So You Think You're Bipolar. Can we Talk?

in StemSociallast year

Madwomen of the Salpétrière (Courtyard of the Mentally Disturbed)

Madness Gautier__Salpetriere 1857 public.JPG

Image credit:1857 lithograph by Armand Gautier. Cushing/Whitney Medical Library. Public domain
The caption under this picture states that it shows, "personifications of dementia, megalomania, acute mania, melancholia, idiocy, hallucination, erotomania and paralysis in the gardens of the Hospice de la Salpêtrière."

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On June 8, 1809, firebrand of the American Revolution, Tom Paine, died and was quietly interred on his farm. It is reported that he was generally despised at that time. Six people attended the funeral.

About two hundred years later, the founder of Reason Magazine, Lanny Friedlander, died in virtual obscurity (March 18, 2011). By the time of his death, he had become so removed from mainstream life that publishers of Reason couldn't find a picture of him to hang on the wall. No one at the magazine had ever met Friedlander.

Modern sources speculate that Paine suffered from bipolar disorder. Friedlander was diagnosed with schizophrenia as a youth and was treated for the disease until his death.

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Brain Scan of Patient Diagnosed with Bipolar Disorder

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Image credit: Petergstrom. CC 4.0 license
The caption under this scan reads: "Fronto-insular regions of grey matter reduction in bipolar disorder".

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Schizophrenia Illustration BruceBlaus 4.0.png

Image credit: BruceBlaus. Used under CC 4.0 license.
The caption under this picture reads: An illustration depicting schizophrenia.

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These two brain scans are, in a way, reassuring. We can see the disease. We can understand it, these scans suggest, because there are pictures of afflicted brains.

Ah, if only this were so. If only we could invite suffering patients, take pictures of their brains and say, "You have schizophrenia," or "You have bipolar disorder".

Sadly, this is not the case.

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Charles Meryon in His Madness, the Night Before His Removal

Charles Meryon in_his_madness,_the_night_before_his_removal_Wellcome 4.0 L. Flemang 1858.jpg

Image credit: Artist, L. Flemang, 1858. Photo source: [National Gallery of Art) Public domain
Charles Meryon (1821-1868) was an artist who worked exclusively in etching, because he was color blind. Meryon's life was marked by hardship. He was admitted several times to asylums and died in one.

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Consider two recent studies on the ability of mental health professionals to diagnose bipolar disorder and schizophrenia. The first was published in the Shanghai Archives of Psychiatry, and the second was conducted by Johns Hopkins.

Shanghai Article on Bipolar Disorder
This article, published in 2018, begins by explaining that bipolar disorder has, "a high misdiagnosis rate and commonly misdiagnosed as...depression, schizophrenia, anxiety disorders, obsessive-compulsive disorders, and personality disorders..." These misdiagnoses result in, "mistreatment of clinical symptoms and increasing of recurrent episodes."

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"Puerperal Mania in Four Stages"

Medical Times Gazette Puerperal_mania_in_four_stages Wellcome.jpg

Image credit: Wellcome Collection gallery (2018-03-31): https://wellcomecollection.org/works/hbqeamrf CC-BY-4.0
The diagnosis of Puerperal Insanity was quite common in the 19th century. The malady apparently struck women who had recently given birth. Over the years, this diagnosis dissolved into a variety of other disorders: manic depressive, dementia praicox, toxic confusional and neurotic states.

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The Shanghai Archives article goes on to describe a study in which 177 patients diagnosed with bipolar disorder were examined in an outpatient clinic. In this group, 136 (76.9%) were found not to have bipolar disorder. The article goes on to state that many of these patients actually were suffering from depression, or other "psychotic" disorders.

Simple Mania Patient at West Riding Lunatic Asylum

Simple mania patient_at_West_Riding_Lunatic_Asylum_Wellcome 1871 4.0.jpg

Image credit: Wellcome Collection gallery (2018-03-21): https://wellcomecollection.org/works/xcr6gpkf CC-BY-4.0 1871
The Welcome citation for this image:"Mary Shaw, a patient at the West Riding Lunatic Asylum, Wakefield, Yorkshire. Photograph attributed to James Crichton-Browne, 1871."

