53 Comments to
9 Myths of Bipolar Disorder

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  1. Nice post, and I reinforce point 6 that patients need to be in therapy. By the way, it is a shame you did not mention that a diagnosis of Bipolar is not responsibly made in one evaluation setting unless the patient has a textbook presentation and reliable collateral reports. Bipolar disorder is grossly overdiagnosed in this country the past 10 years, and in my opinion thanks to over aggressive marketing by pharma and, somewhat lazy evaluation techniques by psychiatrists until proven otherwise.

    But, when accurately diagnosed, an illness that needs reliable and continuous mental health care support, or else the consequences can be far reaching. Mania can be as devastating as depression. Hope others will chime in.

  2. I could have sworn that a federal judge – if not the Supreme Court classified bipolar as a “physical” illness. That means it is a medical disease. By your criteria, i.e. it needs therapy and other things in addition to meds, diabetes would also not be a medical disease since insulin is only one component of treating certain types of diabetes. Other types are not treated by insulin at all but by nutrition and exercise, as should be included with insulin managed diagnosis. I know a college professor that completely controls his severe diabetes solely through diet and by walking 2 miles a day at lunch. Does this mean his diabetes is not medical? That is what it means according to your criteria.

    Mental illness is first a biological, physical, medical disruption of neurotransmitters. It is NOT some esoteric, mysterious something simply occurring in someone’s mind. A person’s mind won’t even function without nutrients and it certainly won’t function correctly when deprived of them as the American diet does. Additionally, a fact that few doctors share with their patients while the pump them full of pharmaceuticals is that 60% of the neurotransmitters that control brain function are manufactured in the intestines. THAT is physical and with that knowledge one begins to believe that mental illness is NOT solely “mental” (whatever that is).

    It is because doctors treat symptoms and not causes that the medical mindset is structured to throw medication literally developed for specific symptoms. It is rare that medicine seeks to HEAL. Medicine THINKS what it does is healing and they haven’t been able to complete the paradigm shift needed to see the difference.

    I am the most high functioning bipolar person my doctors and therapists have ever met. But until I came to understand and find evidence that the illness does respond to physical stimuli, I felt that someone had hung a sign around my neck. That is sad and I work very hard to erase this stigma in others that I meet.

    You can help too. Look at the evidence. It is a physical disease. Sadly, it is often triggered by severe trauma. But that doesn’t make it physical. We know that when the physical component is managed, the emotional part comes along as well and therapy will move that along. DBT is particularly helpful because it teaches skills that replace the maladaptive skills developed in a traumatic environment.

    I am sorry but you are perpetuating a myth. I will continue to work every day of my life to end it. I know mental illness responds to physical nutrients. If the disease was not physical, a medical disease, it would not respond to either nutrients or drugs.

    • You did a phenomenal job of articulating my thoughts regarding bipolar not being a medical illness. The doctor’s statement that it is not like diabetes can confuse people about the reality that all illness have a mind, body and spirit component. To say bipolar is not like diabetes is like saying diabetes is not like rheumatoid arthritis. Of course it’s not. They are two different illnesses. But they are still medical illness.

      We are comprised of all three realities–mind, body and spirit, and none can be separated from the other. When we attempt to separate them we feel out of balance and eventually our health suffers.

      This is not to say that only out of balance people get sick. Sickness, in some form or another, is a part of life. But when we are in balance, I do believe we heal faster and experience an overall sense of well being even if we are medically classified as being chronically or terminally ill.

      Thank you for your insight.

  3. This is an excellent post – long over due.

    My concern is that Bipolar Disorders – note the plural – are spectrum disorders. Who knows how the new DSM-V will describe them. Or how many they will describe. (I often wish that manual didn’t exist. And that diagnoses didn’t exist, as Harvard clinical and research psychologist Paula Caplan has discussed in her work.)

    What I especially like about this post is that it stresses that there are many ways to treat the symptoms of a bipolar disorder diagnosis, depending on the individual.

    What particularly pleased me was the fourth point. Bipolar Disorders and many other psychiatric disorders are not all “chronic illnesses” … I’m not particularly fond of the diabetes analogy that’s always trotted out.

    There are many treatment tools and certainly medications are among them. There are others that go beyond symptom management and can lead to recovery. They’re not quick fixes, but they work in many cases.

    Yes, recovery is possible in many severe psychiatric disorders, including Bipolar Disorders.

    What concerns me is that “talking therapies” are not more widely used and stressed as mainstream approaches for mental or emotional disorders. In England, Australia, New Zealand and Germany, pharmaceuticals are de-emphasized as ways of dealing with mental health issues of all kinds.

    In North America, we are wedded to an approach that treats symptoms instead of investigating the root causes of a disorder. This tendency is based on the widely held assumption that psychiatric problems are caused by “chemical imbalances in the brain” – which has yet to be scientifically proven. There are many causes.

    I am really happy you posted on mythology. This should be an ongoing discussion. We are all different. I support and value celebrating “difference” and violently oppose trying to turn everyone into “square pegs”. Mental health issues and mental or emotional disturbances/disorders must be viewed very specifically to each individual.

    There is much more to say and I hope you will continue saying it and drawing our attention to it, encouraging this open discussion.

    Your previous commenter is absolutely right about mania. My mood disorder is unipolar – severe mania with psychosis. I have never experienced depression, but I’ve been hospitalized 20 times for mania.

    It can be devastating, indeed. Luckily, one medication – Tegretol – has worked for me and I have not had a major manic episode since 1988. However, without psychotherapy which give me insight, I wouldn’t be able to manage my hypomanic tendencies nearly as well as I do.

    Thank you, so much, for this post.

  4. I’m sorry – but I’m in the camp with Thomas Szasz and Peter Breggin (Google them both). Mental Illnesses are problems in living and not diseases at all. A good starting book is Blaming the Brain by Elliot Valenstein.

  5. Is it really true that the mood swings of bipolar lessen in fregencey/severity?

  6. @Jan – Luckily we don’t rely on courts to practice medicine, but rather scientists who help define things such as mental disorders through decades’ worth of research. If you look at the the cross-disciplinary research dating back since the 1950s, you’ll see these are most definitely not simple chemical disorders or brain neurotransmitter malfunctions.

    I don’t have the space to debate the research that has demonstrated that our knowledge about the brain’s neurochemistry is still surprisingly small, but here’s a good review of why, for instance, it’s not as simple as we thought (it discusses serotonin and depression, but the same is true for any of the “biologically-based” mental disorders):


    @Adam — Indeed, what little research that has been done on the topic suggests that the mood swings can lessen in intensity and frequency as one ages.

  7. If it lessens over time then is it possible that I DON’T have bipolar disorder? I ask because I seem to be getting worse.

  8. One thing Dr. Grohol that gets me about this article is that you state that “While some marketing propaganda might simplify bipolar disorder into a medical disease, bipolar disorder is not — according to our knowledge and science at this time — a medical disease.”

    This is striking! I understand that theories in psychology often change according to the Zeitgeist so to speak. Psychology is known for this. However, according to the National Institute of Mental Health (NIMH), bipolar disorder is characterized (perhaps incorrectly, although I find that hard to believe by the NIMH) as a medical disease (see…http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml).

    Additionally, I wouldn’t quite go so far as to say that bipolar disorder is similar to heart disease or asthma (i.e, medical diseases). But it does strike me as a sort of “medical issue” and I haven’t seen a lot of research disproving this theory of BPD.
    As with autism, the terms and symptomology keep changing and I wouldn’t be surprised if BPD is no longer considered medical as a result of extended research.

  9. Ha. Jan stole my diabetes analogy exactly. I’ll concede that it is incorrect to think that bipolar disorder ought to be treated entirely medically, but the fact that its etiology is not fully understood does not automatically mean that it is excluded from being “medical.” I have fluctuations in my mental state that respond very well to certain medications (and not at all to others). Because of that, and as far as I’m concerned, this is predominantly a biological condition. Medicine helps = medical. Therapy helps = mental. Can’t it be both?

