Posted by simcha on August 26, 2010, at 16:07:43
In reply to Re: Is It Depression or Bipolar? » violette, posted by ed_uk2010 on August 26, 2010, at 15:37:00
As a psychotherapist (ok, so I came out again), I find this trend to include more and more people under the "Bipolar" label to be misguided. As others have said, many of the symptoms they are now describing as "mildly Bipolar" are also attributed to Personality Disorders, Chronic PTSD, Adjustment Disorders, and Attachment Disorders. I hope that Attachment and Chronic PTSD get more room in the DSM V. But it seems like they are widening the scope of the Bipolar diagnosis as a "catch all."
As a worker in the field working with Social Workers, Drug Counselors, Psychiatrists, Psychologists, and other Master's Level Psychotherapists I have noticed a trend to focus more on more on Bipolar Disorder. Sometimes I'm disturbed by this and sometimes I wonder if we are just becoming more accurate and attentive of symptomology in widening the definition of Bipolar. And there's a lot of politics and money that is involved here as we all know.
One of the frustrations I have with our mental health non-system in the USA is that psychotherapy isn't valued. Insurance (public and private) reimburses poorly if at all for psychotherapy. We Master's Level Psychotherapists are paid crap because of this. And some of our work is dismissed as "not evidence based" as if everything in the human psyche can be measured and quantified nicely in scientific terms.
I believe that our mental health non-system places way more weight on using drugs and psychiatrists due to the giant medical and pharmaceutical lobbies. We Master's Level Psychotherapists have been playing "catch-up" for decades in order to get properly reimbursed for our services and even to have our contributions to the field of mental health recognized.
Yes, psychotherapy can be expensive especially if it's indicated as a long-term therapy. CBT gets all the press and is one of the few treatments that gets reimbursed because it's allegedly "evidence based." There are issues with the "evidence" that many CBT practitioners use to claim that their treatments are "evidence based." And insurance companies prefer CBT because it's more quantifiable and it's a form of more brief psychotherapy. Therefore they don't have to pay for longer-term treatment that might actually get to the root issues causing the symptoms that CBT treats.
As a mental health client/participant/patient/consumer I have more and more practitioners really stretching and searching for any signs that I may be Bipolar even though I've never been manic, ever. They look at me sometimes like I'm lying when I tell them this. I even had a pdoc give me a book written by someone who suffered from Bipolar Disorder to see if I related to it. I related to the depression. I didn't relate to the mania detailed in the book.
Have I ever had "sub-threashold" symptoms that could be categorized as "sub-threashold" hypomania? I'm not sure. There are many people in my family who suffer from Bipolar Disorder. So I have a greater likelihood of developing Bipolar Disorder. However, is it useful to classify periods when I'm feeling well (and not "better than well") as "sub-threashold" "hypomania?" Does this change the direction of my treatment? Does this mean that other medications should be used with me?
I wish I could afford psychotherapy. I know that when I could see a psychotherapist weekly I did much better than with just medication alone. It's ironic that I provide psychotherapy and can't afford it for myself because my insurance doesn't cover long-term therapy and I don't make anywhere near enough to afford to pay full price for weekly sessions.
However, I do wonder sometimes if the mental health practitioners may be seeing something I haven't seen in myself. I do have a hard time focusing sometimes. I'm a starter and not necessarily a finisher when it comes to projects. I'm a major procrastinator. I have anxiety around procrastination. In my younger adulthood I had a very difficult time in choosing a career and I've been through 4 very divergent career changes in my life. So, I do wonder if I don't have some "sub-threashold" "hypomania" sometimes, or if I experience mixed states when I'm depressed.
There's a lot to consider here and I've wandered more than a bit in my ranting here. I hope this makes sense.
poster:simcha
thread:959557
URL: http://www.dr-bob.org/babble/20100821/msgs/960008.html