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Johns Hopkins Study on Schizophrenia
This was a small study, conducted at the Hopkins Early Psychosis Intervention Clinic (EPIC). In a cohort of 56 patients who had been referred to the clinic with a confirmed diagnosis of schizophrenia, only 26 were found to actually have schizophrenia (according to the criteria of the clinic). The remaining patients (51%) were found to be suffering from "anxiety or mood disorder".

One reported symptom that seemed to doom patients to a diagnosis of schizophrenia was hearing voices. According to the researchers at Hopkins, "Hearing voices is a symptom of many different conditions, and sometimes it is just a fleeting phenomenon with little significance..."

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Man Diagnosed with Schizophrenia

schizophrenia Mental_diseases._A_textbook_of_psychiatry_for_medical_students_and_practitioners 1913 public.jpg

Image credit: Mental diseases. A Text-book of Psychiatry for Medical Students and Practitioners. Public domain. (1913) The text under this picture: "A man with schizophrenia engaged in stimming behavior".

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Russell L. Margolis, M.D., professor of psychiatry and behavioral sciences at the Hopkins Schizophrenia Center, also attributes the high rate of misdiagnosis to "checklist psychiatry": a clinician reads off symptoms listed in the DSM. If a patient has enough of those listed symptoms, they have schizophrenia.

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Incidence of Misdiagnosis Confirmed by Other Sources

There exists the possibility that the Shanghai and Hopkins studies are outliers, that misdiagnosis of bipolar disorder and schizophrenia is not so pronounced. The following sources suggest that Shanghai and Hopkins might be on the mark.

caduceus smaller22730761_1280.jpgFrom Translational Psychiatry (2020): "Patients with BD are often misdiagnosed, and the correct diagnosis can be delayed for several years after illness onset."

caduceus smaller22730761_1280.jpgFrom Acta Neurologica Belgica: "Reports of FTD (frontotemporal dementia) misdiagnosed as schizophrenia or schizophrenia-like psychosis are frequently reported in the literature."

caduceus smaller22730761_1280.jpgFrom European Psychiatry:Kleine-Levin Syndrome "Kleine-Levin syndrome misdiagnosed as schizophrenia"

caduceus smaller22730761_1280.jpgFrom the American Psychological Association: "Black and Hispanic (Puerto Rican) bipolar patients may be at a higher risk than Whites for misdiagnosis as schizophrenic, particularly if they are young and experience auditory hallucinations during affective episodes."

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Woman Diagnosed with Schizophrenia in 1921
Schizophrenic pubertial weakmindedness_and_obesity,_age_19 public.jpg

Image credit: Лорд Алекс edited & made the image transparent. Photo by E. Kretschmer. Public domain. The caption associated with this picture: "Dysplastic growth of fat. Schizophrenic pubertial weak-mindedness, age 19. Hypoplastic mean mid-face; plump, coarse development of cheek-bone and chin; formless obesity".

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Diagnosis of Bipolar Disorder, or Schizophrenia is an extremely consequential event. In the United States, it can affect a number of rights...such as the right to own a firearm, and the right to manage one's own affairs. It can affect even the right to be free.

One of the most serious results of a bipolar or schizophrenic diagnosis is treatment with powerful anti-psychotic drugs. These drugs can have life-changing--even fatal--side effects.

This excerpt from the British Journal of Psychiatry illustrates just how consequential taking an anti-psychotic may be: "Those who had taken only conventional antipsychotics were twice as likely to die compared with those taking atypical agents (P<0.02). For those aged 53-65 years, conventional agents were associated with a sevenfold increase in mortality."

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Patient with Medicine-Induced Dystonia

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Image credit: James Heilman, MD. Used under CC 3.0 license. Although the patient in the picture gave permission to use his image, I've blurred his face. One of the potential side effects of taking an anti-psychotic is a drug-induced movement disorder. There are several kinds. This patient is experiencing dystonia, although it is not stated that an anti-psychotic brought on this condition.

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Conclusion

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Modern Science in Medicine

Modern_Medicine_Alston public wpa.jpg
Image credit: Charles Alston (1907-1977), 1936. The mural was painted in Harlem Hospital for the Works Progress Administration. Public domain.

My blog today is not intended to be an indictment of psychiatry. What I hope is that readers will regard psychiatric diagnoses with a healthy dose of skepticism. Many healthcare professionals who work in psychiatry want to help. However, it is unfortunate that a psychiatrist's judgment is often accepted without question. I'd like to see some more questioning, not only by patients, but also by psychiatrists themselves.