    I don’t understand why you feel that the ‘bipolar = medical’ line of thought is a myth that ought to be dispelled. Referring to mental illnesses as being medical problems helps to decrease the stigma surrounding them. If you take that away, it really is just “all in my head.” I don’t blame chemicals entirely – I have gotten a lot of benefit from some therapy – but I do feel very strongly that a medical disorder of sorts is the foundation of my troubles.

    I have encountered opinions similar to yours in a couple of my therapists. They made little effort to hide their disapproval of my chronic medications until I’d have a medication or dosage change that completely changed my disposition. Then they would concede that there was a “biological component.” However, it was frustrating and discouraging to have something so life-savingly (literally) helpful to me be scorned in that way. Seriously, I would not have been in therapy at all if I thought the problem was purely chemical.

    You can continue to disagree with me and Jan all you want, but for the time being, and until research definitively proves otherwise, I see no harm in letting the “medical” hypothesis linger.

  10. @RichardB — It varies from person to person and doesn’t lessen for all.

    @DrT — I guess at the end of the day, I’d say don’t get too hung up on semantics, as they are used for marketing purposes and reducing stigma more than they are for conveying accurate, scientific information to the lay public.

    For instance, in the NIMH’s brochure on bipolar disorder, they introduce it as a “brain disorder.” That’s fine, too, but again, not really capturing that this is a brain disorder quite unlike Alzheimer’s or MR. Mental disorders are complex phenomenon that, unlike medical diseases, have significant psychological and social components — which are in some cases the only components of the disorder.

  11. I do agree Dr. Grohol.

    The distinction between disorders and medical diseases can certainly be skewed or blurred by an inability to correctly utilize terminology and facts. I can still see, however, why depression and BPD would be viewed or stated as being a “medical disease.” It is very often the symptom that acccompanies a physical illness or any sort of medical/neurological disease such as migraines. It has a medical component; although the psychological and social components must not be ignored I agree. It can get tricky!

    Additionally, there may be some positive psycholgical effects to using the term “medical” in referring to bipolar disorder. It does indeed reduce stigma (while perhaps misleading the person suffering from the disorder), but it may work to encourage the person to seek help because they see the disorder in a medical sense and not a pathological or neurobiological perspective.

    I am BIG on terminology and an advocate for watching out for marketing (even with the NIMH,NIH,WHO,etc.) in the scientific realm. It’s as detrimental as a shark and has unfortunately confused and misled a lot of the public.

  12. Bipolar disorder not a disease? Do you also think that depression is not a biological illness? I have recurrent major depression and anxiety. I know my own body and I know my own mind, and I know that the biological component of my illness is huge.

    Can psychosocial factors make my condition worse? Certainly. But that is true for many non-mental illnesses. I do not think the contribution of psychosocial factors to mental illness negates it being a disease.

    Many times, my condition has worsened without any external trigger. I feel the beast roll in like a fog. My energy levels change, my cognitive capabilities change, and my very thought patterns change. It feels absolutely biological right to my very core. Now that I have been on effective medication, such downturns are much less frequent.

    I’m not knocking psychotherapy. I’ve benefited from fine counseling, and my coping skills are pretty good. But the bottom line is that if I do not take my medication, I relapse. Badly. With effective medication, I go about the business of living. The medical intervention is the correct intervention for me. It is that simple.

  13. I appreciate someone’s effort in compiling these 9 myths. It might be good for discussion at a dinner party. I have been bipolar for 27 years at least. I agree that I am not crazy but I admit to acting crazy on occasions. I may not be on medication for the rest of my life but not many doctors would support me in stopping. I would need to be in a controlled environment. I stopped my meds twice with disastrous consequences. I never stopped because of feeling better. It was because of side effects or because my life was in turmoil. I certainly hope that something I have taken explains my weight ballooning. I would have like some expamples of Atypical antipsychotoics. Finally, the tenth myth is that anyone knows a damn thing about Bipolar Disorder.

  14. I want to address myth #9. I had an experience that was somewhat of the reverse of this. Because I have multiple relatives with bipolar II, the first clinician to evaluate me when I suddenly became crushingly depressed was very reluctant to prescribe an antidepressant—even though a careful interview with me and questioning of my husband over the phone revealed no evidence of mania or hypomania in my history. I agreed with him that it was possible that I had bipolar like my relatives, and simply had not experienced my first manic/hypomanic episode yet. Unfortunately, that led to me being prescribed a mood stabilizer that proved rather useless to me. It took months to titrate the dose up high enough to be certain that it just was not going to help. Thank God I found a good CBT therapist who helped with many of the underlying psychological issues. And thank God for careful clinicians who eventually got me on an effective course of medication. I can’t blame them for not trying SSRIs sooner considering my family history.

    Actually, considering that bipolar disorder is a spectrum disorder, I wonder if the etiology of my illness is closer to BPD than MDD—but a variant without mania. I’ve had unstable moods since my teenage years, though never severe enough for me to seek treatment until the incident I just described. The dark spells come on their own and then go away on their own (though I think meds do help). But still, no trace of hypomania at all.

  15. I found this treatment somewhat weighted towards the pychological professional. Other than supportive therapy or CBT in depression, bipolar disorder is poorly served by depth psychotherapy, which can actually worsen the symptoms.

    Further, our understanding of simple strep pneumonia is not much better than our understanding of bipolar disorder; why 30% of us carry the bacterim, much like meninogococcus, and never succumb is a mystery. Mood management can very much resemble controlling one’s blood sugar, with maintenance and adjustments.

    As for the question of “medication” for the rest of one’s life, most studies aver that it will be necessary, but you don’t have to tell the patient that; medication compliance is hard enough without this added burden.

    In all, a good article, but a little loose around the edges from the perspectivhe of a doctor and long time sufferer.

    C. E. Chaffin M.D. FAAFP (third-generation bipolar)

  16. I need to add a little of my own take on this subject. I have two son’s with bipolar 1 and 2. Our son with bipolar 2 takes meds plus therpy, he does very well. I believe that it is a medical illness, his therpy helps him live with his illness. My son that suffers bipolar 1 also takes meds and see’s a doctor only. He is doing very well and so far is dealing with his illness. I say it is a medical illness. I believe the illness comes first, and because of the stigma and what a person goes through before they recieve help can be a deciding factor in how much therpy they will need to adjust to the illness.
    I myself have a medical illness and the pain is hard to deal with, depression sinks in when pain takes over, I use talk therpy to deal with the depression. I have no mental illness, but I do need therpy to deal with my illness.

  17. This article infuriated me as did some of the comments below. I agree with Jan that the author is perpetuating his own myth here.I have coped with my husbands bipolar disorder and a close relative’s severe depression and psychosis for many long years and observed their epiosdes both severe depressions , and manic / hypomanic or mixed episodes literally come out of nowhere overnight ,after sleeping without any obvious trigger at all just like a hypoglycaemic attack in diabetes can sometimes do even if the person is taking their medication and not doing anything to destabilize their illness, especially if their medication combination or dosage is not right.

    I have 28 years qualified medical experience .The fact that children can develop bipolar disorder or diabetes for that matter in perfectly healthy well balanced, happy homes in happy children and healthy eating children and parents with no disturbance, it can be nothing to do with their lifestyle often without traumatic events, just as Diabetes comes on in children out of the blue. Bipolar Disorder can also come on in children though more commonly in mid to late teens or early twenties out of the blue. It is hard to find anyone nowadays who at some point in their life has not had stress or some kind of personal family or social trauma if yiu look hard enough for one, so I feel it may well be more often coincidental that they develop Bipolar disorder ,and may well have come on later anyway without traumatic triggers, as many do not appear to have had any such traumas, but Do have a family history ( genetic )even without growing up with that person or being affected by their behaviour.

