Last week, in The Depression-Mania Two-Step, I referred to the Draft DSM-5, which drew 14 comments. Dysmystic took the words right out of my mouth with the observation that “I think DSM-5 got its info off a Wheaties packet.”
My long version to this observation adds up to 11 blog pieces on my daily blog, Knowledge is Necessity. This includes seven report cards in which the average grade is an F. More pieces are in the works. (Links to the blog pieces are at the end of this sharepost.)
As I stated here last week:
What I would like to do here and in future shareposts is comment on some observations that jumped out and hit me in the face as I was “grading papers,” and in turn invite your feedback.
Part I dealt on how depression and mania/hypomania are linked via the cycling phenomenon that defines our illness. An astute clinician, through careful observation of anomalies within one’s present depression, may deduce a history of mania/hypomania. Then, by asking the right questions, may elicit confirmation from the patient.
The psychiatrist who initially evaluated me failed to do this, and judging from your replies, neither did the ones who first evaluated you. As Survivor noted, part of why she was misdiagnosed with clinical depression ...
... was due to a psychiatrist who didn't know what he was doing. By then I had learned to my surprise that bipolar didn't mean spending your life savings on shoes or running around pulling off your clothes and screaming.
Tabby, who finally found a psychiatrist who knew what he was doing, had this to report:
He asked me to describe times when I felt mad for no reason or agitated. He asked how I felt about my assorted co-workers over the years and how I compared to them in doing the same work? He asked a lot of very very very strange questions, questions no other pdoc had ever taken the time to actually ask me. ...
He then looked at me, put his pen down, and said "Bipolar with Schizoaffective traits" and I sat stunned. ... I asked why no one else had ever diagnosed me correctly with bipolar? He asked: "Did you go to see [a doctor or psychiatrist] while you felt good and able to handle the world?" and I answered "of course not” ... He leaned back in his chair, and nodded.
The depression-mania two-step flows in two directions. Just as depression can point to mania/hypomania, so can mania/hypomania give us an insight into our depressions, namely by providing us with clear markers into how long they last and how fast they come and go.
Literally everyone with bipolar experiences recurrent (as opposed to “chronic”) depression. In the fictitious world of the DSM, recurrent depression is classified as part of unipolar depression, but the classic view is that recurrent depression and bipolar are part of the same “manic-depressive” phenomenon.
Indeed, that was the opinion of the pioneering diagnostician, Emil Kraepelin, who coined the term “manic-depression.” The DSM-III of 1980 replaced this wide view of manic-depression with an extremely narrow one of “bipolar,” replete with its ridiculously high diagnostic threshold of full-blown mania.
