that seems like such a glaring omission that my first instinct when I read this a few days ago was to disregard the whole thing (even though I believe the premise anecdotally). How do we know if people seem to be getting "better" because they got therapy, took meds (maybe still do), were misdiagnosed in the first place, really just had teen-aged angst, or matured?

Posted by: Wendy at October 7, 2009 07:01 PM

Malborojones,

I totally agree with you!

"The problem with almost all psychiatric dx is it depends COMPLETELY on the way a persons wishes to interpret their symptoms."*

I'm sorry Mr. M.D.Sorboro but this is not the experience of any patient who was locked on a mental institution. lol
You didn't answer my main concern:
Do you park your car any place when you're not working?

Once again a psychiatrist comes to this blog saying the same old stuff and as strange as it may seems patients reports keep on being...

ANECDOTAL EVIDENCE!

I'm so tired of listening to the: other branches of medicine have yadda yadda yadda...

I will have to make a post asking about the parking question.

Philip Dawdy says: stop being sarcastic.
I'm sorry Philip!

*I'm amazed by the way the comment was phrased! It seems to me that there are some mistakes not only in the English but it lacks some internal logic of the language and thinking.
But psychiatrists are known for not having too much knowledge of other fields than DSM.
Seriously! It's amazing that they don't understand anything about literature, arts, philosophy, science and worse: about human nature.
Everyday I ask Shakespeare to forgive me to treat his language the way I do. After reading this comment I guess I'm not the number one at his list any longer.
What a relief!

Funny story:
I gave a book to one psychiatrist. It was a Eduardo Galeano's book. He asked me: "Who is this man?"
Dear Lord! It's like not knowing who is Chomsky in USA!
lol
I have other stories. However the first psychiatrist I met, he is already dead and would be appalled by the post-Prozac era, discussed philosophy, politics, literature, exobiology... you know: the basics for someone who has an PhD!
PhD= Doctor in Philosophy!

Posted by: Ana at October 7, 2009 08:21 PM

Ooops,

I meant: "a" PhD!

Ph= Philosophy!

Watch this:

http://hellaheaven-ana.blogspot.com/2009/10/monty-python-40th-anniversary.html

It's Monty Phyton Philosophy Football.

Oh! I forgot: psychiatrists don't have sense of humor.
lol

They keep looking at their patients with that serious faces trying to guess which diagnose.

Psychiatrist -Do you hear voices?
Patient -Of course, all the time.
Psychiatrist thinks? (I'm jealous. He can hear and I have do admit that I can't!)

Just made it up. I believe that there is some diagnoses for that!
Think abot the drug you will prescribe first and give the diagnose according to that!

Oops...

exceeded the number of characte...

Posted by: Ana at October 7, 2009 08:30 PM

Oops!
Me again.
I'm a little hyperactive.

"abot"?

I meant "about".

Now I'll take the Ritalin although what I really want to do is comment on every post.

Life is hard! We...

Posted by: Ana at October 7, 2009 08:35 PM

What Am I doing here?
I thought it was the other article.
Sorry Philip!
Sorry friends....

Posted by: Ana at October 7, 2009 08:37 PM

This is scary because so many folks with the label are told they MUST always take their meds no matter what and the meds dope them up so much they'll never find out they don't have "bipolar disorder." Still it's important for such news to get out but my understanding of the label is that if you get over it you never had it in the first place and hence we can add the people who "no longer have bipolar disorder" to the group who never had it in the first place, if you believe such a disorder exists.

Posted by: Sally at October 7, 2009 08:38 PM

Yeah, Sally, and what's really sad? Patients buy that crap all the time. Someone posted this on a conservative Bipolar board I frequent and they ALL responded with, "Sorry, but if you 'recover' from Bipolar, you probably never had it in the first place." It's like no one can fathom that sometimes people get ill, recover, and leave the illness behind.

In addition to the harm they do to us with their meds, I think the harm they do to our psyches is palpable. It can't feel good to have a doctor (position of authority, status) saying that we have defective brains, that can never truly be fixed, and that we need drugs like a diabetic needs insulin. Internalizing it is all the worse. I know for me, I pretty much assumed my doctor was full of crap right out of the gate, but I had to keep seeing him for the disability paperwork... and over time, what he said seeped in. Still recovering from that damage, and may be for a long while...

Posted by: kimbriel at October 7, 2009 11:10 PM

Kimbriel, exactly. My experience was that my family told a pshrink I had previously been diagnosed as bipolar and he just started medicating me. I never took the meds thank goodness, and finlly go the the label removed - but back then when I requested the MRI I'd been led all of my life to believe could diagnose bipolar disorder, etc., I discovered that MRI's can't diagnose any mental illness because there really are no diagnosable differences between "normal brains" and "crazy brains." Then I wanted a blood test, chemical imbalance you know, and it turned out that's "an educated theory" too - no evidence.

