Transcription
It's not about getting the treatment. It's about getting the label. It's the narcissism of it, right? The "I have this," uh, and that gives me status.
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"I'm bipolar." Really. Bipolar diagnosis is such an excellent example of why psychiatry is much to blame for where we are today culturally, where denying someone's diagnosis is like a moral indictment. It's like, "Are you denying my suffering?" Where if you exclude someone from the label that they're shopping for, it's for them indistinguishable from personal invalidation. We've gotten to the point where someone's diagnosis is supposed to tell you something about them, about them as a person.
>> Being diagnosed with bipolar and OCD made me feel less crazy by giving me an explanation for why I was crazy.
I'm diagnosed bipolar disorder type one, um, ADHD, and I suffer from post-traumatic stress disorder.
>> I got diagnosed with autism and ADHD and, um, already [snorts] having had CPTTSD and, um, treatment-resistant depression.
The buck stops with psychiatrists. They're the ones who blurred the lines, and the evolution of the bipolar diagnosis shows exactly this. Shows exactly how we can get to the point where you one day say, "I think I have this," and then the next day you go to someone else and you say, "No, I got this diagnosis instead."
It all started in 1899 with Emil Kraepelin. He described manic-depressive insanity, and for him, the illness was unmistakable, like we described in the previous video, where you cycle from manic to depressed. And that view held through the first two revisions of the DSM, one and two. And it was very, very rare, a lifetime prevalence of 0.4%. So how did it happen that half a century later, we've seen a 20-fold increase? And we have to hear things like, "I'm so bipolar today."
And here, I think it would help us to understand a little bit about the history of psychiatry. By the middle of the 20th century, they were in crisis. Until then, psychoanalysis dominated the picture, and they didn't like the reputation that gave them. As you can imagine, the reliability was very low between practitioners, and that's why they were accused of being unrigorous. And also, neurology came up at that time, and they very quickly lost credibility to that field.
So, a new generation of psychiatrists came up. They called them neo-Kraepelinians, and they wanted to rebuild the field on a biological foundation. And this is important to remember, not just for the bipolar, but for all the different diagnoses, right? This was the groundwork for the whole neurochemistry myth that we somehow still believe. And that's because they tried to rebuild it in the image of medicine. They tried very hard to become just another field of medicine. We're still desperate to explain psychological psychiatric illnesses in terms of neurobiology, desperate for it.
And these psychiatrists, these neo-Kraepelinians, they thought that standardization was the cure. And the third revision in 1980, that was a product of this. And in came the lists, the durations, the arbitrary thresholds. But the science behind those lists is thin. I think it's so important to remember that the criteria to fulfill psychiatric disorders, they were decided upon in conference rooms by committees, by vote. And this transformation of psychiatry, nowhere is this clearer than in this rebranding of manic-depressive illness. So that's why I'm sort of harping on about bipolar disorder.
So what happened? What that was that a manic episode, it was no longer, you no longer required psychosis. That was the first thing that happened. You only required a distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least one week. And just that small difference had the prevalence double from fewer than one in 200 to one in 100. But we haven't even started yet.
Then came the 1990s. Enter the spectrum. My favorite. Just, just think about it. Every time we move to a spectrum in any field, think about autism, think about gender, think about ADHD, the inclusion of children inevitably follows. But in any case, so the 1990s completely blew the diagnostic frame off of its hinges.
And this is where I'd like to point out that it's easy to blame Big Pharma for what's happened with the psychiatric over-medication, but it's too easy. It's the psychiatrists, psychiatrists opened the gate for Big Pharma. Otherwise, it would all be off-label, which it's not. And so they are first and foremost responsible for not gatekeeping. Of course, the influence of pharmaceutical companies as well, like, don't get me wrong, but you know that it's too comfortable to stay in the lane of "Pharma is responsible for over-medication." The soil was already tilled because of psychiatry's hunger to prove itself a medical field.
And then add to that, influential psychiatrists like Joseph Beerman, Ronald Pies, and Nassir Ghaemi. They wanted to broaden the criteria as an act of compassion. So this is where we get to the motivations behind, not just "is this medically relevant?" This is, this already started to be about, "What type of person is this? What type of people do we want to be?" It started to become moral. So you had all these different psychiatric, these psychiatry activists, and they wanted to make a bipolar continuum and a bipolar temperament. And what are you doing then? You're blurring the lines. You want to include more people. That wasn't something that they were shy to admit.
And so in the fourth edition of the DSM in 1994, it became the bipolar spectrum. They recognized a host of new subtypes. And what gets to me is that this wasn't to treat people. This was to legitimize suffering. And that's something else. You want to get to the point where you say, "You have this diagnosis," and that makes you okay, rather than, "You have this diagnosis, let's treat you so that you can function normally." Because now we have people saying, "I have this diagnosis, but so everyone has to accommodate me."
"It's not about getting the treatment. It's about getting the label. It's the narcissism of it, right? That I have this," and that gives me status. And the bipolar is perfect because it speaks the language of neurotransmitters. "It's not my fault. I just, I was born with a bipolar brain."
And in this spectrum, only bipolar one remained to describe the classic, what it used to mean. And every matter of subjective interpretation. This is where they brought in bipolar two, which is the hypomanic episode with depression in between. The hypomanic episode had to last four days. And what you needed to cross off the checklist was speaking faster, needing less sleep, being excitable, or being irritable, things like that. And you can imagine when you're sitting in a session with the psychiatrist, that you know, "Being irritable. Have you been irritable?" "Yes, I think I've been irritable." It's just so, it's a subjective interpretation of a subjective story.