    Obviously if their is trauma, the biological impact and connection is obvious. It causes a flood of stress hormones which is a normal primitive flight or flight response such as the release of corticosteroids and adrenaline etc, and , maybe the surge of these into the brain at critical and sensitive timess in a persons life and development such as adolescense or childhood when brain tissue is still developing or after viruses in any age or in the menopause, male or female , when there are distinctive drops in hormonal levels, this may well add to an already genetically vulnerable and challenged brain.

    But this is still medical and physical even with psychological and mental presentation because it is the brain it is affecting. The brain is responsible for higher mental functions, cognitive etc , ( as well as all essential organ control / hormone control) and emotions/ behaviours which come broadly under psychological and cognitive headings Many behaviours are learned through observing others function, by example by copying in infancy and childhood, though some are automatic such as feeding instinctively at birth and defecating. These are not really behaviours but functions and essential survival behaviours if you like. We just learnor are shown or habituated into how we will carry them out differently in our own distinctive ways in life, such as hurrying our meals or rushing around too much to be able to sit down for long enough to defecate effectively.

    If these are affected it is still all medical. The brain is just one of our organs with a specific role to play. Learning,Thinking, behaving , feeling, expressing ourselves by communication in many forms , appropriately hopefully and controlling essential bodily functions automatically. If the brain is not functioning due to tissue damage or chemical depletion, interruption or chemical imbalance or faulty signalling betwen neuromessages, this will be manifested in all the above mentioned functional areas, naturally. Common sense. So ofcourse Bipolar Disorder is a medical, physical condition which is manifested in all the these areas of function due to brain malfunction ! Fact !

    Lets face it how often to the psychiatrists actually hit on just the right drug or amount for someone. It can take years to establish what works and how much chemical medication is required, and is trial and error for a long time for most people, though some do have very effective medication treatments, and self manage very painstakingly and responsibly to enhance that, in addition to having supportive and educative psychotherapeutic help, which is all they do, but they help people cope anf come to terms with having an illness, and how to manage it, all of which reduces stress by increasing understanding and examining lifestyle impacts too, such as sleep, activity and what we put into our bodies all of which will affect our chemistry directly. Still Medical !

    I would say that only people with mild bipolar disorder can possibly manage with therapy and self management , lifestyle adjustmets alone. The majority with moderate to severe illness do need some medication as it is clear their brain chemistry is obvioulsy more disfunctional than someone with a very mild or milder forms. Nevertheless , milder forms that go untreated for years often develop later in life into full blown or more severe forms of Bipolar Disorder, 1 or 2,which will most likely need medication treatment as well as all the complimentary therapeutic approaches .

    This illness does not just go away even if people have years of apparent remission. For some their pattern is to only have very infrequent swings, and for others its every few months, weeks or days or hours depending on whether they have Classic Bipolar 1, or Bipolar 2, cyclothymia, Rapid , ultra rapid or Ultradian Rap Cycling which is the cycling every few hours or minutes type.

    There is a lot of variance and compliance with medication and other self management is also affected by ones level of mental insight into eoisodes, particularly when high, ( manic or hypomanic ,as judgement usually is significantly diminished very early on in even in Hypomania once the mental Insight goes. Complinace is alos affected by the level of intelligence as it is a lot to take on board and understand, and by the level of support that the individual has from mental health services and in their home or social or work environments. This can all have an impact on how they learn about their illness, accept it, manage it and cope. The severity and pattern or frequency of their individual bipolar Disorder can also affect outcomes and compliance with treatment.

    Bipolar disorder can vary alot as it a spectrum disorder, but is still a medical illness. Spectrum disorder just means that their is a scale and range of symptoms and degrees of severity, and people often have the illness presentation at different stages on that scale along that spectrum. However , that can change throughtout their lives, becoming more severe or less severe, and better managed, managed worse. It all interplays.

    The same applies for any chronic illness be it physical or mental in presentation, they are all still MEDICAL. THe brain is just another bodily organ with a specific function like all our organs. When they don’t work we have a medical illness, and the brain is no different in this respect. If our kidneys were responsible for thought processes, then our symptoms would be urinary. THe brain has a job to do and it can’t do that job properly if something in it is malfunctioning, and it is as simple as that.

    Emotional, Psychological, behavioural difficulties are all dependant too on brain functioning and part of that function is cognitive, to do with learning , that includes behaviour. Stressors in life have a direct effect on brain tissue development and stress hormones all of which affect memory and behaviour, so ofcourse environment plays a part and early experiences but only in so much as they either allow the brain to deveolp normally or they hinder it from growing and being able to store healthy information to enhance effective learning and appropriate behaviour. IT has been proved that brain tissue actually shrinks in response to repeated negative abusive comments and behaviour towards children or grows in response to positive praise and encouragement and coninues to grow and deveolop well with positive reinforcement.

    On top of all this we also have genetic abnormailities of specific protiens in the brain that have been found in those with Bipolar Disorder and which respond to Lithium and other mood stabilizers. Research has been done to show exactly how Lithium works on these protiens and explains why it is effective though I can not explain that here as I am not a neurobiologist or chemist .

    All these findings confirms that Bipolar Disorder is without a shadow of a doubt a medical Disorder which is why it responds to medical treatments such as medications. If the route cause is faulty brain chemistry then the route back is to normalise those chemicals even if we still need to do a lot of work to refine and improve them and make them less toxic or work on finding what has caused them to be depleted or malfunctioning in the first place, but malfunctioning they are without any doubt.

    That makes this a medical Condition with its presentation found in the functions directly related to the organ affected and responsible for those functions. If Bipolar Disorder were a gastric disorder, it would present with gastric symptoms. Because it is a brain disorder of function it shows itself in those functions the brain would normally carry out, emotions, thought processes, and behaviour. This is so obvious but rarely stressed or explained.

    Emotions, thought processes and behaviours are all functions regulated by the brain, therefore if the brain function is disrupted in any way chemically or otherwise so will these higher functions appear to be affected. Hence faulty thinking, difficult, distressing, inappropriate behaviours, and grossly distorted moods and emotions . Speech , behaviour and capacity to recall , ability to organise normal tasks or even regulate bodily functions can all be effects of bipolar brain malfunction hence all the physical symptoms of the illness too. It can be experienced very physically, not just psychologically or emotionally or cognitively. It can affect all other systems which even adds to the fact that it is a brian functional problem and can over stimulate or understimulate lots of other organs leading a whole range of symptoms that are not imagined, such as chronic unexplained pain , appetite changes, nausea, skin sensations, constipation, visual disturbance, olfactory , gustatory or visual or auditory hallucinations all connected with faulty direction of sensory nerve signals going to the wrong parts of the brain leadng to expression of psychosis ( false thoughts and beliefs , thats all it is )which is just false perceptions or faulty thoughts which lead to a disturbed reality . But it is very real to the person because their brain is creating these things.

    Bipolar Disorder is without any doubt a Medical disorder of brain malfunction of Dopamine regulation primarliy and other neurotransmitters such as serotonin which are either depleted or not signalling properly with other chemical messengers. If it were not a medical problem individuals would not respond as quickly or as effectively as they do once given the “right combinations” of chemical treatments and in “adequate dosages” ,which they often are not , of medications which restore the brains chemical balance and restore functioningin all the affected arease. As chemicals affect thought processes and cognitive functioning, and thoughts lead to emotions which in turn lead to related behaviours which seem relevant to the individual experiencing the real or false emotion.

    Of course along the way people will have deveopled maladaptive ways of coping and behaving too with their undiagnosed or poorly treated illness as well as in some cases other troublesome behaviours or beliefs due to their upbringing . This will further complicate bipolar disorder if they have never been taught apropriate behaviour which they can return to in the first place, or have difficulties expressing emotions.

