Talk:Bipolar disorder

Changed paragraph one: Two episodes of mania are NOT needed according to DSMIV. Only one episode of mania and 0,1 or many episodes of depression. Article should be accurate.

Vandalism

I came this article looking for information on bipolar disorder. Instead, I come across complete & utter garbage. It appears that this article has been vandalized, as witnessed by the first paragraph: "Bipolar disorder, often referred to colloquially as manic depression, is another diagnosis that Ed Goodfriend happens to have." This is just another prime example of why Wikipedia is one of the most dangerous websites for mis-information. Cairnben (Talk)

Ocassionally vandals strike at random articles, but vandalism is usually reverted quickly. I just did so myself in this case. Anarchist42 19:20, 27 March 2006 (UTC)[reply]

Marijuana

I agree, People on here who are under the belief THC (marijuana) is helping them are for the most part idiots ,ignorant, or only suffer from Bi-Polar type 2. They must smoke pot so much that they believe the government is after them; and are coming up with many false ideas about drug treatment. I have suffered severe Bi-polar type 1 and almost slip into psychosis immiediatly when I'm manic(acute mania). Ive smoked pot intenstly before onset of the disorder and after but have stopped. Marijuana will only cause 'short term' relief but in turn cause your illness to become worse as any psychoactive drug(including alcohol) will. So in the long run youre really doing yourself in, cause you think you are treating your symptoms but youre only making yourself cycles happen more often and have your episode more severe. Of course I hate Lithium and anyother anti-psychotic drug they stick me on, but im not going to be an idiot and make my illness worse. Just cause Marijuana is natural doesn't mean its safe...is cocaine safe? Nope. In conclusion, if you have Bi-polar type 2(which is really not that severe except the depressive episodes), or misdiagnosed Bi-polar(which happens more than you think) perhaps Marijuana is working for you. Do understand that 'these' same people who think Marijuana should be a legal mood stabalizer would be saying Lithium is the best mood stabalizer if it got them 'high'.

I don't who the above anonymous AOL contributor is, but throwing around insults such as 'idiots' is not a convincing argument, although it does demonstrate the uninformed bias faced by mentally ill medical merijuana users. One person's anecdote means nothing, especially when that person also had negative experiences with Lithium. Anarchist42 20:06, 20 January 2006 (UTC)[reply]

The first anon comment above is pretty ridicoulous. It is POV and seemingly based on personal anecdotal evidence.I find the comment about BPII not being serious espicially telling. 68.66.108.121 10:32, 19 February 2006 (UTC)[reply]

OK, that part about marijuana 'helping' manic disorder is extremely biased and pov. in most cases, it has been known to worsen the condition of the user if he is currently suffering from bipolar.

No, the part about marijuana having no benefits is extremely biased and POV. The pharmaceutical lobby has spent billions to keep it off the market because it grows anywhere and can't be patented. Heaven forbid that people can medicate themselves instead of paying an exhorbitant price for prescription anti-depressants of dubious quality. In my case, as well as the case of several acquaintances of mine, marijuana is very effective at relieving mood swings. I wouldn't be surprised if the majority of regular users of MMJ are self-medicating for bipolar or depression.

My experience with prescription anti-depressants has been very disappointing. They all (lithium, trazadone, Paxil) seem to feel the same: they wipe out my libido, turn me into a zombie, give me bad stomach cramps, and, worst of all, drastically alter my sleep patterns to the point that I have to stop taking them after a couple of weeks. MMJ is much easier on my system; it works within minutes instead of weeks, and doesn't have the 'zombiefication' effect of prescription drugs.

To reiterate, I am absolutely sick and tired of having Squibb, Johnson & Johnson, et al. dictate to me what I can take to alleviate my bipolar disorder. These companies are very unscrupulous and have no qualms against turning the United States into a police state (highest incarceration rate in the world) to maintain their death grip on the anti-depressant market.

The adds that have changed the "Marijuana" section to the "Medical Marijuana" section are very POV, if there isn't any good backing for it, I think that it should be deleted or reverted at least. NorseOdin 12:43, 31 December 2005 (UTC)[reply]

The evidence that you provide seems to be convincing enough for me, if you can get a couple of sources behind it then I have no problem with it being in the article. NorseOdin 14:33, 31 December 2005 (UTC)[reply]

--Seems very reasonable. I'm going to do a quick search on Google and see what I can find. There's plenty of studies like the Shaeffer Commission report in the early 70s and others that show marijuana to be relatively harmless. As for studies to the efficacy of MMJ at treating bipolar, that's much more iffy because of the almost non-existence of serious MMJ research in this country due to the War on Drugs. Something else to consider: if the self-medicated use of MMJ by a manic-depressive person is effective, that person probably isn't going to fall under the purview of the psychiatric sector. Also, any doctor who recommends MMJ to a bipolar person is in danger of harassment by the DEA.

-- With regard to studies on marijuana useage, especially long term usage, the article at http://www.guardian.co.uk/drugs/Story/0,,1713042,00.html mentions a much more recent study which shows long term usage actually causes some mental illnesses. I agree, it is discussing a person who suffers from Aspergers, but one of the key findings of the study is that 95% of psychiatrists say that cannibis causes psychosis. Have had a particularly wierd period of psychosis when I was about 19 (I firmly believed I was the re-incarnation of the goddess Ishtar, to the point of demanding my boyfriend worship me) I know how dangerous these are. I agree, the side effects of the drugs I take to medicate my bi-polar are annoying, and I'd love to get rid of them, but to take something which could make one of the main symptoms of my illness worse - you must be joking. E Lizard Beth 17:28 GMT 20/02/06

Be wary of such correlations, since mental illness diagnosis usually occurs long after the mental illness actually begins. Attempts to show "cause and effect" between mental illness and any activity are unreliable unless mental illness was tested for before an activity. Anarchist42 18:39, 20 February 2006 (UTC)[reply]

Can we turn down the rhetoric a bit and supply some supporting citation for these assertions? There is no shortage of emotional opinions on the subject, but very little here to back these up. Just not enough room here for trolling/flaming. Limbo socrates 16:02, 2 March 2006 (UTC)[reply]

Cleanup

This article is a disaster. Perhaps too many bipolars are in the editing process? <grin> I can tell by looking through the talk page that the edit wars on this subject have been intense. I am a psychology undergraduate at my local state university as well as a type II bipolar. It seems to me there are many places in the article that lack sufficent citation as well as perhaps having information that is outright wrong. For example, the article currently lists THC as a viable treatment option, but I don't see a supporting article in the references section. As I stated below I feel that this article should be split. At the very least the various forms of treatment should be split off to their respective articles. Unless I hear otherwise I will probably begin work on that split as well as increasing the rigor of this article ASAP. Also, since the talk page is rather full, and full of splintered rhetoric I'm wordering if unsigned portions of the talk page that are of undeterminant age ought be moved to the end and given their own section, so that people new to the article, such as myself, can make heads or tails of the conversation at hand. Dark Nexus 16:14, 20 October 2005 (UTC)[reply]

Elitest Norms

I know most doctors have gone through 8 years of conditioning to get to whgere they are today, so they'd never admit this medicine, but why exactcly is it that no one mentions the most obvious cure for manic depression, THC? A perfectly naturally, controllable, effect measue for treat this.

The answer is that the pharmaceutical industry is one of the most corrupt in the United States. I'm not sure where to find statistics, but it's my understanding that they have one of the highest profit margins of any industry. They have no problem with getting tens of millions of American kids hooked on Ritalin, so it's understandable that they don't have scruples promoting the War on Non-Corporate Drug Users even if the result is prisons overflowing with mostly non-violent drug 'criminals'.

It's not hard to understand why they fear legalization of marijuana. It works much quicker than prescription anti-depressants, doesn't turn people into zombies, and feels good to boot. From their perspective, it's a non-patentable plant which can be grown anywhere by anybody--they stand to lose billions in revenue from lost sales of Zoloft, Paxil, etc. etc.

Presently, manic depression (like most mental illnesses) is consider to be incurable. Like diabetes, mental illnesses can only be controlled.

Drug use is generally bad for mood disorders although, of all the illegal drugs, those that contain THC are likely the most benign. Cocaine, in particular, is hell on people who are in the manic phase. Successful treatment of bipolar disorder has more to do with REMOVING harmful things, rather than ADDING them. There's been some interesting recent research on aspartame (Nutrasweet) in this regard. -- EFS

--I don't consider marijuana to be a 'harmful thing'. The brain contains at least two types of cannabinoid receptors and THC itself has a resemblance to a natural neurotransmitter anandamide.--

Indeed, this is true. At best, THC can mask the effects of some mood disorders by burying them beneath its own effects, and it hardly makes the user functional. Stimulants - including cocaine - have been documented to trigger full-blown bipolar disorder in individuals who are already predisposed to it. - 129.49.145.65 16:38, 29 August 2005 (UTC)[reply]

--'Hardly makes the user functional'? I've functioned well for years on THC. On the other hand, it's the crap like lithium or Paxil which has disrupted my sleep patterns to the point where I suffered from delirium due to sleep deprivation and couldn't function at all.--

"Self-medication" is an important issue that needs to be discussed in the main article, considering that it takes the average mentally ill person 7 years to get an accurate diagnosis, and even then other co-existing mental illnesses are usually not diagnosed. Once proper treatment begins it can take several years to find an efficient medication regime. Considering these facts, and the deleterious effects that untreated mental illness can have, it is not surprising that the mentally ill resort to "self-medication" (even if they are unaware that that is what they are doing).

Although any mind-altering substance can be dangerous for the mentally ill (including some prescription medications), some can be of some use in the temporary relief of symptoms. Alcohol, as a natural depressant, is often used to "self-medicate" a manic episode (nonetheless, alcohol can be dangerous for those who are prone to addiction!). THC can be effective for immediate symptom relief (unlike prescription medications) and has few and rather mild side-effects (dry mouth, drowsiness, etc.). It should be noted that, unlike cancer sufferers, mentally ill THC users tend to use very small amounts of THC, often if doses so small that they do dot feel "high". Since THC is natural, and hence not patentable, there is no incentive for pharmaceutical corporations to invest in research; additionally, due to anti-drug propaganda, government's rarely fund THC research.

--Good points about THC. I'd like to also add that, in my personal experience, alcohol and bipolar are a very dangerous combination. Sometimes, alcohol can mitigate a manic cycle, but in my case, it usually made me more obnoxious and anti-social by removing my natural inhibitions against 'acting out' in public.

Actually, there are many pharmaceutical preparations of THC/THC-receptor activators, such as nabilone (a Cannabinoid)!!! Perhaps there is good reason why these drug companies haven't tried to cash in on treating bipolar depression?

--I'd like to add that they've also produced Marinol (a THC pill) and, in Canada, they have something called Sativex which is medical-grade marijuana in plant form. I think the existence of these drugs indicates that the pharmaceutical industry considers THC to be safe and effective enough to develop and cash in on the anti-depressant market (not to mention its anti-emetic and anti-spasmodic properties). However, I'd guess the main reason the pharm industry didn't go far with these cannabinoid medicines is that manic-depressives and other users might decide that it's cheaper to simply grow some marijuana plants than pay something like $10 per Marinol tablet.

How the hell is weed going to cure it? Hah, not likely. misanthrope 17:51, 23 December 2005 (UTC)[reply]

--I don't know if any anti-depressant actually 'cures' bipolar disorder--Standard Operating Procedure is that patients are given a prescription of Paxil, Zoloft, etc. for life--so THC is no better or worse than prescription anti-depressants in that regard.

First of all BP is incurable, secondly why should cannabinoids be any less effective than say Neurontin? Anarchist42 17:58, 23 December 2005 (UTC)[reply]

--It's probably just as effective. However, the pharmaceutical industry can't sell Marinol tablets for $10 each when people can easily grow their own marijuana, so the pharmaceutical lobby has decreed that cannabinoids are less effective.

Actually, Neurontin was given to multitudes of BPs despite the fact that there was NO research to suggest that it did anything (the manufacturer admitted in court that the whole thing was a scam). Now that Sativex is on the market (at least in Canada, with limited availablility in the UK and Spain), researchers now have a legitimate pharmaceutical to use in their research - numerous studies are now underway, including treatment for various mental illnesses. Anarchist42

Instead of ongoing rhetoric, could some of the posters here supply supporting references for your assertions? This page would be significantly shorter if opinions and "conventional wisdom" were replaced with emperical argument. Here are some I just Googled which represent differing points of view (in no particular order):

(In the interest of candor, I am a BPII sufferer who has used cannabis with beneficial effect in conjunction with Rx meds; no signs of schizophrenia...yet ;) Limbo socrates 16:28, 2 March 2006 (UTC)[reply]

Bipolar and Mental Health

1. Biploar Disorder 2. Bipolar Affective Disorder, also known as "manic depression" is a disorder of the brain resulting in unusually extreme highs and lows of an individual's mood over time. 3. Bipolar disorder is a condition that causes extreme shifts in mood, energy, and functioning. In most populations it affects around 1 percent of the population. Men and women are equally likely to develop this often-disabling illness. The disorder typically emerges in adolescence or early adulthood, but in some cases appears in childhood. 4. There are no definite known causes. Scientists believe that Bipolar Disorder may be caused by a combination of biological and psychological factors. Most commonly this disorder can be linked to stressful life events. More than two-thirds of people with bipolar disorder have at least one close relative with the disorder or with unipolar major depression, indicating that the disease has a heritable component. Studies seeking to identify the genetic basis of bipolar disorder indicate that susceptibility stems from multiple genes. 5. Mania is often characterized by insomnia, elation, euphoria, hyperactivity, productivity, hyper imagination, a "flight of ideas," over-talkativeness, etc. Depression or Clinical depression, is often characterized by slowness to conceive ideas and move, anxiety or sadness, even suicidal thoughts or actions. It should be noted that this disorder does not consist of mere "ups and downs". Ups and downs are experienced by virtually everyone and do not constitute a disorder. The mood swings of bipolar disorder are far more extreme than those experienced by most people. 6. There is no cure for Bipolar, how ever there are medications that can be used to prevent a person from going out of control.Medications, called "mood stabilizers" can sometimes be used to prevent or mitigate manic or depressive episodes. Periods of depression can also be treated with antidepressants. In extreme cases where the mania or the depression is severe enough to cause psychosis, antipsychotic drugs may also be used. Some common medications are Lithium salts, Anticonvulsant mood stabilizers,and Atypical antipsychotic drugs. Also Psychotherapy and Electroconvulsive therapy have been shown to be effective.

7. Even though Bipolar Affective Disorder can be extremely difficult at times, individuals (and to some degree their families) who have it, tend to be intelligent, creative and successful. Some also believe that the manic state is a type of universal connection which provides creativity and intelligence but comes with the price of the depressive low.

· Support groups · National Alliance for the Mentally Ill(US) (http://www.nami.org/) · Depression and Bipolar Support Alliance (US) (http://www.dbsalliance.org/) · Manic Depression Fellowship (UK) (http://www.mdf.org.uk/) · Child & Adolescent Bipolar Foundation (US) (http://www.bpkids.org/) · Psych Forums: Bipolar Forum (http://www.psychforums.com/forums/viewforum.php?f=135) · Health Diaries: Bipolar Disorder (http://www.healthdiaries.com/bipolar-disorder.htm) 8. BPrayer: Support for Those With Bipolar Loved Ones (http://bprayer0.tripod.com/)

The above are not support groups. They are pro-psychiatry groups. Don't keep calling bipolar disorder or any other mental illness a "disease of the brain" until you can provide the objective test for the disease. Until then, bipolar disorder remains, like schizophrenia, a social construct. -- Francesca Allan of MindFreedomBC

Agreed, too many support groups and websites pretty much tow the psychiatric industry line. For example, just TRY to find any mention of the Neurontin scandal (heck, some websites STILL promote Neurontin as a psychiatric drug!). Additionally, there is rarely any mention that most psychiatrists regularly mis-diagnosis and/or under-diagnose their patients. Anarchist42

NAMI, for instance, is heavily subsidized by pharmaceutical companies. NAMI's website is not much more than a drug advertisement. Their website is also riddled with comical statements such as the shocking news that bipolar people experience a divorce rate of 60%. (Last time I checked, the general divorce rate in North America was 57%.) -- Francesca Allan of MindFreedomBC

Bipolar disorder, talent and famous people Many famous people are believed to have been affected by bipolar disorder, based on evidence in their own writings and contemporaneous accounts by those who knew them. See list of people believed to have been affected by bipolar disorder. There is no definitive scientific basis for classifying dead people as having had bipolar disorder, though they may very well have suffered from severe and even recurrent bouts of disordered mood. Until very recently there were no diagnostic systems with any degree of reliability. Even with the development of tools such as DSM-IV, there is a great deal of diagnostic uncertainty with living patients who have been intensively studied for decades, and there is no reason to think that it is any easier to diagnose individuals in their graves. For these reasons, some doctors regard psycho-history of this sort as a dubious endeavour. There appears to be an association between bipolar disorder and artistic talent in many cases - this is documented in Jamison's book "Touched With Fire: Manic-Depressive Illness and the Artistic Temperament".

24.58.228.xxx makes the assertion that

Psychohistory is a highly unreliable and dubious enterprise generally promoted by less than reputable psychologists and psychiatrists, patients who wish to be in good company, and organizations that stand to benefit from contributions made by those whose sympathies would be aroused by such "diagnoses at a distance".

