Bipolar Disorders

Patients with bipolar disorder may experience family dysfunction, which might result in worse psychosocial functioning through environmental and psychological factors. Research investigating the mediating role of social support, resilience and suicidal ideation on family and psychosocial functioning in BD is rare. The study aims to explore the predicting and mediating effects of social support, resilience and suicidal ideation on family and psychosocial functioning in BD patients. Two hundred forty-six patients with BD and sixty-nine healthy controls were recruited. The Family Assessment (...) Device, Functioning Assessment Short Test, Social Support Rating Scale, Connor-Davidson Resilience Scale and Beck Scale for Suicide Ideation were used to assess family functioning, psychosocial functioning, social support, resilience and suicidal ideation, respectively. Bipolar patients exhibited worse family and psychosocial functioning than healthy controls. Family functioning, social support, resilience and suicidal ideation significantly predict psychosocial functioning in the bipolar group. Social support, resilience and suicidal ideation indirectly mediate the effect of family functioning on psychosocial functioning in bipolar patients. Cross-sectional design and mixed sample including acute and remitted stages. Treatments for patients with bipolar disorder should be combined with family strategies that are formulated to improve psychosocial functioning. An emphasis should be placed on enhancing social support and resilience while paying attention to suicidal ideation. (shrink)

Summary Background Self-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, service users’ views on self-binding directives have not been investigated substantially. This study aimed to explore whether reasons for endorsement, ambivalence, or rejection given by service users with bipolar disorder can address concerns regarding self-binding directives, decision-making capacity, and human (...) rights. Methods This study used qualitative data from an internet-based survey distributed to the mailing list of the UK charity Bipolar UK, which contained multiple closed and open questions on advance decision-making in bipolar disorder. Quantitative analysis of a closed question about self-binding directives had already demonstrated endorsement amongst a very high proportion of participants with bipolar disorder who completed the survey. We conducted thematic analysis of responses from those participants who answered a subsequent open question about reasons for their view. Research was co-produced within a multi-disciplinary team, with clinical, legal, and ethical expertise, and lived experience of bipolar disorder. Ideas and methodologies associated with all these areas of expertise were used in the analysis of these reasons and to gain insight into the thoughts of individuals with bipolar disorder about self-binding directives and associated issues. Findings Between Oct 23 and Dec 5, 2017, 932 individuals with a self-reported clinical diagnosis of bipolar disorder completed the internet survey, with 565 (154 men; 400 women; 11 transgender or other) providing free text answers to the open question. A large majority of respondents endorsed self-binding directives, nearly all describing a determinate shift to types of distorted thinking and decision-making when unwell as their key justification. Responses indicating ambivalence were dominated by logistical concerns about the drafting and implementation of self-binding directives, while those who rejected self-binding directives also cited logistical concerns, validity of their thinking when unwell, and potential contravention of human rights. Interpretation This study is, to our knowledge, the first large study of reasons why mental health service users might endorse or reject the use of self-binding directives. The findings provide empirical support for introducing self-binding directives into mental health advance decision-making practice and policy and may help to address enduring ethical concerns surrounding possible implementation of the directive while a person retains decision-making capacity. The opinions expressed here in responses given by multiple service users with bipolar disorder challenge a prominent view within international disability rights debates that involuntary treatment and recognition of impaired mental capacity constitute inherent human rights violations. Funding The Wellcome Trust . (shrink)

This essay, the last in a series, focuses on the relationship between Nietzsche’s mental illness and his philosophical art. It is predicated upon my original diagnosis of his mental condition as bipolar affective disorder, which began in early adulthood and continued throughout his creative life. The kaleidoscopic mood shifts allowed him to see things from different perspectives and may have imbued his writings with passion rarely encountered in philosophical texts. At times hovering on the verge of psychosis, Nietzsche was able (...) to gain access to unconscious images and the music of language, usually inhibited by the conscious mind. He reached many of his linguistic, psychological and philosophical insights by willing suspension of the rational. None of these, however, could have been communicated had he not tamed the subterranean psychic forces with his impressive discipline and hard work. (shrink)

