The argument of Bipolar

Just a odd question to propose. My sister has in the past been diagnosed with Bipolar I. She has frequent mixed episodes and bouts of psychosis. However, this last stint she has began working with a new psychiatrist, who oddly enough, does not believe in bipolar disorder. She even asked to clarify " Are you saying you don't think I have bipolar, or that you don't believe bipolar disorder exists?" and he confirmed he meant the latter.


I won't pretend I've looked into it much, but it seems rather odd to dismiss bipolar. I wonder what his reasoning/rationale is, or if he just feels it's better lumped into a subset of another illness. Have you ever ran across a mental health provider who did not believe in your diagnosis? Just curious.

My sister takes an antidepressant, an antipsychotic and a benzo. It seems to at least help her some. So, I won't question his expertise, but I do wonder.

I have encountered some mental health professionals with non-standard ideas. No one ever said they "didn't believe in bipolar disorder", but I did go to a psychologist once who said he didn't believe in personality disorders. I don't have a personality disorder, but I think it unfair to those who do that they wouldn't have their challenge recognized by him.

If your sister's doctor treats her with appropriate psychotropic medications, then I guess it doesn't matter what he does or doesn't believe in. However, I would personally steer clear of the guy or at least ask him what the heck "HE" thinks is going on, if he doesn't believe in the illness. If he said something slightly reasonable, one could just agree to disagree. If he said something far out in left field, it would be good to know.

I wonder if he "believes in" schizophrenia or even anxiety.

Great points. I guess my hang up would be exactly that -- what exactly does he think his contribution to his profession is? If he rejects the consensus of the whole or their ability to treat... what is he doing?

I think you said it best though, Soupe. If he's adequately treating the issue it doesn't really matter what he believes, but it does leave a lot of questions on my end as to what actually he thinks/feels is the issue.

I've met doctors (not psychiatrists) who don't believe in long-term use of any medicine for psychiatric issues. I had a doctor once tell me "Look, you say your issues have existed almost your whole life. Change your life, not medications. What you need is to get a therapist and find ways to manage instead of meds." -- it was through discussion he explained that rationale. I found it brutally hurtful because I was suffering, and always had, and was left to feel it's my fault and I'm wasting time looking for help (and to be clear -- no controlled substances were part of this interaction). We all know cognitive/behavioral changes can help with mental illness. We also know there is benefit to things outside of medicine... but the doctor discredited medicine as being viable at all for me. So, I can relate personally to the rejection of the challenges a mental illness can hold.

I wonder if bipolar doesn't exist why he's medicating her with meds used for "bipolar." I've never encountered a pdoc/pnurse that didn't "believe in" bipolar or schizoaffective d/o, the closest to it was my pdoc at the time writing "schizophrenia" as my diagnosis when scheduling because the receptionists didn't know what schizoaffective was or didn't have it in the system, or something along those lines.

I would steer clear of that dr. Most of my dx have been mood disorder nos until my newest team and the right dx has lead to the right meds and I'm the most stable that I've ever been.

I think you can take any mental illness and you’ll find a professional who doesn’t believe in it if you look long enough. I don’t have bipolar myself but I’d steer clear of him. Other members of my family have been diagnosed with it by different doctors, and they both had similar symptoms… doesn’t something like that count for anything?

Luckily for me, he isn't my psychiatrist! I hope that telehealth continues to be a prominent thing because it's very convenient for a small-town person like I am, and availability and diversity of provider. It's slim pickings in a small town after all. I don't forsee an event where I have to see this particular doctor, but I was curious everyone's thoughts!

I agree with all of you, if his view on the particular disorder is that isn't real -- best to steer clear, but like sapien said, perhaps its more nuanced than that. I proposed perhaps he sees part of another collective. For example -- there are people who subscribe to the idea mood disorders are all on the same spectrum, and we may fall anywhere. Most practitioners I know will isolate bipolar disorder and distinct, maybe he doesn't? In the end, he is treating her symptoms. Depression with an antidepressant. Anxiety with a benzo, psychosis with an antipsychotic. Everything is a means to an end anyway. You target a diagnosis to better isolate medicines to help with specific symptoms. He's essentially doing the latter without he former it seems. I don't want to discredit a guy whose has dedicated his time to the profession because of my lack of knowing his rationale. But again, for my own sake of mind, I'd probably steer clear of him too.

That's rather bizarre. As far as I know bipolar (aka manic depression) is one of the oldest and most well-established diagnoses. I'd be curious to know more about why he feels this way. As others have said, I'd steer clear of him, too. Just because it makes me wonder what other weird ideas he has that will affect my treatment.

I've never encountered a psychiatrist who "doesn't believe" in bipolar, but I have of course encountered other people. Even my wife doesn't really want to believe in the genetic component, that it's a real illness. She tends to dismiss that it's a "real" illness and acknowledge only the environmental factors. If I get depressed and start to have negative thoughts, she'll view it as the negative thoughts being the cause of the depression, even though I can feel the depression starting before the thoughts.

I think it's because she doesn't want to believe it's "incurable." But it feels very invalidating to me, especially when I'm in a depression and she tells me things like I have to smile because that's supposed to provoke some sort of reaction that will make me feel better. It makes me kind of just stop talking about it because I don't want to have that argument again. It feels like you have to face all the decisions about meds and so on by yourself. I think if my psychiatrist held such opinions, it would feel similar to me. Unsupportive, and like it's my own fault somehow.

I had a therapist once who said you should imitate a smile- a "half smile" she called it. She said just doing that would signal the brain into feeling happier.

Yeah, I believe there's some research that found that result. I do believe smiling could have an effect on mood, it's just that those sorts of effects are like a drop in the ocean when it comes to depression. It's like exercise, mindfulness, and so on. Sure, it may help to some extent, but it's not going to cure depression. It's like putting a band-aid on a broken leg.

Yes. I agree. A band-aid on a broken leg!