If you found out a provider was a manic depressive would you see her or continue to see her ?

...You mean more than, say, 47 times?

Why wouldn't you see her? Are you afraid it's catching?

Bipolar disorder is a chemical imbalance in the brain, not a "mental illness." People who are bipolar take medications to correct the chemical imbalance, and, when properly medicated, are as normal as anyone.

People with diabetes have a physical disorder. Would you question whether or not to see a diabetic provider? Or one with asthma?

I guess your question causes me to pose one: is the provider you're referring to on medication? If not, that is a problem. If she is, then I'd have to say you're exhibiting a fairly common prejudice in our culture. People have a lot of misconceptions about bipolar disorder. But bipolars are not bad people, they're just people.

xxxooo
Beverly ;-*

In and of itself that is not a reason to not see someone.  Particlarly if someone does take their medications regularly.  I would also listen to what she says about it.  If there has been a lot of chaos a number of times (often around the times that she has stop taking meds), and rather recently (like last year or so) then I would be keeping a close eye on the situation.
 Twice in my life I have inadverdently gotten hooked up with people who weren't managing their illness and became "manicy."  Many people (not all) like that feeling of euphoria and staying up a lot.  But judgement starts to slip and someone who has been pretty health concious can suddenly exhibit risky behavior.
 The last time this happened was someone I met on match.com and the sweater came unraveled at brunch.  Very unpleasant.  That was part of why I dropped trying to meet people via match.com, etc and to explore the hobby.
 But if the person is managing the disease it shouldn't be a deal killer
B

I think it is ok to see a bipolar provider and repeatedly if so desired, but make sure you keep her at arms distance emotionally. The bipolars that I have known tend to be very dependent pepole. Show her a friendly side of yourself, but remember to never lead her to believe that you want to make an emotional investment into her. Further, bipolars tend not to help themselves unless they are presented with no other options. I know from experience, I was married to one for two years. It was like being married to a child.

Besides any platitudes about it I could give you about not being prejudice, you are only going to be seeing her for single hours of her life, it's not like you're going to be paying her insurance bills or anything, or that she's going to wreck your workplace.  

Now for the platitudes: there are many different degrees, different types for this illness.  Bipolar doesn't tell you what she's like at either stage.  When she's manic, she might just be incredible in bed.

However, more than likely, she's under treatment.

. . . as long as it is under control, I think it's okay. I probably won't be able to tell unless she tells me.

As for another form of mental disease such as dissociative personality disorder, I would continue to see her over and over again.

and have found them to be among the most gifted and enjoyable people I have ever known.

Dorthy Parker is one example.

The question should be turned around, if anything.

(And no, I did not date Dorthy Parker, I'm not that ancient.)

One of the symptoms is increased sexual desire and poor judgment, so they might not watch the clock.

Here is a link that gives a list of some famous people with bipolar illness; http://bipolar.about.com/cs/celebs/a/bl_celebrities.htm

Here is another link explaining in detail signs and symptoms; http://www.nmha.org/bipolar/public/signs.cfm

Unless the person is exhibiting some bizzare behavior, why the hell not?  She didn't HAVE to tell you, after all, so this suggests to us that she has some feeling of trust with you.
You're not marrying this girl, after all...or are you?

http://en.wikipedia.org/wiki/Bipolar_disorder#Diagnostic_criteria

and note that they are limited to observations of behavior.

We are baffled how a neurological "chemical imbalance" can be identified simply by observing behavior.   We realize that psychiatrists are also baffled, but they are much more fast and loose with facts than the average liar.   The DSM does not require a psychiatrist to be sure this behavior does not have some other source, because there is no other way.  The disorder IS the behavior.

We would be much more comfortable with psychiatrists who told the whole truth, ie, that bipolar and most psychiatric diagnoses are a matter of identifying maladjusted behavior (which is a social judgment that a psychiatrist is no more qualified to make than anybody else) and medication is symptomatic, and mental health workers tell you it's a "disease" to comfort you, when in fact they do NOT KNOW WTF is going on.