    Believing and thinking in response to a false perception of reality when insight is lost will have a huge impact on how they cope with what goes on around them. Naturally this aspect of the illness may well be helped back to normal or acceptible behaviours by therapy such as CBT or psychotherapy, or behavioural therapy to more normal and appropriate ways of behaviour andthinking if unhealthy patterns of responses have become a habit, but this still all stems from a medical problem of brain function in the same way that someone would feel , think and behave if given intoxicating substances or alcohol which would temporarily disturb their brain function. It alters their chemistry and affects behaviour out of their control just in the same way bipolar brain chemistry is out of the individuals control. Obviously if this becomes a dual problem alongside the Bipolar Disorder as an attempt to self medicate or in a manic / hypomanic period where insight is lost and the most sober of people start suddenly taking things they would not usually take in quantities totally out of chatacter for them, then this won’t help, but they are ony behaving this way either to try to escape symptoms of depression or anxiety if low, or if high have become disinhibited and lost their judgement due to the mania and doing things automatically , impulse driven. It is not a matter of choice. The choices made are dependant on the brain chemistry at the time. Alcohol or drugs taken at that time will add further to even more loss of judgement. But Bipolar Disorder when manic is almost like being drunk and behaving inappropriately like that even without any alcohol or substance taken. It is not within the person s control and can come on spontaneously, perhaps after prolonged stress which has tripped the braines chemical circuit, or after missed medications, or with the wrong medications being prescribed or taken by thev individual, before the illness is diagnosed so when there is no treatment in place yet anyway, and it just comes on.

    The same brian chemistry disturbance is occurring spontaneously without having taken anything, or it it is added to by actually taking something such as drugs or alcohol or too much caffeine once judgement is impaired . If this were not the case individuals would not respond as effectively to chemical treatments if the illness had no basis in chemical abnormalities or imbalnaces. There is also clear evidence of brain differences in scans and at autopsy in those with Bipolar Disorder , Therefore identifying Medical anomolies .

    Though it can be affected by external stressors or body clock or social rhythms disruption , stimulants such as caffeine, sugar or CNS suppressants such as alcohol, ( all of which by the way have a direct effect on corticosteroids and other hormones that are released in to brain cocktail to help disregulated ) generally the abnormality is already there and these stress hormones or external substances once ingested will not help and will bring out the abnormailirt or agravate the symptoms further. They are not the cause. They just worsen or prolong or kick start the illness which would have emerged at some point from its dormant or early stages. This illness come son in people with no history of any substance or alcohol abuse or excesses of other stmulants or stresses, such as children and adults laeding perfectly healthy and nornmal lives. Likewise many people in their adolescence or early twenties often indulge in all these unhealthy excesses yet do not develop Bipolar Disorder, unless there is genetic, familial predisposition . Therefore, it is medical condition which can strike anyone at any age at any time in any circumstance like any other medical condition. However obviously looking after our all aspects of our physical and mental wellbeing as we age , attending to rest and diet, what substances we put into our bodies, activity and happiness might I am sure help ptotect people on some level who might or might not develop it later in life, just like we can help protect ourselves from Cancer with a healthy lifestyle. Bipolar is Medical illness which we may or may not develop or avoid if we are lucky as it can be devastating. get the best treatment you possibly can and follow it. Good luck to all with this medical condition. It can be very well managed with commitment to treatment, and support and education.

    • Thank you for taking the time to write such a detailed response. The limitations of the original article certainly warranted such a critique. Sometimes, these little psychological “soundbites” can mislead and misinform. Less (information), in these instances, is definitely not more. It is incredibly important to be accurate in representing issues of such importance to people’s lives. Such perfunctory and superficial examinations of crucial matters does a disservice to public and to the behaviorial health professions. In this case, your response is in fact what should have been published.

  18. When is my blog appearing. It seems to have been lost which is a disappointment as I spent ages writing it ?

  19. Regarding the above last two comments, I would just like to point out what is a great resource for legitimate Bipolar Disordered patients, that being David Miklowitz’s book “The Bipolar Disorder Survival Guide”, published in the early 2000’s, more specifically Chapter 8, ‘How can I manage my disorder’, which takes a behavioral cognitive approach to issues like triggers, mood charting, maintaining patterns, and other no nonsense tips.

    I have to say as a clinical psychiatrist, as politely as able, that I am discouraged by all the focus on meds to treat Bipolar Disorder, as I see this as just minimizing and rationalizing to validate quick fix mentalities more prevalent in this culture these days. Yes, meds are needed with this disorder, but for those who are quick to dismiss or diminish the role of interacting and problem solving as done in therapy, you are just a step away from relapse in my opinion. Change is best accomplished by hearing and practicing techniques, not just finding the ‘right’ dose or combination of pills.

    That is why this illness is getting harder to treat. Telling a manic patient you can stabilize them with pills is like telling a diabetic they can maintain their glucose levels by taking medication and not paying attention to diet. It is a multifaceted approach to care.

    I think this article puts the problem in the perspective that patients need to consider. Go to Medscape if you want to learn of the meds management du jour, ’cause that is what pharmacology has become.

    Skillsnotpills, board cert psychMD

  20. I have to also disagree about bipolar disorder not being a medical disease. It is both mental and medical. It really bothers me that you had to compare it with diabetes. I am a bipolar 1 and when I explain to people what bipolar disorder is, the best way to do that is to compare it to diabetes. I tell them that bipolar is a chemical embalance of the brain like diabetes is a chemical embalance of the pancrease. A doctor once used that as an example when explaining bipolar to me. It is a great example because even when I have had people who don’t understand bipolar/mental illness they have had a better understanding using the bipolar/diabetes comparison.
    When you don’t use that “medical” comparison way too many people think that mental means ‘just get over it’. If only it was that easy!

  21. Isn’t the whole definition of “mental” as opposed to “physical” somewhat misleading? The expression within a person’s behaviour of a disorder such as BPAD or ADHD is based on a) how their body works and b) what experiences they have encountered during their life.

    There’s a feedback loop between the two.

    Experiences alter the expression of chemicals, either through adaptive mechanisms within certain organs or as is increasingly being studied, at a lower level through DNA folding.

    Chemicals and their resultant effect on behaviour change our experiences through mood and decision making.

    Treatment of any illness, whether it be so-called “physical” or “mental” should be approached from both directions. Even a “purely physical” illness (again, I have to point out the BS inherent in such a term) such as a scoliosis (curvature of the spine) can be aided by psychotherapy — give the person a new attitude towards exercise and I guarantee the scoliosis will have a far better prognosis.

    Step outside of the system people!

