Psychology Today Article Review “A Psychiatric Diagnosis is Not a Disease”

This week I read a fantastic article in Psychology Today that highlights one of the primary issues with bipolar diagnosis and treatment. The article titled “A Psychiatric Diagnosis is Not a Disease” by Jonathan Shedler, Ph.D., points out that the diagnoses listed in the DSM (Diagnostic and Statistical Manual of Mental Disorders) identify descriptions of symptoms, not causes.
In the article Dr. Shedler states,

“Confusion arises because medical diagnoses often point to etiology—underlying biological causes. This is why “chest pain” is not a disease, it is a symptom. Atherosclerosis, myocarditis, and pneumonia are diseases. They are underlying biological conditions that can cause chest pain.

Psychiatric diagnoses are categorically different because they are merely descriptive, not explanatory. It’s not that we don’t know their causes yet. It’s that DSM diagnoses cannot speak to causes, now or ever. The DSM was not designed to speak to causes, only describe effects.”

The problem with the DSM diagnosis of bipolar disorder is that it promotes the misconception that an underlying cause has been identified when in fact the diagnosis is simply describing a symptom cluster.

Dr. Shedler further clarifies:

“The ever-expanding list of entries in the DSM sound a lot like medical diseases, especially with the ominously-appended term disorder, but they are not. If we speak of generalized anxiety disorder or major depressive disorder as if they were equivalent to pneumonia or diabetes, we are committing a logical fallacy called a category error. A category error means ascribing a property to something that cannot possess it—like emotions to a rock.”

A bipolar diagnosis does not need to be a life-sentence. If you become curious about what is causing your bipolar symptoms and then treat the source of the symptoms, you can heal.

To learn more about healing your bipolar symptoms, check out The Mindset Shift to Heal Bipolar Part Three: The Steps to Heal Your Disorder.

You Must Have Been Misdiagnosed

When I share that I have healed my bipolar disorder I frequently have people accuse me of never having bipolar in the first place. They say, “You must have been misdiagnosed.”

This brings up a couple of important questions: “What constitutes an accurate diagnosis?” and “What is bipolar disorder?”

What Constitutes an Accurate Diagnosis?

A medically reviewed article on Psycom.net describes bipolar based on the DSM-5:

 “Bipolar disorders are described by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a group of brain disorders that cause extreme fluctuation in a person’s mood, energy, and ability to function.”

The article then goes on to define the three subcategories of bipolar:

  • Bipolar I disorder is a manic-depressive disorder that can exist both with and without psychotic episodes
  • Bipolar II disorder consists of depressive and manic episodes which alternate and are typically less severe and do not inhibit function
  • Cyclothymic disorder is a cyclic disorder that causes brief episodes of hypomania and depression

The problem with these categories is that there is no underlying cause identified, the categories are clusters of symptoms that can vary widely from person to person—if you meet the diagnostic criteria you are diagnosed with the “disorder”.

I was diagnosed with bipolar in 1998 and during my first twelve years of treatment saw more than seven separate psychiatrists due to moves and hospitalizations and each one independently confirmed my diagnosis. I met all of the diagnostic criteria initially for bipolar two and later for bipolar one after I experienced a psychotic episode during a hospitalization.

What is bipolar disorder?

When you received your bipolar diagnosis what explanation did your doctor give you? I was told that I had a chemical imbalance that required medication to correct. I was later told that bipolar was like having diabetes and medication was like insulin and finally I was told that bipolar is chronic and incurable.

Chemical Imbalance Theory

Did you know that the chemical imbalance theory was debunked in the late 1980s? It was a theory that was developed to try and explain the need for psychotropic medications in treating mental illnesses like bipolar disorder. 

The theory was repeatedly put to the test and consistently failed. Interestingly in the effort to try and prove the theory scientists actually discovered that although there was no preexisting chemical imbalance in the brain, the psychotropic drugs used to “treat” the disorders was causing a chemical imbalance to occur. 

Bipolar is Like Diabetes?

The first time I heard this claim it was made by my psychiatrist. I was struggling with my medication and had told my doctor how much I hated taking the drugs—the side-effects were intolerable and I was still experiencing symptoms.

My doctor had told me that having bipolar was like having diabetes and the medication was like insulin. He reassured me that although I was still struggling that eventually we would find the right combination of medications to give my brain what it was missing.

At the time this convinced me to keep taking the medications because I hoped that I could eventually find relief but looking back the comparison is ludicrous! Bipolar and diabetes are NOT THE SAME!

