the spectrum of diseases know as schzophrenia, schizoaffective and
bipolar disorder. Some of the dissociative disorders would also end up
in there. I'm not sure about schizotypal personality disorder though. In
practice it would I think though theoreticall, according to Kraeplin's
justification of the use of the paradgim of illness to describe these
disorders, it wouldn't.
Kraeplin lumped the two syndromes of schizophrenia and bipolar together
if I remember right but later on thought they should be separated. The
current genetic evdence which will probably be disproved in a decade
points to his original assumption being correct. The biomedical
interpretation of genetic predispoistion is one of the strongest
arguments that these disorders are illnesses. I take a very different
view and one taken by homosexuality campaigners: genetic predisposition
in mental health will eventually identify types of people (a sort of
canvas upon which life paints the phenotype that is judged as a
disorder) but this types have the right to exist and are not illnesses.
The argument for the separation of the two disorders is pretty complex.
In a pure sense the medication used shows they're different. The
outcomes - and this is the other part of the illness concept - are
different. Schizophrenia has much worse occupational and social outcomes
(and significantly worse in the UK) compared to bipolar.
The only evidence I have for the existence of schizoaffective as a
distinct illness is a review by Tsuang (if I remember right) which
showed schizoaffective to have inbetween outcomes and distinctly so in
comparison to schizophrenia and bipolar patients. The course of life was
in genral worse than bipolar but better than schizophrenia. The
diagnosis itself is very difficult to give in practice. Many people
still believe the disorder doesn't exist. The cluster of symptoms
doesn't look the same as someone might expect was inbetween bipolar and
schizophrenia but it is only with this precision that the diagnosis can
be made. It's distinct disease entity according to the outcomes. I
couldn't find much research into the brain disease part or much research
at all when I looked into it a while back. The reason it was considered
something they wanted to remove from DSM in the latest revisions is
because practicing doctors couldn't accurately diagnose it: they'd end
up giving in correct diagnoses to bipolar or schizophrenic patients.
The disorder has two types: bipolar type and depressive type. I was
given the former as my second diagnosis but I've always identiied with
bipolar as my problem. It was a manic episode that got me hospitalised
and a depressive one that hospitalised me again. The third
hospitalisation was a suicide tempt based on psychosis and mania. I've
learned to manage and control the pyschosis and the paranoia comes and
goes. It's the mood that's by biggest problem and has the largest impact
on my life. Even when I went through the worst psychosis I'd ever had I
was capable of working though my social function reduced drastically.
The period of psychosis and the intensity could have been enough to get
me a diagnosis of schizophrenia I think had I gone and seen a doctor.
But I'm not sure I expereince the other 'cardinal' symptoms that have
come to define schizophrenia other than the experience of unshared
perceptions. I did smash up my photography equipment in a paranoid rage
and quit photography. That's just totally mental, i.e. the public would
diagnose me as mad because of it.
These unshared perceptions - by which I mean hearing voices and all the
other 'delusional' experiences - happen in bipolar patients too. There's
also a non-pathological state called schizotypy where people experience
the delusions either at a mild level or at a higher level but cope
better. (actually, I'm not too sure about the "a higher level but cope
better" is observed in the concept of schizotypy but in practice it a
person of that type would be 'diagnosed' (it's non-pathological) as with
schizoptypy too.)
I've always associated myself with bipolar. Even when they gave me a
diagnosis of schizoaffective I didn't believe them. When they gave me a
diagnosis of dual diagnosis I didn't believe them. When they gave me a
diagnosis of mixed affective disorder I didn't know what it was and it
wasn't explained to me. I identify most with the bipolar aspect of my
being. I have intense high periods of mypomania which have stepped up to
hypermania. I've had depression so intense the blackness sucked in the
light. I've experienced unusual states of consciousness, some drug
induced and some not.
I currently have no label. I'm sure I could get one if I wanted. But
perhaps I didn't get one the last time I saw a psychiatrist because I'm
now 'normal' or was recovered enough then to be considered without need
of medical care. Is that the definition of recovery? And is a recovered
person still labelled with their old diagnosis? Fuck knows. Fuck cares.
I'm going to get drunk now.
The difference in the stigma is significant. People are ok saying they
have bipolar in public. People with schizophrenia aren't. The public
don't know what schizoaffective is but it has the schizo- bit.
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