To return to the original question: if you know a provider is "bipolar" would you keep seeing her?  Depends on what you're seeing her for, and what risk there is.  Is she going to be any more crazy than the one you DON'T know is (fill in the blank,  with whatever history or diagnosis you want).

being an organic neurological disorder.   Note the clinical diagnostic process is nothing more or less than observation of behavior; we are advised by neurologists that a neurological "chemical imbalance" cannot be identified this way; and that most psychiatric diagnoses are PURELY SUBJECTIVE judgments that a person consistently exhibits a particular type of maladjusted behavior.  (Note that Andrei Sakharov et al were substantially maladjusted with respect to Soviet society, and medicated for depression, without anybody ever asking if the rest of Soviet citizenry shouldn't also be depressed.)

We are inclined to think that the patients and the society at large would be much better off if shrinks did not BS us about what they know.  If those fuckers knew anything about human behavior, they'd be playing the stock market instead of holding the hands of distraught people for $150/hour on your medical insurance tab.

You want to contribute to somebody's mental health?  Treat her like a human - take her someplace nice when you can, and if she misbehaves, turn her over your knee.

on wikipedia.

We are frightened by mental health workers who routinely violate informed consent by misrepresenting the type and level of their knowledge, and lead people to believe diagnoses is objective, reproducible, or connected to a neurolgical "chemical imbalance".   That is all bull.

What they DO know is that there are (relatively)common behavior patterns that can be symptomatically treated by certain types of medication.  As we all know, whiskey was widely used for a variety of medicinal purposes a century ago, and of course we have gotten better at it.

We still do not know what is going on inside our heads, and for psychiatrists to lead people (patients, courts, parents, teachers) to believe otherwise is one of the most widespread corruptions of our society.

We routinely label people who misbehave as "mentally ill", and sometimes relieve them of liability or punishment, or sometimes just lock them away in ways that would drive a normal person crazy - fighting the diagnosis is often taken as a sign of "mental illness"  - and we label & medicate overactive kids and sad housewives, instead of dealing with them as humans exhibiting a range of behavior.

You CANNOT identify a neurolgical chemical imbalance simply by observing a human's behavior, because there are far too many variables, including the possibility of conscious deception.  What you CAN do is use unusual behavior to stigmatize or label that person for legal or other purposes.  While that may be legitimate in some circumstances, we are hard pressed to imagine ANY circumstances that justify misrepresenting the nature of the process.

recent advances in using brain scans have found actual physical differences in the brains of people with various mental conditions, so to say that a subjective evaluation of a person's behavior is the only diagnosis is incorrect.  

This correlates with the fact that certain medications do a good job at treating the symptoms on a reliable basis.

for a boatload of mental disorders.
paranoid schizophrenics, florid delusionals, and those that simply fit the clinical definition.

Lay people would argue that anyone (SP or hobbyist) who participate in these circles has some borderline psych issues.

The original question is too general - the answers depend on the specific situation and individuals.  the old "street smarts."

. . . but it is certainly a symptom based on physiologic conditions. Neurochemical pathways has been identified in depression.

I avoid taking any medicine unless it is absolutely necessary, so I understand where you're coming from. The some view in treatment of psychological (or neurological as we can't distinguish the two anymore) can be extended to other forms of symptoms. Is it a disease or is it behavior within the boundary of normal human variations? I would say if it interferes with your well-being or daily function then you should do something about it, whether you call it a disease or a behavioral difference.

There are numerous brain scans that actually show the abnormal brain patterns of a person with Bipolar and with Schizophrenia as opposed to the normal brain.  Not to mention the positive results of medication for those who suffer from these type afflictions.  http://www.angelfire.com/home/bphoenix1/brain.html

I do not buy the statement that people are just behaving badly and being labeled with these diagnoses.  That to me is a cop out of those who do not want to acknowledge that there are in fact real mental illnesses.  These issues do need to be addresed by society.

-- Modified on 2/27/2006 1:54:36 PM

Ask a psychiatrist how he can identify a neurological "chemical imbalance" by comparing people's behavior, and deciding one is more or less, oh, say depressed.

Neurologists tell me it can't be done.  Psychiatrists hem and haw until you pin them down, then admit eventually that most DSM diagnoses are a description of behavior types, generally with UNKNOWN etiologies.

I was absolutely amazed when a psychiatrist handed me a technical journal article, and it admitted that (1) all psychiatric diagnoses are COMPLETELY subjective, ie non reproducible (which is a standard for western science), and (2) there is no known etiology for amny major common diagnoses.

