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The Problem With How We Treat Bipolar Disorder (nytimes.com)
32 points by jjb123 1692 days ago | hide | past | web | favorite | 10 comments

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.

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.

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.

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.

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.

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.

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

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.

Fish oil is far more safer and effective...

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