[blame_lewis]

This is a really dangerous and misleading way to look at bipolar.

The disease proper of bipolar disorder is progressive and degenerative. This progression is accompanied by structural changes in the brain [1] as well as biological changes in the body [2].

If someone had the syndromes of manic or depressed symptoms in response to a medication, that does not prove either way that the person actually has the progressive and degenerative disease that can induce those syndromes spontaneously. If withdrawing the medication completely solves the problem, it simply indicates that they don't have the disease.

The sentiment of "we're all a little crazy" is very old, and very dangerous to go around repeating. There's a specific threshold where things suddenly get orders of magnitude more fucked up, and anyone who has crossed this threshold will know how damaging it is to treat these diseases as if they're just an extension of normal human experiences.

If you have this disease, you need to halt the degenerative process. I've taken my meds every single day for the last 14 years because I know what will happen if I stop. I have friends and family that went down that road, and it isn't pretty.

[1] https://www.sciencedirect.com/science/article/abs/pii/S00063... [2] https://www.sciencedaily.com/releases/2016/05/160531104421.h...

[jniedrauer]

> The disease proper of bipolar disorder is progressive and degenerative.

This is also not entirely true. It may spontaneously resolve itself in many cases[0]. I suspect that we've grouped a number of different disorders under the label "bipolar" because they all manifest with similar symptoms.

[0] https://www.sciencedaily.com/releases/2009/09/090929141530.h...

[blame_lewis]

Thank you for that! I hadn't seen it before.

I'm a little nervous about the idea of coming to conclusions about individual outcomes based on national surveys of self-reported diagnoses. It seems like there are vast opportunities for outside factors to mislead attempts at analysis.

For example, the proportion of people who were misdiagnosed to start with; the increased openness over time when it comes to accepting or speaking about the diagnosis; the improvement in mental health resources meaning more diagnoses; the possibility that patients decompensate and lose insight or reject diagnoses over time; etc etc.

If you're thinking "that sounds like a No True Scotsman", you're right. The disease is clearly progressive for some people. Declaring that people who don't demonstrate that progression don't have the disease is semantically useless but may be clinically useful.

[Skgqie1]

I think a large part of the problem lies in the difficulty of accurate diagnosis, coupled with people's personal experiences with misdiagnosis.

I've been misdiagnosed as bipolar in the past, and the medication regime I was put on lead to schizoid delusions and incredibly unstable emotional state that only resolved once I stopped taking the medication (under the monitoring of the psychiatrist who initially prescribed them).

My mother was also misdiagnosed as bipolar, leading to her actual condition of Borderline Personality Disorder going untreated until she attempted suicide (she died 6 months after because of complications relating to the attempt).

A friend of mine who is schizophrenic was also misdiagnosed as bipolar, because his delusions and paranoia were fairly minimal. In his case, the misdiagnosis was probably more helpful than not, as the medications were helpful in stabilising his mood.

My point here isn't that the medical establishment is bad or that doctors are stupid. It's that disorders related to mental illness are very, very difficult to diagnose and treat, even for incredibly intelligent trained professionals. Many disorders have significant overlap with other disorders. An effect whose impact is only made worse by the fact that a bunch of these disorders are highly co-morbid. Mix in the fact that the borders between healthy and unhealthy are not especially well defined, and it's easy to see where a lot of the contention comes from

[mercer]

I'll add that someone who might be (self-)destructively bipolar in one environment, might be able to 'manage' in another, even without medication.

I've had multiple friends with diagnosed bipolar disorder, and harrowing and heartbreaking stories of how this affected their lives well into their twenties or even early thirties.

All of them have found ways to 'manage' their condition, without medication, through a combination of lifestyle changes, (odd) environments, and, perhaps most importantly, a group of friends who can deal with it or provide support in various ways. Some of them have been on medication for periods, and much prefer their current, imperfect situation.

By no means would I advocate avoiding medication, and I'm absolutely not saying that this can work for everyone. I'm also not arguing that their lives are just peachy now. It's a serious disorder.

And I do agree that people making statements like "we're all a little bipolar/autistic/borderline/etc." are often not helping and often actively harming those who are any of that more than 'a little'.

I've been diagnosed with autism and it's maddening how often, when I open up about it, people will say stuff like "well isn't that 'just' <x>" or "everyone has that". At this point I usually don't even bother trying to explain that there's a difference between, say, being punctual and curmudgeonly about it, and having a borderline-meltdown when plans change.

[Talanes]

This is very interesting. I had a childhood diagnoses that I've always chalked up to just imitating my properly diagnosed single-mother. I was also under the impression that if I truly had the disease, that my current level of mood stability would be impossible.

Though my years don't line up with the results of the study at all. I was medicated from 8-14, and then really mellowed out around 19.

[c22]

I've definitely crossed that threshold before and, personally, I feel like I could have been better served by practitioners who viewed my condition as more of a place on a spectrum than as a specific disease that could be treated with medication. I tried many prescription drugs (or many were tried on me), some which had disastrous side effects. I had the best response to lithium which I used for a few years but it made me balloon up in weight and had some other negative side effects. For about 12 years I've managed my position on the spectrum with a combination of diet, introspection, and what I've learned are meditative techniques without any medication. And while I do run the risk of crossing that threshold again I have become adept at noticing when I am approaching it and correcting course. Every year I become more confident in my ability to stay balanced and I no longer experience the negative effects I endured while treating it as a disease.

[solinent]

There are also structural changes in the brain as time passes, and hopefully biological ones as well if I'm going to digest this food I just ate. What structural changes are present and can these changes be used to diagnose the condition? Are these changes necessary for the condition? To me it looks like gray matter loss is not exclusive to this condition, these studies only quantify brain matter density, not structure. This study is also not very well designed, it only studies BPD patients without studying patients that may potentially have the identified defect but not the diagnosis.

Our diagnosis of psychological conditions is very vague as well--is bipolar disorder diagnosed as lack of gray matter? If it's not, then why not?

[blame_lewis]

I'm pretty sure there is more extensive literature involving the exact types of degradation that is characteristic to the disease, but I do not think I'm competent to cite it correctly.

I'd imagine this process isn't so great for diagnosis given that it's mostly been observed in people with decades of uncontrolled disease behind them.