Dr. Goodwin's Bipolar Spectrum Disorder Challenges the DSM

John McManamy Health Guide
  • Tomorrow night I board a flight in San Diego for Hartford, CT. Not far down the road, I will visit my mother for a few days, and see the rest of my family, whom I haven’t seen since Thanksgiving.


    Then the business portion of my trip begins – two talks to NAMI groups in Connecticut, a day off for sight-seeing in New York, a talk to a DBSA group in New Jersey, and another talk to a DBSA group in Washington DC. In between, I’ll be squeezing in visits with old friends, getting off blogs, answering emails, doing my usual research, taking care of business, and rushing out to buy whatever it was I forgot to pack.

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    By happy coincidence, I will be in WashingtonDC when Frederick Goodwin MD, who is a professor at GeorgeWashingtonUniversity, will be launching the long-awaited second edition of his monumental classic, “Manic-Depressive Illness,” with Kay Jamison PhD as his co-author.


    The first edition of Manic-Depressive Illness was published in 1990, with more than 900 pages set out in two columns of text. Almost instantly, the accolades followed, including the first text on psychiatry to receive the Best Medical Book Award from the Association of American Publishers.


    Dr Goodwin’s resume includes former director of the NIMH, former host of NPR’s “The Infinite Mind,” Service to Science Award from the National Association for Biomedical Research … the list goes on and on. Moreover, Dr Goodwin pulled off a unique trifecta with major awards from the three top mental health patients/families organizations – NAMI, the Mental Health Association (now Mental Health America), and DBSA.


    To say that Dr Goodwin is the world’s leading authority on bipolar disorder is an understatement. Last year, Dr Goodwin was generous enough to take the time to read the manuscript to my book, “Living Well with Depression and Bipolar Disorder,” and provide a glowing front cover blurb. As I told my friends, this is the closest I will ever get to being patted on the back by God.


    The new edition to “Manic-Depressive Illness” has more than 1,200 pages. A brand new subtitle – “Bipolar Disorders and Recurrent Depression” - offers a dead give-away to what a lot of the new content will contain. A little backtracking:


    The first edition contained a small and rather understated chapter called “The Manic-Depressive Spectrum.” The chapter set out the concept that mania and depression share the same continuum, but, despite his pioneering work in this area of mood disorders, Dr Goodwin did not strongly develop this theme.


    Last year, at the American Psychiatric Association’s annual meeting in Toronto, Dr Goodwin gave us a foretaste of what would be in his second edition. As I reported in my email Newsletter at the time:


    “The DSM, said Dr Goodwin, by separating out bipolar from depressive disorders, obscures the relationship between bipolar and the early-onset recurring forms of depression.


    "’Manic depression and bipolar disorder are not the same,’" Dr Goodwin continued. Don’t feel guilty if you didn’t know this. The fact that Dr Goodwin had to clear up this misconception to a room full of psychiatrists speaks volumes. The term manic depression was coined by the pioneering diagnostician Emil Kraepelin, who defined it to mean a phenomenon that embraced all types of recurring depression, from unipolar to bipolar.


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    “Another way of phrasing this is that unipolar depression and bipolar disorder are not necessarily separate and distinct illnesses. There is plenty of room in the middle of the spectrum for overlap. This middle ground is what Dr Goodwin and collaborator S Nassir Ghaemi MD of Emory University refer to as Bipolar Spectrum Disorder, falling between some types of recurrent unipolar depression at one end and bipolar II and bipolar I at the other.


    “Kraepelin's focus on recurrent cycling, Dr Goodwin concluded, provides a sounder basis for diagnosis than systems that focus on the polarity between mania and depression.”


    Pow! A direct hit at the DSM and conventional diagnostics. Expect a lot more of this in the second edition. Once the rest of psychiatry gets with the program, all of us will be in much better hands.


    I expect to return home with an autographed copy of the second edition. From me, he can expect a warm thank you for dedicating his life to improving mine. Stay tuned …









Published On: March 20, 2007