The leading author of books on mental illness in history, Kay Redfield Jamison, is a Professor of Psychiatry, at The Johns Hopkins University School of Medicine. She is a MacArthur Fellow. She has been published extensively in peer-reviewed journals. Her book on the subject, 'Touched with Fire', has been favourably reviewed by Herbert Pardes, Dean of the Faculty of Medicine at Columbia University, and James. D. Watson, the Nobel Prize winning discoveror of DNA. Hardly 'less than reputable'.

24.58.228.xxx, your contributions on this subject seem to be remarkably forceful, as if you are speaking with authoritative professional expertise on a subject of which previous authors have little knowledge.

Can you tell us what your qualifications as a medical doctor are?

-- The Anome (who is not a medical doctor)

Reply to Anome: I have entered this reply twice and once in another location for Talk, but for some reason it is not taking. Hence I repeat my reply here, again: For some reason the person who made the original entries on bipolar disorder and depression (you, I take it) deleted my corrections of these and snidely challenged my credentials (assuming that like himself, I was unqualified), while acknowledging that he was not an MD. Somehow my reply to his comment was deleted. The fact is, I am an MD, a neuropsychiatrist and an officer of a society on the history of psychiatry. As I explained, it would not seem appropriate for him to go in and on his own authority delete everything that I have written because he assumes that I am no more qualified than he. I assume that there is a reconciliation to be done between the (rather obvious) misinformation he has been providing and the detailed and accurate information I have provided. Where appropriate I have given chapter and verse for my explanations. Despite the fact that his work was riddled with errors and misleading information, I did not take it upon myself to delete any of his work, and I should appreciate his giving me the same courtesy. (SE)

I have therefore replaced the last version of the bipolar and depression entries with the last version which included what I have written. If you wish to correct anything that you have written, or suggest anything incorrect in what I have written, I welcom you to re-enter these as separate comments. I trust that you will not delete or in any way alter what I have written without informed authorization from the owner/editor of the Wikipedia site.

For some reason, my restoration has not taken in the bipolar and depression entries, so I will replace them again. I trust that you are not purposely erasing my work a second time.

I will attempt to inform the owner/editor of the problem

Thanks, SE

---

Kay Redfield Jamison receives flak because she conducts mesearch and diagnoses the dead. I myself like her work but regard it as somewhere between amusing and tacky.

Kay Redfield Jamison is a beautiful writer and very intelligent woman who found that lithium was an effective treatment for HER. She somehow extrapolated that to recommend such treatment for the rest of us bipolars which was way over-stepping. As I said, she's a fabulous writer but she is merely one pro-psychiatry writer. She is certainly not THE writer on the subject, but rather a minor player. Much more important works were contributed by, among others, Thomas Szasz, Peter Breggin and (most recently) Robert Whitaker (author of "Mad in America", which I highly recommend to everybody, regardless of their personal viewpoint on psychiatry). -- Francesca Allan of MindFreedomBC

Hey, SE! Please don't just revert my changes - I am trying to merge in your point of view. Please don't just write CORRECTION all over the place: it breaks up the article, and forces others to edit the article back into readable shape. Please either:

boldly edit the article to what you think it should be (but be aware you may be boldly edited in turn) or
(better) where there are differing points of view, mention it: 'some say this, others say that' or 'medical opinion now generally considers x to be true; some disagree and say y'

This is particularly true of the several different meanings assigned to 'Manic Depression' over time. Remember, your view is not the only view - and even if you consider yourself to be correct, others may not - so cite evidence for your opinions.

You will find that I have 'authorization from the owner/editor of the Wikipedia site'. As do you. Please see Welcome, newcomers and Most_common_Wikipedia_faux_pas

I am glad to hear that you are an MD. We could use your informed point of view. But please don't assume that non-experts in a given field have nothing to contribute - we are after all the intended audience for Wikipedia, and are generally competent at editing text.

I am sorry that you are upset by my request to state your qualifications - I am more likely to take your point of view seriously as an expert in the field, rather than as another non-expert.

But you do need to _work with_ other authors.

-- The Anome (who is a recognised expert in a number of non-medical fields)

SE, please see my edits to Depression, with matching commentary, in talk:Depression. See how Wikipedia works: the striving for consensus and NPOV? It's not my text, or yours: it belongs to Wikipedia, and via the GFDL, the world. -- The Anome

Right, now watch the same process applied to Bipolar disorder, in a number of logically defensible stages. -- The Anome

The first edit: I entirely remove the paragraph you complain about, and replace it with your corrected text. I change the formatting slightly to make it prettier, and remove the start of the first sentence as it no longer needs to state that it is a correction. -- The Anome

The second edit: now I change an assertion that Bipolar II is milder, to the assertion that 'some consider it to be milder'. Now, this is a statement of the opinions of others, that I am willing to give cites for. -- The Anome

The third edit: now I cite your opinion, in your own words, as the opinion of 'other doctors', representing your opinion as that of an MD, rather than that of 'some people'. (You change from 'a doctor' to 'other doctors', as I assume that you are not the only MD that has this opinion.)

The fourth edit: I qualify 'manic people losing insight' with the word 'some' as per your correction.

The fifth edit: I remove the sentences requesting the correction above, as they are now redundant. I leave in the rest of the correction paragraph.

The sixth edit: I take the rest of your qualification to the statement in the para above, and I insert it in-line into the text. I remove your sentence regarding what it is correcting, as it now follows it as an extensive qualification in-line. Note that the qualified statement has always stated that the drugs 'can' prevent episodes, not 'can always'.

The seventh edit: I weaken the qualified statement to 'can sometimes'

The eighth edit: I remove the rest of your correction, as the above I believe incorporates its sense into the text

The ninth edit: I consider G+J to be a classic; you consider the Kraepelin text to be a classic - let's make a list!

The tenth edit: not only do I consider G+J to be a classic, so do all these others: (see http://www.oup-usa.org/isbn/0195039343.html ). I will just let two stand here:
- "The best treatise on the subject since Kraepelin."--Journal of Clinical Psychiatry
- "A classic work--a textbook in scope, but literate, readable, and compassionate. Sets a new standard in scientific medical writing."--Myrna M. Weissman, Columbia University College of Physicians & Surgeons

Oh look, these people are Medical Doctors too. In my opinion, four named MDs, and a number of writers in peer-reviewed medical journals beats the opinion of one anonymous MD, using the well-known techniques of 'meta-review'. So I will delete your comment deriding the G+J book.

the eleventh edit: I downgrade the assertion re historical figures and bipolar disorder to an opinion, and cite that others are skeptical

the 12th edit: I move your sentences qualifying this statement in-line

the 13th edit: I remove your comment deriding those who attempt to consider whether historical figures were bipolar, as there is evidence (see the top of /Talk above) that (at least some) highly regarded medical authorities have taken part in this activity, and the comment appears ad hominem.

the 14th edit: s/Unlike/Compared to/; s/have/are more likely to have/; moved comment re schiz. patients inline; removed CORRECTION notice, as its sense (and some text) is now incorporated into the text

the 15th edit is a pure copyedit, removing dividing lines that are now redundant, and restoring the bullet-list structure of the external link list

the 16th edit: Moved external link to end of article, put comment pointing to end of article in its place

the 17th edit: mentioned your opinion that psycho-historical stuff is dubious

Now I'm done - for now. I hope that I have fairly incorporated all your opinions into the article. If you disagree, please feel free to edit - and please justify your changes here!

-- The Anome

"Many famous people are believed to have been affected by bipolar disorder, including Spike Milligan...There is no definitive scientific basis for classifying any of the above deceased persons ..." Does Spike Milligan know he's dead? The internet doesn't seem to think so. Verloren

Ah yes, but Milligan's not a medical doctor - he and I only think he's alive. An MD's opinion overrides that of a layman, therefore, as non-qualified people, we should accept Milligan's death as a fact. The alternative of thinking that an MD might be wrong about anything is too appalling to contemplate. If I was to believe that, next thing I'd be believing that MDs might actually disagree with one another! And at that point, we'd have to use our tiny brains to work out which doctor was right. I guess that might involve 'cites', or 'literature research', or somefin' -- The Anome

Fixed up the wording cited above as a kindness to SE (s/any of the above deceased persons/dead people/) -- The Anome

I haved moved an earlier version the text before the SE/Anome edit wars to An older, deprecated, version of this page - please note that it contains text that SE, who is a doctor, claims to be inaccurate, and is only there as a temporary copy for comparison purposes, to check if there is any non-contentious material there that might be useful. I will delete it when this is done. -- The Anome

Several more edits made to recreate wiki links: see changelog for details -- The Anome

Changed some of the text to emphasis more the difference between BP in remission and schizophrenia in remission. It's often the case that someone with BP disorder who is not being medicated will appear normal between distrbances and to be fully functional and independent. It's rather uncommon for people with schizophrenia who have undergone several episodes to be fully functional and independent without medication.

Thanks for that. I've since made a couple of (I hope) non-controversial edits: see the changelog comments for details. -- The Anome

I have now added the words associated with mania]] or hypomania to the first sentence - this seems justified as the diagnoses for Bipolar I and Bipolar II (as cited by SE) appear to require an incidence of either mania or hypomania, respectively.

I'm also going to move the 'ups and downs' paragraph up the article to a more logical place, and delete its first word 'futhermore' -- The Anome

There are two essentially identical one-sentence paragraphs crediting Kraepelin with the discovery - replacing/merging the first one with the slightly more detailed second one. -- The Anome

I have now added subheadings, hopefully applying some structure to what is now becoming a reasonable length article -- The Anome

Added note re incorrect, but common, usage of term 'manic depression':

Note: Bipolar Disorder is also commonly (and wrongly) called manic depression by laymen (and by some psyciatrists in the twentieth century) although this usage is now unpopular with psychiatrists, who have now standardised on Kraepelin's usage of the term to describe the whole bipolar spectrum.

Please, SE, note that I am recording usage here, and noting that it is incorrect. -- The Anome

Many famous people are believed to have been affected by bipolar disorder, including Spike Milligan, Lord Byron and Winston Churchill, based on evidence in their own writings and contemporaneous accounts by those who knew them.

I think that Spike Milligan was actually diagnosed with bipolar disorder - in any case, I remember something in one of his books about him being diagnosed "manic depressive" (this wasn't the war books, it was, I think, the intro to a books of his letters, probably published around the 70s). I think he talked about it elsewhere as well - anybody know for sure?

There's a book written by him and Anthony Clare, based on his appearance on Clare's BBC Radio 4 programme. That's where I read about it. -- Tarquin

Dysphoric mania is not the same thing as manic depression / bipolar disorder: it's one of the possible phases of bipolar disorder. Recent thinking is that depression and mania are two different axes, thus creating four possible extremes:

euthymia (ie normal): not manic, not depressed
depression: not manic, depressed
mania: manic, not depressed
mixed state / dysphoric mania: manic and depressed

-- The Anome 07:08 24 Jun 2003 (UTC)

So, I guess it's all covered. Every single mood level is now worthy of psychiatric diagnosis and, by extension, medication. What a pile of shit psychiatry is! -- Francesca Allan of MindFreedomBC

Actually, it's about time that the myth that mania and depression are opposites on the same axis ended, considering that the very existance of mixed states belies that assertion. Anarchist42

Perhaps it's time to retire the myth that biomedical psychiatry is a legitimate branch of medicine. If bipolar disorder were a brain disease (like Alzheimer's or Parkinson's), we would consult neurobiologists not psychiatrists. -- Francesca Allan of MindFreedomBC

WikiProject Psychopathology started, please feel free to join.

I have restored Kurt Cobain to the list of famous bipolar people. In various interviews his cousin Bev Cobain has confirmed that he was diagnosed as bipolar. See http://www.ahealthyme.com/topic/cobainqa for a cite.

The list of alleged, presumed or diagnosed bipolar people probably needs to be spun off into its own article, with just a select few cited here -- large numbers of famous people have been associated with BP, and if we put them all in, the list will overwhelm the article. -- The Anome 21:32, 13 Sep 2003 (UTC)

Sounds good to me. Go for it! Noel 01:19, 14 Sep 2003 (UTC)

What view does alternative medicine hold of the causes/treatments of bipolar disorder? Crusadeonilliteracy 14:55, 25 Nov 2003 (UTC)

A bit of Googling will find a few hits: it's all somewhat bitty. -- The Anome 00:50, 26 Nov 2003 (UTC)

I was just about to do something about that list, some anon keeps adding names to it in no particular order and without wikifying: though shouldent it be put in alphabetical order G-Man 00:57, 26 Nov 2003 (UTC)

Much of it seems already to be alphabetical by surname: I've formatted it as a list item for each letter of the alphabet, to cut down on space. -- The Anome

Depakote is also widely used for the treatment of Bipolar. Is this simply a brand name for one of the listed drugs, or does it belong in the article?

Valproate is mentioned in the article. ElBenevolente 22:31, 8 Mar 2004 (UTC)

Yes, Depakote is a brand name for one form of semisodium valproate. -- The Anome 10:30, 23 Jun 2004 (UTC)

Omega-3s

I'd like to see the omega-3 section fleshed out and either moved to or reiterated in "alternative therapies". And there is no reason (other than snobbiness) to put a commonly understood word in quotes ("alternative").

Yes there is. According to Cliffnotes, quotations are used to distance the author(s) from the word. In this context, there is a debate about whether certain disorders can be treated entirely with alternative therapies/regimens, hence the complementary medicine movement.

Temporal Lobe Epilepsy

There is significant enough overlap between bipolar disorder and temporal lobe epilepsy to warrant its own section. (With info on distinguishing between the two, when possible, and info on MRIs, EEGs, etc.) Kay Redfield Jamison (her again!) notes that Vincent van Gogh had (probably temporal lobe) epilepsy, but diagnoses him with bipolar anyway.

Okay, I'm not really sure how posthumous psychiatric diagnosis works and I'm not sure I want to know either. -- Francesca Allan of MindFreedomBC

The controversial Empowerplus

http://www.truehope.com/

There's a nutritional supplement called "Empowerplus" that claims to control bipolar disorder. Judged by its ingredients, I think you can substitute it with many off-the-counter vitamin pills and supplements (possibly more expensive).

I think this pill is not much different from the inexpensive Walgreen's AthruZ pills.

Nutrient	Empowerplus capsule (3 capsules)	Empowerplus powder (1 serving)	Walgreen's AthruZ (1 caplet)
Vitamin A	960 IU	1440 IU	5000 IU
Vitamin C	100 mg	150 mg	60 mg
Vitamin D	240 IU	360 IU	400 IU
Vitamin E	60 IU	90 IU	30 IU
Vitamin B1	3 mg	4.5 mg	1.5 mg
Vitamin B2	2.25 mg	3.4 mg	1.7 mg
Vitamin B3	15 mg	22.5 mg	20 mg
Vitamin B5	3.6 mg	5.4 mg	10 mg
Vitamin B6	6 mg	9 mg	2 mg
Vitamin B9	240 mcg	360 mcg	400 mcg
Vitamin B12	150 mcg	225 mcg	6 mcg
Vitamin H	180 mcg	270 mcg	30 mcg
Calcium	220 mg	330 mg	162 mg
Phosphorous	140 mg	210 mg	109 mg
Magnesium	100 mg	150 mg	100 mg
Potassium	40 mg	44 mg	80 mg
Iodine	34 mcg	51 mcg	150 mcg
Zinc	8 mg	12 mg	15 mg
Selenium	34 mcg	51 mcg	20 mcg
Copper	1.2 mg	1.8 mg	2 mg
Manganese	1.6 mg	2.4 mg	2 mg
Chromium	104 mcg	156 mcg	120 mcg
Molybdenum	24 mcg	36 mcg	75 mcg
Iron	2.29 mg	3.435 mg	18 mg
CNS Proprietary Blend (listed below)	277 mg	416 mg	--
dl-phenylalanine	?	?	0
glutamine	?	?	0
citrus bioflavanoids	?	?	0
grape seed	?	?	0
choline bitartrate	?	?	0
inositol	?	?	0
ginkgo biloba	?	?	0
methionine	?	?	0
germanium sesquioxide	?	?	0
boron	?	?	150 mcg
vanadium	?	?	10 mcg
nickel	?	?	5 mcg

By the way, they suggest their users to take as many as 18 capsules a day (initial dose). To take so large a dose with other multi-vitamins, you will easily consume too much Vitamin A which could be very dangerous. Many medical doctors and the Canadian government do not suggest it. Some called it a hoax.

--Toytoy

I can't see any double-blind trials for this. Why are they not doing this, if it's apparently so effective in an open-label trial? Independent, reproducible, double-blind tests are the gold standard for evidence. -- The Anome 10:30, 23 Jun 2004 (UTC)

WHAT BP HAS DONE TO ME

Since December 2001 when I had my first relaps I have been obsessed with the number 3. I feel better now however my obsession is stronger than ever. Please vist the following to see what I mean. http://brianmiller.batcave.net/TOE

Regards Brian Miller...

This sounds like OCD, which some people with bipolar disorder sometimes contract. That's my theroy.

BP NO RELAPS PLEASE

How long can you go without a relaps?