Perhaps nothing so radically changes one’s value perspective as psychosis. In a moving article, writer Mark Lukach describes his wife Giulia’s struggle with an illness presumed to be bipolar disorder. A woman with a “concrete life plan … to become a director of marketing at a fashion company and have three kids by the time she turned 35”, Gulia’s acute psychosis resulted in her ranting “unintelligible babble about heaven, hell, angels, and the devil”. For her husband, Gulia had become a (...) different person; “the person you love is no longer there, replaced by a stranger who’s shocking and exotic”.Yet, change to value systems is ubiquitous and usually far less dramatic than that occurring in... (shrink)

What is the relationship between negative experience, artistic production, and prudential value? If it were true that (for some people) artistic creativity must be purchased at the price of negative experience (to be clear: currently no one knows whether this is true), what should we conclude about the value of such experiences? Are they worth it for the sake of art? The first part of this essay considers general questions about how to establish the positive extrinsic value of something intrinsically (...) negative. The second part emphasizes the importance of various distinctions within the realm of the negative. We must distinguish between adversity (which is non-mental) and negative mental states, and between negative thoughts (or attitudes) and negative affect. Within the realm of negative affect, we must distinguish between negative emotions and moods, on the one hand, and negative affective perspectives on the other, and then between mildly negative affective perspectives and severely negative ones (for which I reserve the term ‘suffering’). These distinctions matter greatly, since different types of negative experience have very different degrees of prudential disvalue. Although many types of negative experience may be “worth it”—because their positive extrinsic value outweighs their negative value—this is rarely true of severe suffering. (shrink)

Owen, Freyenhagen, and Martin present a novel discussion of the meaning of decision-making capacity. They frame their discussion in the context of deficits in executive function after traumatic brain injury, but their observations and suggestions for expansion of how DMC is appropriately assessed have potential implications for people with other disorders that can potentially affect executive functioning, including those with certain forms of neurodegenerative conditions and some of those with serious mental illnesses such as schizophrenia or bipolar disorder....

Although the cognition is significant in strategic reasoning, its role has been weakly analyzed, because only the average intelligence is usually considered. For example, prisoner's dilemma in game theory, would have different outcomes for persons with different intelligence. I show how various levels of intelligence influence the quality of reasoning, decision, or the probability of psychosis. I explain my original methodology developed for my MA thesis in clinical psychology in 1998, and grant research in 1999, demonstrating the bias of the (...) classic IQ method, and how the intelligence limits thinking. Based on that I defined Personality Model, providing insight into understanding of psychosis (schizophrenia, bi-polar), which has not been explained yet by psychology or psychiatry. In addition, it enables to analyze and assess non-linear problems, utilizable in computer programming, visualization (animation) or other fields including Baduk game. I've already applied some principles in complex information system www.each.co.uk, and video-animations exhibited in London, Germany, Tokyo. I need to mention my experience in chess composition between 1994 and 2000, winning a few international prizes and inventing a special class of fairy rules redefining the mate. The chess composition principles or patterns show the way to organize logical series to higher advanced mechanisms (like calculus), applicable to other fields. One of such principles is a logical aesthetic innovation: new strategy, defined by Italian composers. Finally I show how the simple redefinition of the classic utility concept links economics and psychology to explain irrational / destructive behavior. All presented results (from the research) can be repeated. (shrink)