The key is to recognize the diagnostic procedure of the DSM is comparison of behavior, which CANNOT identify a neurological malfunction.  There might be one; but you can't find it by DSM procedures, which is the diagnostic standard.  

I was thinking this was science too, and it ain't.  It's identification of socially maladjusted people.

Yes, meds are symptomatic treatment.  They do not "cure" because neurologists don't know a lot about what's going on in there, and they certainly cannot track all the variables of behavior.

You should not take my word for it.  You should look for yourself:  read the DSM, talk to a neurologist, think for yourself.

most of those studies (you'd have to talk about a specific one) do not eliminate other variables (there are an incredible number) and most of them have no way to differentiate between the effect of the diagnosis, and the effect of the medication for the disorder.  IOW, in many cases, the differences are more probably caused by the medication.

Ask your doc if there is a valid independent test for the existence of the disorder, and if so, what is it.

It's not just a matter of "behaving badly".   I am not saying people are behaving badly.  I am saying that shrinks lie when they lead you to believe they know what is going on.   We DON'T KNOW.   Socially, we may decide to excuse some people, or institutionalize others.  It's the lies that corrupt the society.

What I am saying is that neurology is the discipline that describes what we know about what is going on inside brains, not psychiatry.   Psychiatrists lead people to believe they know what is going on, and commonly violate informed consent by failing to tell their patients that they DON'T really know what is going on; that they are HYPOTHESIZING a disease, in the total absence of evidence, and using diagnostic methods that CANNOT identify an organic disorder.

Check out Bloch (ed) Psychiatric Ethics on Amazon, and you will see that the people who TEACH these disciplines recognize these problems and abuses.

what I disagree VIOLENTLY with is the common psychiatric pattern of misleading patients into thinking that there is a lot known about this, or that psychiatric diagnoses are organic, etc, because that misinformation leads patients and others down misconceived management paths.

IMHO, any ANY treatment that is involuntary or based on misinformation is the same sort of human rights abuse that was peretrated on Soviet dissidents.   ALL professionals owe their clients a fiduciary duty of candor, including what is NOT known.  

MDs will tell you that neurology & psychiatry took different paths in the 50s.  The problem with "mental health" diagnoses is that the methodology only identifies people who are behaviorally different, and rarely gets into why.  So it's a social discipline, not a medical one; and it's really not much of a discipline where it's practitioners are less than forthright with other people.

I absolutely agree that people should act to solve whatever they see as a problem in their life.   I just don't think any of us benefit by being bullshat.

There's lots of evidentiary problems in connecting DSM diagnoses with neurology, far too many to list in a post.   "some" evidence is not a preponderance, and the usual problem is that people are not told the whole story, the most obvious part being that no organic disorder can be identified by noting that a person behaves in a certain way, simply because there are far too many possibilities.  

There are 2 key issues:  (1) the diagnostic process, per the DSM-IV-TR; and (2) the technical studies which necessarily vary among drugs.

The diagnostic process in almost all DSM diagnoses (eg depression, ADHD) is a purely subjective comparison of behavior.  Even if there was an organic disorder, it could not be identified this way.   After having been bullshat by many shrinks, I have learned what questions to ask, and I have the facts on hand for those I am most concerned with, and it usually takes me about 3 minutes to let a professional know that they don't need to blow smoke at me.  Many MDs and psychs have admitted to me that the most common DSM diagnoses are NOT organic, they are behavior patterns of unknown etiologies, and the ONLY thing we know is that we can symptomatically suppress some aspects of behavior with some medication.

The other issue is the technical one.  LOTS of evidentiary problems, starting with misxing correlation vs, causation, being unable to differentiate between the effects of the medication and other variables.   I ahve seen a number of studies w/rt/ ADHD that wouldn't make it out of a junior year lab exercise.

Psychiatry is a social phenomenon; there are many reasons we do things this way, but concern for truth or science are not foremost.

The meds are symptomatic, and that's legit; but by & large, we have no way of knowing long term effects.  It's a social judgment, and it's fine and good when an adult acts on complete information.  It's an entirely diffeerent calculation when information is skewed or incomplete or misleading, or treatment is involuntary.