BM

Spontaneous remission does happen. I have had two bipolar episodes in my life, 15 years apart, both triggered by SSRI antidepressants. Managing life issues rather than trying to medicate them away works for a whole lot of people. Good luck. -- Francesca Allan of MindFreedomBC

Brand names vs. generic names

Suggested policy: In the general case, we should refer to drugs by their generic names only, except when a patented drug has a famous brand name such as Viagra or Prozac, in which case we should also add a reference to its generic name as well. -- Karada 21:42, 30 Aug 2004 (UTC)

I disagree with this suggested policy, on the grounds that it limits the usefulness of the Wikipedia. Lamotrigine is also known as Lamictal, Lamictin and Lamogine. Why is it a problem to display these helpful search targets? Why should Viagra and Prozac be different? They START with an extensive 'also known as' section. Does this imply that the information is important? This suggested policy is bizarre and counterintuitive. How does one search for the brand name Lamotrigine, when it is branded Lamictin? How can I be confident that they are the same thing unless a reputable source tells me so?

Split the article?

It's really huge. The treatment sections (all three of them) should probably be made a separate article. --Smack (talk) 21:12, 27 May 2005 (UTC)[reply]

I agree that the article is quite long. Perhaps the longer sections should be made into their own articles, replaced in this article with a short summary and a link to the "main article". --Ithacagorges (talk) 17:10, 5 Jul 2005

I too agree that the article should be split. Perhaps new articles for "Medication" and "Research findings"? I could do that. Would like to see an expert expand the "Psychotherapy" section. HalD 04:22, 16 September 2005 (UTC)[reply]

I also agree that the article should be split. Though it isn't clear to me in what way it should be split. It seams to me that discussion of each medication/treatment and its effect/efficacy in treating bipolar could be relegated to that medication/treatment's article... e.g. there is already an article on Lithium_salt. Then we could reference to those individual articles perhaps directly to a subheading established in regards to that treatment and its relation to bipolar. Dark Nexus 14:46, 20 October 2005 (UTC)[reply]

Suicide statistic

Is the 15% suicide figure for treated, or untreated cases? And can we have a cite, please? -- Karada 5 July 2005 19:57 (UTC)

15% is a traditional estimate you'll find in a number of books and sources. More recent research suggests it may be somewhat lower, but estimates still typically range between 10% and 20% (for treated and untreated cases combined). I have added a link to a page with abstracts of many recent scientific articles on bipolar disorder and suicide, including some which discuss the lifetime prevalence rate. -- Ithacagoreges 20:05 5 July 2005 (UTC)

- It may also be worth citing the baseline suicide rate, which most studies put at around 1% for the United States. As for the 15% figure, IIRC that's a traditional unspecific figure for "mood disorders" in general, including depression and bipolar disorder. Most recent studies I've seen put the suicide rate for depression at more like 2-6%, and bipolar disorder at more like 3-9%. I haven't seen any estimates as high as 15% from any studies conducted in the last 10-15 years. --Delirium 12:42, August 2, 2005 (UTC)

- Another thing that should be noted is that all these statistics are specific to the United States. Suicide rates are strongly influenced by culture, so U.S. figures are not easily transferrable to other cultures, especially very different ones. --Delirium 12:46, August 2, 2005 (UTC)

External Links

There are a lot of external links here, some of which look pretty much like advertising to me. Here's an extract from Wikipedia:External links:

What should be linked to

Official sites should be added to the page of any organization, person, or other entity that has an official site.

Sites that have been cited or used as references in the creation of a text. Intellectual honesty requires that any site actually used as a reference be cited. To fail to do so is plagiarism.

If a book or other text that is the subject of an article exists somewhere on the Internet it should be linked to.

On articles with multiple Points of View, a link to sites dedicated to each, with a detailed explanation of each link. The number of links dedicated to one POV should not overwhelm the number dedicated to any other. One should attempt to add comments to these links informing the reader of what their POV is.

High content pages that contain neutral and accurate material not already in the article. Ideally this content should be integrated into the Wikipedia article at which point the link would remain as a reference.

Maybe OK to add
[This part is not relevant to this article.]

What should not be linked to

Wikipedia disapproves strongly of links that are added for advertising purposes. Adding links to one's own page is strongly discouraged. The mass adding of links to any website is also strongly discouraged, and any such operation should be raised at the Village Pump or other such page and approved by the community before going ahead. Persistently linking to one's own site is considered Vandalism and can result in sanctions. See also External link spamming.

Links to a site that is selling products, unless it applies via a "do" above.

I'd like to hear discussion around which of the links on the main page meet these criteria. - brenneman ^(t)^(c) 08:15, 19 July 2005 (UTC)[reply]

POV issue

The following paragraph seems to have some POV issues.

"There is no compelling scientific evidence for the biochemical imbalance theory for bipolar disorder or for any other mental illness. Such theories are the brainchild of pharmaceutical manufacturers who are interested in profits, not mental health."

While I neither agree nor disagree with the assertion here, due to lack of cited sources, I feel that it is rather subjectively slanted against pharmaceutical companies without adding anything of value to the article. Perhaps a more neutral wording should be in order here:

"There is no compelling scientific evidence for the biochemical imbalance theory for bipolar disorder or for any other mental illness. Such theories have been criticized as the brainchild of pharmaceutical manufacturers who are interested in profits, not mental health."

I'm going to go ahead and edit this for now, feel free to change it if I'm out of line here. - KrisWood

I added that statement but I disagree with you that it doesn't add anything of value to the article. I think it's critically important for the public to be aware that psychiatrists are not able to identify mental illness through any objective physical test. The reason that they can't is because mental illness, by its very nature, is merely a reflection of society's norms. By way of example, homosexuality was only removed from the DSM in the 1970s. I do agree with you, however, that more neutral wording is almost always better and I appreciate your edit in this case.

24.108.4.85: your recent contributions have introduced quite a bit of POV into the article. I can see that when others and I have tried to edit your changes to remove the POV you have accepted and taken account of the changes in your subsequent edits, but it would be better if you could try to make your initial edits a little more neutral. --ascorbic 19:04, 31 July 2005 (UTC)[reply]

Some specific thoughts on certain points that 24.108.4.85 keeps reintroducing: the term "electroshock" is unscientific and probably POV. Use "ECT". An "ever-growing minority of critics": is it ever-growing? Do you have any sources to back this claim up? In lieu of evidence, let's just keep it as "a minority of critics" (I think we can all agree it's a minority). Overall, 24.108.4.85 manages to introduce POV in every edit. Could we tone it down a little? --ascorbic 09:56, 1 August 2005 (UTC)[reply]

I appreciate your comments. I'm not sure how to get around the "POV" problem. You and others haven't just edited my changes, in many cases, you've deleted my contributions. I certainly will try to make my edits more "neutral" (read palatable) but the facts about biomedical psychiatry are indeed upsetting and controversial and it's hard to put that into neutral language.

What is unscientific about "electroshock"? Electroshock is completely accurate terminology -- it's electric shocks being fired into a patient's brain while they are under anaesthetic. By way of contrast, ECT is a politically correct term which attempts to divert public concern. Yes, the minority is ever-growing. Please check out the websites of MindFreedom, PsychRights, the Coalition Against Psychiatric Assault and the International Center for the Study of Psychiatry and Psychology. If you want further information, please email me at efsimpson@canada.com

Thanks for responding. The problem is that most of your additions use highly slanted language, such as referring to "myths" (it's your opinion that it's a myth), while comparisons to lobotomy are an inflammatory red herring, and not relevant to the article. The same can be said for the mentions you made of the Nazis. The most neutral term is ECT, so it's best to use that. In the other sections of the article, I've tried to moderate your contributions in order to ensure NPOV is maintained, but you persist in reverting the chnages made by me and other editors. You've probably violated the 3RR in that respect. While you feel strongly about your points, you cannot post them as "facts" because many (most?) people would dispute your opinion. These means that it's important to avoid bias in the article. Rather than just reverting our changes, work with us in producing a neutral article. --ascorbic 13:58, 1 August 2005 (UTC)[reply]

I'm going to now go through your recent additions, point by point, and try to make them neutral. I'll detail my reasons in each summary. Can you let me make this changes and respind before reverting. Thanks. --ascorbic 14:02, 1 August 2005 (UTC)[reply]

Yes, sorry, I didn't realize we were supposed to discuss changes first. Psychiatric diagnosis and treatment IS a myth. That's not a matter of opinion. Psychiatrists themselves cannot objectively measure mental illness. ECT may be most neutral but that doesn't it make the most accurate and I will continue to use the term electroshock. I can't publish the facts because MOST people don't agree? So we either follow the herd or be silenced? Is that what Wikipedia is all about? If so, I'll probably bow out now and just link to the Wikipedia bipolar definition on my own website to point out the misinformation published here.

Again, I'm a newbie and just read the 3RR just now. If I'm guilty of breaking the rules, then others are too here. I'll certainly follow the rule from now on, though. -- EFS

Sorry, but your facts are widely disputed and the article has to reflect this plurality of opinion. You cannot just state them as facts or myths without allowing for alternative viewpoints. Read the guidelines on NPOV. If you want an article to just reflect your opinion as to what the facts are, then it can't be here on WP where we expect NPOV. I've gone ahead and made changes. Can you accept these as neutral insofar as they reflect your views as well as those of people with whom you disagree? --ascorbic 14:20, 1 August 2005 (UTC)[reply]

But not allowing for alternative viewpoints is exactly what YOU are doing. With respect to your changes:

YOUR COMMENT: It is disputed as to whether BD is *caused* by ADs, or if they just trigger episodes in those already prone to them.

MY REPSONSE: It is not disputed. In fact, mainstream psychiatry recommends treating unipolar depression with mood stabilizers (rather than just ADs) for precisely this reason. Whether or not someone is prone to (whatever that means) mood disorders, if they don't exhibit mania until treatment with antidepressants, then bipolar disorder could be said to have been CAUSED by antidepressants. Please check out the National Alliance for the Mentally Ill -- they're pro-psychiatry and they confirm this as a cause of mania.

YOUR COMMENT: Calling the theory a "myth" is highly POV. "Confirm" implies "fact", rather than opinion. Changed to "assert".)

MY RESPONSE: On the contrary, calling the biochemical imbalance theory "credible" is highly POV. Again, there is no compelling (non-biased) research on the subject. Until there is (which will be never -- you cannot pathologize the human condition), the Mad Movement's going to fight the status quo.

YOUR COMMENT: The survivors are included in the critics, so mentioning them separately is not needed.

MY RESPONSE: Sure, they're included but they are due special consideration, given that they know firsthand the devastating effects of the treatment. I think it's important to point out that the mechanism of electroshock is brain damage, as even psychiatrists admit this and they have no idea for the reason for the alleged "success" of the treatment. If electroshock were effective, then they'd hardly be pushing maintenance electroshock for life, would they? -- EFS

I do, however, accept the changes made and appreciate your input. -- EFS

I feel that I should comment on this section. 30 July 2005, I reverted the content regarding electroconvulsive therapy. I felt that it was very POV and unsubstantiated. I also felt that references to Nazi Germany were not appropriate to an article on bipolar affective disorder. I wish now that I would have added something on the talk page Saturday when I made the changes to the article. I am glad to see things are getting resolved. If there isn't already a page, I thing an article on the history of the therapy could be very interesting if done appropriately. Psy Guy 16:58, 1 August 2005 (UTC)[reply]

Actually your reversions were, for the most, reverted. However, I agree that the references to Nazi Germany (although completely truthful) were unnecessarily inflammatory. Things are getting "resolved" only in that a psychiatric assault survivor is once again being told how and when she may speak. -- EFS

One doesn't have to be a critic of psychiatry to aim for truth in language. Electroshock is a treatment whereby electric shocks are generated and applied to a patient, with or without his consent. Calling it "ECT" may make pro-psychiatry types feel better, but does nothing to clarify the issue. The word is electroshock. -- EFS

If anyone wants to learn about the history of electroshock, they could start at the Deadly Medicine exhibit at the Holocaust Museum in DC. -- EFS

You're only being told how you may speak in terms of asking you to stick to the policies of this site. Like it or not, the policy here is NPOV. There are plenty of places where POV is allowed. Myself, I have written many opinionated pieces (including one you may find interesting and relevant), but I don't post them on wikipedia, because that's not what WP is about. You seem to be trying to use WP to advance an agenda. This is a futile quest. --ascorbic 00:57, 2 August 2005 (UTC)[reply]

No, I understand the POV policy. That's not the issue. -- EFS

I agree that 90%+ of 24.108.4.85's edits have been POV with no place in this article; they promote the so-called "anti-psychiatry" agenda, and typically make misleading, inaccurate, exaggerated, and/or non-scientific claims. I have just reverted her most recent batch, and there are a few older ones that should also be reverted. As an aside, in this case we are not "silencing positions on Wikipedia" either as you suggest; most of 24.108.4.85's postings appear in several places on the anti-psychiatry article, related articles, and the anti-psychiatry section of the general psychiatry article. (In fact, if you read some of them I would argue those are the articles that currently need more balancing, not the "mainstream" articles.) --Ithacagorges 02:35, 2 August 2005 (UTC)[reply]

It's not the "so-called anti-psychiatry agenda." We ARE anti-psychiatry and our "agenda" is to bring truth to the mentally ill and their families. I have said NOTHING misleading, inaccurate, or exaggerated. "Anti-scientific" is a comical complaint, given that the entire field of psychiatry is merely a social construct. I have only posted to this article therefore your claims about other places where my postings appear are invalid. -- EFS

The POV policy absolutely is the issue. You have made dozens of edits in the past couple of days, and virtually every one has introduced POV. When we try to make edits to balance your changes, you revert them or change them in another way to make them POV. YOU consider these things to be facts. Others disagree. NPOV is about not slanting an article to one viewpoint, and that includes not expressing contested opinions as "fact". This is NOT the place to argue your agenda, or any agenda. Your viewpoint is well represented in the article, but you don't seem to be content with that, and want it to be the only viwepoint that is acknowledged as "true", with everything else dismissed as "myth". THIS WILL NOT HAPPEN, however many times you edit the article to try to make it so. --ascorbic 07:54, 2 August 2005 (UTC)[reply]

You could make the same point about some of your reversions. The original article was very one-sided. It's not a matter of what I consider facts. I'm looking at the whole field of psychiaty and the scientific evidence that they have. There is no credible link, for instance, between low serotonin and depression. The only reason the facts I am introducing into this article are contested is because they fly in the face of mainstream psychiatry. That's a serious problem with psychiatry, not for me and I have every right to speak out whenever I see mainstream psychiatry spewing its BS. Contrary to what you say here, I am very content with the changes I have seen in the article and I think my edits were well worth my time. In summary, IT DID HAPPEN, however many times you try to deny it. -- EFS

PS I enjoyed your article you linked to above. Were the proposed changes enacted? I'm in Canada and our mental health laws aren't as strong, however, many psychiatrists get around this by just ignoring them. -- EFS

A note from the frontline

EFS, speaking as someone with personal experience of bipolar disorder, I can assure you that it is very real, painful and disabling. It can, however, in many cases be controlled very effectively with the right drugs. It may take years to find the right drug combination; but when the right treatment is found, the results can be dramatic, with more or less complete remission of bipolar symptoms. (You may also be interested to know that before I found the right treatment, I was actively considering ECT as a treatment option if drugs failed to work; and, yes, I know about the side-effects of ECT in great detail.)

In my opinion, your efforts to "bring truth to the mentally ill and their families" are not only unhelpful and misleading, they risk harming people by preventing them from seeking effective medical help. -- Karada 08:31, 2 August 2005 (UTC)[reply]

I'm not sure anecdotal evidence is that helpful; I have my own anecdotal evidence I could use to argue that psychiatric treatment of bipolar disorder harms more than it helps. I'd say we should probably stick to summarizing the (very large) debate from all sides. --Delirium 08:33, August 2, 2005 (UTC)

I agree, not all treatment is effective, and everyone's experience is different, so I can speak only for myself. I found both depakote and lithium quite ineffective, and the side-effects of each were seriously unpleasant. However, I'm now stabilized on lamotrigine, which -- quite suddenly and to a quite extraordinary degree -- stopped my previously treatment-resistant ultrarapid cycling dead in its tracks. What's more, I am stabilized "above the waterline", without any trace of lingering depression, or any progression to hypomania. Note: this is my personal experience only, and is not to be taken as medical advice, medical treatment should only be undertaken under the supervision of a properly qualified physician.

