• John McManamy
    Health Guide
    June 09, 2009
    John McManamy
    Health Guide
    June 09, 2009

    Hi, NumberTwo. Very good question. The short answer: None. The long answer: Quite a bit.


    Let me explain:


    Like just about all mental illnesses, there is no physical "paper trail" to bipolar. No observable brain damage, nothing that turns up in a urine or blood test. But we do know something is going on.


    The ancient Greeks are on record as observing bipolar behavior, and in the late 19th century clinicians began making careful observations. In early 20th century, Emil Kraepelin coined the term "manic-depression" to describe decades of precise observations on patients.


    In the decades that followed, various family studies offered strong evidence that the symptoms that Kraepelin described were heritable - in other words genes and biology had something to do with bipolar.


    We have yet to identify the genes, but brain science is pointing to various brain anomalies, both cellular and systems, both structural and functional. In addition, the same brain science is showing a strong interplay between the genes and environment.

    Brain scans show convincing pictures of the brain in depression as well as the brain during mania.


    In short, we have incontrovertible scientific evidence of both a clinical phenomenon and what may be going wrong in the underlying brain circuitry. But the pieces of the puzzle are not all in place.


    From your point of view, there is no fool-proof diagnostic system in place as there is for neurological and physical illnesses. Because of that, it is always fair to question your diagnosis. In fact, misdiagnosis frequently occurs. For instance, people with bipolar tend to first get misdiagnosed with depression. On the surface, it is difficult to distinguish between bipolar and borderline personality disorder. And sometimes it is hard to tell us apart from those with schizophrenia.


    Just to make things more confusing, drug use and alcholism are further confounders. As are co-occuring illnesses or even a light whiff of co-occurring ills such as anxiety.


    Not surprisingly psychiatrists often get it wrong.


    So yes, we know bipolar exists. It's real. But knowing when to make the right call is still more of an art rather than a science. But the science is moving ahead incredibly fast.




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