>> When I was being diagnosed with bipolar two, one of the questions my psychiatrist asked was, um, whether or not I had, um, thoughts about harm, physically harming other people. She's like, "You don't have any thoughts like that, right?" And I was like, "Well, girl, actually, actually, multiple times a day, I think about beating the [ __ ] out of people. I fantasize what it would be like to just punch them in the face so many times that they never look like themselves again."
And to the surprise of absolutely nobody, by the end of the decade, the bipolar spectrum could boast a lifetime prevalence rate of 6.4%. And they started to portray bipolar more and more in movies and TV shows. "I'm bipolar." >> "Really?"
But sadly, the worst was yet to come. Because as I mentioned, when you start talking about a spectrum, you will include kids. And by the early 2000s, you already had this concept of the bipolar child. And before this, it was always understood that bipolar was something that was triggered later in life, by late adolescence. And we have Joseph Beerman also to thank for this. He became the voice behind pediatric bipolar disorder.
These were not kids that were manic in any way. What he did was that he argued that severe irritability and explosive anger could be seen as early signs of bipolarity.
>> Signs of pediatric bipolar: severe temper tantrums. Anger can turn to destructiveness. Child is reactive to limit setting. Duration of outbursts lasts over 30 minutes. Child may lose memory during tantrums.
And where do we see irritability and explosive anger in kids? Also in what we call ADHD or other behavioral problems. So here again, you see how psychiatry blends with the cultural moment, and how psychiatric disorders take up the role of telling someone who they want to be rather than what they have. Because parents massively advocated for this bipolarity in children. They were exhausted and tired of being blamed for having chronically enraged and sleepless children. They didn't want anymore that moral sting. And the term bipolar, it gave them an exoneration from that, from the blame. It gave them a medical reason. And the children were no longer defiant, they were ill. So like in the case we talked about where borderline turns into bipolar because it gives a moral exoneration, also here you see, "I'd rather have a bipolar child than a child with behavioral problems or with ADHD."
>> Um, he was diagnosed in the hospital at three with, um, bipolar disorder, rapid cycling.
And of course, it worked. Between 1994 and 2003, the outpatient visits for pediatric bipolar disorder, it rose something like 40-fold. And none of these children had any resemblance to Kraepelin's archetype. They weren't alternating between mania and depression. They were alternating between irritability and rage.
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And there's a huge red flag that I think should be obvious, and it's that the majority of these bipolar kids, they were boys. Well, the majority of the diagnosed adults, they're women. And this inversion makes very little biological sense if both groups are supposed to be suffering from the same illness. Add to that, more than half of these bipolar kids, they also seem to meet the criteria for ADHD, and then, or and also oppositional defiant disorder. And then they do another little sleight of hand. They say this overlap proves comorbidity. And you hear this again and again with all kinds of, you know, ADHD and autism as well. You see, they have the same thing, so it must be true.
And then I just have to ask, are you saying that all these children were just unlucky enough to inherit two separate brain disorders, two separate rare brain disorders? But how plausible is that really, when both ADHD and bipolar disorder is diagnosed through a clinician, through clinical interview, through subjective interpretation of self-report? There are no lab tests. There are no imaging findings. There is no ADHD brain. There is no bipolar brain. There are no biomarkers to confirm one, let alone two. And each one rests on a clinician's judgment that certain behaviors fit a checklist written by committee in a conference room. And both of the disorders, ADHD and bipolar, have expanded dramatically as those checklists loosened.
No, the better explanation, and the more troubling one, is that psychiatry didn't uncover two overlapping hidden epidemics. It created overlapping categories for the same behavioral and cultural phenomena. That's what happened. And so, consequently, thousands of children were treated with lithium, with antipsychotic medication. And these are heavy, brain-altering drugs that create sedation, weight gain, anxiety, depression. These are not uncommon side effects. Sedation happens invariably with those medications. You are dooming someone to a life that feels like treading water. That is what they all describe. When you're put on lithium or put on antipsychotic medication, you feel constantly foggy. I mean, yes, of course, it numbs the irritability and the rage because it numbs absolutely everything.
And so, you know, psychiatry did realize what they had done, but only too late. So they tried, in the DSM-5 that arrived in 2013, they tried to rein it in a little bit, and it's very telling how they did that. So they made a completely new diagnosis to try to redirect these bipolar children into, and that was called disruptive mood dysregulation disorder. So that was sort of for these chronically irritable children. But they just couldn't help but widen the gate further in a different place. And they did that by adding to the bipolar spectrum with mixed features. So this means suddenly you could have, you didn't have to alternate from one state to the other. You could have both at the same time. And with that, as you can imagine, the number of people considered bipolar multiplied nearly tenfold.
So from 1990 till today, as we've mentioned, the prevalence rate of bipolar disorder has risen by almost 60%. So, and they did this, they made this possible because they expanded the border out of wanting to be inclusive, wanting to de-stigmatize. Inclusive is just, why would you want to be under a certain label? Why would you want to? It's because we have made it into something that says something about a person. It's no longer about medical destiny. It's about, "If I get included into this tribe, that says something about me. That says that my behavior is no longer something I'm to be blamed for." Right? It takes away a moral sting. And if you look at the diagnostic expansion of autism as well, you see the same pattern. You see the same motivation behind and the same advocacy.
So, thank you for listening, and please like and subscribe.