I also agree with you that this article should not be based on anecdotal reports, and we should stick to reporting documented information in an NPOV style. However, NPOV does not mean giving equal weight to all viewpoints; the overwhelming weight of scientific evidence for the physical reality of bipolar disorder certainly means that the mainstream account of bipolar disorder should be the main narrative in this article, with anti-psychiatry given its place as a dissenting view (after all, it has its own article where its arguments are expressed at length). However, I am more than pleased to enter into dialogue with EFS here, both from a personal viewpoint, and also to discuss the evidence-based medical and scientific issues involved. (I studied biochemistry and biology in my undergraduate degree, so although I'm not holding myself out as a scientific expert, I do have some familiarity with the concepts involved.) -- Karada 09:00, 2 August 2005 (UTC)[reply]

Well, it depends on who you're considering to be "mainstream". In mainstream psychiatry, the psychiatric orthodoxy is of course the mainstream view, pretty much by definition. In mainstream psychology, there is a wider range of views on what precisely bipolar disorder is, and what should be done about it. In particular, many psychologists would narrow the definitions, and diagnose much more conservatively (there are many who argue that only a portion of people diagnosed with "bipolar disorder" actually suffer from any scientifically-identifiable disorder). In mainstream philosophy of mind, there is also considerable disagreement over the status of mental illnesses in general, and bipolar disorder in particular. Not disagreement with the scientific conclusions in general, but more fundamental disagreement over labelling and treatment---e.g. even if there is some identifiable pattern of behavior, some philosophers of mind would object to labelling such patterns "mental illnesses", especially if the person in question is aware of them and doesn't wish to change them. Basically the argument over homosexuality, which the anti-psychiatry folks won, is still continuing everywhere else, in a fragmented sort of way.

As for what this article in particular should be like, I think it's currently biased a bit too much to the psychiatry viewpoint, e.g. the DSM orthodoxy. The DSM is accepted as gospel truth in psychiatry, but is not nearly as widely-respected by non-MD scientists (e.g. psychologists with PhDs in psychology). There is a range of politics involved in the psychiatry vs. psychology debate, but there are also more fundamental disagreements over the science involved (many scientists allege that the DSM is more of a consensus political document than a document that reflects any sort of solid science). --Delirium 09:31, August 2, 2005 (UTC)

I agree with you about the DSM. The DSM lags some distance behind the latest research, and, as you say, there's an element of politics involved. I think the way forward, as in other fields of medicine, is the rigorous use of evidence-based medicine techniques. See this Google search for "evidence-based bipolar" for some examples. I do my best to keep up-to-date on the latest research and meta-reviews so I can be as informed as possible in working with my doc to guide my treatment. I also think that having experienced mental illness puts one in a privileged position with regard to assessing theories of mind; observing broken systems can give you an insight into how functioning systems work. -- Karada 10:25, 2 August 2005 (UTC)[reply]

By the way, I'm musing about illustrating this article with Image:Munch The Scream lithography.gif; several sources, including this [1], cite Munch as having been bipolar, and it's a pretty good evocation of some of the feelings associated with BP. -- Karada 11:53, 2 August 2005 (UTC)[reply]

Hmm, I think the illustration might be hairy. Van Gogh is also cited by some as bipolar, and I think some might object if I were to illustrate this article with "Starry Night", although I think it's also appropriate in some ways. As for the philosophy of mind, you seem to be assuming that there is a scientific/objective way of defining "functioning". As the history of the psychiatry of homosexuality shows, I think it's fairly clear that saying "[x] is illness, and [y] is health" is a subjective decision. Science can tell us what a particular thing is, but it can't tell us if it's good or bad, unless you define "good" or "bad" to mean something specific, like "raises risk of suicide is bad" or "damages the traditional family is bad". --Delirium 12:31, August 2, 2005 (UTC)

Feel free to delete the illustration if you want: I just thought it might help illustrate the article in a way that text could not.

On the illness/health front, the "good/bad" distinction reminds me of Ghostbusters:

Egon: There's something very important I forgot to tell you.

Venkman: What?

Egon: Don't cross the streams.

Venkman: Why?

Egon: It would be bad.

Venkman: I'm fuzzy on the whole good-bad thing. Whattya mean "bad?"

Egon: Try to imagine all life as you know it stopping instantaneously and every molecule in your body exploding at the speed of light.

Ray: Total protonic reversal....

Venkman: Right, that's bad...OK.. important safety tip. Thanks, Egon.

I think there is now pretty clear evidence of organic brain damage as part of bipolar disorder. Similarly, severe cognitive deficit is clearly a bad thing. As is the perception of severe anguish not associated with any external circumstances. I think those can all be described pretty unequivocably as "bad", for all normal values of "bad". Now, I'll not deny that there are good things there in the mix with the nasties, like heightened creativity, energy and sexuality in the hypomanic upswings. However, I'm fortunate in that my -- now effective -- treatment has left me with most of the good BP things intact whilst turning off most of the bad things. Yes, I hardly believed it at first, either. -- Karada 12:48, 2 August 2005 (UTC)[reply]

I may have missed it, but I don't remember seeing studies confirming organic brain damage. I've seen a lot of stuff about relative levels of various neurotransmitters, and different MRI patterns, but that's not the same thing at all, since both of those things can be easily influenced by "mental" factors (giving people placebos visually changes their MRIs, for example, as obviously do things like exciting them). --Delirium 14:12, August 2, 2005 (UTC)

You might want to start off with this: [2]. and this: [3] -- Karada 15:31, 2 August 2005 (UTC)[reply]

Karada, I also have firsthand knowledge of bipolar disorder and I've also been diagnosed with schizophrenia and schizophrenic affective disorder. I would never deny that mental illness is real, frightening and disabling. In fact, bipolar disorder almost killed me before I got effective treatment. Drugs are only one option and it is negligent of psychiatry to ignore the work that legitimate researchers have done on alternatives. I'm sorry you find my work unhelpful and misleading. Others have told me I've profoundly changed their lives for the better. And if I'm doing ANYTHING to steer people away from biomedical psychiatry, then that's the biggest compliment you could ever have given me so thank you. As for the pretty clear evidence of organic brain damage, let's hear it. What's the evidence? -- EFS

Well, here are a few references on the correlations between various types of depression and brain shrinkage and/or changes in function: see [4], [5], [6], [7], [8]: and in borderline personality disorder: [9]. And here's a reference on brain metabolites and bipolar disorder: [10]. -- Karada 15:19, 2 August 2005 (UTC)[reply]

Delirium, thanks for your post. Many people have in fact been harmed more than helped by psychiatry. Many have been killed and many suffered a worse fate: a lifelong sentence of a psychiatric label, stigma, government housing, an agreement with psychiatry that their brains are diseased, that they can't be normal, that they can't live happy and productive lives. -- EFS

Karada, correlations don't equal cause and effect. Nobody would argue there aren't correlations between various brain chemicals and mental illnesses. The issue is: How do we determine whether chemical imbalances cause the mental illness or the other way around? There is lots of good research out there showing that environmental changes and psychotherapy have positive effects on brain chemicals. Think of it this way, if it helps: Do you believe adrenaline causes fear? Because, using this analogy, biomedical psychiatry would want to treat the excessive level of adrenaline, whereas the anti-psychiatry movement would prefer to remove the person from danger. It is dangerous and expensive (in every sense of the word) to ignore the causes of mental illness and focus merely on the symptoms. -- EFS

Correlation between A and B can imply:

mere coincidence (but this becomes less likely as the number of coincidences gets greater)
that A causes B
that B causes A
that A and B share a common cause

Modern research is finding more and more correlations between bipolar disorder and various forms of cognitive, emotional and biochemical phenomena. As it becomes less likely that these correlations are mere coincidence, it becomes more likely that one or more of the three lower explanations may be true. What the actual explanation for bipolar disorder remains to be seen, but the fact that, for example, some people with a different version of a serotonin transporter gene, are much more likely to become depressed, is highly suggestive of at least a partial biochemical explanation for bipolar disorder. Similarly, the well-known kindling effect also strongly suggests that stress plays a significant part in the process. As a matter of interest, what do you think causes bipolar disorder? -- Karada 22:43, 2 August 2005 (UTC)[reply]

Karada, your simplistic and childish "analysis" is utterly out of place here. We hear a lot about serotonin pathways but that is only one player in brain chemistry. Psychiatry hasn't even determined what "A" and "B" are here. They don't know what chemicals are critical, nor can they agree on what symptoms constitute bipolar disorder or any other mental illness. "Modern research," as you put it, has pretty much focused on semi-measurable biochemical phenomena. If they actually did care about cognitive, emotional and environmental factors, we wouldn't be having this argument. And you really didn't read what I said. Who knows whether serotonin and bipolar disorder or causally linked? Psychiatrists don't. The basis for SSRI type antidepressants is the theory that low serotonin equals depression. But that flies in the face of a lot of evidence. Many suicide victims are later found to have EXCESSIVE levels of serotonin. Suppose they find down the road that a mutated serotonin transporter gene makes a person 50% more likely to become bipolar. Would it follow that serotonin is the major player in bipolar? No, it would not. And as for stress playing a part in illness, of course it does. MOST illnesses are more problematic when people are under stress. Uh, that's not news. I don't think there is a single cause for bipolar disorder or any other mental illness. The quest to find a simple chemical answer for the problem of living is futile.

Cease fire?

As someone who has not yet been diagnosed with bipolar disorder and is actively researching it before seeking help I would like to ask that we please stop all this POV fighting on both sides. Wikipedia is not the place for point of view no-matter-what. It is near impossible to find unbiased information when both sides edit eachothers edits mercilessly at the drop of a hat. Even more so when it's done a dozen times in the space of a weekend. Please take extreme care to keep everything in context, cite all assertions, and take extreme pains not to introduce your own point of view into the article. A good policy is to post your ideas in discussion before making an edit so you can get feedback. Another is, if in doubt, don't post it!

What is good for one person is not good for everyone. If you have evidence of a cause or harmful side effect by all means cite it and add it. Just make sure it doesn't have a slant. If you wish to make your opinion known there are innumerable forums for that out on the net, this is simply not the place. Wikipedia exists to provide a repository for unbiased knowledge, not a battleground between differing points of view.

I would love to be able to look at this article as a reference of what research has been done on BD, what its symptoms officially are, and current treatments that are in use. Assertions that one method is better or worse than another outside the scope of documented research only obfuscate the truth and pollute the article regardless of which point of view they are, for OR against the issue. Can't we all just get along and let the wiki do what it's supposed to do? --KrisWood 14:13, 2 Aug 2005

Ok I'm going to follow my own advice and propose some edits here, let's see if we can get everyone to agree some some things before wantonly editing the article:

The third paragraph has been butchered completely and is gramaticly incorrect in that the first sentence is no longer supported by the rest of the paragraph:

"Bipolar disorder, as with all mental disorders, is now generally considered to be a biochemical disorder of the brain and its associated hormonal systems. There is no definitive biochemical test for the disorder, nor is there any test for its absence, although there has been some success in identifying blood flow patterns in the brain using brain imaging. Critics (including a minority of psychiatrists and scientists) assert that there is no compelling scientific evidence for the biochemical imbalance theory for bipolar disorder or any other mental illness, and point to the well-established link between pharmaceutical manufacturers and the rise of psychiatric diagnoses in North America."

Proposed edit:

"Bipolar disorder is now generally considered by the psychiatric community to be a biochemical disorder of the brain and its associated hormonal systems. Without proper treatment bipolar disorder can effect families, friendships, careers, and even lives. Bipolar disorder can be so profoundly distressing for those that suffer from it that tragically, roughly 15% of people with bipolar disorder commit suicide.

There is no definitive biochemical test for the disorder, nor is there any test for its absence, although there has been some success in identifying blood flow patterns in the brain using brain imaging. Critics assert that there is no compelling scientific evidence for the biochemical imbalance theory for bipolar disorder or any other mental illness, and implicate a link between pharmaceutical manufacturers and the rise of psychiatric diagnoses in North America."

I had to dig through old edits to get some useful information for the first part of the paragraph. The second part really stood on its own. A few minor changes to that paragraph were made to adjust POV back to neutral; "(including a minority of psychiatrists and scientists)" can be taken as a slant in either direction, and is inferred by the word "Critics" and context anyway. The phrase "and point to the well-established link between pharmaceutical manufacturers" is extremely slanted as well as uncited. I'm not saying this is not an acceptable viewpoint, I'm saying that if you want this viewpoint to be represented you should cite which link you are referring to and its documented source as well as choosing an more anti-inflammatory wording. I chose "and implicate a link between pharmaceutical manufacturers" because it means the same thing without a need for citation until people start questioning exactly which critics and which links are in question here.

Perhaps a split or some sort of arbitration from higher up is required here? I think an article on this anti-psychiatry movement in general might be a better place for many of the more unbiased assertions rather than an article that is apparently supposed to be about the mainstream definition of bipolar disorder. --KrisWood 15:03, 2 Aug 2005

Not all critics of the biochemical imbalance theory are believers in conspiracy theories, so you might want to decouple "critics assert..." from "some anti-psychiatry campaigners believe...". Still, I like the general tone of what you are proposing. NPOV is the only way forward, but as the policy article suggests, NPOV is not the same as giving equal weight to all opinions: minority and fringe beliefs can still be labeled as such, mentioned in passing, and dealt with fully in their own articles. -- Karada 22:32, 2 August 2005 (UTC)[reply]

Karada, your paragraph above is a perfect example of how POV your own contributions are. Questioning the "science" of psychiatry and acknowledging the devastating harm that it has caused does not make one a conspiracy theorist. Psychiatry has some very serious issues and probably the most important one is that there is no objective diagnostic test for any of these so-called brain disorders. Despite this lack of solid science, people across North America are incarcerated and force drugged and electroshocked. In response to this sorry state of affairs, the Mad Movement was born. We are not "campaigners" nor do we hold "fringe beliefs." Why do you have to be so offensive and so hypocritical? You say "NPOV is the only way forward" but what you actually appear to mean is only pro-psychiatry's bizarre and distorted version of NPOV. -- Francesca Allan of MindFreedomBC

KrisWood, if you're looking for mainstream psychiatry stuff, I really think you should go right to the websites of organizations like Canada Mental Health or National Alliance for the Mentally Ill. There are tons of mainstream psychiatry organizations. I'm alarmed that you'd choose to inform yourself via Wikipedia on such an important issue to you. But if you're really interested in the truth about psychiatry, check out MindFreedom.org or PsychRights.org. Both of these organizations are devoted to getting people REAL help.

Karada, your condescending "analysis" on cause and effect was a big waste of time. Please just consider what I said because it's the truth -- brain chemical imbalances may be caused BY or may be a cause OF mental illness. Mainstream psychiatry has yet to determine the chemical make-up of a "healthy" brain, let alone try to peg various diagnoses to varying chemical levels. The chemical imbalance theory is just that -- a THEORY. Might be true, might not be true, yet to be proven. Based on everything out there right at this moment, it looks like it's more likely NOT to be true.

There have been recent articles in the New Yorker and in Mother Jones on the problem of Big Pharma financing the FDA and effectively running medicine. That's not conspiracy theory. Read about the Texas Medication Algorithm Project and associated flowcharts. You will see that in virtually every case, the most expensive medicines are tried first. Many of the atypical antipsychotics have not been around long enough to be tested for safety. It's in psychiatry's interests to convince people that they have a brain disease that requires lifelong treatment. I reject that point of view and I am joined by thousands of people in that rejection. If mental illness were TRULY a chemical issue, how would it be possible for it to be cured WITHOUT chemicals? Yet thousands of us do it -- we turn our backs on psychiatry and find our own way to health. Why is that so threatening to you? The World Health Organization reports that psychiatric treatment does more harm than good. Do you believe the WHO is also a victim of conspiracy theory? That must be one hell of a conspiracy.

As to your question of what causes bipolar disorder, your question is unanswerable. Bipolar disorder, just like schizophrenia, is a huge spectrum of symptoms, ranging from trifling to life-threatening. I find it very humourous that you are asking for NPOV while you slyly refer to me as a conspiracy theorist. What is so threatening to you about anti-psychiatry that you can't just read the articles for yourself without exhibiting such obvious rage?

If you have a vested interest in believing in a chemical imbalance that cannot be proved, that's up to you. But I hope that at some point you get less personal and more discerning. Good luck and you're going to need it. -- EFS

Fascinating. An actual look at the TMAP algorithms and physician's manual for bipolar disorder [11] shows that the first-mentioned mood stabiliser recommended for bipolar disorder is good old lithium carbonate; the cheapest. non-proprietary. drug in the entire psychiatric pharmacopeia. Whichever branch you follow for bipolar, TMAP starts off with mood stabilization, and lithium is the first-mentioned mood stabilizer. Based on my reading of recent medical research, the choice of drugs looks pretty much what might be expected based on the results of recent clinical trials. Did you actually read the TMAP algorithm before you wrote your comments above? -- Karada 00:58, 4 August 2005 (UTC)[reply]

By the way, to the best of my knowledge, lamotrigine came off-patent in the UK in May 2005. Valproate is also available as a generic. -- Karada 01:02, 4 August 2005 (UTC)[reply]

Indeed I did. Keep researching TMAP (specifically, the new "atypical" antipsychotics), Karada, if you can't understand where the problem lies. And, generally, how do you feel about medicine via flowchart? -- EFS

Despite Karada's offensive comments, the anti-psychiatry movement includes many brilliant psychiatrists, other medical doctors, researchers, scientists, writers, activists and advocates. We are not a "fringe group." We represent a legitimate alternative to the oppression of psychiatry and we will eventually prevail. What you are laughably calling NPOV (mainstream psychiatry) is anything but. Mainstream psychiatry is a nasty, hurtful profit-driven industry. Psychiatry is a sham and forced psychiatry is a human rights violation. If Wikipedia users prefer to go with them, feel free. There are thousands of psychiatrists ready to welcome you, with their prescription pads at the ready. -- EFS

"Mainstream psychiatry is a nasty, hurtful profit-driven industry"? I'll have to tell that to my underpaid NHS psychiatrist. Now, I agree that the biochemical theories of bipolar disorder are only that, theories, until they can be demonstrated to be both falsifiable, and to pass tests that risk disproving them. We only report the majority view that most workers in the field believe that these theories are increasing likely to be true, whilst acknowledging that no proof exists, only (quite a lot of) suggestive evidence. A question: if demonstrable scientific proof (in the sense given above) was available for these theories, would you change your views at all? -- Karada 01:08, 4 August 2005 (UTC)[reply]

I was referring to the entire field, not any particular psychiatrist. The majority in the field do indeed believe in the theory but that's thanks to the massive marketing power of the pharmaceutical industry. There is no compelling evidence for the chemical imbalance theory. If demonstrable scientific proof came along (and I don't think for a second that it will), that would certainly change my view on etiology. However, it would NOT make me support involuntary treatment. The issue of involuntary treatment is entirely separate from the issue of cause/treatment of mental illness. -- EFS

Ok ok, this seems to be getting carried away. I think both of you have adequitely made your positions on the topic known to yourselves and everyone else and have gone over to arguing with eachother over your viewpoints rather than discussing civilly what should or should not be in an unbiased article.

