Diagnostic Labels: What Are They Good For?

Patient Expert

This would ordinarily be the fifth in our conversation of the overlap between bipolar and ADD (or ADHD), but I feel now is the time to look back and get a bit of perspective. Of late, I have been doing a lot of "overlap" posts, exploring links between bipolar and: schizophrenia (schizoaffective disorder), PTSD, personality disorders, and  alcoholism and substance abuse. I see anxiety and sleep disorders in the near-future.

Rarely, if ever, do we "just have bipolar." Something else is invariably going on. Perhaps not full-blown, often "a little bit of this" and "a little bit of that." For instance, Ellen Frank of the University of Pittsburgh has done work into the overlap between mood disorders and anxiety. I recall hearing her in a talk telling people that just two symptoms of another condition can significantly complicate the course and treatment of the mood disorder.

You are probably reading this page because you know in your bones that you have bipolar. If you are like me, you may have welcomed the diagnosis. It explained your whole crazy life. It offered you the hope of getting your life back on track, once you figured out the nature of this beast.

But, if you are like me, you also found that their were more obstacles to your recovery than you bargained on. Once you had a handle on controlling your depressions and manias, you may have noticed some quirks in your thinking and emotions and behaviors. What was going on?

A little bit of this and that? Another full-blown diagnosis?

Again, if you're like me, you have also probably started to have very serious doubts about the wisdom of diagnostic psychiatry. Perhaps there was no such thing as "bipolar," after all, or "anxiety" or any of it. Perhaps you may have concluded that there is no mental illness, period.

Yet, deep down, we know that our brains have failed us too many times for us to place our trust in ithem. Something, somewhere, simply isn't working right.

The brain science over the last 10 or 15 years has given us an enormous insight into our concerns. Researchers are not observing bipolar in action - or anxiety or something else - so much as a neural circuit not firing right or a bundle of neurons over-reacting or a certain part of the brain not booting up right.

I have heard numerous prominent researchers in lectures remind their audiences to the effect that the brain is not organized with the DSM in mind and that our genes do not code for specific illnesses. The brain is way too complicated for that.

The way I have reconciled matters is to think of the DSM as a very rough guide, very useful if you don't take it too literally. The DSM makes no attempt to explain the conditions it describes or let you know what may be going on beneath the hood. Rather, it sort of tells you what depression looks like. It sort of tells you what mania looks like. It sort of tell you what anxiety looks like. And so on.

The ubiquitous symptom checklist can be very useful in this regard. Where the exercise fails is in its all-or-nothing approach. We've all done it. We've gone to the DSM and looked up something like borderline personality disorder. We counted the symptoms that apply to us and breathed a sigh of relief that we only manifested two or three rather than the mandatory five.

Yay I'm not borderline! you may have exulted. But what about those tell-tale three symptoms? Are we supposed to just ignore them?

Maybe we need to be asking what these symptoms are really telling us? Do they have anything in common with your bipolar symptoms or your anxiety symptoms or your substance abuse symptoms or your alcoholism symptoms? Do they point to a common condition such as stress? Do you react to stress by flipping out or melting down or self-medicating?

Is your vulnerability to stressful situations the real problem, then? If so, how can you best deal with it? Are the people in your life causing you a lot of stress? If so, how can you change it?

Or to cite a different example, involving our current inquiry into ADD: Are the symptoms telling us we have a problem with impulse control? Are the symptoms telling us our minds are too fatigued or revved up to concentrate? Maybe then, we don't have an ADD or bipolar problem so much as an impulse control problem or a failure to focus problem. If so, how do we best manage the problem?

Throwing away the diagnostic labels, then, can be the key to recovery. But first, we have to play with the diagnostic labels. Be smart. Question everything ...