Hello and welcome to another edition of Best 5 Reads. Lets start!
Recently, we’ve been hearing more in the news about celebrities who have openly shared their bipolar stories and have encouraged others to recognize bipolar in their own lives. And tragically, we’ve also heard about individuals allegedly with bipolar disorder who have died by suicide or committed acts of violence against others. From a society perspective, bipolar disorder is slowly coming out of the woodwork, and people are starting to ask more questions about this often misunderstood mental illness. Heightened awareness is a good thing, of course. But a profound stigma against treatment still exists, along with a general lack of understanding about bipolar disorder and what can be done about it.
The gap in knowledge about bipolar is exceeded only by the length of time people with the illness begin showing symptoms and when they’re actually treated appropriately. Drancourt et. al (2012) showed that, on mean average, patients will have waited nearly 10 years from their first bipolar mood episode to the time they receive a mood stabilizing medication specifically for bipolar disorder. Another study showed about two-thirds of bipolar patients are misdiagnosed and treated as having other psychiatric disorders (mostly major depression), while those patients had consulted a mean average of nearly four clinicians before receiving appropriate care (Hirschfeld, Lewis, & Vornik, 2003). Because of this 10-year gap in treatment, we have a whole population of underlying bipolar disorder presenting as relational dysfunction, substance abuse, unipolar depression, attention deficits, self-harm, personality disorders, domestic violence, workplace conflicts, and many other common presentations to outpatient therapy.
But the biggest problem with unidentified and untreated bipolar disorder is suicide, which is at least 20 times higher in bipolar patients compared to the general population (Berk, Scott, Macmillan, Callaly and Christensen, 2013). Perhaps even more striking, The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association [APA], 2013) states that “bipolar disorder may account for one-quarter of all completed suicides” (p. 131). While many people with undetected bipolar matriculate—then languish—through an often cumbersome mental health system, their condition worsens, threatening their own life along with the well-being of every concerned person around them.
With a prevalence up to 5% of the population (Ketter, 2010), a unified method to effectively recognize and comprehensively treat this chronic and deadly mental illness is critical. It’s certainly time to fully understand what bipolar is, how to better recognize and openly discuss it, and treat it in a unified manner with active support around the person suffering from uncontrollable mood swings.
A clinical review, published in Evidence Based Mental Health Month, suggests numerous issues, including poor app design and privacy concerns, have contributed to a low engagement rate for mental health apps. The article goes on to suggest that more patient engagement during the app design process and the creation of standards could help remedy these issues.
Psychoanalysts have generally avoided targeting behavioral change in psychoanalysis or psychoanalytic psychotherapies, believing such approaches can disrupt effective treatment. A central concern has been that these strategies constitute “suggestion,” an effort to influence or manipulate patients. A core focus of psychoanalysts has been on gaining insight, making the unconscious conscious; this increased understanding was considered the primary goal and paved the way for behavioral change. If behavioral change occurred without proper analysis, conflicts were believed to persist, leading to the substitution of different symptoms or problematic behaviors. Over the course of psychoanalytic history, there has been an increasing emphasis on the clinical impact of the therapeutic relationship independent of insight, but these theories and approaches still consider behavioral change to be a secondary outcome.
Old data have recently been gathered and systematically presented—reinforced by a new study, but perhaps contradicted by another. So it’s time to revisit this story.
A growing number of Americans suffer from some form of mental illness, yet only a fraction receive treatment. These companies offer a solution.
Thank you and see you tomorrow for another edition of Best 5 Reads.