In this paper I examine the ways in which our language and terminology predetermine how we approach, investigate and conceptualise mental illness. I address this issue from the standpoint of hermeneutic phenomenology, and my primary object of investigation is the phenomenon referred to as “mania”. Drawing on resources from classical phenomenology, I show how phenomenologists attempt to overcome their latent presuppositions and prejudices in order to approach “the matters themselves”. In other words, phenomenologists are committed to the idea that in (...) our everyday, natural attitude, we take for granted a number of prejudices and presuppositions that predetermine how we conceive of and understand what we experience. In order to properly approach the phenomena themselves, we need to find ways of neutralising our presuppositions and prejudices in order to develop new (and hopefully more accurate) accounts of the phenomena under investigation. One of the most popular examples of such an attempt at neutralisation is what Edmund Husserl calls the epoché, which is the practice of bracketing out or suspending presuppositions. However, later phenomenologists developed alternative approaches. Martin Heidegger, for instance, engaged in etymological analyses to discover latent meanings in our language and terminology. Hans-Georg Gadamer also engaged in historical analyses of how our traditions sediment into latent prejudices. After discussing the various ways in which phenomenologists have attempted to neutralise presuppositions and prejudices prior to engaging in their investigations, I apply some of these principles and methods to the domain of psychopathology, and discuss some of the prejudices inherent in contemporary discussions of the phenomenon of mania. I examine recent attempts to link the phenomenon that we today refer to as “mania” with the ancient Greek concept of “μανία” (mania), and argue that the practice of linking contemporary and historical concepts can be detrimental to attempts at reclassifying disorders. In addition, I consider the implications of the shift in terminology from “manic depressive illness” to “bipolar disorder” – especially how conceiving of mania as one of two “poles” predetermines its description by both clinicians and patients. Finally, I address the implications of the headings under which mania and bipolar disorder are discussed within diagnostic manuals. For example, I discuss the removal of the headings of affective and mood disorders in the DSM-5, and the explicit decision by the authors to place bipolar disorder between depressive disorders and schizophrenia. What I aim to accomplish in this paper is not so much a phenomenological investigation of mania as it is a pre-phenomenological investigation. In other words, I offer a preparatory investigation of the phenomenon (or phenomena) referred to as “mania” in contemporary discourse, with the intention of laying the groundwork for further phenomenological and psychological research. (shrink)

In this article, I examine the relation between philosophy and madness. It is often assumed that madness has to be suppressed, excluded, or conquered before a philosophically sensible text, logical argument, or world of meaning can appear. I argue, instead, that a certain concept of madness, when grafted on phenomenological psychiatry and philosophical mysticism, is intrinsically related to the project of philosophy. With the help of experiences of madness as presented in psychiatry and articulated in mad autobiographical reports, including my (...) own, I will show that philosophy and madness are in closer connection than is commonly assumed. In the introduction, I refer to some superficial... (shrink)

In this paper, I examine recent phenomenological research on both depressive and manic episodes, with the intention of showing how phenomenologically oriented studies can help us overcome the apparently paradoxical nature of mixed states. First, I argue that some of the symptoms included in the diagnostic criteria for depressive and manic episodes in the DSM-5 are not actually essential features of these episodes. Second, I reconsider the category of major depressive disorder (MDD) from the perspective of phenomenological psychopathology, arguing that (...) severe depressive episodes should not be characterized by any particular moods (such as sadness, hopelessness, or guilt), and should instead be characterized by a diminished capacity for finding ourselves situated in and attuned to the world at all. In other words, the affective dimension of depression should be characterized as a change in the way we have moods, not as a change from one kind of mood to another. Third, I turn to mania, arguing that manic episodes, taken as the opposite of depressive episodes, should be characterized not by any particular moods (such as euphoria, grandiosity, or even irritability), but should instead be characterized by an enhanced or heightened capacity for finding ourselves situated in and attuned to the world. In other words, the affective dimension of mania, like the affective dimension of depression, should be understood as a change in the way we have moods, not as a change from one kind of mood to another. Fourth, I return to the phenomenon of mixed states and argue that the affective dimension of depression and mania, when conceived along the phenomenological lines I set forth in the previous sections, dissolves the paradox of mixed states by showing that the essential characteristics of depression and mania cannot and do not coincide. Many cases of mixed states are diagnosed because moods that we take to be essential features of either depression or mania arise within the context of what is considered to be the opposite kind of episode (e.g. dysphoria, typically associated with depression, often arises in what is otherwise considered a manic state). However, if we conceive of the affective dimension of depression as a decrease in the degree to which one is situated in and attune to the world through moods, and the affective dimension of mania as an increase in the degree to which one is situated in and attuned to the world through moods, then the particular mood one finds oneself in is simply irrelevant to the diagnosis of either depression or mania. As a result, the manifestation of any particular moods in what otherwise seems to be a pure manic or depressive episode does not constitute a mixed state. (shrink)

