Sunday, March 28, 2010

The People’s DSM: My Alternative Bipolar (Cycling) Diagnosis - Part II

As opposed to depression, a highly-complex illness that clinicians dangerously over-simplify, one can make a strong case that bipolar is far more simple than it looks. Change the name to “cycling illness” characterized by “phases” rather than “episodes” or “states,” borrow what’s relevant from what we already have for depression, fill in the blanks with a little bit about what “up” looks like, and stop right there.

Indeed, my first installment did just that. When stripped to essentials, cycling illness is basically a pattern of down and up. And since we tend to be down way more than we are up, it’s fairly accurate to say that cycling illness is depression with speed bumps.

“Up” is anything that contrasts with down. You don’t have to be dancing on tables. “Normal” or “better than normal” will do, so long as it shows you have a depression that is not standing still.

Complex depression, simple illness. Simple, really.

Okay, “up” needs to be explained a lot better than what you find in the current and highly antiquated DSM mania/hypomania symptom list. You can have racing thoughts, grandiosity, pressured speech, and all the rest, but are you feeling great or feeling lousy?

The DSM doesn’t tell you. Can you believe it? Myth has it that we’re supposed to be feeling like Leonardo DiCaprio with Kate Winslet on the bow of the Titanic (or vice-versa), but too often we’re more like Kim Jong il on a bad hair day.

Depression with a power surge, in other words. “Dysphoric” mania/hypomania, as opposed to “euphoric,” which I laid out in full in Part I.

Another way of looking at it is our depressions and manias are mixed. Hence the need for this Part II exercise. Think of dysphoric mania/hypomania as the cycle gone crazy - out of phase, so to speak - with both up and down screaming for attention at once. One is crashing down the door while the other hasn’t yet left the building.

How much depression inside mania/hypomania do you need? Only enough to turn euphoric mania/hypomania dysphoric. No need to count symptoms. Simple. Do we even have to add the specifier, “mixed,” to dysphoric? No. It’s totally redundant. Then again, maybe we better, thus:
Meanwhile, over on the other side of the diagnostic divide, we already have “agitated (or mixed) depression with mania” (which we would include on this side of the divide, as well, without specifically having to spell it out). In some cases agitated depression may appear difficult to distinguish from dysphoric mania/hypomania, but, hey, this is life in the real world. Depression and mania co-exist on the same spectrum, and, contrary to what the current and future DSM would have you believe, the two overlap. One bleeds over into the other. They don’t separate for the convenience of clinicians in a hurry.

Finally, what about situations involving say just two symptoms of mania combined with just three symptoms of depression? Going by official DSM criteria, you are healthy. Except for the fact that you are feeling rotten. Fortunately, The People’s DSM is not anal about symptom counts. Problem solved.

Dare we get more complicated?

Coming soon: We get more complicated. In the meantime, your feedback is strongly encouraged. Comments below ...


Willa Goodfellow said...

So are you simply going to erase these two categories and their redundancies in favor of a mood disorder spectrum, with "unipolar, non-recurrent, one antidepressant and you're good to go" depression off to one side? What are you waiting for? People's DSM II? :-)

John McManamy said...

Hey, Willa. You got it! Why wait? :)

Willa Goodfellow said...

Do I get a prize?

John McManamy said...

Absolutely. An autographed copy of The People's DSM. :)