It's not the meds that bother me; it's pushing them under false pretenses, it's that the general public believes that this is reproducible science, and descriptions of organic conditions.   That is not so.

remember that a few years ago, there was a diagnosis for homosexuality.  Before the Civil War, there was a diagnosis (Drapetomania) for runaway slaves - one of the recommended treatments was flogging...

What the DSM talks about is social maladjustment, not neurological diseases.   What is fundamentally corrupt is telling a patient or court otherwise.   And are psychiatrists more capable of making a social judgment than you?  There are studies suggesting they are not - as if that was needed.

it ain't contagious.   If you're worried that she's gonna be crazy and do something weird, she's not more likely than anybody else with her history.

Her history is the way she gets diagnosed.  If you found out because she went nuts on you, then there's a pretty fair chance she might do it again, just as with an undiagnosed person who went nuts on you.

You can't ever know about people, and that particular label isn't as revealing as you think.  People commonly find labels for something they are dissatisfied with; you need to decide if it affects the reasons you are seeing her.

at least she's been honest, which is a DAMN good sign as far as it goes.  

What you gotta watch out for is the one who drops the information on you AFTER you're married.

". . . the most obvious part being that no organic disorder can be identified by noting that a person behaves in a certain way, simply because there are far too many possibilities."

I agree. The reason the same drug prescribed to treat a disease fails to work 100%, or much below 100%, of time is that there can be many possible defects in one protein signaling pathway that cause the illness; drugs usually works one defect. Proteomics show promise that the specific defect can be identified and drugs developed for that one defect. Patients with the same symptom may be prescribed different drugs.

Yes, I believe that certain illnesses are biological in nature. However, some people are given a diagnosis too easily and without much consideration to research. I would call those explanations hypothesis until further scientific proof (i.e. a brain scan, etc.) I also believe that many people fall victim to being exploited by drug companies and psychiatrists.

Hugs,
Ciara

that are beyond practicality.

There are many psycho-active medications that have been in use for decades.  For better or worse, they are better than not using them, and improvements in them continue.

I do not have any studies at my finger tips to quote you.  I run across articles in magazines and on the web occasionally.

I don't see any point in the arguments you are making.  you seem to be treating the subject as if it were a philosphy class trying to prove some epistimilogical point rather than help people understand that bi-polar sufferers can and are being helped to live normal lives.

And for the record, I agree with much of your points about modern psychiatry.  No longer are the ideas and mental environment of the patient valued as worthy of discussion.  Instead it is just a process of finding the "right" pill and moving on.  Today to do real psychotherapy you have to see an unlicensed counsilor, which is exactly what I did, and am I ever grateful to that coucilor today.
Nevertheless, psychopharmacology has its place too.

I will look into it.  Now you have my curiosity..

The DSM sets the diagnostic standards for the mental health professions.  Almost all mental diagnoses (there are some real disease mixed in for the purposes of credibility) are made in terms of comparative behavior, ie, does these things more or less (than other people).

So that's the facts you have, is observed behavior.

IMHO, it is fine and acceptable if we want to drug people, voluntarily or not, who behave differently, AS LONG AS we are honest about it.

The harm comes in saying that because a person behaves (sometimes extremely) differently, they must have a "disease", and then we start hypothesizing neurological chemical imbalances in the complete absence of any connecting evidence.

Yes, there are studies that show this or that brain chemistry may be more or less connected with some types of behavior (the evdientiary problems of those studies cannot be generalized, but they are typically financed by drug money and I have seen software engrs punch holes in the methodologies; one of the most common problems is inability to differentiate between the effect of the meds and the alleged condition)  but the basic problem is that you CANNOT find that because a person exhibits a specific comparative behavior pattern, that they have a neurological chemical imbalance, because inter alia, the behavior might be legitimate in the environment, or it could be deliberate.

But it's not about helping psychaitric patients.  It's about categorizing and stigmatizing people who are annoying in one way or another.   It's a social treatment, not a medical one.

Now this may be appropriate in some situations. What is NOT EVER appropriate is misrepresenting the nature of the process.

http://www.us.oup.com/us/catalog/general/subject/Medicine/PsychiatryPsychology/?ci=0192628992&view=usa

I found it in a local law library when I was doing some research.   You will note that it's edited and written by department heads at major universities, and it talks about many things, including the issues I have mentioned, about the social role of the "mental health" professions, and in abstract terms, comes to the same conclusions.