EFS, your comments seem more often than not to be intentionally inflammatory. Whether or not that's how you intend it that IS how you are coming accross. If you cannot post without insulting, belittling, or otherwise provoking a fight perhaps you should take your posts somewhere other than a repository of knowledge such as wikipedia where they might be better recieved. WP is not a platform for debate, it is a place to put documented and generally accepted knowledge. To assert that something which is not generally accepted is indeed fact requires some sort of substantiated proof, and furthermore should indeed be noted as a minority view.

Kadara, while your arguments do show sympathy to those who suffer from BD, they do seem to be egging EFS on and encouraging him to become a bit of a troll on the subject. Sometimes the best way to win a fight is to abstain from the fight itself, and let the agressor show his true nature where everyone can see it. Pushing back with more aggression seems to be adding fuel to the fire as it were.

Both of your views seem to equally biased, and if anything illustrate how clearly controversial this topic is. In such situations would it not be best to stick ENTIRELY with documented sources and the driest, most impartial wording possible in an effort to provide the most information possible with the least amount of spin? The goal of any article on WP should not be to steer a reader toward a conclusion, but rather to inform the reader of existing research so they can make their own conclusions.

If this argument, and the now absolute disarray of the article itself cannot be resolved peacefully and academicly, I again suggest that we seek arbitration from whatever higher powers be here at a WP. --KrisWood 03:48, 8 Aug 2005

Ok I did a little wandering around wikipedia and quite accidentally stumbled upon this lovely page which precisely illustrates my point: Wikipedia:What_Wikipedia_is_not. Specificly, Wikipedia is not a soapbox. Any number of other rules and guidelines on that page and linked to from that page also come into play in this argument. The article is not about the good or evil of psychiatry as a whole, it's a collection of encyclopedic knowledge about a medical condition. I'm going to go find a template now for "this article needs to be cleaned up to adhere to a higher level of standards" or whatever it is and stick it at the top of the article. --KrisWood 04:47, 8 Aug 2005

KrisWood, thanks for your input, but I had a question about something that you posted:

"To assert that something which is not generally accepted is indeed fact requires some sort of substantiated proof, and furthermore should indeed be noted as a minority view."

Try looking at it another way. The generally accepted biochemical theory has no substantiated proof. That hasn't slowed down psychiatry from actively promoting it. The lack of scientific evidence behind this theory is a critical problem - psychiatry kills and maims, all based on an unproven theory. -- EFS

Yes but you are still preaching from your soapbox. Regardless of how right or wrong you are such communication of viewpoints does not belong in WP. Can you think of a way to show documented sources to back this up in direct relation to Bipolar Disorder? It's not what is said so much as how it's said. NPOV is a must, and is a golden rule of WP. -- Kris

No, actually, I'm not preaching -- just pointing out that simply because something is generally accepted does not make it true. I could certainly provide you with references to Internet resources that discuss the utter lack of evidence for the chemical imbalance theory, but I fear that you wouldn't consider those NPOV either. Pretty much what I'm hearing from you is that the only way to be NPOV is to follow the herd. Contrary to your assertion, this article (and much else on Wikipedia) is absolutely riddled with point of view. -- EFS

WP is not the place to argue that the orthodox view is false. It's not the place for arguing a point at all. You're bound to see WP as biased against your viewpoint, simply because the articles refuse to dismiss the biochemical imbalance theory as a myth. You'll notice that it doesn't dismiss your viewpoint either. It presents them both, with weight given according to how widely accepted the viewpoint is. That's NPOV. If you continue to feel that th article is biased, then the best plan is probably if we take it to arbitration or other external authority, as suggested above.-- ascorbic 06:47, 10 August 2005 (UTC)[reply]

WP also refuses to acknowledge the truth -- that there is no credible evidence for the biochemical imbalance theory. I agree that you haven't dismissed my viewpoint, however, I don't feel you've represented it fairly, either. Do you remember me being informed that electroshock wasn't as scientific a term as ECT? Good grief! Your definition of NPOV is absurd and inaccurate. True NPOV would be a presentation of the available facts with no regard at all as to how many people choose to ignore those facts. I'm not interested in arbitration as I'm satisfied with containing my comments in the "discussion" section rather than trying for equal weight in the actual article. -- EFS

I thought you were going to contain your POV to the talk page. Your recent edits were once again POV-pushing. Either leave the page alone, or go for arbitration. Please don't continue to add these slanted passages to the article. Thank you. --ascorbic 19:37, 14 August 2005 (UTC)[reply]

So your definition of "slanted" would be another way of saying "not in agreement with everybody else"? Okay, got it. I feel as an electroshock survivor, that I actually have more to contribute than anyone who doesn't know firsthand about this barbaric "treatment." I provided a great source and I've got the facts to back me up. What exactly is POV about my recent edit on the electroshock section? Your hypocrisy is astounding. -- EFS

No, my definition of slanted would include adding "cure" in scare quotes, and especially describing studies as "completely unsupported by an analysis of the facts". You cannot simply make this assertion. The fact that you believe that is is unsupported is not enough. The fact you provided a source is not enough. Even if it's true, it's not enough. It's a contentious topic, so you can't just dismiss the studies like that: you need to acknowledge both points of view. This is especially important as the opinion you're presenting is a minority view. Over and over you add your point of view as fact, and even if it is in the context of something like "critics say...", you will present it in a form such as "critics point out that this is not true". The problem I have is not with your point of view, it's with the way that you present it in the article. I would feel exactly the same if your view were the complete opposite, and you added something like "Critics of ECT claim that it causes long-term damage and offers little benefit to the patient, but these views are completely unsupported by clinical studies". Either way, it's one-sided. I'm not expecting you to be "in agreement with everybody else", I'm just asking that you don't present your POV in a way so as to dismiss all others. Yes, your experience of electroshock gives you an insight into it, but it's also clear that it makes it hard for you to remain neutral, as perhaps you're too involved - and angry. Either way, I've removed the section, as I don't think it's really useful to the article, and certainly not worth such disagreement. The treatment is relatively rare for bipolar, and the only content in there was not specific to its use for bipolar disorder, and belonged in the main ECT article if anywhere. --ascorbic 22:27, 15 August 2005 (UTC)[reply]

Really not sure what you mean by "'cure' in scare quotes." The fact is that the mainstream studies are extremely flawed. If it's a contentious topic, then why is my material dismissed so easily but, as you say, opposing material can't just be dismissed because ... well, because it's a contentious topic. Do you not see the double standard here? The bulk of this article IS ALREADY one-sided and I'm trying to remedy that insofar as I am able. Much of the language within the article makes it very clear that dissenters must be non-scientific flakes. That is simply not the case. We've got some great doctors and researchers on our side. I agree that being an electroshock survivor adds an element of emotion that isn't helpful. On the other hand, when I read people saying that electroshock is harmless then it TAKES an electroshock survivor to point out the truth. Contrary to what you say above, electroshock is a very common treatment for both phases of bipolar disorder. You are doing me and the viewing public a great disservice. -- EFS

On the balance of the article, POV, etc.

Although I am quite tempted to jump in on the above discussion, I will withhold for now. On another note, I noticed that a short time ago that one editor deleted the entire introduction. While I agree that the previous introduction was too long, I also believe the article needs an introduction of some sort (maybe on the order of two or three paragraphs plus the note on usage). Also, some of the content from the old introduction probably could/should have been moved into the main section of the article, but I don't think this was done. Anyone else agree and/or want to give some attention to this? -- Ithacagorges 06:38, 15 August 2005 (UTC)[reply]

No need to jump in, Ithacagorges, for you've made your position more than clear. Let me sum up for you: anything that mainstream psychiatry comes up with is honest and scientific. And anyone who disagrees is a member of a campaign with an agenda of dishonesty and exaggeration. Got it. Nothing POV about where you're coming from.

-- EFS

The fact that someone makes edits to try to bring balance to an article does not warrant your sarcastic accusations. I don't know about Ithacagorges, but my edits have simply been an attempt to improve the quality of the article. As you read the article on mental health law that I wrote and gave you a link to earlier, you'll see that I am by no means a blind apologist for current psychiatric practice. I just want to avoid this article degenerating into a useless mass of revert wars and POV-pushing, and perhaps even become a half-decent article on bipolar disorder. --ascorbic 22:34, 15 August 2005 (UTC)[reply]

The accusations were entirely accurate. My frustration (and resultant sarcasm) is due to my perception of what some posters mean by the term "balance." It really does appear to me that anything "mainstream" is called NPOV and anything outside the mainstream, no matter how true or how well cited, is called POV. It's very frustrating. Like I said, I was impressed with your article and am surprised that you're not more adamant about getting the facts out there on Wikipedia. Why is it that anything not palatable is called NPOV? Because it is mainstream psychiatry that is horribly skewed, and completely POV. I haven't even begun to address what's wrong with psychiatry in general and the bipolar diagnosis in particular. I haven't talked much about bipolar disorder being caused by antidepressants, although that's a huge problem and is certainly how I developed it. I haven't discussed the huge role that nutrition (or, more accurately, poor nutrition) plays in bipolar disorder. I also haven't discussed how many of us manage our mood swings effectively without medication. I just cannot believe psychiatrists are given so much power when their work is so consistently poor. The documented error rate on psychiatric diagnosis is around 50%. Lives have been destroyed by psychiatric treatment based on this kind of shoddy science. I've been as restrained as I can. -- EFS

As I said: it's not enough for it to be true or well cited. You cannot simply present the conclusion that one side of the argument is right or wrong. The article should not be about making a conclusion or convincing people either way. It should be about presenting the facts and letting the reader decide. It is a fact that critics say such and such or the APA says something else, and that's ok to say. You cannot, however, make a conclusion that one or the other is "true". That is not a fact: that is an opinion. It may be a correct opinion, but others would dispute that. Where in the article do you find it skewed towards "mainstream psychiatry"? As I read it, it presents the mainstream opinions as just that: the mainstream medical opinion. It likewise presents the criticisms as that: the opinions of a minority. It does not conclude which is correct. You may be surprised that I don't appear to you to be adamant in getting the facts out there. I will take that as a compliment. I am adamant in having the article represent the facts and the balance of opinion. This is not the place, and I am not the person to decide for readers what is the truth. That would constitute original research anyway, which is not allowed. I would be equally active in maintaining NPOV if there were an editor as active as yourself who wanted to remove all of the criticisms, or dismiss them as false. I do hope that if you make the changes you mention, you do so in a manner that reflects the balance of opinion, and doesn't use inflammatory language. Editing the article in order to say "what's wrong with psychiatry in general and bipolar diagnosis in particular" would be a VERY BAD idea. However, it's ok to report in a neutral tone on the views of those who share your belief. This article is also not the place for general criticisms of psychiatry: keep that to psychiatry and anti-psychiatry. From what I understand, you are active in the anti-psychiatry movement. This means you should be doubly careful to ensure that your bias doesn't enter into your edits. --ascorbic 08:31, 16 August 2005 (UTC)[reply]

I really do appreciate your comments, Ascorbic, and I think I should direct my energies elsewhere (huge sigh of relief all around!). I just wanted to say, though, that much of this article (and the ones on electroshock and schizophrenia) actually do put forward one point of view as fact. And that point of view is just not supported by the evidence -- there is NO evidence for the chemical balance theory and thus it is unethical to teach people that there is something diseased about their brains, especially when that teaching leads to discrimination and human rights violations.

What if we had a Wikipedia-friendly NPOV article about racism? You know, some people feel that Races X and Y are inferior. Of course, someone would jump in and rage and say the whole notion of racism is bunk! Do you know what I mean? And when I make edits that ARE neutral (here and in the other articles I mentioned) they get re-edited in very offensive ways. As I'm sure you're aware, the anti-psychiatry movement is significant, certainly enough to make psychiatrists start to pull up their socks. For example, at least one state in the USA has now partially opted out of the Texas Medication Algorithm Project in that they will require parental consent before screening. This is a HUGE victory and is entirely due to the work of organizations that I'm involved in. So when someone edits my "critics of psychiatry" to "some rather vocal former psych patients," yes, I am offended, very offended. I had a great cite on the electroshock page to a practicing doctor who did a very credible analysis of other studies. Well, that link was deleted right out without explanation. I'm not suggesting for a minute that you do this but I'm trying to get you to see how frustrating is to read this bumpf. Anyway, like I said, you've done brilliant work here, with me. -- EFS

To echo and add to absorbic’s comments, this is an article on a medical, mental health, and psychological topic. As such, the article should have somewhat of an emphasis on the prevailing mainstream medical, psychological and scientific view. My position on this was sarcastically mocked above but I stand by it as appropriate. That said, there is certainly a place for the views and assertions of critics in this article (and at present many are given). However: a) they should be stated as the claims/beliefs/opinions of a minority of critics, the anti-psychiatry movement, and the Scientologists, not as absolute fact; b) they should not use inflammatory, sarcastic, or outrageous language; and c) if they make claims that are widely disputed or considered inaccurate or misleading by the mainstream community, such should be noted. The tenor of a certain vocal editor’s recent contributions are generally not in this spirit. In addition, as absorbic points out, this article is not the place for general criticisms of psychiatry; that belongs on the psychiatry and anti-psychaitry article. Likewise, criticisms and claims about ECT generally belong on the ECT article. Finally I will note that if someone tries to start a topic on the talk page about a subject completely unrelated to one’s particular criticisms or beliefs about a subject, it is not necessary or courteous to juggernaut said section(s) as a further pedestal for your views. (FYI, you may be surprised to learn that I have certainly had far cry from a 100% positive experience with the mental health/psychiatric community, that I added a section on criticisms of psychiatry on that article, and I have also made some contributions that certainly do not put the drug industry in very good light.) -- Ithacagorges 10:06 16 August 2005 (UTC)

You've outdone yourself again, Ithacagorges! The scientologists are but a subset of the anti-psychiatry movement and it is so typical of you and mainstream psychiatry to attempt to smear us by referring to us as scientologists. That's not NPOV, man! We don't have mere "claims, beliefs, opinions" when psychiatry has "evidence." Your POV is dripping right off the page! Do you get the distinction? We have equally, actually more, compelling evidence for the environmental/social causes of mental illness and by extension the case for treating mental illness with psychotherapy and risk avoidance. Re your comments on electroshock, yes, that section has been moved but at one time it was embedded right in the bipolar article so I don't understand your complaint. Yes, I would be flabbergasted to learn that you have been badly treated by the mental health industry because you seem to be all for it here. -- EFS

EFS, I'm glad you appreciate my efforts here. I don't feel you;re being fair to Ithacagorges. The quote in question said "the anti-psychiatry movement, and the Scientologists", which is perfectly true: both the anti-psychiatry movement and Scientologists oppose psychiatric practice. The use of "and" not "including" does not to me read like referring to you as scientologists. Can you try to calm down a little: some of your recent comments (though not those directed towards me) have been quite aggressive. ---ascorbic 22:57, 16 August 2005 (UTC)[reply]

Start with a personal attack. Take a couple points I made, distort them significantly, then hammer on them as much as possible. And/or maybe take a couple things I actually didn’t say at all, and do as above. Use ample sarcasm and exaggerated language. Ignore most of what I said, particularly when inconvenient or counter to the intended point.

This is how I would briefly characterize EFS’s responses to my recent comments on this talk page. Quite interstingly, I would say this is analogous to many of EFS’s contributions regarding psychiatry (e.g. replace "on my comments" with "on current psychiatric or mental health practice"), and frankly is an approach used in a lot of anti-psychiatry and related literature and information. This is one of the primary qualms I have with both EFS’s contributions and the anti-psychiatry movement in general.

I think my statement was unambiguous in that I did not call EFS (or critics or members of the anti-psychiatry movement generally) a Scientologist. If EFS had checked my record, as I alluded to, she would have would seen my contributions have not been universally praising of mainstream psychiatry. I would be the first to admit that many patients’ experiences with psychiatry are not entirely positive, and some even find the downfalls worse than the benefits. On the other hand, in my experience and I would assert in general, only a very small number patients/former patients take on the views of or join the anti-psychiatry movement, or claim of intentional injury, "oppression" or "assault".