  22. I was diagnosed, at age 49, with Bipolar disorder. This diagnosis came after years of irratic (and at time irrational) behavior. …Many moves, to many states, many marriages, many successes and many failures.
    I was given Lithium, Abilify and Depakote along with many other medications. After suffering Lithium Toxitity on 4 occasions,and hospital stays that I do not remember, My family Doctor referred tme to a different Pshychiatrist. This Doctor changed my medications to Cymbalta, Depakote, Seroquel and Neurontin. I suffered a head injury (Brain Bleed) as well as Type two Diabetes, along with Neuropothy in my feet. I was then assigned to a Neurologist who increased my Cymbalta and Neurontin significantly. My Pshychiatrist is way over booked with parients, so he has an assistant that sees patients for medication reviews. The person I saw once was well aware of the increases to my medications by m Neurologist, yet when I began to suffer serious depression, she elected to once again increase the Cymbalta and the Neurontin. My depression became even worse. Not long after the additional increase, I became so depressed that I was not functioning in ny capactiy and became suicidal. I have had enough Mental Health education and therapies that I know what to do wheI get in this condition. As difficult as it is to do anything, except wanting to end my life, I did call for help. I spoke to th Hospital’s Menta Health Nurse, who, much to my dismay, called the police after she said she was calling for someone to bring me to the hospital. I was very embarressed that the police showed up, particularly since we live in a very small town and prior to my becoing so depressed for many months, I had been active on two committees in our tow, one for the town festival and one for the town beautificaton and ‘gren’ program. One of the Police officers that came to my home sits on these boards as well and is a neighbor. No one in twn knew of my Mental disability and I wanted to keep it that way, but now it is too late. In either case John, the police officer and neighbor, did arrange for me to get a ride to the hospital. I was admitted. This was one of the worst, depressing, Yuky places I had ever been. My pshychiatrist did come to see me everyday. He elceted to take me off of all of my medications and to begin a new program. His decision to put me back on Lithium has me perplexed and scared. In addition he reduced the Cymbalta I had been taking (120Mg per day), to just 30 mg per day, and the neurontin from 400Mg per day to 200mg per day. After I voiced my fears concerning Lithium, he promised to watch it carefully and I do have blood work done, each Wednesday for the next 8 weeks, to watch my Lithium levels very carefully. I will admit I did begin to feel better after three weeks o the new regiment; with one very big exception. My pshychitrist is aware that I am also being treated by a pain management Doctor or Chronic pain. I had a serious in home accident in 2004, which is when I had th Brain Bleed and also suffered multiple broken Bones. I now have an artificial elbow, because my bones shattered in my left arm. In addition, I have metal in my left foot (it holds my big toe on and in place) a well as screws, bolts and a metal plate in my left knee, a metal screw in the right side of my neck and have suffered and had filled in 4 vertebrae compression fractures. In have osteoarthritis throughout my joints in my knees, ankles, wrists and back. Needless say I have a reat deal of pain on a daily basis which makes it difficult to move and to do simple daily tasks. Before the Doctors began to increase my Cymbalta and Neurontin, I was prescribed Methadone by the pain managemaent Doctor. While hospitalized, my pshychiatrist decided to take me off of the methadone and id not replace it with aything other than the Cynbalta and Neurontin. These two medications did absolutley NOTHING to relieve my severe pain, so I discussed this with my pain management Doctor, who, even though my Pshychiatrist promised to contact while I was hospitalized and to send a report to, had never been informed of any treatment by the Pshychiatrist. Before my pain management Doctor would do something to help me he left a message for the Pshychiatrist to return his call. The Pshychiatrist NEVER called him or sent any reports. My pshychiatrist wanted to know what the Pshychiatrist would recommend for pain in lieu of the methadone. After a week of UNBEARABLE PAIN, my husband and I dicsussed it and I began the methadone treatments again. I did call my Pian Management Docotr and did explain how we were beginning again with small doses, just as I had originally done under this Doctors care. My pain management Doctor once again tried to contact my Pshychiatrist to no avail. I called the Pshychiatrists office and could not get hol;d of the Doctor, so I spoke with his Nurse. I explained that I had begun the methadone again, because I was suffering extreme pain. I told her exactly what dosage I was taking and again gave my Pain Management doctors contact information. The next call that I received, was actually a message left on my voice mail, from My Pshychiatrists Nurse. it went as follows “The Doctor says if you are going to continue with the Methadone; the Docotr will not see you as a patient. Call us back and tell us where you want your records sent.” How UNPROFESSIONAL is that!!!. The Pshychiatrist has not bothered to speak with me or my pain Management Doctor. Anyway, I have not yet sought out another Pshychiatrist and I do have an appointment with my Pain Management Doctor tomorrow morning. What am I supposed to do? Live with Pain that is so bad I cannot function? The Mental health meds do NOTHING for such severe pain. I would like this Pshychiatrist to walk in my shoes for one day without pain meds and see what it feels like. Has anyone else been thorough an ordeal like this before? Any suggestions would be greatly appreciated.

  23. I see some of the posters on this site are doctors and I need help. I am 28 years old and suffer from ADHD and Bipolar. I was diagnosed at the age of 13 years old and put on many different medication. At the age of 18, opted to discontinue treatment. This was partly do to cost and the side affects. I have had my “come to Jesus” momment and realized I need help. The bad news is that few insurance companies cover these disorders and if they do, the coverage is horrible. Does anyone have any suggestions? I need help! My girlfriend says I have entered a manic state and have become suicidal. Yesterday I slept for 14 hours straight. Today has been a better day. I have tried playin with the children and started reading up on new treatments for this condition I have. Any help or suggestions you can give would be grately thank you. I can be reached at [email protected]

  24. Re Keith’s above comment, if you are in a state deemed “crisis” for you or called by others close to you, the only responsible intervention is to go to an ER asap and be evaluated by a clinician who would see you in person. I would never engage in treatment via email or the internet via chats/blog, as that is not responsible, and I strongly advise you to not pursue interventions this way either.

    By the way, going to the ER does NOT mean you would then be hospitalized, but at least ID your situation as needing immediate follow up and perhaps bump you up the line a bit at an outpatient clinic or urgent care type mental health program. I do support your request for help and hope this will give you some direction, just with hands on opportunities.

    To Dr Grohol, I hope this comment is seen as supportive but not encouraging people to use your site as a source for treatment.

    Skillsnotpills, psychMD

  25. Hi,

    I am a bipolar II patient. I have been controlled, stable, without crisis, and feeling good for almost 4 years. I just wanted to say, psychoterapy MADE THE DIFFERENCE FOR ME. I have no doubt about it, it is a MUST , in a good treatment plan for bipolar disorder. I even plan to study psychology at some point, so I can help others that are in the same position that I once was.

    Of course, medication is another must, but I definetly think psychoterapy should always be considered too.


  26. While I like your site and agree with most of the points in this blog, I do disagree when you say that it is a myth that Bipolar is like diabetes. While you correctly point out that Bipolar has comlpex roots including biological, social, and psychological factors, your implication that Diabetes does not have those same factors is, in my opinion, incorrect. Social factors such as fast food restaurants, the use of corn based sweeteners, and whether my peers drink soda or milk can impact the diabetes disease process. Psychological factos like stress or low motivation to exercise can exacerbate diabetes. I think diabetes is a very good model for mental illness including Bipolar, including the fact that both medicine and behavioral changes can help to manage the illness.

  27. if these meds are meant to be good for us why do i feel worse when i’m on them. the box says don’t drive a motor car or heavy machines how do i work?.its the meds that keep stopping me from steam rolling forward instead it’s like the meds are the bi pola.i think it’s time to take us off meds and give all some kind of break from drugs..learning to live with bi pola is the best way out. stick your meds……

  28. Whomever wrote this article should have listed more
    of the adverse reactions and side effects, one can get while taking antipsychotics. I have a friend
    whom, after being on antipsychotics for a very long
    time, ended up developing a rare, serious but non-fatal movement disorder, called Cervical Dystonia. This can be reversed, if caught in time. Another side effect which one could get taking anti-psychotics is another disorder, which is also a movement disorder similar to dystonia but it’s called Tardive Dyskensia. The thing I don’t know about it, is if it is treatable and/or reversable. I think those side effects need to be pushed in people’s faces. I haven’t taken many AP’s throughout my life, as I never needed them, thank goodness.

  29. The ninth myth applied to me when I first displayed symptoms of Bipolar. I went to my normal MD at the base, and he had asked some questions and did a small evaluation. He wasn’t very knowledgeable in the field of psychology, let alone psychiatry. He had diagnosed me with Clinical Depression and subscribed me an antidepressant. Very soon, we noticed an extreme increase in my energy, racing thoughts, and being overjoyed.

    I knew from the start that Depression didn’t sound right. I was close to my school counselor, so after talking to him over the months of that seventh grade year, I decided toward the end of the year to go to Sacred Heart’s adolescent psychiatric ward/floor (whatever you wish to call it.) There, I was quickly diagnosed with Bipolar I after reviewing my symptoms and complaints.

    Now, I have to say that you made Bipolar sound rather mild in this article. More mild than what I’ve been told I have. My symptoms are very controversial, and some people think one diagnosis fits more than the other.