This paper explores the factors that contribute to the degree of a mood disorder patient’s self- insight, defined here as her understanding of the particular contingencies of her life that are responsive to her personal identity, interpersonal relationships, illness symptoms, and the relationship between these three necessary components of her lived experience. I consider three factors: (i) the Diagnostic Statistical Manual of Mental Disorders (DSM), (ii) the DSM culture, and (iii) the cognitive architecture of the self. I argue that the (...) symptom-based descriptions of mood disorders which eliminate the subjective features of the patient’s illness experience, in conjunction with the features of the DSM-culture and the cognitive biases that guide the patient, contribute to the impoverishment of her self-insight. The resulting impoverished self-insight would prevent her from developing resourceful responses to her interpersonal problems. In analyzing how these factors combine to influence the patient’s self-insight, I distinguish the therapeutic impact of receiving a psychiatric diagnosis, which facilitates patient’s clinical treatment, from its reflective impact, how the diagnosis informs the patient’s reflection on who she is, how her mental disorder is expressed, and how her interpersonal relationships proceed. I substantiate my argument by considering a patient’s memoir of psychopathology. (shrink)

Temporality and Spatiality have been extensively addressed in philosophy, and their disturbances have been extensively studied in psychopathology (e.g. Wyllie 2005). Mental health patients: (1) describe pathological experiences of Time and Space (Gallagher and Varela 2003); (2) show disturbed timing (Tysk 1984); (3) experience psychopathological phenomena that could be the cause of changes in temporality and spatiality. These topics will be discussed in the case of mood disorders, in particular euphoric and dysphoric mania episodes. Any phenomenological study in mood disorders (...) is delicate as affective disorders are in themselves phenomenologically diverse, because they have obscure meaning, multitude of criteria and inconsistent reference norms. Also, psychoanalytical, colloquial and cognitive psychologies keep instilling comprehensive and epistemological structures onto both mood and time/space notions. Nevertheless, bridging philosophical phenomenology and epistemology on time and temporality with mood psychopathology and taxonomy constitutes an on-going project. Theories by Heidegger, Husserl and Merleau-Ponty as well as by Minkowsky, Binswanger, Fuchs, Parnas, and Sass could help to describe this relation deepened into many other Twentieth-Century philosophical papers. A similar account of space and spatiality will be brought about. We will reason about the concept that they provide evidence to address current conceptualization of “bipolar” disorder and the hierarchical grouping of dysphoric and euphoria mania. (shrink)

Mood in humans is a complex phenomenon that integrates emotion , cognition, perception, ideation, and action in a coherent manner. In bipolar disorder extremes of mood occur outside the normal range, in which all the above functions are coherently affected. Mood is controlled by a series of separate but interactive brain circuits that involve much of the brain, but particularly the limbic system. The question addressed in this paper is whether the coordination of all these separate systems into one coherent (...) functional mood is mediated by non-linear dynamics acting between these systems as equal participants; or whether it is affected by a single master regulator controlling the others. The possible roles, as master regulators, of non-linear dynamically linked populations of neurons, and of the C1–C3 adrenergic nuclei in the medulla is discussed. (shrink)

The determinative issue in applying the insanity defense is whether the defendant experienced a legally relevant functional impairment at the time of the offense. Categorical exclusion of personality disorders from the definition of mental disease is clinically and morally arbitrary because it may lead to unfair conviction of a defendant with a personality disorder who actually experienced severe, legally relevant impairments at the time of the crime. There is no need to consider such a drastic approach in most states and (...) in the federal courts, where the sole test of insanity is whether the defendant was “unable to appreciate the wrongfulness of his conduct at the time of the offense.” This is because the only symptoms that are legally relevant in such jurisdictions are those that impair reality-testing and thereby affect the person's capacity to understand the nature and consequences of her actions. However, if the test of insanity includes a “volitional prong” (inability to control one's behavior), some way must be found to limit the scope of the defense to the core cases (involving psychotic conditions) to which it has traditionally been applied, and to prevent a shift toward a deterministic account of criminal conduct — i.e., “people can't help being who they are and doing what they do.” The best way of accomplishing this is to limit the definition of mental disease to severe disorders characterized by gross disturbances of the person's capacity to understand reality. (shrink)