Diabetes is a clearly defined, measurable medical problem with a consistently effective treatment protocol. The insulin is replacing something the body is missing.

“Bipolar disorder”, on the other hand, has no single, clearly defined cause. It is diagnosed based solely on symptoms and then the drugs used to treat the symptoms are not something the body normally produces. In fact, as stated above, the chemicals introduced into the brain with psychiatric drugs abnormalize the function of the brain instead of normalizing it.

WARNING: If you decide to switch from medication to micronutrients DO NOT go off of medication “cold turkey”, or stopping all at once. Medication alters your brain chemistry and withdrawal symptoms can be dangerous, even life-threatening. DO work closely with someone specifically trained in cross-titration—either Truehope customer support or a trusted psychiatrist who has been specifically trained in cross-titration—to safely withdraw from the drugs and transition to the micronutrients that will help heal your brain.

Is Bipolar Disorder Really Incurable?

The reason people assume that I was misdiagnosed when I share that I have healed my bipolar disorder is that they believe it is impossible to heal. I often ask people why they believe that and no one can ever adequately answer the question. 

The reality is that the treatment approach of using psychotropic medications long-term to address the symptoms is itself preventing the cure. Bipolar is a group of symptoms that indicate the brain is in distress. There can be a number of different underlying causes.

Researchers have begun to uncover some of these underlying issues that lead to symptoms of mania and depression: 

The first twelve years after my diagnosis I diligently took every psychotropic drug I was prescribed and got progressively worse. Then I began to gradually uncover the causes of the symptoms and the tools and resources to treat those issues. As the underlying problems were treated the symptoms went away and I healed.

Bipolar disorder doesn’t need to become chronic and incurable; it can be healed using an integrated, research-based approach designed to address the underlying causes of the symptoms. 

To learn more, check out: The Mindset Shift to Heal Bipolar Part Three: The Steps to Heal Your Disorder

Can You Heal Bipolar Disorder?

Can you heal bipolar disorder? I remember asking that question when I was first diagnosed back in 1998. I struggled with accepting my diagnosis because there was no tangible evidence of my disorder. No blood tests or brain scans, just a lot of ambiguous, hard to define symptoms that felt like character flaws and moral failings to me. 

Then one of my doctors compared my diagnosis to having diabetes. He asked me if I would be embarrassed if I was diagnosed with type one diabetes and I told him no because diabetes is a clearly defined and measurable physical problem that causes your body to be unable to regulate your blood sugar. The treatment is to monitor and balance your blood sugar so your body can function in a healthy way. 

My doctor then told me the same was true for having bipolar. My brain chemistry was unable to regulate itself properly and we needed to find the right medication to help it function in a healthy way.

At the time this comparison really helped me accept my diagnosis and I believed that I would find the right medication and eventually be able to live well with my bipolar. But it wasn’t true. I didn’t understand that the diagnosis of bipolar is not based on the cause, it is based on the symptoms. The generally accepted treatment doesn’t treat the cause, it treats the symptoms. 

Treating the symptoms of bipolar doesn’t help people to heal. At best it helps them manage the symptoms a little better, at worst it causes additional damage to the body and mind and creates new problems and diagnoses. So why are alternative treatments that aim to identify and treat the causes of bipolar symptoms considered taboo? 

Normalizing Suffering

Something that is especially discouraging in the online “support” communities for bipolar disorder is the insistence that no one discuss any treatment for bipolar other than psychotropic medications. Alternative treatments, no matter how well researched or validated, are off limits and called dangerous. The result is that the groups end up normalizing suffering with bipolar.

Over half of the posts in these groups are people asking for advice on what to do about the terrible side-effects they are experienceing from their medications–weight gain, insomnia, lost libido, etc. The other half are people talking about the horrible symptoms they are continuing to experience even on medication–excessive spending, hypersexuality, explosive rage, etc. 

People continuously lament medication related issues like drastic weight gain or “medication hangovers” that make it feel impossible to wake up in the morning. They also talk about not being able to work or maintain healthy relationships and share feelings of fear and despair at the prospect that their life may never get any better. 

The medication route often doesn’t provide long-term relief for people either. Recently in an online group someone asked how many times people in the group had been hospitalized–the results were staggering! Dozens of people responded with numerous hospitalizations and several had been hospitalized over twenty times! It was so disheartening to see how much everyone was suffering! 