    “While bipolar disorder is a serious mental disorder, it is no more serious than most other mental disorders. Having a mental disorder doesn’t mean you’re “crazy,” it just means you have a concern that is negatively impacting how you live your life. Left unaddressed, this concern can cause a person significant distress and problems in their relationships and life.”
    ~9 Myths of Bipolar Disorder: By John M Grohol PsyD

    As a supposed result of my “mania,” I am told to believe that is why I get what is arguably “DID-like symptoms.” I have “alternates” which show a significant amount of independence in patterns of thought processes, interests (and likes or dislikes), opinions, reactions, etc. They even present themselves with their own supposed background story (which I very well know are simply the results of my own mind’s creativity and ability to generate fictional stories/situations.

    When I think “mania,” I think abstract, hyperactive, racing, disorganized thoughts. But these “alternates” clearly show an amazing amount of consistency, organization, and complexity. These “alts” are as identifiable as any separate person (with the exception of looks/visual features, however, they do tend to have their own specific sets of expressions, postures, etc.)

    I am on atypical anti-psychotics (however, to reduce the “dull” feeling, we are lowering the dose of atypical anti-psychotics, and relying on some natural supplements like melatonin, fish oil, and vitamin D, to help with other symptoms/side-effects.) Since I started on these atypical anti-psychotics, the first being Olanzapine, the “alts” went away, but not definitely. They would reoccur from time to time, visit me a little, make an appearance, but that dramatically declined the longer I was on the atypical anti-psychotics, and I grew dull, unmotivated, etc.

    Nothing has worked as it should, the symptoms are very irregular and atypical for Bipolar, yet when I inquire, doctors never even think twice. If what I have is so definitely Bipolar, how could Bipolar not sometimes be “crazy” (in the psychotic, not-in-your-right-mind sense?) And how could it be no worse than some of the other disorders?

  30. I’m taking Lamictal, Wellbutrin and Prozac. My depression lessened with Prozac (40mg/day) and Wellbutrin (200mg/day), but even though the Lamictal (175mg/day) helps stabilize my mood swings, the side effects make me wonder if it’s worth it.

    I have a slight tremor and there’s some general loss of coordination/balance but those effects aren’t severe. The side effects I have trouble dealing with are “word searching”, general memory loss, and the incredibly annoying inability to spell simple words or use familiar words correctly. (I must have typed this post at least 5 times because of spelling and word usage errors and I’m still not sure if I’m making sense!)

    My pdoc and I are trying to come up with a medication and dosage combination that will reduce or even eliminate the intolerable side effects but so far we haven’t found it. The lowest dosages don’t work and higher doses cause the most distressing side effects. It’s getting to be VERY frustrating!

    By the way, Lamictal, Wellbutrin and Prozac are not the only meds or combination I’ve tried. In fact, you name it and I’ve probably tried it. Lithium, Cymbalta, Seroquel, Zoloft, Luvox, and on and on and on. This is the combination that works best so far but as I said the side effects are still very frustrating.

    I’m know I’m not the only one having difficulty finding the right medication but I just had to vent!

  31. I used to take them for schitzoeffective disorder. I know people that take them and they really work for them. My experience was horrible. It actually dibilitated me even more. I am a high functioning person. My husband said that on them I was a pious bitch and not loving. I was like a different person in a bad way. It was like no matter what kind I took I had some kind of bad reaction. He felt I was better not on them.

  32. My only comment is that it’s a shame that anytime a person who’s isolated and suffering reaches out in person to a pdoc or on the Internet; chances are there’s pharma advertising behind the website or the canned advice. Big suprise.. there’s 3 separate ads for Seroquel XR (not generic Seroquel but a new patent extended version). I’m no conspiracy theorist either; I have 20 years experience on the business end of treatment. One thing the mental health industry is short on is results, best to put your hopes elsewhere

  33. 4 help w/ psychological disorders, add checking your blood sugar, nutrition levels, and especially B vitamins – which nourish the nervous system and brain w/ the things it needs to keep the proper chemistry. Seriously, most of the meds will deplete some of your vitamin intake. The worse you feel, the worse your diet gets too. Forget to eat your fruits & veggies and you’ll feel even worse, (should be 2/3rds of your diet). Also, many mental disorders can be a symptom of your body’s rejection to some kind of chemical or food (allergies/sensitivities). Eliminate things that make you feel worse 1 to 3 days after eating and you’ll see what I mean. The Dr’s won’t tell you this though, because they can’t make $$ off of a healthy patient. They don’t know squat about nutrition. Same reason w/ the med companies. Don’t stop your meds, but supplement with a healthier intake of food – and the #1 secret to mental health is this – don’t eat processed foods, read the labels if you don’t believe me, it’s all chemistry, not nourishment. And they all affect your brain and CNS (see FDA.com for lists of food additives and problems with them).

    • I am interested in seriously changing my diet. I have finally been compliant for a whole year, and I’m doing great. I know that to feel much better, I need to change my junk food diet, and start to excercise.

      Can you suggest some foods that will help?

      I’m thinking High protein smoothies, yogurt, cottage cheese, salmon, turkey sandwiches,
      sauteed vedgetables for dinner.

      I love coffee, but I add too much creamer, so I’m thinking green tea.

      If you have time please add your input
      Thanks so much!

  34. Well, I don’t know about all of that above and all of those posts.. What I do know is that I am a 33 year old male who lives with Bipolar 1 every single day of my life. And here is my story.

    After years and years of misdiagnosis and medication after medication, got off all of my meds, went to college, spent 4 years “self medicating” with weed, cocaine and extacy. Sleeping about 30 min per night. Had lots of friends. Came home after getting my degree and spent 2 years sitting in a chair not able to eat on a regular basis, take baths/showers for weeks at a time, shave, brush my teeth or go the the store for food without having a panic attack. At the end of those 2 years I was able to finally lift myself out of my chair and slump. I figured out that something was wrong with me that no md or therapist could tell me up till this point. NO ONE asked the right questions and no one had an idea what was wrong. I went to my local medical school and did 4 weeks of research on my own and came down to 1 of 5 possible choices that it could be. I then went back to the docs and asked them to test me (independent from eachother) to see which one it was. While they were compiling their results I started to go back in my memory and I started asking my family questions to see what memories of my childhood I could remember and which ones were real. The doctors came back and (not knowing what the other doctor had concluded) both said that I was Bipolar 1. I then spent the next several months compiling my memories and my childhood as far back as I could remember. I went back till about age 4. My first auditory and visual hallucinations were around age 9. I was shown my school report cards from every year since first grade and it showed that during one portion of the year I did great and had lots of friends and the second part of the year my grades slipped and I had trouble keeping friends. SINCE THE FIRST GRADE mind you. I kept up with my research on myself and continued to pile up my life in notebooks and realized that my depression and manic eppisodes usually lasted about 6 months each and the manic eppisodes usually came first. About half of my life was spent in a world of my own that only I remember and the other half was spent sad and all alone. Several eppisodes can be contributed to what I call acts of nature or things that happend in my life. Most of them have no reason for happening at all. They just started and then the finished with no rhyme or reason. After figuring out my life I started to go to therapy and take meds at the same time. I did this for about 4 years untill all of the known medications were used up and all known psyhcotherapy was used up. I then got myself admittied to a hospital in a psych ward for 6 weeks. Read up on all of the books about Bipolar and realized that for some people meds just don’t work. So I worked on finding my triggers and my signs that I was slipping into a manic or depressive episode and learned to control them on my own. Shorty after leaving the hospital I started to rapid cycle and mix cycle. My episodes from “normal” to full blown mania (auditory and visual hallusinations) to full blown depression (suicidal thoughts) and back to “normal” would last about 15 min. and occour about 3-4 times a day. This is when I figured out how to “ride the waves” and function at the same time. I then heard about a trial for Bipolar study meds and enrolled in it. I found a blend of medications that stopped the rapid cycles and eventually gave me my life back. My meds along with my daily, hourly and some times minute by minute self checks were able to get me functional and on my feet. I don’t know about meds vs in your head and all that the other posts talked about. What I do know is that if you are Bipolar, study up on it. Read about it. Learn yourself inside and out. Be honest with yourself and your doctors. Take every possible, available opportunity and use every angle to get a leg up on what ever it is that is causing your Bipolar. Know what works for you and if you have not found it yet, keep trying differnt things. Don’t stop untill you find your concoction, your mix, your blend. Whether it be meds, therapy or both. You can get a handle on it.