Meanwhile I have two friends, one in her 40's who admits she was sexually abused by the pshrink who labeled her in her teens, and one in his 50's, both of whom never questioned their diagnoses and are severely physically disabled by the kidney problems caused by taking lithium for years, though of course they take other, worse drugs now, and the label is each's identity. The first thing out of their mouths is, I'm bipolar...sad.

But at least some of us see the light.

Posted by: Sally at October 8, 2009 03:17 AM

I don't disagree with any of the comments about psychiatry being pseudo-science m-jones.To the rest, your experiences are your own and I cannot comment on them. I do not dismiss them ever. I just have no objective access to it therefore I cannot make an objective comment on it. People have a right to be angry at psychiatry as many on this post appear to be. I think most are best off without it. My car is parked.

Posted by: John Sorboro MD at October 8, 2009 04:39 AM

kimbriel,
Since I now longer hang out in Mental Health Land I don't get to hear the "you never had it in the first place" stuff. Thank goodness. In my case, yes most of my MDD was caused by undiagnosed/untreated hypothyroidism. But I also have pretty severe PTSD and I've worked my butt off to learn new ways of living and relating to people. I would be very insulted to have my years of hard work brushed off with "you never had it." Bllleeeecccchhhh!!!!!!!

Posted by: Sherry at October 8, 2009 05:41 AM

"MUST always take their meds", is the religion.
Have faith my child.(joke)
From a schizophrenic who doesn't take "medicine".

Posted by: mark p.s.2 at October 8, 2009 07:42 AM

I mostly agree with the hypothesis in this study, which may surprise some of you who know I am less med-skeptic than other FS commenters. (It also surprises myself, given that my grandmother had full-blown bipolar disorder type I her entire life -- or certainly some condition that strongly resembled the description for BP I in the DSM-IV.)

My own bipolar disorder has receded somewhat as I prepare to turn 41. And frankly, I have to ascribe much of it to lifestyle rather than meds.

I've moved to a warmer climate, which I think has revealed (and eliminated) the seasonal affective symptoms I was likely suffering. I'm getting married and have changed professions, which adds stability to my life. I'm exercising a little more. And I've moved 1,000 miles away from my loving but highly dysfunctional family.

I still take some meds, but I've cut back considerably on dosages. And while I see no need for others to attack me for taking meds for the "just in case" scenario (strictly my opinion; it's one of many things I do in my life in the name of prevention), I also see no need not to enjoy the good that life has given me in the last 18 months.

Posted by: Larry at October 8, 2009 09:23 AM

Sorry, but I can't resist replying to the comment earlier.

My own conclusion would be that Rush Limbaugh/Glenn Beck ultraconservative jeremiads have about as much to contribute to the ultimate treatment and cure of bipolar disorder as do the current R&D and marketing of Big Pharma's wares:

Not much.

Posted by: Larry at October 8, 2009 09:29 AM

Mr. M.D. Sorboro,

Angry? I don't think we are angry at psychiatrists!
We just lost some of our faculties because of their practice and some became more and more ill for the same reason.
I think it's fair enough not to like to lose our health.
It's also very disappointing to need help to control some symptoms and never get better.
I think you would not like to have a heart attack due to Vioxx in case you were lucky enough to survive or, for instance, have your right leg open during a surgery when it was the left that is ill, or, take your newborn to the pediatrician tell him that he is not urinating and listen that he did but you didn't notice. In the middle of the night you wake up and for some instinct you go to the hospital and it was a life saving decision because the baby was very, very ill.
That's all.
It's pretty simple to understand the reasons.
Not only psychiatrist are... irresponsible.
You can make a test:

Pretend you are not a physician and the next time you are surrounded by three persons ask than:
"Did you ever had any problem with a physician?"
I'm sure you will listen to, at least, 3 stories.
If the conversation keeps going you will have more and more stories of the friends of these 3 persons. You might end up with 9 or 12 stories.
Do it just for fun.

Posted by: Ana at October 8, 2009 12:15 PM

Ana, you communicate well and obviously have a lot of energy for social and structural change, but if you go back and take another look at Dr. Sorboro's original post, can I just point out that he is actually highlighting the futility of diagnoses and the diagnostic process? That he is looking at his part in this very same picture, but, importantly, from a different angle?
In my very humble opinion, I would like to suggest that there are a great many doctors who, contrary to much client experience, are in fact, 'on our side?'
I was one of the people who DID get a diagnosis of Bipolar, in my teens, through pressurising my psychiatrist and some half truths when it came to the subject of narcotics. However, I think the point is that we are all in together on this rollercoaster - whether patient, client, doctor, survivor, victim, friend or parent - and while we're here with whatever part we can play in this all important discourse, we may as well get along and enjoy the ride.
For the record, since being discharged from psychiatric services, the greatest battle is, as it always has been, with myself, and how I choose to see things, as the only one who really has to live with me, whatever the diagnosis, is of course, me. And I don't think any doctor can change that.