Two lecture styles were examined to determine which was more effective for enhancing content learning in college students. The same experienced guest lecturer presented information about bipolar disorder to college students in human service-related fields. Students in classes assigned to the control group received a standard, didactic lecture. In classes assigned to the experimental group, the presenter began the lecture by informing the students that she had bipolar disorder and enhanced the standard didactic lecture by interspersing descriptions of her personal (...) experiences living with bipolar disorder. Content-specific pre-tests and post-tests developed by the researchers were used to compare acquisition of knowledge about the disorder across groups of students. Results showed that students who received the personal/experiential lecture acquired significantly more knowledge about bipolar disorder than did students who received the standard, didactic lecture. Theories and procedures that may enhance student learning and thinking in related areas are discussed. (shrink)

The essay aims to analyse the gradual historical process of the partial overlap, replacement and expansion of the theoretical paradigm of depression with respect to that of melancholy. The first part is devoted to analysing some of the central features of the multivalent thematizations of melancholy drawn up during modernity, also with relation to the spirit of capitalism (in its Weberian acceptation). This is followed by an overview of the birth of the modern category of depression, and the process that (...) during the twentieth century led to its transformation into a theoretical and nosological paradigm which in the end replaced that of melancholy. The second part is the attempt to draw up a Zeitdiagnose: the aim is to assess the ‘depressive’ psychosocial impact exercised by particular socio-economic mechanisms and cultural trends, with particular reference to what has been defined as the ‘new spirit of capitalism’, as well as the new forms of individualism and their paradoxical dynamics. In conclusion, I will form a bridge between the history of the two aforesaid paradigms and the contemporary psychosocial dynamics correlated to the phenomenon today interpreted as a ‘depression epidemic’. Der Aufsatz zielt darauf, der Prozess der historischen Überlagerung, Substitution und Verbreitung des theoretischen Paradigmas der Depression gegenüber jenem der Melancholie darzustellen. Im ersten Teil wird versucht, einige der einschneidenden Eigenschaften der Thematisierungen der Melancholie in der Frühen Neuzeit anzugeben, auch im Verhältnis zum Geist des Kapitalismus. Nachdem eine Skizze der Entstehung der moderne Kategorie der Depression, geht es darum, den Verlauf nachzuzeichnen, der im 20. Jahrhundert zu ihrer Transformation in ein weitläufiges theoretisches Paradigma geführt hat, das schließlich jenes der Melancholie ersetzt hat. Der zweite Teil stellt den Versuch dar, eine Zeitdiagnose umzureißen: An dieser Stelle ist die psychosoziale Bedeutung bestimmter sozioökonomischer und kultureller Mechanismen zu untersuchen, unter besonderem Hinweis auf das, was als »der neue Geist des Kapitalismus« bezeichnet worden ist, sowie auf neue Formen des Individualismus und ihre paradoxen Dynamiken. Abschließend wird eine Brücke geschlagen, zwischen der Geschichte der beiden bezeichneten Paradigmen und der zeitgenössischen psychosozialen Dynamiken, die mit dem als »depressive Epidemie« interpretierten Phänomen verbunden sind. (shrink)