    • Hi there

      Saw your post..and it is a very frustrating condition to go through. I know I suffer from depression and anxiety, as well many symptoms of bipolar. Thank you for your note.

  35. There are two issues I have with this post. First of all, Bipolar IS a medical illness. It is highly genetic. Why is it a medical illness? Because “thinking the right thoughts” wont make it go away. If you try to treat it only with talk therapy, it will not be successful. It needs medication, which makes it a physical illness. Unlike many other forms of mental illness, which can be healed or dealt with using talk therapy alone, bipolar disorder cannot be. Sadly, whenever there is somee illness that occurs in the brain, it is automatically a “mental” disorder, which, by most peoples terms, carries more stigma and is seen as ultimatly controllable by the sufferer, either my changing their thoughts or changing their viewpoint, beliefs, etc.

    Just because the doctors classifiy it as a mental illness doesn’t mean it’s right. There have been many many instances in history where doctors were wrong. Furthurmore, the whole classification system is rather subjective anyway. When you say “mental illness” versus “physical illness” what do you really mean? I mean, mental illness is the software of our brains, and physical illness is the hardware. Without medication, you can’t change the hardware. Although studies have shown that the best treatment includes both talk therapy and medication therapy, this is most likely because talk therapy can help a person deal with the consequences of having bipolar- which are many and varied.

    I think believing that bipolar is a “mental illness” is one of the worst things a person with bipolar disorder can do. Because then the bipolar person believes that you can “think your way out” of bipolar, so they’d be less likely to take their meds. Plus it makes people with bipolar feel bad about things that are really out of their control. the only thing in your control is to take your medication and accept this disorder.

    Me- I’m a high functioning person with type 2 bipolar disorder. I think of my medications as a sort of vitamin for the brain- my brain just doesn’t happen to make the same chemicals (that prevent extreme hypomanic, depressed or mixed moods). Its just like how how body can’t produce certain vitamins- (vitamin K, vitamin B12, etc). Did you know that if humans lack those vitamins, we could get depressed, irritable, sluggish, etc? But thats the case for ALL humans, and those vitamins are also easily available so it doesn’t bother us. But people with bipolar- well, we are just different. We just have an “extra” vitamin that we have to take. It’s nothing to be ashamed about.

    I wish people would stop continuing these myths about it being a mental illness that you can think your way out of. Also, I am really upset about how this author says that you wont need meds for the rest of your life. Why is the author saying that when it’s most likely not true? And furthurmore, what is wrong with taking medications, especially if it’s a physical illness that just happens to be in the brain? Nothing! Thats what.

    So for people out there who have bipolar and are agonizing over all of this- don’t worry about it. There is nothing wrong with YOU. As a person. And there is nothing wrong with medications. It wont change YOU as a person, because it is affecting a medical illness and not a mental one. The bipolar moods are not your real moods- they are just products of a physical disease. If you want to have a normal life, don’t listen to the fools who tell you not to take medication. It’s just like any other medical illness- you really need to.

    • Saying that being bipolar is a mental illness does nothing to help the problem! Believing that something is wrong with my brain only makes me feel powerless to the disease, as if it’s something that I cannot control. I’m glad this article called it a myth.

  36. Some portions of the medical community, who benefit from an older model of bipolar, have trouble incorporating newer scientific studies.

    What has been proven is that bipolar is a disease of the brain. It has stigma because, at times, the abnormal brain chemistry produces unusual behavior.

    Medication can aid in correcting some of the physical problem. Because drug therapy is not an exact science there must be back up to manage the disease.

    Under the old model of bipolar it was thought that the individual has emotional problems and psychological therapy was necessary. Because bipolar is actually centered in the brain and causes an inability to process emotion normally, talk therapy offers no resolution, although may provide a support person.

    Once the diagnosis is accepted what does work is life management. As with most diseases it is recommended to reduce stress. Careful self observation can lead to enough awareness to let the psychiatrist know about possible medication adjustments.

    I use the term “normal” to mean functioning within society, and not exhibiting extreme highs or lows.

    I hope there will come a time soon that Doctors let go of talk therapy as a necessity for bipolars. As with other sufferers of brain disease, like Multiple Sclerosis, therapy is not what helps the symptoms.

  37. The fact is that bipolar is a disease of the brain.

    If someone wants to go metaphysical and ponder the “why” of any disease they have that freedom.

    Psychotherapy does not aid, or resolve what is centered in the brain. For some it may be helpful to have a support person.

    If anyone would like to educate themselves on the disease of bipolar and abnormalities in the brain there are many opportunities to do so.

    Promoting a belief as fact is very dangerous.

  38. The fact is that even the DSM itself says that people do not know the cause of “mental illness”, including “bipolar disorder”.

    So, you call yourself bipolar and take drugs, and feel better. Guess what, lots of people feel better when they drink alcohol or smoke weed. You don’t know that your favourite drug isn’t just making you high or impaired. Until a doctor can come along and scan your brain and test your blood and tell you exactly what’s going on, I think it’s dishonest to say you have a brain disease.

    And note that I am taking lithium at the moment, have a diagnosis of Bipolar 1, and have been tried on at least 9 or 10 different psych drugs, most of which have made me feel crappy, not normal or balanced, so I have “been there”, wherever “there” is – seems that whenever someone is critical of biological theories, they’re accused of not “really” knowing what it’s like to have the experiences in question. Though I will say that there are things in the description of bipolar disorder that don’t resonate with me.

    I think it’s good to see someone say that we aren’t doomed to a life of what amounts to social deviance. If some people prefer not to take drugs, why not let them try? Like I said above, it’s not like your doctor is coming to you with blood test and brain scan results that tell you that something specific is going on in your brain. It’s not like thyroid disease or diabetes where they can say “Your TSH is elevated and thyroxine will bring it down,” or “Your blood sugar is raised, take metformin and change your diet and it will come down”.

    Sure, there is research going on. But until that research is actually proven to be applicable to *my* brain, I’m carrying around a sack of skepticism. I know very well that taking lithium may calm me down (after all, that’s what it originally did to guinea pigs), but I’m not going to conclude it’s treating some exotic biological problem until I’m given proof that I have one – proof in my own brain, not statistics, or pretty fMRI pictures of other people’s brains, or a psychiatrist’s behavioural judgment.

    And did you know that when lithium was originally used, in the late 19th century, it was thought that manic-depression – then a fairly new concept, too (putting the insane in asylums had allowed them to start classifying madness) – was related to the production of uric acid and to gout? After the uric acid theory fell out of favour, lithium was abandoned for decades. Just goes to show that all sorts of theories have been used to justify what are essentially empirical treatments.

  39. After suffering all my life with severe insomnia resulting in hallucinations, speed-talking, wild thinking—and trying every psychological “treatment” including Primal Scream therapy, talk therapy (Freudian & Jungian), art therapy, prayer, meditation, biofeedback—NOTHING worked until I got medication. Depakote & seroquel stopped the endless manias and made the suicidal thoughts Stop after I’d been on both meds for 6 weeks. I am able to stay stable by meeting with an MD & staying on my meds. Talk therapy did Nothing. Meds helped so much. I also have to be sure to exercise, not drink alcohol (I never did “street drugs”) and stay away from negative people. No one can convince me that meds are bunko. They saved my life. I was 45 when diag. with bipolar. I had suffered from Day One. My father has this. So did his mother. It is a physical condition. Psychologists may want it to be a “mind issue” so they can get paying clients. But I am living proof that suicidal thoughts & super manias can be successfully treated with Medications.