Posted by: thewhiterabbit19 at October 10, 2009 10:44 AM

John Sorboro MD wrote:
"...Research in physics or biology or even most areas of medicine does not depend on what someone says..."

I'm guessing you're a shrink, not that it matters. Anyway, the comment I was going to make was this: there is no other way to assess the state of a person's mind, other than by analysing what they say, because what they say is a direct reflection of what they're thinking (sure, they may censor some of their comments, but not so's to make that much difference - if they lie, other comments will soon contradict that lie, which is how I know that most pharmaceutical companies are lying their heads off about pretty much everything).

Mapping a person's mind in this way is pretty trivial stuff, but the questions being asked should never presuppose the end result and should never be prepared in advance (asking strings of largely unrelated questions is one sure way to get people to close down, I've noticed).

If one asks unrelated questions, with the intention of making a diagnosis, then rather than have a nice, clear train of thought to follow, the patient would have to "leap around," the questions would be impersonal, and a person who was already vulnerable would be made more nervous. I regard it as a pretty dirty trick to play on somebody, to be honest.

The science is contained in the asking of questions, with a clear, stated goal in mind. Diagnoses and drugs are consequently irrelevant, as far as I can tell.

Matt

Posted by: Matthew Holford at October 11, 2009 06:00 PM

"asking strings of largely unrelated questions is one sure way to get people to close down, I've noticed"

That's a very good observation, Matt. That kind of questioning is actually interrogation, not conversation isn't it? I never really thought of it much. (Too used to being interrogated, I guess.)

Posted by: Sherry at October 12, 2009 09:19 AM

Sherry wrote:
"...That kind of questioning is actually interrogation, not conversation isn't it?.."

Possibly - it's a style of questioning that tends to accompany fishing expeditions, if you get my meaning. It's also indicative of a tickbox mentality... Has this occurred (tick)? Has this occurred (tick)? Et cetera. And if one gets to tick all or most of the boxes, then one can apply the solution that one had in mind, at the outset, and all parties to the solution must be suitably shaped, in order to fit!

You're right: a conversation takes a meandering, seemingly pointless course, where the participants don't (necessarily) have a clear view of any particular objective, and where each new contribution is inspired by something that has just been said - there is a clear and recognizable train to the conversation, in other words, irrespective of any prior determination by the particants.

Like I wrote: question-asking is a science!

Matt

Posted by: Matthew Holford at October 12, 2009 07:15 PM

Well I do not disagree with any of what Matt has to say about the limits of obtaining information on another persons emotional state and the whiterabbit gets my point. There is no other way indeed to access someones mind other than what they say which is exactly why psychiatry can never be science and I can say nothing of certainty as a psychiatrist or a human for that matter about another persons emotional experience. Minds cannot be mapped. I know my own experiences an no others.

Posted by: John Sorboro MD at October 13, 2009 03:11 PM

John Sorboro MD wrote:
"...Minds cannot be mapped. I know my own experiences an no others."

You are correct in that I can never know your experiences as you do, but I disagree as regards mindmapping, although I suppose it rather depends on what we interpret "mindmapping" to mean. People don't like to be made to look foolish, nor malignant, because society has sanctions for stupidity and criminality. People make choices, in innocence, which have unwanted consequences. Some people make choices knowing that those unwanted consequences will arise, but judging that they won't get caught, they press on, making sure that anybody they perceive may be impacted negatively is deceived long enough for the actor to profit from the deception.

It's all very complicated and abstract. The long and short is that if a person believes that they are going to be portrayed as anything other than excellent, then they will refuse to speak. As if it needed saying, it's not a good thing, when a person's triggers (eg, a fear of punishment), are so deeply established that they recoil inside themselves at any hint of interest shown by another person, however innocent.

Humanity prides itself in its ability to communicate. Personally, I've seen no evidence of this fabled ability, particularly when the vast majority of people make an assessment of the person they're facing, before deciding whether they are important enough for them to be bothered with. As an example, Gordon Brown and Baeraech O'Bama are "too important" to talk to me. In fact, most people only communicate at length, when they've identified someone that they can punish. It's a bleak view, I know, but as you suggested: you'd have to be me to understand how it is I've come to that conclusion.

Matt

Posted by: Matthew Holford at October 14, 2009 03:41 AM