I Wanna Be Bipolar

Yeah, and shoot twenty foot of jism too. And fuck up the Jews.

I wasn't gonna go near this with a ten-foot pole until this morning when I was over at Polarcoaster and Soulful Sepulcher and spotted a couple of comments by Jon, the author of the blog Living With A Purple Dog, about the blogosphere's response to the SBD diagnosis:

I can’t decide if all the outrage I’m reading about this is really pointed at big pharma, or if it’s because a private club will suddenly be adding marginal members.

Doesn't it almost seem like many with bipolar disorder are threatened by SBD? Like everything else, it's black and white. With us or against us. Pro or con. Bipolar.

These comments struck a chord with me first and foremost because I was privately questioning the assumption that SBD was all the doing of evil psychiatrists and pharmaceutical companies trying to maximise profits by thrusting evermore constrained definitions of normality down our throats. Of course, Jon's comments don't address the issue of what is motivating shrinks and pharmas to come up with this stuff, but instead go straight for the jugular, attributing the criticism of it to a perceived elitism on the part of those diagnosed with 'ye-old-style' bipolar. I'm actually more interested in the former than the latter, but will return to his most contentious of contentions later on.

For the record, I do have a problem with SBD, largely because I have a problem with the way psychiatry is currently practised. It is practised in a way such that the more exposure someone with mild-to-moderate emotional difficulties has to it, the greater the likelihood that those difficulties will be exacerbated to the point where they do meet the criteria for one or more Axis I or II diagnoses. For example, injudicious use of SSRIs and antipsychotics, coupled with the disinhibiting effects of benzodiazepines, can provoke a miserable but otherwise calm person into a frenzy of restlessness, impulsivity and self-destructive behaviour - in other words, drug-induced akathisia that can easily be taken for some kind of bipolar or personality disorder. Furthermore, one's induction into contemporary psychiatric modes of thinking encourages them to view every form of emotional discomfort as an expression of their 'illness', and thus as a source of panic ("Have the drugs stopped working?"), leading to a diminished sense of their own resilience and the failure of once-useful self-soothing strategies. With the patient now more distressed than ever, the cycle then repeats itself.

On the other hand, I have no problem with the idea that bipolar symptoms exist on a continuum; in fact I find it quite sensible, much more so that the notion that there exists a discrete subset of the population in which a genetic switch gets thrown, causing them to swing from suicidal to berserk with ever increasing frequency. The problem is, as many bloggers have pointed out, when mild, infrequent mood changes begin to be seen as variations on more serious mood disturbances, as opposed to variations on normal. This broadening of the range of emotional and behavioural states that are deemed pathological has a variety of causes and consequences, that are often difficult to disentangle. So what's really behind SBD? Is it really Big Pharma, in cahoots with prescription-happy psychiatrists, or are Big Pharma and friends merely capitalising on an already well-entrenched demand (which, yes, they are probably responsible for instigating and/or perpetuating) for comfortable, non-ego-dystonic, mild-but-somewhat-serious-sounding diagnoses for those for whom something isn't quite right?

Now, no one wants to be a schizo of any stripe; that's no fun. And don't get me started on personality disorders - they probably represent the biggest market for subthreshold bipolarisation. It would have to be so much nicer to be considered to occupy the fringe of a condition with positive connotations (e.g. artistic creativity) that is also taken seriously as a source of occasional disability, than to be called rude names by psychiatrists who just don't like them, and who couldn't be bothered doing their jobs and trying to figure out why they're behaving the way they are. From the lazy psychiatrist's point of view, the arrogant, the attention-seeking, the suspicious and the traumatised can be bundled up and onto medication, conveniently ignoring the fact that diagnosing them as bipolar will only feed their grandiosity by invoking comparisons to Vincent Van Gogh/Lord Byron/Sylvia Plath and all that crap. And of course it is all that crap that makes subthreshold bipolar such an attractive and flattering diagnosis.

I've commented elsewhere about the stigmatisation within the consumer/survivor/ex-user community of people diagnosed with borderline personality disorder. As this is the only personality disorder whose diagnostic criteria emphasise affective instability, it makes it the most susceptible to bipolarisation, and so it wouldn't surprise me at all if some are keen to draw the line between 'us' and 'them', because you know what difficulties those darn borderlines have with boundaries. (Of course, if you're bipolar, 'affective instability' is just 'rapid cycling'.)

But does this go beyond routine borderline-bashing? Is Jon right, and is this a sacred turf war? Will expanding the concept of bipolar to include mild hypomania dilute and sully the sense of positive difference associated with bipolar I and II, and more to the point, would anyone diagnosed with bipolar care enough to wage a false war on SBD by setting up Big Pharma as the sole bad guy?

Sad to say, but many of the people I've met in real life (as opposed to on the web) who proclaim their bipolar diagnosis to the world, especially those I've encountered lording it over consumer groups, make me ever so slightly inclined to say yes.

d has already responded forcefully to Jon's comment at Soulful Sepulcher. But she and the rest of you should feel free to rip me a new asshole.