4 ms·

I don’t know this lady or her struggles, but the article paints a very clear picture of someone with childhood-onset bipolar disorder who has gone from manicall

I don’t know this lady or her struggles, but the article paints a very clear picture of someone with childhood-onset bipolar disorder who has gone from manically creative highs to depressing lows. Strangely, there was no mention of it, aside from “relentless anxiety and depression, eating disorders, exercise addiction, obsessive-compulsive tendencies.” All of these are common comorbidities in bipolar individuals.

ludamad 5y ago
What's the advantage of labelled baskets of symptoms vs treating symptoms from first principles? Honest question
- tediousdemise 5y ago
  Misdiagnosing bipolar disorder as a purely depressive disorder can have disastrous consequences, especially if prescribed antidepressants instead of mood stabilizers. [1] [1] https://www.webmd.com/bipolar-disorder/news/20100601/bipolar-disorder-misdiagnosed-as-depression https://www.webmd.com/bipolar-disorder/news/20100601/bipolar...
  - captainredbeard 5y ago
    > disastrous consequences, especially if prescribed antidepressants Viewed differently, this speaks to the extreme dangers of psychiatric drugs. They should be a tool (vital!) of last resort but are often used as a frontline therapy.
    - tediousdemise 5y ago
      I agree. It should go without saying that you only get one brain. Fundamentally, anything that modulates the brain should be used with extreme caution. Although the brain is remarkably resilient, sometimes drug-induced changes or side effects can be permanent. For some, this may come as relief, yet for others, they may find that the solution was worse than the problem. As they say, caveat emptor.
  - treeman79 5y ago
    Everything is depression. Had major brain fog problems. But was generally happy and good natured. Spent years seeking help, at every stage was told it was depression. Turned out it was a horrible disease that was slowing killing me. I imagine a lot of “depressed” people have an underlying chronic condition that isn’t being addressed.
    - anonymouse008 5y ago
      Mind sharing how one could go about testing for this condition? (This sounds a bit familiar)
      - treeman79 5y ago
        Genetic testing for clotting. Autoimmune work up. Spinal tap for pressure. Make a list every symptom, and what affects your symptoms. Take it to every kind of specialist. Then keep repeating. Take an advocate. I would explain stuff, could see they had mentally written me off. The wife would start bawling. This would wake them up, and they would dig further. A neuro-ophthalmologist was reading my list. Looked up and declared I had Sjogrens. He was right. Now he missed the clotting disorder. Then have a clot in your lungs. Then you get taken seriously. That’s when they found factor 5 Leiden. So between the two my body and mind were trashed.
        spicybright 5y ago
        Crying wife is a good lifehack!
- whalesalad 5y ago
  I wish more people thought like this. Treating from first principles should be the way - but lately it is not.
- bosie 5y ago
  do you mind expanding on what 'treating symptoms from first principles' means? I have a hard time visualising how that works in medicine
  - deleted 5y ago
    [deleted]
  - ludamad 5y ago
    I guess first principles here just meant whatever you might do without the other symptoms in consideration
- LatteLazy 5y ago
  The theory has been that if you could find a single underlying cause, you could just treat that, and then all the symptoms would disappear in one go. This would also let you treat symptoms that can't be treated directly (you can tranquilise away anxiety, you can't do much about hearing voices). That theory has largely failed as we can't even really agree which groups of symptoms make which diseases. Hence the constant changes to systems like the DSM. Full disclosure, I may be bias and I'm also an example: I have Major Mood Disorder. I used to have Severe Clinical Depression. Before that, I had Treatment Resistant Depression. Before that it was just Clinical Monopolar Depression (It's still called monopolar sometimes to differentiate it from Bipolar). My symptoms haven't changed. Nor has the treatments offered. But in the last 10y we've repeatedly renamed, recategorised, reshuffled etc just common depression. God knows what it's like in more complex, less common symptom sets... The BBCs Life Scientific podcast discusses this very question in this episode if you're interested: https://www.bbc.co.uk/programmes/m000sj7c https://www.bbc.co.uk/programmes/m000sj7c The wider series is also very good imho.
