
The Problem With How We Treat Bipolar Disorder - jjb123
http://www.nytimes.com/2013/04/28/magazine/the-problem-with-how-we-treat-bipolar-disorder.html?pagewanted=1&_r=0&ref=general&src=me
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QuantumGood
They're just throwing chemical darts and trying to sort out what they're left
with. They don't know if they're making people worse or better.

E.g article comment at <http://nyti.ms/12QAy1D> points out "six months of
mania as the result of a [drug] reaction…followed by a misdiagnosis…" Author
herself doesn't seem to notice that she has depression _before_ being treated
with drugs, but it's bipolar _after_ being treated.

Not a single mention of meditation or similar therapies, which have been much-
studied and successful for many people. As if they don't exist as therapies.

A friend took a drug for mental health issues for ten days, and has had nearly
twenty years of side effects (so far) affecting his sleep (he twitches when
melatonin is released—or taken as a supplement). It never happened before,
became severe on the drug, faded slightly in the months afterwards, and has
never fully receded. Has tried many things to treat. And this is a small
thing!

Throwing chemicals at problems when they don't know what will be solved or
caused should really only be a last resort.

~~~
lk145
It was a last resort, the author was in in-patient treatment in extreme
circumstances in which she had had frequent suicide ideation. Therapies that
aren't drug based, while often effective, don't work that quickly and are more
of a long term thing than an immediately stabilizing treatment for someone in
an extreme crisis. Drugs are your best (and only) shot in that kind of
situation. There are plenty of places to get therapies like meditation and
similar therapies relating to mindfullness - from psychologists who offer
cognitive behavioral therapy and its offshoot mindfullness-based cognitive
therapy. They're two of the very popular and widely available types of
psychological therapies in the US. In this story I wonder if the author's
insistance on going to her father's doctor has skewed her perception of modern
psychiatric and psychological treatment -- the story took place in the 80s and
if the doctor treated her father he had to have been kind if old, probably
trained in the days when psychiatry research was in complete disarray and
completely unsympathetic to patients' well-being and when the few popular
psychological therapies that did not involve drugs or surgical treatment were
things like rogerian therapy and psychoanalysis - not as effective as CBT and
frankly based on little science.

I think there is also a misconception that psychiatrists and psychologists are
the same thing when they have entirely different purposes and training.
Psychiatrists have med school educations, thus they deal with drugs (which are
often quite necessary and effective) and acute in-patient kinds of cases more
often. Psychologists have training which focuses more on effective treatments
which are either are not drug based or work in conjunction with
pharmacological treatments. They're the ones you go to for issues with the
self or if you want therapies related to mindfullness or cognitive behavioral
therapy.

~~~
QuantumGood
True that "as suicide eclipsed all other thoughts…The next day I was
hospitalized" but there is no mention of _any_ therapy, intervention, nothing
before that point, and they decided as a first choice to go to a
pharmacologist because he had helped her father.

By last resort I mean try something else first. Later, the pharmacologist
explained that she was very different than her father.

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tokenadult
It took me a while to read all the way through the article, because I was
doing things with my family. And maybe that is exactly the issue. The author
of the article reaches a happy ending when she reflects on involvement with
children and hoped-for grandchildren. The anecdotes she relates about her
treatment, by the way, reflect the how far understanding of bipolar mood
disorders and their treatment has come in the last few decades. She writes as
a sixty-year-old with decades of treatment behind her. If you are the age of a
typical Hacker News user, you are younger, and today in 2013 if you seek
treatment your doctor or psychologist has a much better experience base and
theoretical framework to work from in designing your treatment.

The author's main point about what needs more attention in treatment of
bipolar mood disorder I cannot fully agree with. Unlike her, I have lived in
more than one country of the world for a long span of my life, and at a
slightly younger age, I have decades of my life that were spent looking back
at living a very culturally and linguistically different place, where "self"
plays a very different role in individual lives. Human beings get better as
they become more connected to their communities, not usually as they become
more self-absorbed. (I'm looking for a link just now about that--perhaps I'll
add it in an edit if I find the link I'm looking for.) It's great that the
article author has family and community connections. The best reason to take
individually prescribed medicine is to help build up interpersonal
relationships. Preoccupation with self-identity is not a cultural universal,
but being with and dealing with our fellow human beings is.

~~~
logn
I think the author is focusing on the "self" in terms on her conscious state
and how she feels. Like the difference between being drunk, sober, stoned, or
hyped up. Look at patients on heavy anti-psychotics and you'll know what she
means. Doctors focus on stabilizing people, not making them feel normal. If
you can get up and shower and go to work, they're happy. They don't care that
you might feel completely drugged.

~~~
andreasvc
No I do not think so. What you describe are called mental states, which are
transitory; the self is a relatively persistent concept, spanning one's
personality, identity, and life experiences. The author is arguing that rather
than just suppressing symptoms with medication, an important part of recovery
should be to develop a new self-image that includes the disorder. The
medication doesn't help in this regard, but apart from that there are the
things one did during episodes which can be very hard to rhyme with one's
previous self-image.

tokenaudult's point of other cultures not having such a focus on the notion of
the self is very interesting; it seems to completely undermine the idea that
the self is key to recovery. It is very typical that stories about mental
health end with some suggestion that is going to solve it all, but to me it's
clear we are simply stumbling through the dark.

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abecedarius
Well-known hacker Zooko wrote about his family's experience with bipolar
disorder: <http://zooko-on-aaronsw.blogspot.com/2013/02/part-2.html>

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jjb123
The self is such a critical over-looked aspect for doctors that are primed to
think of everything as a physical, chemical, medicinal equation when it is
often so much more than that.

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yekko
Fish oil is far more safer and effective...

~~~
illuminate
Snake oil, you mean.

<http://www.badscience.net/category/fish-oil/>