I apologize if this is somewhat aggressive and sarcastic myself. More on the balance of the article later. --Ithacagorges 00:06 August 17, 2005 (UTC), minor revisions 03:00 August 17, 2005 (UTC)

But the scientologists are just a subset of the anti-psychiatry movement. They are very prominent because many of their members are, as I'm sure you know, Hollywood celebrities. However, they are not better or MORE anti-psychiatry in any respect. IMO, saying "anti-psychiatry activists and scientologists" is an intentional slur against the anti-psychiatrists. Otherwise, why don't you mention "anti-psychiatry activists and libertarians"? As for personal attacks, Ithacagorges, weren't you the one who said "90%" of my posts were misleading, exaggerated, non-scientific, etc.? I've asked you some time ago to back up your claim and am still waiting. Many patients' experience has been "not entirely positive"? You crack me up. May I ask what you do for a living? FYI, MANY survivors find psychiatry causes more harm than good. You are correct that statistically only a small number of former patients oppose psychiatry. At least part of the reason for that is that some former patients were killed outright by psychiatry and many others live a kind of living death: an endless despairing cycle of trips to the psych ward, interspersed with appointments with shrinks they loathe and fear, "assisted" housing, asinine day programs, all this on the basis of a theory which has no credible evidence. -- EFS

Ascorbic, I would like the same standards to be applied to both sides. That is manifestly not the case at present. -- EFS

We try. You can help. If you look at Ithacagorges' last edit, it's actually balancing my edits to the now-defunct ECT section to reflect more of your POV. Ironic, considering your recent comments. --ascorbic 22:57, 16 August 2005 (UTC)[reply]

You are right! That is much more balanced and, dare I say, even approaching NPOV. Thank you for restoring the link to Dr. Peter Breggin's paper. Any idea who killed it in the first place? -- EFS

This is Ithacagorges FIRST reference to my edits: "I agree that 90%+ of 24.108.4.85's edits have been POV with no place in this article; they promote the so-called "anti-psychiatry" agenda, and typically make misleading, inaccurate, exaggerated, and/or non-scientific claims." The funny part is that he says "I agree" but the previous editor hadn't made an analogous claim. If "aggression" is being accused here, I would suggest that Ithacagorges set the tone of this discussion. Once again, I ask for specific examples of where I make "misleading, inaccurate, exaggerated, non-scientific" claims. -- EFS

Introduction

Let's try this again. I noticed that a short time ago that one editor deleted the entire introduction. While I agree that the previous introduction was too long, I also believe the article needs an introduction of some sort (maybe on the order of two or three paragraphs plus the note on usage). Also, some of the content from the old introduction probably could/should have been moved into the main section of the article, but I don't think this was done. Anyone else agree and/or want to give some attention to this? -- Ithacagorges 22:56, 15 August 2005 (UTC)[reply]

I agree. While the old introduction was not great, and had quite a bit that should have been in the body of the article, the article does need at least something as an intro. -- ascorbic 23:06, 15 August 2005 (UTC)[reply]

I think before such changes are made (and I agree that they are required) we should try to figure out how this topic can be presented without being an advertisement for mainstream psychiatry. I am just appalled at some of what is in this article so far. You're swallowing Big Pharma's line -- that the only way to "manage" this "disease" is by taking medication.I don't think it's unreasonable to give a fair piece of this article to something other than Big Pharma driven narrative. -- EFS

PLEASE give me an example of where I have introduced something misleading and/or exaggerated. -- EFS

Neurological basis.

I was hoping to find some kind of summary or indeed collection of the neurological bases of bipolar disorder here. Maybe someone with an appropriate understanding of the field could add to this article?

At this time, there is no compelling scientific evidence of a neurological origin for bipolar disorder (or any other mental illness). -- Francesca Allan of MindFreedomBC

Genetic Component

The current entry has this:

Bipolar disorder is considered to be a result of complex interactions between genes and environment. The monozygotic concordance rate for the disorder is 70%. This means that if a person has the disorder, an identical twin has a 70% likelihood of having the disorder as well. Therefore, the genetic component makes up about 70% of the risk for the disorder. Relatives of persons with bipolar disorder also have an increased incidence of having unipolar depression.

However, since twins are brought up in the same environment, a monozygotic concordance rate does not give you a percentage of the risk of the disorder. Sometimes studies of adoptees are done--twins who were seperated at birth. At very least, there needs to be a nuanced comparison between monozygotic twins and non-twins. There is also the issue that "70% of the risk for the disorder" is so vague as to be effectively meaningless. Risk for whom? Someone who doesn't have "the gene" is at 30% at risk? No, that's muddled. I'm not trying to be pedantic or lash at people for hard work--thanks for doing what you've done. Just trying to justify my removal of the sentence in bold. Cheers--Pigkeeper.

"Complex interactions between genes and environment" pretty much demonstrates how little psychiatry knows as most if not all diseases are a complex interaction of genes and environment. The truth is that as of this moment there is no objective diagnostic test for any mental illness. If, by some miracle, they actually did find some biochemical or other marker, then bipolar, schizophrenia and depression would no longer be dealt with by psychiatry but would be true brain diseases and treated by neurologists. That is unlikely to happen.

Also I found the following unsigned paragraph above: "It's often the case that someone with BP disorder who is not being medicated will appear normal between distrbances and to be fully functional and independent. It's rather uncommon for people with schizophrenia who have undergone several episodes to be fully functional and independent without medication." This is completely untrue. First of all, it's not a matter of "appearing" normal -- between episodes a bipolar IS normal and fully functional. Second, it's not at all uncommon for schizophrenics to go into remission, even 2 or 3 year decades into their illness. Chronic disability is caused by psychotropic drugs, not the alleged disorders. -- Francesca Allan of MindFreedomBC

Mixed States ; "Bipolar" vs. "Manic Depression"; Manic depression includes unipolar?!

Number one: The page could use more information on mixed states. If/When I get a chance, I'll add it. No time at present or for coming weeks.

Number two: People are disparaging the term 'manic depression', but I know I am not the only one out here who prefers the term to bipolar disorder. It is precisely because of mixed states that I say this.[12]

Manic Depression is, in my view, a better term for the condition, the reason being that there really aren't two poles. It is possible to be manic and depressed at the same time, believe it or not. These so-called "mixed states" are can be the most troubling--I know they are for me. Many people have a somewhat romantic notion of manias, but when you're your mind is hyperactive but you're unhappy, it really sucks. The best word that comes to mind to describe this is "aggitation". It is hard to deal with people in relationships when they are being this way. It's also when people feel crap enough to kill themselves, but have the energy to pull it off.

Number three: From the introduction:

"the term manic depression is also now used (by a relatively small number of mental health professionals) to refer to the entire clinical spectrum of mood disorders that includes both bipolar disorder and unipolar depression."

COULD SOMEONE GIVE A CITATION FOR THIS PLEASE? I THINK THIS IS WRONG. I've never heard anyone say that unipolar depression is a form of manic depression! I'd respectfully admit I was wrong if you have any sources. But at any rate, I think it's such a minority that it's misleading to put it in the introduction. However, bipolar spectrum disorders is another thing... Bipolar I, bipolar II, cyclothymia, etc...

Cheers, Pigkeeper, Oct 17, 2005

I've never heard this either and I agree with you that it's probably in error. One other point is that when bipolar disorder is caused by antidepressants (i.e. a depressed person takes antidepressants and becomes manic for the first time) some psychiatrists refer to this as "latent bipolar disorder" becoming evident. This is an obscene interpretation of a fairly obvious cause and effect relationship. -- Francesca Allan of MindFreedomBC

Feb 2005 Journal of Affective Disorders had a entire issue devoted to the *theory* of Hagop Akiskal MD of the University of California at San Diego about Bipolar and Unipolar Despression being on the same spectrum. Journal of Affective Disorders: http://www.sciencedirect.com/science?_ob=IssueURL&_tockey=%23TOC%234930%232005%23999159997%23568410%23FLA%23&_auth=y&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=40fc023079b068243a79a0dad8579d7e And a layman's description is here: http://www.mcmanweb.com/mood_spectrum.htm Curlywhirly 03:52, 16 December 2005 (UTC)[reply]

Chaos

This article is presently a bit chaotic. I've done some cleaning up, but there are still two sections about creativity and bipolar disorder etc etc.

I feel the article still lacks the basics, but contains the latest research that has made the popular press. That is immensely confusing for the reader. There's a lot of work to do here. On the Medical WikiProject, we stick to a fixed format: signs and symptoms, diagnosis, mechanisms of disease, treatment etc, see here. This may be less suited for this article, but may be worth trying. JFW | T@lk 23:18, 15 November 2005 (UTC)[reply]

Link vandal

Anonymous user 24.199.113.69 keeps adding a link to http://bipolartreatment.com in multiple sections of several articles, including Medicine where it is inappropriate - what can be done to prevent him or her from repeating this over and over again? unsigned comment 19:26, 23 November 2005 by Anarchist42

Same from other anonymous IP addresses. Getting quite aggressive with the linkspamming. CarbonCopy 19:44, 23 November 2005 (UTC)[reply]

France

I heard that the country with the lowest rates of bipolar disorder is france. What is the cause of that. I May have heard something about natural salts? any help would be apreciated. ---Bohouse 20:50, 1 December 2005 (UTC)bohouse[reply]

Natural salts high in lithium? JFW | T@lk 23:11, 1 December 2005 (UTC)[reply]

The answer is lithium carbonate. --165.236.228.81 03:12, 9 December 2005 (UTC)[reply]

clean this sh*t up!

Man this article is riddled w/poor writing. I don't have time to work w/it now but we need more quality information (better no info than false/poorly supported info!) I changed some things under the "creativity" section; there has been TONS of research on BP & creativity links, so it shouldn't be hard to cite. I added two articles, but i don't know how to put them under the reference section. anyone else w/access to a university library database could fix this for me... --Katwmn6 00:39, 5 December 2005 (UTC)[reply]

I'm sorry it's not in the best of states now. Feel free to remove whatever sounds illogical or cannot be backed up with a CITE. This is an important condition, and there is little reliable information online. Wikipedia should have a good article on it. JFW | T@lk 15:33, 5 December 2005 (UTC)[reply]

Please add a section on how Bipolar and Schizophrenic parents affect children's self esteem and safety.

I'm sure many people who have these mental problems will want to know how to protect their children from their outbursts, and how to explain their out-of-control behaviors to their children. I have seen some children who were told that their parent's behavior is "normal", who then LEARNED to copy the behaviors and attitudes, which created many problems for the children. (karenjoyce_bell).

Their outbursts? Which outbursts would those be? Francesca Allan of MindFreedomBC 15:35, 5 December 2005 (UTC)[reply]

People with borderline personality have outbursts of anger etc, where people with schizophrenia have relapses of psychotic episodes and people with bipolar have episodes of mania or depression.

As opposed to the general population which never gets angry, high or depressed. Francesca Allan of MindFreedomBC 18:19, 11 December 2005 (UTC)[reply]

"Mental problems?" You remind me of a teacher I once heard say that bipolar patients should never be so "selfish" as to raise children. misanthrope 17:48, 23 December 2005 (UTC)[reply]

Hypomania

in the section "Domains of bipolar disorder," there is a brief mention of Hypomania, but there isn't really a description of its features beyond its characterization as "mania-lite." Honestly, after reading this article (and knowing a few BPs) I'm curious as to what hypomania is, and the article didn't really do it for me. Can anyone expand this section? Shaggorama 05:28, 14 December 2005 (UTC)[reply]

A terrible mess

This article, whilst containing some good writing and verifiable information, has been bloated by drivel and has become a structureless mess. It needs substantial editing and trimming of redundant material. And yes, I have made a small start on doing so. -- The Anome 17:54, 17 December 2005 (UTC)[reply]

I too have made a start at bringing things into a more coherent article. Please forgive me and point me in the right direction if I don't follow wiki-ettiquette, as this is my first time working on the project. Here are my proposed changes for the first paragraphs (combined into one):

Bipolar disorder, also sometimes called manic-depressive disorder, is a mood disorder in which a person experiences episodes of mania and depression without other environmental or medical etiologies. Other causes of manic or depressive symptoms such as hyperthyroid or sleep deprivation negate the diagnosis of Bipolar Disorder. These mood "cycles" which can vary in speed can effect the victim's levels of motivation, energy, cognition and overall functioning, and can be disabling as they have extreme shifts in mood between depression and manic euphoria or irritability. The DSM lists two main types of bipolar disorder (recognized clinically as Bipolar I and Bipolar II), the former of which features more marked mania. Some people with Bipolar also experience psychotic symptoms along with the mood disturbance. Treatment of disabling bipolar disorder is with mood stabilizers, prominently lithium salts and/or some anticonvulsants and/or anti-psychotic medications.

Looking forward to input from others,

Curlywhirly 23:03, 18 December 2005 (UTC)[reply]

This sounds very good. JFW | T@lk 23:30, 18 December 2005 (UTC)[reply]

Here are my proposed edits for the second section on Epidemiology:

The lifetime prevalence rate of Bipolar Disorder I and II is between .6 and 2% of the population. Bipolar I disorder is gender-neutral, affecting both women and men equally, although Bipolar II is found more frequently in women. There appears to be no difference in frequency among races. Often the disorder starts with a depressive phase, and mania or hypomania then follows. For many years it was believed that Bipolar was a disorder that emerged in late adolescence and young adulthood, but recent research has shown that even young children can suffer from Bipolar symptoms. In the vast majority of cases the symptoms are present for the rest of the persons life, although there are some occasional reports of single manic episodes and then full recovery with no reoccurrence. It should be noted that manic symptoms that are caused by other medications or diseases or disorders rule out the diagnosis of Bipolar Disorder, and this is possibly the root cause of some of the full recovery case reports.

Bipolar Disorder can be co-morbid with a number of other disorders and problems, including panic disorder, social phobia and substance abuse/dependence, somatization disorder, personality disorders, suicidality and delinquency and possible associations with Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Tourettes syndrome, impulse control and eating disorders, ADHD, Oppositional Defiant Disorder and conduct disorder.

I have 2 references for my edits:

Co morbids and prevalence rates, etc http://www.wpic.pitt.edu/STANLEY/3rdbipconf/Sessions/sess2main.htm

BP in children http://www.nimh.nih.gov/scientificmeetings/pediatric.cfm

Would the proper style be to add these to the References section or should I cite them as part of the article itself? Curlywhirly 23:38, 21 December 2005 (UTC)[reply]

I would like to suggest merging the Multiple co-occurring explanations & Etiology categories. There is much over lap of information and it becomes quite confusing to me. I am still working on providing adequate references for statements made... I'd post those before making the changes listed here. Here are my proposed changes:

A diagnosis of bipolar disorder means the diagnosis of clinical depression and at least one major manic episode... Quite frequently, a patient will be diagnosed with clinical depression, modified to bipolar after the onset of mania. The causes of a manic episode may also be indeterminable, leaving the diagnosis of chronic bipolar disorder in doubt. See manic episode or depressive episode. A person can have symptoms of mania without having bipolar disorder, or without being depressed.

Multiple factors may be involved in developing Bipolar Disorder. Stressful events or major life transitions, a family history/ genetic predisposition to psychiatric diagnoses including bipolar disorder, clinical depression, or schizophrenia (This increases a family member's likelihood of having psychiatric symptoms by 10% or more), past or present drug use (may complicate diagnoses if present and may lead to misdiagnoses), sleep deprivation can also cause a manic like state. Drug use, both legal and illegal may also contribute to the development of Bipolar Disorder. According to the "kindling" theory [1], persons who are genetically prone toward bipolar disorder experience a series of stressful events, each of which lowers the threshold at which mood changes occur. Eventually, the mood episode itself is sufficient to trigger reoccurring difficulties. Conversely, Bipolar disorder may be caused by a combination of biological and psychological factors. In some cases the onset of this disorder can be linked to stressful life events. Periods of depression, mania, or "mixed" states of manic (euphoric) and depressive symptoms typically recur and may become more frequent, often disrupting work, school, family, and social life. It is possible to see single occurrences of depression and mania which do recur.

Drugs and Bipolar: Adderall and other drugs and amphetamines (including meth) have been cited as producing mania, even after the drug is not in the bloodstream. For such a patient, the euphoria of the Adderall might not wear off as quickly as it may for others. They may exhibit manic symptoms while on the drug. Some medications have depression as a side effect. Conversely, often a manic patient will, if untreated, be misdiagnosed by laypersons and even medical professionals as being "high" on meth in a state of "meth psychosis," which also includes the co-occurrence of a string of sleepless nights found in a true, or full blown 'mania.' At this point, without medical intervention, the manic state and sleeplessness can combine to form a vicious cycle which only proper intervention, can end. According to their prescribing information published by the manufacturers antidepressant medications can also possible trigger manic or psychotic episodes which may or may not resolve when the medication is resolved.

Three sections I was unable to merge successfully. If anyone else would like to try that would be great, otherwise I can try to find appropriate places for them elsewhere in the article. Looking forward to input.