Most of the general public regards the mental health professions as a hard, objective science.  It is NOT.   The next question is, in a specific case, does the professional have any insight that the parents (who live with the patient) or the court (who go over the case in ass-aching detail, as compared to the INCREDIBLY sloppy investigative techniques of psychrinks - who basically do nothing more than get a thorough consensus that the subject does in fact behave annoyingly) and the answer is, guess what, no.

Now.  That does not mean anybody else has answers.  What it means is that mental health workers ROUTINELY send us barking up the wrong tree in the belief that they have knowledge that they don't, and most often that the "disease" is a fixed condition.  

We do have enough experience to know that the right meds will usually suppress behavior.   What we are not so good about is predicting long term social and medical side effects.   And most shrinks will tell youo the meds "cure" the behavior.  With most "disorders" that is simply not true.   The person may develop out of it; they may also become psychotic as a result of medication.

I started getting into this when my ex started acting on a depression daignosis, and tried to diagnose all of my kids with various things, depression, ADHD, etc.   It has taken me years to pin down the docs, and now I know the questions to ask, and how to deal with stock responses.  I still have a long way to go to get fair treatment for my kids.

Just Kidding. Typically, I would say it isn't a big deal. It just means she has highs and lows. What woman doesn't !

BUT, I ran into a woman in this business that was rumored to be bi-polar and she really gave me some trouble.

I had never even met this lady and she went nuts on me calling all the time, quite a crazy situation.

She ended up getting banned from some of the boards and I stopped answering but boy did she go nuts.

Use your judgement but with that one situation with that one provider I would not wish that on anyone.

xo Lisa Butler

I cannot answer your questions about a study without reviewing it.

I have heard that from many docs, "studies show..." and that depends on your taking their word for it.

Of course the issues are detailed.  It's a complex subject, BUT there are facial problems that most people miss - and these are what I am getting at.

The core of the problem is that mental health workers routinely lead people to believe, specifically or by inference, that a DSM diagnosis is an organic disorder.  IT IS NOT; it is identification of a social maladjustment, WITHOUT serious investigation.  Psychs do not have the reources to seriously investigate individual cases.  That is fine, as long as they do not mislead people into thinking that they know things they don't.

Documentation of the most common diagnoses (eg depression, ADHD) consist of nothing more than confirming that many of the key people in the patient's life agree on the behavior pattern.  There is rarely any serious question about the etiology of the problem, for many reasons.

NOW - when you say, this will "help" people, you need to understand the context.  The general public (courts included) believe, based on the psychs hype, that this is methodical and reproducible.  IT IS NOT.  Significantly, the psych's judgment of what is "good" is a social judgment, not medical as they usually present it; and so what happens is this person's social judgment is replaced by the MHW, who does NOT know the situation well, and usually has limited interest.   Far too often, they simply make excuses or peddle drugs, and this is usually to the most vulnerable in our society - sad housewives and children.

Now, some people are helped by therapy and drugs.  However, I would use their own standard to decide this, not the therapists.   The problem is, it is very difficult to know which ones it will be.   In my own circle of friends and relatives, I have known one person who was helped, and I think it was because she was ready, and almost anybody or anything would have helped her.  OTOH, several people have been put into psychological limbo, and others have been diagnosed where there was obviously  no maladjustment.

My suggestion is not that we should kill all the psyhrinks; but that we should teach them that misrepresentations of their knowledge and their process, to their patients and the general public, is very bad.  It is a lie, both to the patient, and to the public at large; and it is one of the most basic professional corruptions in our society today.

what we doubt is that a neurological disorder can be identified by comparing people's behavior.

Most DSM diagnoses do that & nothing more.  Most shrinks say, "you have a chemical imbalance" when in fact they should be saying, "we don't know WTF is going on in your head, but we do know that your behavior pattern can usually be suppressed by meds.."

Which is really nothing more than a sophisticated version of know that whiskey makes most people fall down.

Drugs are not per se bad.  Misrepresentations are.

Check out, inter alia, http://www.oup.com/us/catalog/general/subject/Medicine/PsychiatryPsychology/?ci=0192628992&view=usa