  - tediousdemise 5y ago
    It amazes me how complex the brain is. We are barely equipped with the tools to understand its complexity. An article I read earlier today on HN stated that the brain contains up to 11-dimensional neural networks. [1] I think we’ve been incredibly lucky to have the fields of psychology and psychiatry to fill the medical role, especially when the quantitative gaps in our understanding of the brain seem to be widening. [1] https://bigthink.com/paul-ratner/our-brains-think-in-11-dimensions-discover-scientists https://bigthink.com/paul-ratner/our-brains-think-in-11-dime...
  - hpoe 5y ago
    This kind of constant relabeling and recategorizing along with everyone I know who works in mental health fields constantly diagnosing everyone around them is why I am skeptical of the entire field of psychology/psychiatry.
    - tediousdemise 5y ago
      Look at it this way. Turbulence is an observable phenomenon that you may have experienced while riding an airplane. Modern fluid dynamics cannot adequately explain turbulence. Richard Feynman has described turbulence as the most important unsolved problem in classical physics.[1] We don’t dismiss fluid dynamics because turbulence is ill-defined, and we also don’t deny that turbulence exists just because we lack a thorough mathematical understanding of it. This is analogous to psychology/psychiatry and mental illnesses. If we had magical brain oscilloscopes that we could hook up to visualize every mental disorder, we’d use them. Until those exist, we must rely on qualitative and statistical approaches to provide treatment. [1] https://en.wikipedia.org/wiki/Turbulence https://en.wikipedia.org/wiki/Turbulence
- cpach 5y ago
  Good question. A unipolar depression is very different from a bipolar depression in many regards. E.g. likeliness to eat less vs. likeliness to eat more. And a unipolar depression can possibly be treated and then be gone. (If the treatment works out.) If one has bipolar disorder, it won’t go away. One has to live with it the the whole life.
mola 5y ago
That maybe important for a practioiner. But otherwise these labels don't have much meaning. Obviously her situation is unique. Although it may fall under the umbrella of some DSM definition, but the meaning there is only for a medical perspective and not "a human perspective". We cannot be reduced to some statistical artefact. We may statistically significantly share some common traits with other people, but it doesn't make us the set of these common traits. The model is not reality especially so for the DSM, which was built in a medically theraputic context. And should be taken as such.
- pmoriarty 5y ago
  Many therapists use the DSM only for insurance purposes, as insurance companies demand an official diagnosis before covering treatment. The DSM's role in therapy itself is highly questionable.
- guerrilla 5y ago
  > But otherwise these labels don't have much meaning. Hard disagree, the experience of somone with bipolar is a lot different than somone who's schizophrenic or only has major depression or generalized anxiety. Mania and the specific difficulties it causes for psychosis are radically different than what the others have to deal with and so is the general unpredictability of life (for planning and commitment purposes) and especially the types of effects it has on relationships. Each of the disorders have totally different profiles subjectively and objectively and different things they have to deal with. It's definitely not just a "statistical artefact" dispite the possibility of multiple diseases causing the same symptom clusters.
  - mola 5y ago
    And these experiences usually can't be reduced to the symptoms list in the dsm. These lists are very simplified models that are useful for certain things.
watwut 5y ago
If there is no official diagnosis, would it be ok for journalist to amateur diagnose her? Afaik, that is not considered acceptable.
IG_Semmelweiss 5y ago
A lot of these issues go hand in hand. I havent finished reading the article yet but this really struck me as narcissism with some othee commorbidities that you mention. What makes you think of BD?

