Talk:Bipolar disorder/Archive 2

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)


 * 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)


 * 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)


 * By the way, I'm musing about illustrating this article with Image:Munch The Scream lithography.gif; several sources, including this, 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)


 * 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)


 * 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: . and this:  -- Karada 15:31, 2 August 2005 (UTC)

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, , , , : and in borderline personality disorder: . And here's a reference on brain metabolites and bipolar disorder: . -- Karada 15:19, 2 August 2005 (UTC)

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

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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

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 * 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)

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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)

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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

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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 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)


 * 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)

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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

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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)

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

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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: 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)

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)

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)

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

I have a question, call me stupid or whatever makes one feel better about my question , but it is a serious one. I, myself do not have any bipolar disorder , but a friend of mine does. I came to this site in prayers that I might find some help understanding how I could help her. I have, instead , experienced all these people fighting with one another instead of trying to help one another. My question, is the site built to give people the oppurtunity to share experiences in order to help one another or am I misled and is this site a place to act out bipolar behaviour by arguing with one another and running each others opinions down??????????? justme

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)


 * 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)

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)

-

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)

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)

-

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)
 * 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)

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.

"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)

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)

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)

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


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

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

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)


 * 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)

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)

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)


 * "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)

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)

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)


 * 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)

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

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)

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)

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)

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)

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)


 * 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)

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)


 * 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)

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)


 * 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)

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)


 * 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)


 * 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)

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)


 * 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)


 * 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)

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)


 * 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)


 * 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)

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)


 * 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)

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)


 * 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)

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)


 * (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)

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)


 * 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)

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


 * 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)

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)

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)

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)

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)

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)

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)


 * 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)


 * 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)


 * Mood Spectrum needs to be moved -- probably up, some work done, and some cites added...but 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. --[[User:Mjformica|Mjformica 17:19, 7 January 2006 (UTC)

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 Reliable sources. JFW | T@lk  22:28, 21 January 2006 (UTC)

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)

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)


 * 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)


 * 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)


 * 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)