Another question in an online group was how many mood-swings is it normal to have in a year. The responses were varied, but the people responding found it normal to continue to experience mood swings, even on medications. They have been convinced that this will be normal for them for the rest of their life. Why? 

If so many people are suffering with continued mood swings, side-effects, poor quality of life and hospitalizations, why is medication continually propped up as the only “effective” treatment for bipolar? Why are alternative treatments that seek to identify and treat the cause of the symptoms considered taboo?

Healing my Bipolar

I was diagnosed with bipolar in 1998 and for the first decade after my diagnosis I actively sought treatment with psychotropic medications, but I just got progressively worse. In 2008 I was hospitalized multiple times, experienced my first psychotic episodes, had electroconvulsive therapy done on me causing major memory loss and made multiple suicide attempts. I was actively seeking treatment and nothing was working.

In 2010 my doctor and I discovered an alternative treatment option that was well researched and had a surprisingly high success rate in helping people manage or eliminate the symptoms of their bipolar. With the help of my doctor and the company’s customer support I was able to titrate off of my medications and onto the micronutrient treatment. 

My doctor admitted to me during this process that he normally would not have even considered this treatment option. He told me that the only treatment option they were taught in medical school was psychotropic medication and all of the continuing education is funded by the pharmaceutical companies. The only reason he was even willing to consider this alternative treatment was because he could see how hard I was trying with medication and how much I was suffering. He had become as desperate to help me as I was.

A few months after I started on the new treatment I woke up one morning and felt like I was finally truly awake for the first time in over a decade. It took several years for my brain to fully heal, but during that time I was so much more stable on the micronutrients than I had ever been on medication so I stuck it out. I am so grateful that I did! 

Over the past 13 years I have gradually learned the other tools necessary to heal my mind, eliminating triggers and finally becoming mentally healthy and balanced for the first time in my adult life. That is why I was so excited to start my blog! I wanted to share what I had learned. I wanted to help people suffering with bipolar to learn how to actually heal and become mentally well.

When I first started my blog at the end of 2020 I was filled with hope and enthusiasm for sharing what I had learned. Imagine my surprise when I joined online support groups for bipolar and discovered that there seemed to be no interest in helping people to actually get well. The groups seemed designed to create a space for everyone to struggle together. These groups perpetuated the idea that the best anyone with bipolar could hope for was suffering well with their disorder.

Alternative Treatments are Taboo

I soon discovered in the groups that if you could commiserate with a person on how they were suffering, you were allowed to comment. If you had tips for how to cope with side-effects from medication, you were allowed to comment. If you had recommendations for other medications that might work better, you were allowed to comment. 

If, however, you suggested that there might be an alternative treatment that would help heal their brain and eliminate symptoms and side-effects, you were censored and kicked out of the group. Even simply answering questions from people asking if anyone managed their disorder without medication would result in being removed from the groups.

The problem is that for decades–as my doctor admitted to me–we have been told that the only viable treatment option for bipolar is medication. But why? Medications are not actually treating the cause of bipolar, they only treat the symptoms. 

Treating Only the Symptoms, Not the Cause

There are risks for not seeking to identify and treat the underlying causes of bipolar symptoms. To use another medical analogy, if you have strep throat but the doctor doesn’t treat the strep just the symptoms–giving you something for your sore throat and something for your fever–you might get some short-term relief but it increases your risk for additional issues. The untreated strep could progress and cause further serious infections and even damage your kidneys or heart.

Medication can have potential value in the short term to treat the serious symptoms of bipolar like psychosis and suicidality. This is similar to giving a patient with strep ibuprofen to help bring their fever down temporarily to give the antibiotic time to work on the underlying infection. But long-term if a person wants to actually heal, they need to treat the underlying causes of their illness. If you want to live well with bipolar you need to identify and treat the causes of your symptoms. 

Some of the suggested causes of bipolar disorder symptoms are nutrient deficiencies that cause the chemicals in the brain to be out of balance. Severe, unhealed trauma has been linked to the occurrence of bipolar symptoms in many people. Bipolar symptoms are also perpetuated by unhealthy thought and behavior patterns, unhealthy coping mechanisms like addiction and unhealthy boundaries. 

Long-term treatment that only addresses the symptoms of bipolar isn’t bringing relief and healing for most people, it is just prolonging and even compounding the suffering. People on medication long-term can also develop serious, permanent issues like tardive dyskinesia (TD), lowered immune system function, and damage to the liver or kidneys.

Healing Your Bipolar

It is possible to get to the bottom of what is causing your bipolar symptoms and heal. It will require a lifestyle change for your mind. This is why I created the Map to Wellness, to show you the way to healing.