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Note

I didn't cite the Rosenhan Experiment because it is fairly well known and has been attacked vigorously (whether fairly or unfairly) by the psychiatric community. I thought using pillars of the community would be more effective.

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Some Sources Used in Writing This Blog

  1. History.com American Revolution Thomas Paine
  2. Chicago Tribune
  3. Campbel Fine Arts.com
  4. Shanghai Archives of Psychology
  5. Science Daily
  6. Sage Journals.com
  7. Merriam Wesbster Stimming
  8. Acta Neurologica Belgica:
  9. European Psychiatry:
  10. Kleine-Levin Syndrome
  11. American Psychological Association:
  12. rights...
  13. British Journal of Psychiatry
  14. BMJ
  15. Brain and Behavior
  16. Brazilian Journal of Psychiatry
  17. Science Daily
  18. Current Psychiatry Reports
  19. BMJ Acute Dystonia Induced by Drug Treatment
  20. Heart
  21. Blake Chelmsford Funeral Home: Lanny Friedlander
  22. Journal of Affective Discorders
  23. Mayo Clinic
  24. Psychiatric Srv.
  25. Psychology Today

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Sources Caduceus: https://pixabay.com/id/vectors/caduceus-dokter-obat-medis-2730761/

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Very interesting ... and well written. I experienced a bit of these mental stuff as a teenager, it must have been 88' or 89' and I absolutely never felt helped by institutions, all the contrary - I developed a "Whatever happens I know where not to go" attitude and practiced it since then. It went ok enough in my case, but for many this surely isn't the best solution. There is a lot to do in that compartment of the current civilization.

Hi Borjan,
A lot of interesting people have had the same experience:) In many cases, especially for young people, I think taking stress off is the most therapeutic thing that can be done. There is so little understanding of how the brain works and how it's connected to the rest of the body..."treatment" is guesswork.
Your art, your cats, the forest...these are great tonics. They are for me, and I'm a terrible artist. Also, I think I'm an interesting person :))
Hoping today brings peace, health and soaring Hive prices,
AG

What an interesting informative read AG. There are so many types of mental illnesses that I think we have a tendency to lump them all into one or two generalities.

It seems to be the way to push pills onto people and if the diagnosis is not correct, much harm can be done to the patient.

!tip

Thank you my friend. I love it when you stop by and comment on my posts. And that tip is really generous.
Pills, pills, pills...given often with little regard to the side effects, some of which are irreversible once they appear.

Have a wonderful Sunday afternoon with your beautiful cats (I just visited your blog and saw the great photos).

Most welcome AG. 🙂

Thanks for visiting my blog and your kind remarks.

Wishing you a wonderful week ahead.❤️

🌷🌷

Thanks for your contribution to the STEMsocial community. Feel free to join us on discord to get to know the rest of us!

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Thank you very much!
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Hello @agmoore,
thanks for your well researched writeup, i believe mental health is category of health that needs more spotlight especially in africa where individuals once associated with mental health are shunned and looked down by society. Many attribute these conditions to spirits and a other stereotypes, not to discredit them or anything but i believe when we learn more we will understand better and stop these discriminatory acts. It was fun reading. Have a nice time.

Regards,
Nat

Thank you very much!
Some years ago I worked (as a teacher) in a school for children who had been diagnosed with psychiatric disorders. Many of the issues I address in the blog were obvious back then--the difficulty of diagnosing, the extreme effect anti-psychotic drugs had on the kids, and the absolute authority of psychologists and psychiatrists over the children's lives. It is an imperfect world, but in the case of psychiatry I think that imperfection can be starkly tragic.
Thank you for sharing the situation in Nigeria with regard to mental illness. I think in the United States we have left behind the spirits, but unfortunately shunning is also the fate of many who suffer from mental illness.
I wish you health and peace.
Regards,
AG

Thank you very much, stay safe and stay healthy by the way i am from Ghana. I think i am the only Ghanaian in the community but i am looking forward to getting some of my colleagues onboard.

You can talk to one or two people there in Ghana to join stemsocial, but am very sure there are so many Ghanaians here on hive blockchain

Hi @nattybongo,
I'm so sorry I made that mistake. So many Hiveans I know from Africa come from Nigeria. It is a very active community here.
In the past I have written about Ghana, indirectly. I wrote a very involved blog about the Guinea worm eradication program.
Peace and health,
AG

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