1)Rarely does the disease first manifest in a manic or hypomanic episode: generally these occur after years, even more than a decade of clinical depression.
2)Often emergency room hospital personnel will view any manic behavior as symptomatic of drug abuse, whether or not the patient has any drugs in their system or not. Most emergency room staff have little or no training, which could contribute to the high rates of suicide among bipolar patients who seek help and are denied medicinal intervention.
3)Conversely, it is also possible for the the onset of the depressive aspect of bipolar to first appear in the late teens with no "kindling" or outside stressors. Such patients are often diagnosed with clinical depression until the first manic episode occurs, usually in the mid-to late twenties. In these patients, the biological factor seems to be prevalent, although co-occurring substance use or 'self-medication' can cause a misdiagnosis or further complications.

Curlywhirly 17:31, 27 December 2005 (UTC)[reply]

Off Label Use of APs

I have a concern about smkatz edit of the first paragraph.

Treatment of disabling bipolar disorder is with mood stabilizers, prominently lithium salts and/or some anticonvulsants and/or anti-psychotic (also known as neuroleptic medications). When antipsychotic medications are indicated, they are often used "off-label". Such off-label usage is controversial. Some antipsychotics have recently been approved for management of acute bipolar mania crises.

To the best of my knowledge, the use of antipsychotic medications for Bipolar is not off label any more than anticonvusants. In most cases AP and AC use is in line with all of the current major treatment guideline publications in the scientific literature. For example, the American Psychiatric Asociation http://www.psych.org/psych_pract/treatg/pg/bipolar_revisebook_index.cfm I'd be very interested in seeing any other information you may have. Curlywhirly 23:56, 21 December 2005 (UTC)[reply]

bipolar disorder caused by antidepressants

This is a fairly common phenomenon which should be addressed in the article. When mania occurs as a result of antidepressant use (particularly SSRIs), the psychiatrist typically responds by labelling the patient bipolar and adding mood stabilizers into the mix. A more appropriate course of action would be to treat the patient for what he/she is actually undergoing: a toxic reaction to psychotropic medication. Francesca Allan of MindFreedomBC 04:16, 22 December 2005 (UTC)[reply]

Actually, when a psychiatrist diagnoses Bipolar disorder based on a manic or bad reaction to an antidepressant (or any med) they are mistaken. The DSM-IV specifically states that if the manic symptoms can be traced to any other cause, then Bipolar is not an appropriate diagnosis. You are right though, this happens all too frequently. Curlywhirly 05:44, 22 December 2005 (UTC)[reply]

Bipolar disorder is a real disorder that affects millions. Individuals are not treated with medications unless they display symptoms. Bipolar symptoms that are caused by an antidepressant would be infrequent occurances if they occur at all. If it is so common and frequent, it would be great to see citations. --24.55.228.56 13:14, 22 December 2005 (UTC)[reply]

It happens frequently and it certainly happened to me. It's a common enough occurrence that NAMI and others recommend mood stabilizers in addition to antidepressants. If you're truly interested, you could search the internet under "latent bipolar disorder" because that's what psychiatrists fraudulently try to attribute it to. Francesca Allan of MindFreedomBC 15:44, 22 December 2005 (UTC)[reply]

24.55.228.56, Yes of course Bipolar is real. However I must say that manic or manic type reactions to antidepressants are not as rare as we could wish. And the DSM-IV does specifically state that reaction to meds negates the BP diagnosis. Of course, the DSM-IV is not the perfect answer to everything, but it is the standard used by psychiatry at this time and so it does have relevance. In the Paxil prescribing information http://us.gsk.com/products/assets/us_paxil.pdf I found the following list of possible adverse reactions that could be or appear to be or may be related to manic/psychiatric reactions; Insomnia, Agitation, Nervousness, Anxiety, Hallucinations, Emotional Lability, Abnormal Thinking, Euphoria, Hostility, Manic Reaction, Paranoid Reaction, Antisocial Reaction, Delusions, Manic Depressive Reaction, Psychotic Depression, Psychosis. Other SSRI medications have similar adverse reaction profiles according to the manufacturers. I can list their PI pages if necessary so we can look at them individually if you wish. I think this may be an important issue to discuss in the article. Curlywhirly 18:14, 22 December 2005 (UTC)[reply]

Francesca, I am going to assume good faith, but I must say your comments come across very angry and condescending and my initial reaction was very negative. From what you have said you had a rough experience with medications and I think I understand having BTDT with multiple family members. However, it might be more useful in this Wikipedia arena and to helping others avoid the same pitfalls if we all provide fact based evidence to back up our concerns so that we can focus on writing the best article on BP to help the most people. Respectfully, Curlywhirly 18:14, 22 December 2005 (UTC)[reply]

Hi, Curlywhirly. You might be responding to my own response to some very condescending pro-psychiatry editors. I am endeavouring to provide further information so that others can be spared what I went through. Regardless of what the DSM says, the fact is that many depressed patients are treated with antidepressants, become manic as a result, and are forever afterwards treated as bipolar. Francesca Allan of MindFreedomBC 01:16, 23 December 2005 (UTC)[reply]

Francesca, your statements provide all the more reason to write the best, most fact based article possible for Wikipedia. If we hold to the standard of factual evidence rather than opinion it won't matter if the editor is pro- or anti- psychiatry. Facts are facts. Now, instead of telling people to look it up on Google for themselves, please provide evidence to back up your statements and refrain from making accusations, rather assume good faith just as I am doing with you. If you feel that BP caused by ADs is an issue that should be in the article, then please write it up, cite your sources and post it here for interested parties to discuss. Curlywhirly 06:38, 23 December 2005 (UTC)[reply]

Here is an article that deals with various adverse effects of SSRI treatment, including mania: http://www.mcmanweb.com/article-19.htm Francesca Allan of MindFreedomBC 01:51, 28 December 2005 (UTC)[reply]

I am very familiar with that article and the information therein. It does point out some serious problems with SSRI medications when given to someone with Bipolar disorder or other genetic vunerability to negative effects. However that is a very one sided article as the author did not cite ebven one bit of evidence of the *benefits* of these meds and the hundreds and even thousands of people who have been helped. I have no doubt about the problems associated with these meds OR the benefits, which is why we need to get fair and balanced information out, so that people can make informed choices. Curlywhirly 05:01, 28 December 2005 (UTC)[reply]

Hey, Curlywhirly. Most articles do present one side over the other, don't they? You won't find an article of Torrey's acknowledging the horrendous effects of psych meds, for instance. It's important that you understand that SSRIs can cause mania in someone who has never before had mania so a "genetic vulnerability" in such a case is very unclear and is more likely a psychiatrist attempting to cover up the harm done (by blaming it on pre-existing but invisible illness). As far as informed choices, the vast, vast majority of information on the internet and elsewhere is backed by Big Pharma so I think it's important that the other side gets heard. And, just so you know, I do think there's a place for medication but treatment has to be collaborative and not forced. Francesca Allan of MindFreedomBC 05:11, 28 December 2005 (UTC)[reply]

Yes, most everything you find will have the bias and POV of the author or whomever is paying for the article to be written. That is why an article with NPOV is so important on Wikipedia. Do you have any facts to back up your claims about psychiatry? I have yet to see you post a citation that directly supports any of your disputed statements. Instead you post innuendos and cast allegations. If you care to discuss facts then I am your gal, otherwise I have other things to do with my time and energy. Curlywhirly

I've posted several links to good information -- articles by Dr. Peter Breggin and journalist Robert Whitaker, just to name a couple. I've also posted links to organizations such as PsychRights and the International Center for the Study of Psychiatry and Psychology. In some cases, my links are deleted by pro-psychiatry editors. Most of the related articles on wiki aren't NPOV but rather heavily slanted in favour of biomedical psychiatry. Francesca Allan of MindFreedomBC 15:46, 28 December 2005 (UTC)[reply]

The problem with BP is that the psychiatric profession is based upon as much opinion as fact (for example, Neurontin was until recently thought to be an anti-depressant, but is actually just a placebo). Also, and not surpisingly, the psychiatric profession does little research on how inaccurate their diagnoses are (or are not). Anarchist42 15:59, 23 December 2005 (UTC)[reply]

Anarchist, can you provide some evidence to back up your assertions that psychiatry is based on opinion as much as fact? There are in fact thousands of studies working on finding the best information even as we speak. It is true that there is a tremendous lack of understanding of the brain and how it effects behavior and emotions. However the lack of complete information has never prevented the medical profession from attempting to help people, and new areas on understanding have often not been well received or trusted by the general population. Note: Neurontin was developed by the pharmaceutical companies as an anticonvulsant. It was then heavily marketed for Bipolar, but it proved to be ineffective and to even cause some people to become manic. There is a lawsuit over this issue. Experience and further research has shown Neurontin to be effective for certain types of pain, anxiety, and possibly migraines. http://www.pfizer.com/pfizer/download/uspi_neurontin.pdf http://bipolar.about.com/cs/neurontin/a/neurontin_suit.htm Curlywhirly 19:37, 23 December 2005 (UTC)[reply]

I realize that you didn't address your question to me but I'd like to point out anyway that psychiatry not being based on fact is patently obvious by the way psychiatrists approach the subject. The DSM contains detailed lists of symptoms with no regard to etiology. Psychiatrists match up their patients to the symptom lists and a psychiatric label is born. Without any evidence for underlying pathology, psychiatrists confidently pretend that the needed discovery that would legitimize psychiatry is "just around the corner" and in the meantime cheerfully inflict damage on their patients, many of whom do not even have the right to reject treatment. As unwanted effects arise from these medications, psychiatrists just expand the diagnostic spectrum. Treat a unipolar with SSRIs and create a bipolar. Great, because we've got even more drugs to prescribe for that one. Psychiatry, as a branch of medicine, is a sham and forced psychiatry is a severe human rights violation. Francesca Allan of MindFreedomBC 02:00, 28 December 2005 (UTC)[reply]

Back in the dark ages standard medical treatment consisted of blood letting and various other practices that seem crazy today. Would you suggest that doctors back then should have thrown in the towel and not done the best they could with the tools and knowledge they had? If not, then what are suggesting now? So far psychiatry has managed to start categorizing different problems and to figure out that something in neurotransmitters and/or structure of the brain is causing the suffering and illness people are experiencing. That's a heck of a lot further than medical science was around 1700. It is taking tremendous study and research to try to find the answers. Does everyone conducting the research have the best motive? Probably not.... but would you suggest that we not do the best we can with the tools we have? Rather than throw around accusations why don't you write up something positive and helpful, cite your sources, and post it so we can discuss how to make the best article possible to help the most people. My family has suffered doubly from the illness and from the treatments, but we can't just give up. And my family members *do* have their lives back, despite the difficulties. We have to keep trying to find the answers, and bitterness and anger won't help. Curlywhirly 05:01, 28 December 2005 (UTC)[reply]

Actually, in psychiatry, not much has changed. Treatment is still violent but perhaps slightly less barbaric. As for your question, my answer is Yes! It would have been much better if doctors had backed off and said Hey, we don't know what we're doing, let's try to make these patients comfortable, let's stop submersing them in freezing water and putting them into insulin comas. The neurotransmitter theory is bunk (so far, anyway). We know next to nothing about how emotions affect the brain and vice versa. I'm not "throwing around accusations." I'm just pointing out the abuses that psychiatric patients face every day and questioning people when they make unproven statements such as "mental illness is a neurological disorder." As for "positive and helpful," the best advice I could ever give anyone is to run, not walk, away from psychiatric treatment. Mental illess is real and sometimes disabling. Get real help with the underlying issues and don't rely on masking symptoms. Francesca Allan of MindFreedomBC 05:19, 28 December 2005 (UTC)[reply]

Not much has changed... yet. That's my point! They didn't start really working on this til 50 years ago or so. Medical science has been in process of finding cure for somatic problems for thousands of years. Cite a source for the neurotransmitter theory being bunk? Cite a source on what the "real underlying issues" are? Cite your sources or else all you are doing is making baseless accusations. Curlywhirly 17:48, 29 December 2005 (UTC)[reply]

Nonsense. Society has been torturing the mentally ill since the beginning of time. I can't give you the one source that would open your mind but please consider checking out www.icspp.org, www.psychrights.org, www.mindfreedom.org, etc. and see for yourself what researchers are working on. Read Robert Whitaker's "Mad in America." Read about Dr. Loren Mosher's work at Soteria House. There's not one "real, underlying issue" behind mental illness and the fact that you demand an answer in that form shows your bias. You're demanding a simple medical answer to a complex human question. The causes of mental suffering are extremely varied and psychiatry does mental patients a huge disservice by their one size fits all theories such as trying to pathologize the huge spectrum of human emotions by simplistic models (e.g. depression = low serotonin). In my opinion, people "go crazy" because reality is too painful to bear. I am not making baseless accusations. I have been the recipient of involuntary psych treatment and was almost killed by it. I have a "severe mental disorder" yet I found my own methods of coping that don't involve toxic drugs. I don't have to prove that to anybody by citing a medical source as I am living proof that psychiatry can be rejected and I am certainly not alone in my experience. Francesca Allan of MindFreedomBC 01:25, 30 December 2005 (UTC)[reply]

Your reference to Neurontin proves my point: there were no facts to show that Neurontin did anything at all for BP, yet all it took was the opinion of drug salesmen to convince psychiatrists that their patients should buy it(note that none of us have yet received a refund from the manufactured nor an appology from our psychiatrist). Anarchist42 20:02, 23 December 2005 (UTC)[reply]

Anarchist, the purpose of the lawsuit is to right the wrongs you mentioned. My point in mentioning Neurontin is to provide the accurate facts about the medication. I do know and understand that there is some truth in what you say, but I still don't see you providing any factual evidence for any of your claims. Why don't you write up what you think needs to be in the article, cite your sources, and post it here and we can discuss it and get the best information into the article? I have no interest in debating opinions and accusations but would appreciate discussing factual evidence. Curlywhirly 20:12, 23 December 2005 (UTC)[reply]

(Actually, since all patients did not benefited from the lawsuit, it didn't really right all the wrongs) The factual evidence was provided in court, where the drug corporation admitted to lying to and bribing psychiatrists. In addition, since there were no actual peer-reviewed studies to show that Neutontin helped BP, the only logical conclusion is that psychiatrists relied solely upon opinion rather than actual facts. Anarchist42 20:27, 23 December 2005 (UTC)[reply]

List of bipolar notables?

What would anyone think about the addition of a list or a category of famous, notable and brilliant folks in history who were bipolar, like Mozart? Chris 19:15, 30 December 2005 (UTC)[reply]

There is a start the external links section. I think this would be a great addition. if you wanna write it up. *smiles* Curlywhirly 19:48, 30 December 2005 (UTC)[reply]

I think posthumous psychiatric diagnosis is ridiculous and serves no purpose whatever. Francesca Allan of MindFreedomBC 02:53, 31 December 2005 (UTC)[reply]

Although definitive diagnosis of the dead is impossible, there are some cases (George Gordon Byron is an example in point), where it seems very likely from their detailed life history, that the person suffered from bipolar disorder. Our modern post-Kraepelin understanding of bipolar disorder and its highs, lows, and vicissitudes can illuminate Byron's life far more than regarding his behaviour as inexplicable, or assuming that poets and romantic geniuses are simply different from the rest of us, or merely saying "Byron was bonkers".

However, this article is not the place for stamp-collecting famous bipolar people; this article is long enough as it is. Probably the best thing to do is to put it in a separate list, and list it in "see also". -- Karada 01:15, 2 January 2006 (UTC)[reply]

Since definitive diagnosis of the living is also impossible, I concur with your very first point. Francesca Allan of MindFreedomBC 01:56, 2 January 2006 (UTC)[reply]

Editor

I've been reading this entire discussion as a non-involved outsider. I have bipolar one, and have dealt with issues of medication, misdiagnosis, genetics - the same as many here. However, my personal experience is not relevant to this article. And were I not informed about my condition, I would be pretty confused by this article right now.

Agreed, this article has become more confusing and disorganized recently. Anarchist42 19:40, 6 January 2006 (UTC)[reply]

From the NPOV policy:

"The neutral point of view attempts to present ideas and facts in such a fashion that both supporters and opponents can agree.

The NPOV of wikipedia is what makes it so usefull (knowing all sides of a topic make it much easier for readers to form their own informed opinion). Anarchist42 19:40, 6 January 2006 (UTC)[reply]

Some examples may help to drive home the point I am trying to make:

1. An encyclopedic article should not argue that corporations are criminals, even if the author believes it to be so. It should instead present the fact that some people believe it, and what their reasons are, and then as well it should present what the other side says.

LOL. The gap between what the psychiatric industry believe and what their patients believe is huge, a fact which should be made clear while presenting both views in a reasonable manner. (Note that at least one drug corporation admitted in court to the massive scam of selling a placebo called Neurontin to BPs) Anarchist42 19:40, 6 January 2006 (UTC)[reply]

Perhaps the easiest way to make your writing more encyclopedic is to write about what people believe, rather than what is so. What people believe is a matter of objective fact, and we can present that quite easily from the neutral point of view."

I am an editor by profession, and I would love to take a crack at this article...not so much the content as removing some redundencies. But honestly, I am hesitant to do so because there seem to be NPOV issues right now with this topic. And I think we can ALL get both accepted body of knowledge (whether we agree with it or not) and alternative views expressed here. But to do that, we have to say "this is the currently accepted body of work." And "however, some believe that X is true."