Begin first, by learning to successfully manage your mood swings by creating a Mood Cycle Survival Guide. This will help you be proactive in managing your symptoms so you can lessen the impact they have on you and your family and shorten the duration of the mood cycle.

Second, identify what your brain needs to get healthy and balanced. There are organizations and doctors that are focused on helping people identify exactly what their body and brain need to function in a healthy, balanced way. Using a mood-tracking app will help you in this process to identify symptoms that can indicate specific deficiencies. This process takes some detective work, but it will be worth the effort as your brain begins to heal.

Third, working with a good, competent therapist is crucial. You need to identify and heal:

  • Trauma,
  • Unhealthy thought and behavior patterns,
  • Damaging coping mechanisms, and
  • Unhealthy boundaries.

This will take some time, so learn how to utilize therapy proactively and stick with it.

Fourth, develop a self-care routine that includes:

  • Mindfulness meditation,
  • Yoga,
  • Simple exercise,
  • Healthy, consistent sleep habits, and
  • Simplifying your life to eliminate unnecessary stressors.

Developing this self-care routine is a process. Learn and apply one tool at a time and you will eventually be able to create a lifestyle that will support you in living mentally and physically well.

Finally, seek support from others who are on the path to wellness with bipolar. It is important to have support and encouragement as you work on this life-style change for your mind. If you are a mom, or potential mom with bipolar join Bipolar Moms Learning to Live Well.

You can live a healthy, balanced, productive life with your bipolar disorder. There is hope and there is help! Are you tired of suffering and ready to live well with your bipolar? Get started on the Map to Wellness here!

Mental Health vs. Mental Illness

mental health vs. mental illness

Over the past few years there has been an increase in the public discussion of mental health due to the increasing stressors in the world. This is such a positive shift towards awareness of mental health needs and challenges. One important aspect of this conversation is the distinction between mental health vs. mental illness. These terms are not interchangeable, and understanding the definitions of both and their relationship is important for anyone seeking treatment.

The Center for Disease Control (CDC) definition of mental health: “Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make healthy choices.”

The CDC definition of mental illness: ‘“conditions that affect a person’s thinking, feeling, mood, or behavior.” These can include but aren’t limited to depression, anxiety, bipolar disorder, or schizophrenia.’

Another way to put it is:

Mental health is to mental illness

what physical health is to physical illness.

Physical Illness

There are different ways that our bodies can become physically ill, some examples are:

  • You can contract a virus or disease that is temporary and can be healed over time, sometimes requiring outside intervention–like contracting the flu or a sinus infection.
  • You can develop a disease that may have some genetic predisposition but was brought on by neglected health–like heart disease or type 2 diabetes.
  • You can experience physical trauma that causes damage–like a broken leg.
  • You can be born with or develop a disorder that causes the body to need external assistance–like type one diabetes.
Photo by Polina Tankilevitch

While some illnesses may be the result of negligence or poor personal care, most people acknowledge the value and importance of professional intervention in the care and treatment of these physical ailments. In general physical illness and disorder is not stigmatized and people will seek treatment for their illnesses or injuries.

Mental Illness

Unfortunately, the same is not always true for mental illnesses. Our society has made great progress towards acknowledgement and acceptance of mental illness, but there are still stigmas that cause people to resist diagnosis and treatment. The result is unnecessary suffering.

Mental illnesses, according to the CDC website, are among the most common health conditions in the United States.

  • More than 50% will be diagnosed with a mental illness or disorder at some point in their lifetime.
  • 1 in 5 Americans will experience a mental illness in a given year.
  • 1 in 5 children, either currently or at some point during their life, have had a seriously debilitating mental illness.
  • 1 in 25 Americans lives with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression.

Mental illness has a broad range of causes and diagnoses, just like physical illness. 

  • Some people can have a temporary illness brought on by environmental factors or as a companion with physical illness. 
  • Some may neglect their mental health and suffer a breakdown or the onset of chronic issues like anxiety or depression.
  • Others may experience severe trauma that causes emotional or mental damage resulting in mental illness.
  • Some people are born with a genetic predisposition to developing a mental illness.

Years ago I was struggling with accepting my diagnosis and need for treatment. My psychiatrist at the time asked me if I would feel the same if I had been diagnosed with type 1 diabetes. I said no, of course not. Diabetes is a real, very serious disorder that if not treated could result in serious illness and even death. The doctor then told me that a diagnosis of bipolar disorder was no different. 

