Wednesday, July 25, 2007

Medical Trends

So according to yesterday's queries, everyone has bipolar disorder. Or, everyone has written a memoir about having it. We've been getting a lot of them since that Newsweek article a few months ago on it.

Diagnostic trends are very interesting. They're not so much trends but further understandings of disease and our limited abilities to categorize them. The patient wants to hear something. A classic case is Crohn's Disease/Ulcerative Colitis. In the ten years since my diagnosis with the former, I've heard dozens of stories of people who've said they were misdiagnosed with one and really had the other and only just found out. There's a doctor on my team who has a theory that UC is actually one of the five subtypes of Crohn's, and you can determine which type you have based on a blood test. I had the blood test, and the numbers came back, and I asked what they meant, to which my doctor replied, "We don't know yet. We'll know in about ten years." It was basically research. This doctor probably isn't wrong, either; he's the guy who invented immuno-suppressant drugs, which were the major way of fighting the disease until Remicade came along in 1998.

Psychiatry has even greater challenges because of so many symptoms that overlap, are inconsistent, and are sometimes incredibly subjective. Two hundred years ago, everything was monomania. Then they added schizophrenia. Then manic depression. Then bipolar disorder. Then they divided bipolar disorder into two types, Type I or II, then debated whether one of the types wasn't just manic depression, because the two major symptoms (mania and depression) were overlapping. Then they started labeling people with various personality disorders, which gave them a much wider range to work with, but didn't really define anything except in certain cases. I have a friend who was diagnosed with "schizoid affective disorder. " I cannot find a single doctor who can effectively tell me what that is. Also, he has symptoms that don't fit into that subtype, and I know he's not under good care, so he may well be misdiagnosed. For a while it didn't matter, because treatment was limited, but now that we not only have SSRIs but know how to use them in combination with newer drugs, it's more and more important to put the right label on the right person.

Anyway, I don't think the little boom of bipolar-based memoirs is due to the Newsweek article entirely, but it helped. There were probably people with memoirs floating around about their illness, and they decided to mention the diagnosis in the query, figuring bipolar disorder is a hotter topic than it was a year ago (which is true). Also, because it's being more commonly diagnosed (to the point where many say it's over-diagnosed), we're just going to see more people who say they have it.

All of this doesn't work for or against the query. When it comes to memoir, it's whether the person has an intriguing story and the ability to communicate in a way that makes people want to read about it is or not is the determining factor. I just thought that was an interesting little note.


Anonymous said...

Not only do the patients not know what these terms mean, the doctors don't know, either.

I work at a big teaching hospital with several mental health units. Daily we get charts to code (for billing and statistical purposes, every diagnosis a doctor writes has to be translated into a number). Daily we get charts documented by fully qualified psychiatrists, in which one day the patient has bipolar, the next schizoaffective, the next major depression...

And we're supposed to discern one main code out of all this drivel.

If the docs don't know what the criteria are for diagnosis in these categories, how are they supposed to communicate to the patients?

I think the problem is that psychiatry has progressed to a point, but not enough. The struggle the professionals face is to determine what little box to put the patient in. If the bipolar box or the schizoaffective box or the major depression box doesn't fit an individual, they'll MAKE it fit.

If this sounds like medieval alchemy, this might be the reason.

Name withheld to protect--well, somebody.

Kim Stagliano said...

Does that mean they get to write in two genres?

My Yahoo pop up tells me how to diagnosed myself with bipolar. Open any magazine and read the ads, "I didn't know my mood swings were more than just depression." We're trained by the pharm companies to convince ourselves we're sick. Got to go, my restless legs just won't let me stay in my chair....

I'm an autism Mom, don't get me started on Pharma.

(Why did you remove your other post? I learned quite a bit from it about your religion. It was interesting!)

Anonymous said...

So, were these queries... bi-polar?

One minute calm and the next enraged and demanding representation, only to end with "Hugs and Kisses"?

Sorry, but that was my initial thought.

dan said...

it was an interesting little note, thank you. your last note also was interesting, but it made me momentarily question the burrito I was eating yesterday, when I read it. I'm gonna have to have another tree planted in the negev or somethin.

Anonymous said...