The essay aims to analyse the gradual historical process of the partial overlap, replacement and expansion of the theoretical paradigm of depression with respect to that of melancholy. The first part is devoted to analysing some of the central features of the multivalent thematizations of melancholy drawn up during modernity, also with relation to the spirit of capitalism (in its Weberian acceptation). This is followed by an overview of the birth of the modern category of depression, and the process that (...) during the twentieth century led to its transformation into a theoretical and nosological paradigm which in the end replaced that of melancholy. The second part is the attempt to draw up a Zeitdiagnose: the aim is to assess the ‘depressive’ psychosocial impact exercised by particular socio-economic mechanisms and cultural trends, with particular reference to what has been defined as the ‘new spirit of capitalism’, as well as the new forms of individualism and their paradoxical dynamics. In conclusion, I will form a bridge between the history of the two aforesaid paradigms and the contemporary psychosocial dynamics correlated to the phenomenon today interpreted as a ‘depression epidemic’. Il saggio mira ad analizzare il graduale processo storico di parziale sovrapposizione, sostituzione ed ampliamento del paradigma teoretico della depressione rispetto a quello della melanconia. La prima parte è dedicata ad analizzare alcuni dei tratti nevralgici delle polivalenti tematizzazioni della malinconia avvenuti nel corso della modernità, anche in relazione allo spirito del capitalismo (nella sua accezione weberiana). Segue una panoramica sulla nascita della categoria moderna di depressione, e del processo che nel corso del XX secolo l’ha condotta alla sua trasformazione in un paradigma teoretico e nosologico che ha infine sostituito quello della melanconia. La seconda parte rappresenta il tentativo di elaborare una Zeitdiagnose: l’obiettivo è valutare l’impatto psicosociale di natura ‘depressiva’ esercitato da particolari meccanismi socioeconomici e tendenze culturali, con particolare riferimento a ciò che è stato definito il «nuovo spirito del capitalismo», nonché alle nuove forme dell’individualismo e alle loro dinamiche paradossali. In conclusione viene gettato un ponte tra la storia dei due suddetti paradigmi e le dinamiche psicosociali contemporanee correlate al fenomeno oggi interpretato quale «epidemia depressiva». (shrink)

Classifying Madness (Springer, 2005) concerns philosophical problems with the Diagnostic and Statistical Manual of Mental Disorders, more commonly known as the D.S.M. The D.S.M. is published by the American Psychiatric Association and aims to list and describe all mental disorders. The first half of Classifying Madness asks whether the project of constructing a classification of mental disorders that reflects natural distinctions makes sense. Chapters examine the nature of mental illness, and also consider whether mental disorders fall into natural kinds. The (...) second half of the book addresses epistemic worries. Even supposing a natural classification system to be possible in principle, there may be reasons to be suspicious of the categories included in the D.S.M. I examine the extent to which the D.S.M. depends on psychiatric theory, and look at how it has been shaped by social and financial factors. I aim to be critical of the D.S.M. without being antagonistic towards it. Ultimately, however, I am forced to conclude that although the D.S.M. is of immense practical importance, it is unlikely to come to reflect the natural structure of mental disorders. (shrink)

The diagnosis of bipolar disorder has been linked to giftedness of various sorts and this raises a special problem in that it is likely that the condition has a genetic basis. Therefore it seems possible that in the near future we will be able to detect and eliminate the gene predisposing to the disorder. This may mean, however, that, as a society, we lose the associated gifts. We might then face a difficult decision either way in that it is unclear (...) that we are preventing an unalloyed bad when we diagnose and eliminate bipolar disorder through prenatal genetic testing and yet if we allow the individual to be born we are condemning that person to being an unwitting sacrifice in that they might well suffer considerable net distress as a result of our need to keep our gene pool enriched in the relevant way. (shrink)

In order to avoid reluctance on the part of subjects to discuss mental illness, this paper argues that a study of traits rather than symptoms or syndromes is not only less charged, but also more satisfactory for the scientific study of the relevant semiology. The relation of traits to the classification and etiology of bipolar illness is discussed in four vignettes, each from a distinct vantage. Two study methodologies are proposed that would confirm and expand upon that which anecdotal evidence (...) already suggests, namely, that the role of stress remains grossly under-appreciated and that the bipolar "personality" is pretty much the DSM equivalent of the common cold, a possibility requiring intensified research. (shrink)