If we can agree to that format, I would like to really work on this article as an editor, not a content provider, because that's where I can really add value. JB

Perhaps we should take it one section at a time for now? Anarchist42 19:40, 6 January 2006 (UTC)[reply]

Sounds great to me. :) Any section you want to look at first? I noticed this article is tagged as needing to be shortened. JB

Top down should work Anarchist42 18:34, 7 January 2006 (UTC)[reply]

I'm with JB, and you, too, A42. I've tried to begin creating a consistency in format through the psych pages, beginning with Overview, Diagnostic Criteria. That's about as far as I've gotten.

Content-wise, take a look at what I did last night. I re-wrote the intro, cleaned up Co-occurring conditions, removed redundancy and nonesense from Diagnostic criteria (which needs expansion to be compliant across pages...my DSM is in my office), consolidated some sections, and removed some sections (redundant one liners) completely.

Keep in mind that the DSM is outdated with respect to BP. Anarchist42 18:34, 7 January 2006 (UTC)[reply]

How so? Clinically speaking, the DSM-IV-TR is still valid, until the DSM V comes out in 2006. Anything else is POV, is it not? Help with this... --70.135.192.93 13:49, 8 January 2006 (UTC)[reply]

Mood Spectrum needs to be moved -- probably up, some work done, and some cites added...but [[User:Mcman|Mcman] wrote it and, moving forward, it appears that it would be prudent for me not to touch anything he's got his hand in. --Mjformica 17:19, 7 January 2006 (UTC)[reply]

What contributions are needed?

What type of contributions would add value to this link? We are adding video content to our site Bipolar Treatment, but really want find a way to make this site more helpful for those searching for Bipolar information. We do not want to spam the article but really think we have a professional opinion on the subject. Would very much appreciate any feedback.

It is a secondary source and hence not very useful compared to directly cited journal articles. Please review Wikipedia:Reliable sources. JFW | T@lk 22:28, 21 January 2006 (UTC)[reply]

Your recent edit seems to be to POV, please explain

I'm new to this so please excuse any procedural bumbles.

I do not believe my edit is POV. My intention was for the introduction to better reflect the large body of scientific opinion (and sufferer experience) which does not conceptualise mood problems as necessarily reflecting an 'illness' to be dealt with via a medical model.

The medical approach is of course just one of many that claim to scientifically address mental (dys)function. I believe it is misleading (although typical of official psychiatric sources) to exclusively assume medical axioms and terminology, especially in an introduction. Even the quote from the sufferer (obtained from/selected by the NIMH I believe) refers only to 'medical care' rather than any other kind of care or support.

For this reason, I would add that I disagree with the above suggestion that mental health pages should be structured like medical pages into "signs and symptoms, diagnosis, mechanisms of disease, treatment etc". This would be implicitly assuming a paradigm which developed to address distinct problems with the 'hardware' of the body, but applying it indiscriminately to an area which is also about higher-level functioning in a social context (rough analogy to software). Shouldn't the articles acknowledge the range of scientific and reasoned approaches as far as possible in the introduction - or at least adopt the lowest common demoninator initially, e.g. talking of mood problems rather than a mood illness - and then be clear within the article when taking the perspective of a medical model or another model or approach?

I do agree with the above suggestion that the spectrum view of these problems should be more prominent. It seems to be very clear (and acknowledged within psychiatry, though not usually highlighted) that there isn't a single bipolar disorder but a range of problems that merge imperceptibly into 'normal' mood variance. The same goes for many other mental health problems of course.

I would be interested to make further edits of mental health pages in line with this approach, backing up with citations, after any feedback. Franzio 18:53, 22 February 2006 (UTC)[reply]

p.s. The Wikipedia mental health pages seem to be based on public material from NIMH, National Institute for Mental Health. Yet every page on its website has the banner: "Working to improve mental health through biomedical research on mind, brain, and behavior" (emphasis mine). This is therefore not an impartial source, it is an organisation that works exclusively within a medical model (and it shows). NIMH is also exclusively American - under 'Facts about NIMH' and 'Mission Statement' it states 'we harness powerful scientific tools to achieve better understanding, treatment, and eventually, prevention of these disabling conditions that affect millions of Americans".

Franzio, your point is well taken. However, as I have learned, you must think like a journalist here, and not an academician or scholar. If a page surveys a particular topic, then we have to start with the common wisdom on that topic, and expand it from there.

Since the average reader's exposure to, in this case, mental health, has likely been through a counselor, social worker, or school psychologist, and those individuals are trained from the medical model standpoint (no matter their personal position or style), it stands to reason that the average reader starts from that point. It is my feeling that this perspective is implicit in the presentation here.

Rough analogy -- if you go to your doctor with symptoms of Lyme disease, with the expectation of a 30 day anti-biotic regimin, and s/he starts talking about Spirokete, Lyme-D, Aloe Vera Juice, and Arnica Montana -- a legitimate non-traditional remedy -- right off the bat, it'd be awfully confusing. If s/he said, "This is what we usually do, but this is an alternative re-dress...", it's more palatable.

Further, Wikipedia is somewhat "authority poor", as one of our fellows put it, so there is a relience on available material that pales against InfoSeek or the Dissertation Abstracts International. No comment against our fellow writers, or their sources...it's all about perspective and doing our best with the tools we have available. --Mjformica 12:32, 2 March 2006 (UTC)[reply]

Hi, Mjformica tells me this in regard to the above: "Actually, a great deal of your work here has been, and continues to be, POV. Kindly bear in mind that this is venture is collaborative. Major edits are to be discussed. And minor edits should be just that. Further, as an example of your positionality, changing a single phrase that you consider to be "labrynthine" (nice word) is about you...that's POV. Changing it without the prejoratives would be just as effective."

My intention here was to provide you with some general guidelines, for which you asked. My intention was not to offend you in any way. Nor was I referring to anything specific. I was unclear in my presentation. This, "a great deal of your work here has been, and continues to be, POV" might have read, "a great deal of your work here might be perceived as POV." You have a strong hand, as do I, and it shows. I applaud that.

Please can I ask Mjformica to address these issues in this open forum where I was asked to address them. And can you be more specific. 'Major edits are to be discussed' - I agree and I am sorry if you are referring to my initial bipolar edit which you feel was major, it was my first attempt and trying to be bold. 'Minor edits should be just that' - if I have marked an edit as minor that you feel is not, please clarify otherwise I cannot learn (sometimes I have made a few edits of the same paragraph within a few minutes, despite previewing beforehand, and so marked the latter changes as minor thinking that would help, perhaps you refer to that).

As this was not referring to anything specific, hence your Talk page was the appropriate forum.

I'm not sure what your point is regarding 'changing a single phrase'? The word 'labyrinthine' was used by Vaughan, which I discussed with him on the Schizophrenia talk page.

My apologies...the history page made it appear that the word was yours, and I felt the comment was harsh. Notice, "I felt"...POV, mine.

I feel that you are erring towards being unfair and abrubt in this message and in your initial comments to me on the Borderline Personality Disorder talk page. If you feel I have made a POV edit or suggestion, please raise it. For the record, I am very clear that Wikipedia is a collaborative NPOV approach, something I very much admire and value, and I'm not sure how unspecified accusations of POV and 'positionality' help. Franzio 12:24, 2 March 2006 (UTC)[reply]

There was no accusation intended. And I am abrupt...much to the dismay of many here, but I'm working on it. If you read the post above, you will see that I am attempting to sheperd a valued asset here (you), as I have was sheperded by others here, with regard to the filtered application of our talents. It is, as I noted, one thing to write as an academician, and another to write as a provider of general information. --Mjformica 12:43, 2 March 2006 (UTC)[reply]

Well, thank you for clarifying your intentions and perceptions and for making sure I am aware of these issues. I posted my reply to your personal comments before I saw your reply to my general comments incidentally.

Regarding the substantive points about assuming a medical approach:

I wouldn't say that counsellors, social workers, or (school) psychologists are trained in a medical model, so we must be meaning different things by the term. The theories and approaches learned and applied by these professionals are often drawn from psychological and social fields without recourse to (and are often alternatives to) medical concepts and frameworks. Of course they also learn and work with those concepts and frameworks.

Your wider point that the public have a primarily medical perception of mental health and so expect this upfront - I agree to some extent, although I would say that much of the public do not, or are aware of alternative approaches. Your analogy concerns a medical doctor who would be expected to reflect the standard medical line, but in regard to issues of mental distress and function the situation is less clear-cut. I do recognise that the term being explained is primarily psychiatric in origin and common presentation, but I think the context of this can also be clear from the start.

I agree with your points about academics and source material, I think this applies equally to medical as to less medical approaches. Franzio 14:16, 2 March 2006 (UTC)[reply]

Removing specific DSM criteria

I have had an on-going discussion with the permissions people at the APA, and they are adamant about refusing to give Wikipedia permission to display or publish the DSM diagnostic criteria, or any version thereof, even if the area where that information is displayed is locked and uneditable.

That said, and to avoid potential litigation, I would like to remove the criteria listed on this page, and insert a link to the "official on-line page" and boilerplate explaining that outlink. Kindly see the DID page for an example.

Comments? Objections? Support? --Mjformica 12:06, 2 March 2006 (UTC)[reply]

First, what is 'the DID page'? Are DSM diagnostic criteria to be removed from ALL mental illness articles? Are all mental illness articles to now have NO diagnostic criteria from now on? Anarchist42 19:00, 2 March 2006 (UTC)[reply]

DID = Dissociative identity disorder, and, yes, all DSM criteria are to be removed from all mental health articles, per the APA. Diagnostic criteria will be outlinked to the APA site. --Mjformica 21:46, 2 March 2006 (UTC)[reply]

OK, revisit...that was me being harsh and abrupt again...the APA has adamantly proscribed that Wikipedia not display the criteria in the DSM and that the sources should be outlinked to an authorized site.

Those definitive "are"s and "will"s on my part would better serve us as "should"s and "ought"s. --Mjformica 22:43, 2 March 2006 (UTC)[reply]

Can you please provide a link about the new APA policy regarding the DSM criteria? I do not believe that simply linking to an arguably biased source is sufficient for such important information as diagnostic criteria for serious illnesses. Anarchist42 17:44, 3 March 2006 (UTC)[reply]

It's not a policy, and it's not new. It's a question of copyright infringement. When referencing copyright material of any sort, you need permission from the source. APA will not give Wikipedia permission. Period. This is an on-going conversation that I have had with their Permissions Department regarding my own sites, and one I've broached with them re: Wikipedia...even if the information is placed on uneditable pages, then answer is a resounding, "No.".

As for the "arguably biased source"...well, they've got permission. Go figure. If you can find a better link, have at it. I haven't been able to find one, frankly. Cheers! --Sadhaka 14:26, 12 March 2006 (UTC)[reply]

External links

All the external links were removed by a recent edit by User:Barrylb without any prior discussion. Was this accepted by other members? A quick glance showed the links nicely organized without spam links. Maybe some did need to be taken out, but I don't think removing all of them is a good idea. Comments? Gflores ^Talk 22:02, 2 March 2006 (UTC)[reply]

I added some boiler plate to accomodate the directory linking format. See what you think. I believe the intention here was a good one, and supports comments made by others re: external link policy and the number of links (previously) on this page. I dropped Barrylb a note to heads him up on what was done to accomdate the directory concept here. Maybe the ODP will pick up on it. —The preceding unsigned comment was added by Mjformica (talk • contribs) .

Oops...sorry, thanks. --Mjformica 22:51, 2 March 2006 (UTC)[reply]

There was NO DISCUSSION at all! True, there were too many redundant links, but some were valuable references. Anarchist42 17:47, 3 March 2006 (UTC)[reply]

True, but there was also no delete. Technicaly, what Barry did was a re-direct. And it is a redirect supported by a Wiki-Project. Conundrum. --Sadhaka 14:27, 12 March 2006 (UTC)[reply]

List of support groups

I've moved this from the article. Does anybody think it belongs there? It was moved from Bipolar disorder support groups. -- Barrylb 01:17, 12 March 2006 (UTC)[reply]

Support groups

Patients with bipolar disorder often find comfort in support groups. Since it is sometimes difficult for them to find a support group in their local area, many support groups have been started on the internet, including:

Useful Link

We have just added article and video content created by key opinion leader Physicians as well as government health organizations and would like to be considered as a useful resource for this page. We are hosting an online symposium on mental health and spirituality and think this would also be a valuable contribution to the community.

Thank you,

Ryan

Depression Treatment

Ketogenic Diet

The section called ketogenic diet indicated that a study was underway at Standford University. The correct university is Stanford. Here is a link to the study Stanford University Bipolar Disorders Clinic: Ketogenic Diet in Bipolar Depression [13]

Also, If you are taking Depakote, check with your doctor before starting a ketogenic (Low Carb) diet. My personal experience was a 75% reduction of Depakote's efficacy. Since this was my primary defense against mania, I quickly became hospitalized.

Changes without discussion

There seems to be massive changes to the article by User:70.95.218.47 and User:Rob.towers.

Significant changes to the article should be discussed on the Talk page. --WikiCats 02:22, 9 April 2006 (UTC)[reply]

re changes

The additions I (User:70.95.218.47 and User:Rob.towers are the same individual) made are for this article are intended to increase the pages timeliness, readability, usefulness and higher ranking in search engines such as Google.

Additions from others are both welcome and helpful.

Rob

Is there a major focus of how a page ranks in search engines? I have never seen that as a justification before. Sparkleyone 06:34, 9 April 2006 (UTC)[reply]

Making extended or significant changes are of concern to other editors. Every edit to Wikipedia is checked by other editors. Making numerous changes over many days makes it very hard for others to check your work. Please propose major changes on the Talk page. You risk having your work reverted. --WikiCats 07:05, 14 April 2006 (UTC)[reply]

Changes to unify article

I have a concern about this article. First, this subject is continually evolving because it is a very hot topic in the psychiatric literature right now. So there's really a lot of information. In particular, this page seems to be very broad. I've looked at the "Diabetes" page and it is organized quite clearly and cogently. I have decided to stop making adjustments to the page because I need more input from others.

Contents [hide] 1 Etiology or causes 2 Two personal descriptions of the bipolar experience 3 History of the bipolar disorders 4 A new epidemiology: bipolar spectrum disorder 5 Domains of the bipolar spectrum 5.1 Bipolar depression 5.2 Hypomania 5.3 Mixed state 5.4 Mania 5.5 Rapid and ultradian cycling 5.6 Cognition 6 Misdiagnosis and the treatment lag 7 Avoiding misdiagnosis and the current diagnostic criteria 8 Current diagnostic criteria for bipolar disorder 9 Suicide risk

10 Treatment of bipolar disorder *****[should be removed]

11 Comorbid or co-existing conditions 12 Treatment of bipolar disorder *****[placement here makes sense] 13 Prognosis and the goals of long-term treatment 14 Avoiding relapse

15 Research findings *****[candidate for a related article ? ] 15.1 Heritability or inheritance of the illness 15.2 Recent genetic research 16 Current and ongoing research 16.1 Medical imaging 16.2 Personality types or traits 17 Research into new treatments

18 Bipolar disorder and creativity ***** [important but candidate for a related article ? ]

19 Sources 20 References 21 Further reading 22 See also 23 External links

For people who would like to edit this further I'd be interested as well. I'm a first-timer at wikipedia. So any help would be appreciated.

Thanks.

rob

Surely you need to have a description of the disorder before you launch into personal accounts, etiology and history? I would propose that you have

- Brief history

- Domains of bipolar spectrum

- DSM-IV diagnostics (with sub-section 'Reasons for possible misdiagnosis' with a more NPOV take)

- Etiology

- Treatment (with sub-sections 'prognosis', 'avoiding relapse', 'suicide risk' - Wiki is not a self help book, there doesn't need to be half a page of "what to do if you're feeling suicidal")

The research stuff should be in it's appropriate sections - e.g. do we need a whole section on research in heritability when these findings could be discussed in the etiology section?

Oh, and surely we don't need all of 'sources', 'further reading', 'references', 'see also' and 'external links'? Can't we have some nice shiny footnotes like other articles use?

This page is a shambles, and thank god the millions of edits have ceased. I'm all for reverting back to the article the way it was a few weeks ago, there was a great order and flow then. Okay, rant over. Sparkleyone 05:24, 17 April 2006 (UTC)[reply]

SEX

Is it true that someone with a bipolar disorder cannot control their sexual urges. If anyone can answer this question, it would help my relationship immensly. Thanks

I was just wondering if anyone out there could help me. I am engaged to a very beautiful women who was recently diagnois with bipolar. She was told that because of her disorder, she would not be able to control some of her feelings or actions. She was also told that she would have highs; where she felt untouchable and COULD do about anything she wanted. Other times she would have lows (manic depression); where she WOULD do just about anything. What I would like to know is; "Can her manic episodes be controlled?"

Wikipedia is not a doctor's office. If your friend thinks she cannot control her behavior, she should take advice from her doctor. Perhaps a patient support group, or a support group for friends and relatives of bipolars, as well as couple counseling (with a therapist who has a good knowledge of this disorder and its influence on intimate relationships) could help you. Apokrif 14:44, 16 April 2006 (UTC)[reply]

You can't tell someone with an eating disorder to stop eating or eat more. Sexual addiction (or lack of interest) is very real. If she is currently seeing a pDoc, then she needs to address these issues as they occur. Telling signs are hypomanic behavior and well thought excuses.