Bipolar Thoughts

Holy Triumvirate

For almost all mental illness, three questions are evaluated, and three treatments are prescribed. This is as true of one time “clinical” depression as Major Depressive Disorder, or as true of Agoraphobia as Bipolar Disorder or even the ‘big one’, Schizophrenia.

Those three things that are evaluated are the duration, the intensity, and the frequency of any mental disturbance. Doctors and therapists don’t tend to come right out of the gate with these questions. They generally attempt to draw them out by asking about your history, how much your everyday life as been affected, things like that.

But what they really want to know is duration, intensity and frequency. And the reason those things are so significant is because we know so little about the causes of mental illness, and we are so ill-equipped at defining the diseases that all we can use are standard emotive words and add emphasis. I’m depressed, well everyone gets depressed. I’ve been depressed for a month, ah! Now we are talking about Depression, not depression.

Mental illness is basically when normal bad stuff is exaggerated, or at least, that is how we currently view it. To be perfectly clear, not all three of those things need to be an issue for you to have, well, an issue. Two is plenty for treatment and a lot of the time just one, if it is bad enough, can score you some sweet meds. When you suffer from long, deep and frequent depression, or long, highly excitable states of mind (but here frequency doesn’t matter), or debilitating and frequent anxiety (duration isn’t an issue here), well those are the times you end up with a significant diagnosis and a large treatment plan.

My two cents? It is all garbage. I doubt it will change much in my lifetime, but we have to come up with a deeper understanding, and above that, a new language to describe symptoms. The major problem with a mental health diagnosis is how subjective it is. And it two ways! Both the describer of the symptoms and the interpreter of them are being subjective.

How do I know that my depression is bad? I have never experienced your depression, right? Maybe I’m terrible at dealing with depression so I stay there longer and react more poorly. It is possible right? Maybe the difference between myself and someone without anxiety is that I don’t deal with stress as well. Who knows? Maybe the inability to deal with normal stress IS the disease. Maybe?

And when you finally get that treatment, it is generally centered around three things: sleep, physical health (specifically nutrition and exercise), and therapy (both psychoanalytic and psycho-pharmacological). Some of the only things we know with good certainty about mental health is that a regulated sleep cycle is really important, especially for bipolars. Sleeping too little or too much can wreak havoc on the condition. Physical health, being active, not eating terribly, etc, is good in a number of ways. It releases good chemicals in your brain, maybe it flushes out and brings balance to your brain as well. But also your body feels good, you like the way you look, and all sorts of normal stuff that can obviously help. Therapy and medication are the inevitable conclusion that a major diagnosis brings. They can bring stability to your state of mind, but they are not cure-alls. Mental health often unfairly gets compared to diabetes for some reason, but this is one comparison I find apt: taking insulin doesn’t cure diabetes, you still have to be diligent in your diet and lifestyle. The same is true of medicine prescribed for mental health. It can make things less dangerous for you, but you have a lot of legwork left to do.

And here is the rub: the efficacy rates of those three things, that is, the percentage chance that the treatment will work, are all about the same.

I’m gonna let that one sink in for a minute. Maintaining sleep, going for a run, or taking medication and going to therapy, all have the same chance of working. This is why they recommend them together. They don’t actually know which treatment will work for you, but they know there is a good chance they are all somewhat effective. So why not, right?

And this is the real kicker, placebo, as in sugar pills, or a metaphor for the control group in a study that simply believes they are receiving treatment. Placebo has just as high, and often higher, efficacy rate of any of those big three treatments.

No other science, certainly no other hard science, but not even any other soft science, would put up with that unpredictable spread of treatment options. But this is where we are with mental illness. Doing nothing is as effective as what we believe to be the ‘proper’ courses of action, therapy and medication.

It does not leave me with an optimistic vantage point. But nearly every day I read a new article about the breadth and depth of knowledge about mental illness growing. The medical industry stands to make a lot of money on treatment. That is supposed to be the recipe for success in this country.

Hopefully I’ll be dining on the outcomes soon.