The Bipolar Spectrum: Diagnosis or Fad?

The Bipolar Spectrum: Diagnosis or Fad?

The Bipolar Spectrum: Diagnosis or Fad?

The Bipolar Spectrum: Diagnosis or Fad?


In the 1970s, author Joel Paris was one of the first doctors in his hospital to prescribe lithium to a psychiatric patient. In the wake of the drug's success, both in that case and countless others, why this book? As Dr. Paris' historical examination of bipolar diagnosis and critique of the spectrum demonstrates, medicine has often been prone to fads that are assumed correct until proven wrong by science. This book opens discussion about the overdiagnosis of bipolar disorder and the negative impact of this development on clinical care. Dr. Paris explores why patients are being classified as bipolar on dubious grounds and are being prescribed drugs they do not need. He explains the differences between bipolar disorder and depression without mania, personality disorders characterized by unstable mood, and impulsive disorders. A separate chapter discusses the unique issues present in the field of child psychiatry. Fads remain popular as long as they answer elusive and complex questions. Unfortunately, the bipolar spectrum being used to explain a wide variety of psychopathological phenomena has caused classic bipolar disorder to become almost lost in the shuffle. Combining research findings and personal experiences, Dr. Paris documents the damage of overdiagnosis and explores alternative treatments patients could benefit from.


This book tells a troubling and tragic story. Bipolar disorder is a debilitating illness that affects millions. Psychiatrists have made great progress in managing this illness, and will probably do even better as research advances. But clinicians are now being encouraged to participate in a radical expansion of the traditional concept of bipolarity.

One might think that practitioners have enough trouble managing patients who suffer from manic or hypomanic episodes without diverting their attention to a wider “spectrum” of diagnoses. Bipolar patients have a high relapse rate, and finding a drug or drug combination that can stabilize them is often a matter of trial and error.

It’s crucial to remember that the bipolar spectrum is an unproven concept. The alchemy that turns depression, impulsive disorders, childhood behavioral disorders, and personality disorders into bipolarity depends entirely on superficial resemblances between observable symptom patterns. It is not based on any basic understanding of a disease process.

Moreover, while there are evidence-based therapies for classic bipolar disorder, there is no evidence that conditions in the “bipolar spectrum” respond to the same kind of treatment. Yet once patients are seen as having bipolar disorder, it is almost guaranteed that they will receive drugs usually prescribed to those who have either mania or hypomania—and stay on these drugs for years to come, whether they benefit from them or not. Moreover, once patients are slotted into the bipolar category, they will not receive alternative diagnoses that could lead to other and more effective forms of treatment.

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