He said that bipolar disorder is a chemical imbalance in my brain that, if not treated, will continue to get worse and cause me to get more ill, and possibly even die. He told me that with proper treatment, however, I can live a healthy, balanced life, just like someone with diabetes who treats their disorder regularly.

This comparison shifted my thinking about being diagnosed with bipolar disorder and helped me to focus on treatment and learning the tools necessary to live well with bipolar. To learn more about accepting your diagnosis see Bipolar Disorder: The Stages of Grief.

Over the years I have discovered that there are many tools that are necessary to properly treat my bipolar disorder. As I have learned each new piece it has helped me to live a healthier, more balanced and more productive life.

Medication and Supplementation

This one is the most obvious, but also one of the most difficult. One of the biggest reasons for this is that there is not an exact science to identify which medication or combination of medications will be right for each person. I used to say that my doctor was playing “guess and check” with my meds to try and find the right ones. 

For me, finding medications that worked never happened. I really wanted to get well, and I tried everything my doctors prescribed. But I struggled with terrible side-effects and was often not able to tolerate a therapeutic dose of the medication. 

Thankfully after over a decade of struggling and searching my doctor and I found a nonprofit that had developed a micronutrient treatment specifically for people with bipolar disorder. After my doctor reviewed the studies that had been done on the treatment he agreed to help me transition to the micronutrients, and they worked! 

A few months after I switched to the micronutrients I woke up one morning and felt like I was truly awake for the first time in over a decade. To learn more about my experience with medication and supplements see my post Bipolar Disorder: When Medication Doesn’t Work.

The struggle to find the right combination of medication and/or supplements can feel discouraging at times, but most people with bipolar disorder need something to help their brain function in a healthy way. Thankfully there are any number of options to help doctors in the process of discovering what each patient needs to get balanced. Additionally, there are a growing number of practitioners that are discovering the benefits of micronutrients in the treatment of bipolar disorder.

Counseling and Therapy

This is another tool that may seem obvious but many people, like me, resist going to counseling. For me, it was the result of stigmas, and a misunderstanding of what counseling was. Growing up I had heard a relative frequently say, “my therapist said this” or “my therapist said that” and I remember thinking “I will never let someone else tell me what to think.” Unfortunately, the result was that when I was first diagnosed with bipolar disorder, I said I was willing to take medication, but I refused to go to counseling. 

Over the years, however, I discovered that counseling is an essential tool to help someone with bipolar disorder learn how to live well. When you have bipolar disorder you frequently see the world through a distorted lens and can develop unhealthy thought and behavior patterns, unhealthy boundaries and may have unhealed trauma. All of these can continue to cause mood cycles, even after the medication or supplements are correct. To learn more about counseling see my post Bipolar Disorder: Counseling is Essential.

Mood Cycle Survival Guide

An especially valuable tool for proactively managing your bipolar disorder is a Mood Cycle Survival Guide. This guide helps you successfully navigate your mood swings, rather than reactively just suffering through them. 

In this plan you:

  • Identify your Response Team
  • Develop an Early Warning System
  • Determine your Power Priorities
  • Learn how to Reboot Your System

Using this guide will help you proactively care for your mood cycles to lessen their impact on you and your family and shorten the duration of the cycle. Get your free guide to create your own Mood Cycle Survival Guide here.

Self-care Routine

Developing a self-care routine that you do daily to keep your brain and body healthy and balanced is also essential. Some important tools in your self-care toolbox are:

  • Mindfulness Meditation
  • Yoga
  • Exercise

To learn more about self-care see my post Bipolar Disorder: Self-care.

You Have a Choice

Years ago, I had a friend whose father developed type 2 diabetes. His doctors gave him strict instructions about how he needed to care for himself in order to keep himself healthy. He was told he could live a long, healthy life if he was willing to follow the care instructions given to him by his doctor. Unfortunately, he didn’t listen. He liked the habits he had that were against the doctor’s orders and he lost his legs, his eyesight, and ultimately his life.

Bipolar disorder is a treatable mental illness. It isn’t necessary to suffer indefinitely, being at the mercy of your mood swings and doing damage to your life and relationships. It is not easy, but it is absolutely possible to live a healthy, balanced, productive life if you are willing to do the work necessary to learn each of the tools. There is hope and there is help!

If you are a mom with bipolar disorder and you are looking for support in your journey to live well join our free Facebook group Bipolar Moms Learning to Live Well.