The difference between Bipolar and Mental Disorder

Mental Disorder redefined

Mental disorder? If you look closely at the classification of mental disorders published by the American Psychiatric Association (APA) in its Diagnostic and Statisitical Manual version IV (DSM-IV) the majority of 'disorders' listed are actually behavioural and not solely mental. How is 'mental disorder' to be defined? When does 'feeling a bit down' become depression? When does being excited or elated become 'manic'.

Formerly known as manic-depression, bipolar affective disorder is characterised by wide mood swings from excitability and insomnia to depression. Both extremes vary in both intensity and length.

According to DSM-IV there are several types of bipolar disorder each with differing diagnostic criteria: for example Bipolar Type I is characterised by 'the occurrence of one or more Manic Episodes or Mixed Episodes. Often individuals have also had one or more Major Depressive Episodes'. (DSM-IV Categories 296.0x - 296.89)

Who hasn't experienced either manic or depressive symptoms at some time? Does this mean it is a mental disorder or is it sometimes just a normal reaction to events and situations, whether the cause is known or unknown, obvious or hidden?

The difference between bipolar disorder and mental illness according to the criteria classified by the APA and generally accepted by traditional mental health professionals is simply that there is a huge range of mental disorders and bipolar is just one of the many.

Alternatively, it could be argued that bipolar disorder is not a discrete disorder, if it is a disorder at all; it is notoriously difficult to diagnose and mental health professionals frequently disagree on uniform diagnosis and treatment which ranges from medication to psychotherapy and even, in extreme cases, surgical intervention.

Ultimately, how one defines mental disorder is an open question and psychiatrists are not infallible. Diagnoses are not diseases (Mindham, Scadding and Cawley, 1992) and perhaps we should throw the DSM out of the window and examine precisely what we really mean by the terms 'mental' and 'disorder'. More importantly, instead of trying to neatly classify and pigeonhole a patient into a particular category of disorder, we should look more closely at the individual and their presenting symptoms in a wider personal and social context. It may be that the individual is less sick than an irrational society that seeks to label what in many contexts could be defined as perfectly rational behaviour.


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