Q: What actually gets lost when someone takes his symptoms to a cognitive psychologist?
Laurent: “I can tell you where I do not agree with my colleagues from the ethical viewpoint. I am opposed to the behavioral aspect that exists in the usual combination of cognitive-behavioral therapy. The patient is liable to find himself in a confrontation with a powerful authority who tries to impose a behavioral change with a ‘one size fits all’ approach. As though good behavior exists that can be standardized. That is not only harmful to the subject, it is genuinely dangerous to the ideals of freedom. In 1971, at the height of the behaviorist ‘craze,’ Skinner [B.F. Skinner, the father of behaviorism] told Time magazine that freedom is a luxury we can’t afford.
If the postwar age of anxiety was supposed to have ended 30 or 40 years ago, a swath of media articles now suggest a dramatic comeback. A new and widely reported study claims a massive increase in anxiety disorders in the UK, with an estimated 8.2 million sufferers compared to 2.3 million in 2007. The pressures of modern life, we are told, must play a large part here, with job stress aggravating the difficulties of urban populations.
The focus on socio-economic conditions is surely a good thing. In the 1980s, Thatcherism encouraged a redrafting of work-related problems as psychological ones. As each person became a unit of economic competition, it wasn’t the market’s fault if they didn’t get a job but their own. Injustice in the marketplace was glossed over as individual failure.
Hundreds of books and articles have questioned this without gaining media exposure, so why the visibility of the new research? I was puzzled to find not a single sentence in the report linking the supposed increase in anxiety to social causes. In fact, there was no explanation at all, and the headline-grabbing prevalence rate for the UK was estimated from Iceland, Norway and Switzerland.
Here, we find a perfect expression of the new mental hygiene movement. Anxiety is grouped together with dementia, stroke and neuromuscular conditions as a “brain disorder”, and the authors urge an approach that uses “comparable methodologies for both mental and neurological illness”. Disorders are listed in terms of their cost to the economy rather than to individual lives, families and communities. […]
Strictly Bipolar is Darian Leader’s treatise on the psychological disorder of our times.If the post-war period was called the ‘Age of Anxiety’ and the 1980s and ’90s the ‘Antidepressant Era’, we now live in Bipolar times. Mood-stabilising medication is routinely prescribed to adults and children alike, with child prescriptions this decade increasing by 400% and overall diagnoses by 4000%. What could explain this explosion of bipolarity? Is it a legitimate diagnosis or the result of Big Pharma marketing?
Exploring these questions, Darian Leader challenges the rise of ‘bipolar’ as a catch-all solution to complex problems, and argues that we need to rethink the highs and lows of mania and depression. What, he asks, do these experiences have to do with love, guilt and rage? Why the spending sprees and the intense feeling of connection with the world? Why the confidence, the self-esteem and the sense of a bright future that can so swiftly turn into despair and dejection? Only by looking at these questions in a new way will we be able to understand and help the person caught between feelings that can be so terrifying and so exhilarating, so life-affirming yet also so lethal.
Meaning has been stripped from the diagnostic enterprise, in favour of pure external classification.
Clinicians who want to pursue a dialogue here find that they are allocated less and less time with their patients by a bureaucratic and managerial healthcare system. The tragedy is that this deprives us of having any authentic understanding of the symptom, and it introduces a rigid, normative vision of human behaviour. We can know what is a disorder, and what isn’t, without listening to what the person has to say.
Yet nail biting might be a totally irrelevant detail for one person, a terrible curse or a pleasurable habit for another. Classifying such behaviour externally as a symptom, without taking into account what it means to that person, is profoundly inhuman. It is yet another vehicle for imperatives telling us how we should live and how we shouldn’t.
Discussion this week about appalling cuts to mental health services focused on the diagnostic categories “depression” and “anxiety”. Though there are good reasons to question and critique the use of these terms, they have drawn attention away from a major redrafting of diagnostic and prescription trends. While it is claimed that up to one in four people will suffer from depression at some point, over 25% of these subjects are now likely to receive a diagnosis not of depression but of bipolar disorder.
In the early 20th century the prevalence of manic depression was put at less than 1% of the population, but this figure exploded with the ramification of the bipolar categories. If bipolar 1 was often equated with classical manic depression, bipolar 2 lowered the threshold dramatically, requiring merely one depressive episode and one period of increased productivity, inflated self-esteem and reduced need for sleep.
Bipolar 2 and a half, 3, 3 and a half, 4, 5 and 6 soon followed. Today there is even “soft bipolar”, which means a patient “responds strongly to losses”. The World Health Organisation deems bipolar the sixth main cause of disability for people aged 15-44. In children, the diagnosis has increased by over 400%.
Historians of psychiatry have all made the same observation: it was precisely when patents ran out on the big-selling tricyclic antidepressants in the mid-90s that bipolar suddenly became the recipient of Big Pharma marketing budgets. Websites helped people to diagnose themselves; articles and supplements appeared all referring to bipolar as if it were a fact; and nearly all of these were funded by the industry.