  40. Hi I am hanif from Iran .I am bipolar and do not want to control my mood by medicen. I am trying to find the good solution

    • Good luck with that!

  41. I would ask that this doctor spend a year or more as an unmedicated bipolar I and see if going on or off meds helped or not. Psychosis in bipolar is very real as is mania and everything else that happens off medication. Saying its not a medical issue is like saying “this is just your personality flaw”- extremely insulting.

  42. I actually found this article encouraging. I know my bipolar was triggered by certain events. And I also believe in the power of the mind, which makes me able to do what I got to do even if many claim it’s impossible to live with untreated bipolar.

    I found no relief when I was told the problem was in my brain? My brain, which gotten me trough high school with great grades and gotten me into a Uni, where only top 10% people were accepted? This brain was supposed to be wrong? I was actually devasted by this. I was hoping that my shrink would help me to understand myself, but she insisted that all I do is just a symptom and that I need to be drugged into oblivion. The thought that I may gain weight, lose my hair, have problems with memory, feel exhausted, lose my sex-drive, become emotionless… I decided that the risks are far too big for my liking… And to be hooked on chemistry for the rest of my life? Talk about bleak future.

    I still struggle, but i finished my school, I am trying to find a job (and no, it’s not the bipolar that keeps me back, it’s the crisis, and I am just sad statistic of unemployed graduates). I live and despite the occasional lows… I live with capital “L”. I do yoga, I explored the whole eastern philosophies… and I take my bipolar as a personality trait. Just like being lazy (because I am, naturally) and reckless, sarcastic and dark-humor loving, somehow dark in the soul… it can be turned off by a willpower, if the will is strong.

    No offense anyone… but well, you can blame it on my brain, always.

  43. I stumbled upon this site while looking information, and I was appalled that the author would even suggest that bipolar disease is not a physical medical condition. Quite frankly, when my 18 year old son was diagnosed with bipolar disease and put on medication, I was shocked: how could a drug affect the very way he thought? It was one of those moments when all my prior experience and prejudices were called into question, shaken to the core. No amount of therapy had helped him, no attempts to mold his behavior. It did take years to get a diagnosis because of his age and the development of the disease, but please…if you are reading this…don’t let someone tell you it is a “mental” disease as if the brain is not a physical organ affected by chemical imbalances. And yes, he comes from a stable home and was fine until about age 11-13 when he first mentioned the “fastness”. It’s time to bring the so-called “mental” illnesses out of the closet and the funny farm and get beyond superstitition. (P.S. I refuse to call it bipolar disorder…it is a disease, and there is even some evidence that it is viral in nature).

  44. As a clinically diagnosed bipolar patient, just coming home from a weeks stay in the mental health unit, I have to say that I can tell by speech patterns in previous comments who is on meds and who is not. LOL! And to people that think medication does not work: I challenge you to walk around for years experiencing delusions, psychosis, both auditory and visual hallucinations, obsessive thoughts, homicidal and suicidal thoughts, all of which you CANNOT control and would be willing to kill yourself to rid all the former and one’s pain. Realize you are in DENIAL, yet another symptom that comes with Bipolar, and get some good darn help via your nearest emergency room, psychiatrist, and therapist. The mental hospital, depakote, ativan, and therapy has saved my life as well as protected others. Sure, keeping up with meds, doctors, and constant and careful observation of my thoughts is tiring, but its certainly better than a life behind bars or in a grave.

  45. So, what EXACTLY is the difference between an Illness and a Disease?

    I look at the similarities of diabetes vs. BPD. With diabetes, one can control their Disease through a combination of diet and/or medications. It is also possible to come off of diabetic medications by controlling diet. i know of a lady who did just that. However, a person who can do that will still be prone to going back on medications if they alter their diet in a negative direction. But,is that true for all diabetics?
    So, if a BP person can control their moods with diet (and/or therapy), can they come off their meds? And if they change their diet in a negative direction, will they need to go back on their meds? And is this true for all BP people? So, does this analogy make BPD a didease?
    I realize the the answer to the above example is far more complex than that. I don’t mean to minimize the complex nature of BPD.
    I am BP 1, and for sure cannot ever come off my meds without having disatrous effects. Therapy and diet seem to make little difference for me. It is an animal that controls me, I don’t control it. I can recongnize the on-coming symptoms, but I can’t stop them.
    So, do I have a disease or an illness? What exactly is the difference between the two?

  46. How I Cured My Bipolar Disorder
    I read that omega-3 was being used for psychiatric disorders and gave it a try for myself. It didn’t work, but I noticed that after 13 years my urine had no calcium sediments in it anymore. Before omega-3 supplements any extra calcium I ate showed up as extra urine sediment. I then read that calcium was important for proper neuron function and added calcium supplements to my diet thinking that I might not be getting enough. I increased the amount until I started seeing calcium sediments in my urine again. My mental symptoms stopped then. I believe the mechanism for the success of omega-3 is through its ability to allow the body to maintain a higher blood level of calcium. Higher calcium levels are known to reduce the level of excitability of neurons. Perhaps omega-3 allows the kidneys to reabsorb calcium to a level that satisfies all the body’s requirements.

  47. Having a mental disorder since childhood I can say from my own experience that bipolar disorder is a physical illness. I don’t need a doctor or scientist to tell me otherwise. When your brain chemistry is out of whack, that’s physical. Bipolar is part genetic and part environmentally created. For me, both are the cause. When I get depressed the front part of my head feels like a thousand pounds of weight is pushing down on it. Is that not physical?

    My heart goes out to all of you with this disorder. It has caused me great suffering during my life and I hope with medication, nutritional supplementation and therapy I can lead a fuller life, without as much depression.


  48. OK here I go. GMO plus the use of roundup kills the body’s ability to produce a critical enzyme ( I think its called P243. Anyway this renders the body unable to process certain sticky proteins like gluten. This accounts for the growing number of celiac and gluten intolerant people. The growth in autism may also be linked here. Now even if that’s inaccurate it isn’t inaccurate to say that coating your intestine with wheat gluten and starches prevents nutritional absorption and causes leaky gut syndrome/ This can trigger thyroid distress and neurochemical imbalances responsible for brain function and mood.So stop gluten drop sugar and eat clean/organic produce.Of course that is only half the battle. Coping skills and support is what is needed but often unavailable. Thanks internet for being here.

  49. The only thing I wish you had added to this to make it 10 myths is that bipolar is not just one mental illness. There are three different classifications (a,b, and c ) and they are all characterised by different symptoms. A is what everyone takes as typical bipolar but the other two are still around, even if they aren’t as common…

  50. Bipolar disorder is a medical/physical illness. So is meningitis; so is scurvy.

    I quit trusting anything you had to say when I saw #2 and that you thought that that was a myth.

  51. Hi Dr John,

    We are in India. My father is suffering from Bipolar Disorder from more than 30 years.. on and off.
    Recently the severity has become too much. He was on medication: Lithosun SR for last 3 years (since his last manic/depressive episode).
    Now recently it strike again, and i went angry saying you have called for it yourself. You are responsible for it and please leave us or Die!
    My parents are bankrupt because of this disease, and their household is running in rough waters from years now.
    Recently he ran away from home 3 days back. We are waiting, but no wherabouts from any of the relatives or friends.
    What should we do if he returns home? Generally doctors give electric shocks or injections to calm him down. But he doesnt want to visit the doc.
    1. Can you suggest what treatment should he get?
    2. Can you suggest any good doctors or hospitals in India?
    3. Generally doctor gives him medicine and not psychotherapy. Should we get psychotherapy also done? Can psychologists treat him?

  52. Hey so I am 15 years and I think 100% that I am bipolar cause I have all the signs and in all my tests I got high scores I know its not a good thing but I really have 2 many problems tye main one is I can never concentrate especially only in school the 2nd is my mom doesn’t care at all she thinks I am just imagining and nobody is helping me



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