ludamad 5y ago

What's the advantage of labelled baskets of symptoms vs treating symptoms from first principles? Honest question

tediousdemise 5y ago
Misdiagnosing bipolar disorder as a purely depressive disorder can have disastrous consequences, especially if prescribed antidepressants instead of mood stabilizers. [1] [1] https://www.webmd.com/bipolar-disorder/news/20100601/bipolar-disorder-misdiagnosed-as-depression https://www.webmd.com/bipolar-disorder/news/20100601/bipolar...
- captainredbeard 5y ago
  > disastrous consequences, especially if prescribed antidepressants Viewed differently, this speaks to the extreme dangers of psychiatric drugs. They should be a tool (vital!) of last resort but are often used as a frontline therapy.
  - tediousdemise 5y ago
    I agree. It should go without saying that you only get one brain. Fundamentally, anything that modulates the brain should be used with extreme caution. Although the brain is remarkably resilient, sometimes drug-induced changes or side effects can be permanent. For some, this may come as relief, yet for others, they may find that the solution was worse than the problem. As they say, caveat emptor.
- treeman79 5y ago
  Everything is depression. Had major brain fog problems. But was generally happy and good natured. Spent years seeking help, at every stage was told it was depression. Turned out it was a horrible disease that was slowing killing me. I imagine a lot of “depressed” people have an underlying chronic condition that isn’t being addressed.
  - anonymouse008 5y ago
    Mind sharing how one could go about testing for this condition? (This sounds a bit familiar)
    - treeman79 5y ago
      Genetic testing for clotting. Autoimmune work up. Spinal tap for pressure. Make a list every symptom, and what affects your symptoms. Take it to every kind of specialist. Then keep repeating. Take an advocate. I would explain stuff, could see they had mentally written me off. The wife would start bawling. This would wake them up, and they would dig further. A neuro-ophthalmologist was reading my list. Looked up and declared I had Sjogrens. He was right. Now he missed the clotting disorder. Then have a clot in your lungs. Then you get taken seriously. That’s when they found factor 5 Leiden. So between the two my body and mind were trashed.
      - spicybright 5y ago
        Crying wife is a good lifehack!
whalesalad 5y ago
I wish more people thought like this. Treating from first principles should be the way - but lately it is not.
bosie 5y ago
do you mind expanding on what 'treating symptoms from first principles' means? I have a hard time visualising how that works in medicine
- deleted 5y ago
  [deleted]
- ludamad 5y ago
  I guess first principles here just meant whatever you might do without the other symptoms in consideration
LatteLazy 5y ago
The theory has been that if you could find a single underlying cause, you could just treat that, and then all the symptoms would disappear in one go. This would also let you treat symptoms that can't be treated directly (you can tranquilise away anxiety, you can't do much about hearing voices). That theory has largely failed as we can't even really agree which groups of symptoms make which diseases. Hence the constant changes to systems like the DSM. Full disclosure, I may be bias and I'm also an example: I have Major Mood Disorder. I used to have Severe Clinical Depression. Before that, I had Treatment Resistant Depression. Before that it was just Clinical Monopolar Depression (It's still called monopolar sometimes to differentiate it from Bipolar). My symptoms haven't changed. Nor has the treatments offered. But in the last 10y we've repeatedly renamed, recategorised, reshuffled etc just common depression. God knows what it's like in more complex, less common symptom sets... The BBCs Life Scientific podcast discusses this very question in this episode if you're interested: https://www.bbc.co.uk/programmes/m000sj7c https://www.bbc.co.uk/programmes/m000sj7c The wider series is also very good imho.
- tediousdemise 5y ago
  It amazes me how complex the brain is. We are barely equipped with the tools to understand its complexity. An article I read earlier today on HN stated that the brain contains up to 11-dimensional neural networks. [1] I think we’ve been incredibly lucky to have the fields of psychology and psychiatry to fill the medical role, especially when the quantitative gaps in our understanding of the brain seem to be widening. [1] https://bigthink.com/paul-ratner/our-brains-think-in-11-dimensions-discover-scientists https://bigthink.com/paul-ratner/our-brains-think-in-11-dime...
- hpoe 5y ago
  This kind of constant relabeling and recategorizing along with everyone I know who works in mental health fields constantly diagnosing everyone around them is why I am skeptical of the entire field of psychology/psychiatry.
  - tediousdemise 5y ago
    Look at it this way. Turbulence is an observable phenomenon that you may have experienced while riding an airplane. Modern fluid dynamics cannot adequately explain turbulence. Richard Feynman has described turbulence as the most important unsolved problem in classical physics.[1] We don’t dismiss fluid dynamics because turbulence is ill-defined, and we also don’t deny that turbulence exists just because we lack a thorough mathematical understanding of it. This is analogous to psychology/psychiatry and mental illnesses. If we had magical brain oscilloscopes that we could hook up to visualize every mental disorder, we’d use them. Until those exist, we must rely on qualitative and statistical approaches to provide treatment. [1] https://en.wikipedia.org/wiki/Turbulence https://en.wikipedia.org/wiki/Turbulence
cpach 5y ago
Good question. A unipolar depression is very different from a bipolar depression in many regards. E.g. likeliness to eat less vs. likeliness to eat more. And a unipolar depression can possibly be treated and then be gone. (If the treatment works out.) If one has bipolar disorder, it won’t go away. One has to live with it the the whole life.

mola 5y ago

That maybe important for a practioiner. But otherwise these labels don't have much meaning. Obviously her situation is unique. Although it may fall under the umbrella of some DSM definition, but the meaning there is only for a medical perspective and not "a human perspective". We cannot be reduced to some statistical artefact. We may statistically significantly share some common traits with other people, but it doesn't make us the set of these common traits. The model is not reality especially so for the DSM, which was built in a medically theraputic context. And should be taken as such.

pmoriarty 5y ago
Many therapists use the DSM only for insurance purposes, as insurance companies demand an official diagnosis before covering treatment. The DSM's role in therapy itself is highly questionable.
guerrilla 5y ago
> But otherwise these labels don't have much meaning. Hard disagree, the experience of somone with bipolar is a lot different than somone who's schizophrenic or only has major depression or generalized anxiety. Mania and the specific difficulties it causes for psychosis are radically different than what the others have to deal with and so is the general unpredictability of life (for planning and commitment purposes) and especially the types of effects it has on relationships. Each of the disorders have totally different profiles subjectively and objectively and different things they have to deal with. It's definitely not just a "statistical artefact" dispite the possibility of multiple diseases causing the same symptom clusters.
- mola 5y ago
  And these experiences usually can't be reduced to the symptoms list in the dsm. These lists are very simplified models that are useful for certain things.

watwut 5y ago

If there is no official diagnosis, would it be ok for journalist to amateur diagnose her? Afaik, that is not considered acceptable.

IG_Semmelweiss 5y ago

A lot of these issues go hand in hand. I havent finished reading the article yet but this really struck me as narcissism with some othee commorbidities that you mention. What makes you think of BD?