So, does a mid-western bi-polar memior not even stand a chance? What about a New York bi-polar memior?

Sorry, I couldn't resist....

John Elder Robison said...

Don't forget autism . . . from 1 in 10,000 to 1 in 166 in our population.

Are you seeing more books on autism or Asperger's since Look Me in the Eye?

Richard said...

I am always suspicious of labeling people.

There is a wide range behavioural spectrum but I think we get caught up in trying to pigeon hole everyone into "normal" behaviour (hmm, I wonder, are real "quotes" as annoying as those "tic-tic" finger-air quotes people do while speaking?). Clearly if you are not normal, then you are in some way deviant and need to be fixed (or at least treated or controlled).

On the other hand, it may be rooted in the ancient practice of naming something. If you could name it, then you could control it (which is why God never gave his name to Moses). Many cultures had the practice of public and private names.

If we can name "whatever it is" about ourselves, then we can control it.

Alternately, maybe it is the need of feeling special: "I am a bipolar, schizoid old Crohn".

It could also be a way of people trying to excuse themselves of responsibility for themselves, "What did you expect? I am a narcissist with a tendency towards exhibitionism who suffers from aerophagia."

Of course, people also tend to have a herd instinct (even if they think they have an original idea) and just get washed up in whatever is trendy at the time.

Tena said...

I can understand the need to designate whatever mental illness you're suffering from. That way the insurance companies will know what they're rejecting you for.

Kim Stagliano said...

Ding! Ding! Ding! Please give Tena a prize. She wins.

Anonymous said...

"Not only do the patients not know what these terms mean, the doctors don't know, either."

There have been several studies that show that psychiatric diagnoses are as reliable as those pronounced my one of the so-called hard science medical fields such as radiology. In one study, for example, they found that psychiatrists agree on diagnoses as consistently as radiologists.

So this means either that psychiatric diagnoses are as valid as those given by radiologists, or tht radiological diagnoses are as invalid as those given by psychiatrists.

John Elder Robison said...

One of my best friends is a radiologist, adn he dispenses opinions about what's wrong with me quite freely.

La Gringa said...

Well, then hopefully you'll soon be getting a lot of memoirs about people suffering from restless leg syndrome and overactive bladder. (And the truly gifted write will have both. And it will be luminous.)

Anonymous said...

manic depression is not a diagnosis. It was replaced by the term bipolar depression (i.e. two ends; in contrast to unipolar depression). The same with multiple personality disorder; that is now termed disassociative identity disorder.

Diagnoses can get tricky in mental health because they are so profoundly based on the individual's rating. For example, depression inventories ask for notable changes over the past few weeks. If a person has been functionally depressed for many, many years, his/her responses would be lesser than someone with the same 'level' of depression who has only recently begun experiencing depression.

Anonymous said...

If a bipolar author were also an artist of some kind, a memoir describing how the ups and downs affected both his/her life and art might be interesting. For example, a painter who worked a week straight without sleep sure that his/her latest obsession was a masterpiece only to crash convinced it was the worst crap he/she had ever produced. What happened next? How do the meds affect the art? And so on.

Bipolar disorder in an average person, on the other hand? I've listened to my significant other, the bipolar desk jockey, talk about it for years. I will continue to do so until one of us dies because that's what you do when you love somebody. But even if it were well-written, I wouldn't read the book. Snorrrrre.

joycemocha said...

I know that as a parent of a kid (now adult) with either high functioning autism or Asperger' Syndrome, I'd sure like to read a memoir of an experience that isn't a "smiling through the tears" sort of thing calling for a cure for their dysfunctional kid.

I'd like to read about some autism success stories, dang it! It was a good thing that the popular autism parenting memoirs didn't come along until *after* my son was doing well in high school/had graduated with honors, because, boy, I'd sure be a depressed parent of a kid with autism.

(Can you tell I'm not a Cure Autism Now type?)

Mind you, memoir is not my particular strength--I'd much rather write and publish fiction.

Anonymous said...

So according to yesterday's queries, everyone has bipolar disorder. Or, everyone has written a memoir about having it.

Now come all the shills for New Drugs or New Treatments...

"Theories are like assholes. Everybody has one."

Same with Memoirs.