The nosological idea of Bipolar Disorder (whether I or II) defines it in terms of episodes, interspersed with periods of relatively normal functioning. Most mood disorders are similarly explained in terms of their episodic nature, as compared to schizophrenia, which is a more "continuous" diagnosis. Sure, there are active phase episodes in Schizophrenia, but it is not termed to be an "episodic" condition. There is also the notion of Unipolar Mania (where the person has recurrent manic or mixed episodes without depressive spells) which muddles the question further. i'm not sure whether etiologically we should (or can) assume greater similarity with one diagnosis than the other, since newer research reveals contradicting findings. However, the episodic nature of the diagnosis places it in "Mood Disorders", while frequent psychotic breakdowns would place it in the "Schizoaffective/Schizophrenia" category. Don't know whether I just rambled there, but hope it helps :)

The classification of mental disorder, as we know it, cannot really be extricated from its historical roots - bipolar disorder (formerly manic depression) is one part of Kraepelin's dichotomy of the psychoses, schizophrenia (formerly dementia praecox) the other. There are a number of challenges to this categorical view of the psychoses e.g. Comorbidities, secondary illnesses (e.g. The neuroses), psychotic depression, schizoaffective disorder, that suggest current categorisations should be phased out in favour of models based on continua of variation regarding symptoms. Researchers are also moving towards models of mental disorder with different histories e.g. Neurological ones based on complex connectivities and hierarchical views of the mind-brain such as those espoused by Hughlings Jackson. Within such models, psychosis may be more a marker of severity, and/or of recent evolutionary origin, rather than a category that is separable and distinct from other categories. Clinicians are, by necessity, more conservative about moving away from psychiatry's foundations.

In my view, it is best to avoid excessive reification in all things psychiatry - that way, you can bypass many of the time-consuming arguments that lead to nowhere.

True... instead focus on organic causes such as nutritional deficiency, hidden inflammation, food allergies, parasites, heavy metals and all the stressors people have to contend with. Also the social issues of bullying, inferiority complexes, poverty, abuse etc plus the effects of poor self medication using alcohol, drugs, caffeine, nicotine, over work, sexual addictions etc.

AND all the cases where mild distress has been ramped up to full psychosis via over medication, especially antidepressants in young people. This is where organizations like ISPS and the British psychology organization have created some fantastic work. See David Healy, John Read, Richard Bentall, Robert Whitaker and many more researchers work.

No one so far has mentioned genetics, which is how the problem will eventually be resolved. In the meantime before all the genes can be identified, there are a number of behaviour genetic studies which show surprisingly strong genetic correlations between various psychiatric disorders often thought to be clinically distinct. Also, it is more useful to relate disorders to fundamental underlying internalising and externalising dimensions, rather than to other individual disorders.

Genetic studies are unlikely to explain the psychoses, and certainly not in isolation - GWAS have shown that there is a strong genetic component but it is comprised of 'multiple genes of small effect'. Other hypotheses are being followed but that area is far from making any big discovery that can account for these conditions.

http://ajp.psychiatryonline.org/article.aspx?articleID=106785

What has been discovered is an added layer of complexity regarding the overlap between various conditions (not that this hasn't been suspected before) and has opened new areas for exploration.

http://bjp.rcpsych.org/content/196/2/92

The most promising approaches, in my view, are: developmental imaging and electrophysiology combined with behavioural paradigms that examine salience and the workings of inner speech, determining what 'noise' is created by 'secondary illnesses'/ other continua of variation and how these relate to psychosis; any approach that can parse the negative symptoms and make those more understandable and the strong signals coming from the development/child trauma and epidemiology literature.

Heather - I understand your irritation. I myself have been frustrated in the past where gaps in the literature exist because of lack of funding, particularly where a treatment is as good as free e.g. How Lithium works and behaves, comparatively speaking. Academia is not fully rational and great ideas get lost for years because they cannot attract funding at any given time (and scientists lose their labs and jobs, and the world loses expertise, as a result). However, academics must follow the patterns and signals present in the scientific literature, otherwise we might succumb to patternicity, delusion and/or spend our lives studying things that apply to single cases in the belief that this will tell us something about the many (an approach that can lead to insight but which the majority of sufferers may baulk at). I would not judge the funding given to study toxoplasma gondaii a path that was ratified or encouraged but epidemiology found a signal and the area is receiving funding. Child trauma research has received new interest because bullying and abuse have, through very careful study, been found to precede the onset of psychotic symptoms in adolescents and young people and symptoms improve when the abuse is removed. Child trauma obviously has a very long history in psychology/psychiatry but to refer to its study as safe or cliched, even in a broadstroke way, is not to understand the shift that has occurred in psychiatric research and practice in recent times. Finally, the methods and paradigms mention are those that emphasise that which may be unique to psychosis from a phenomenogical perpective AND lends themselves to study at present - we need methodologically rigorous experimental paradigms to proceed.

"The public and social treatment of Linus Pauling, with his 3 Nobel Prises is a prime example of what happens when you fall foul of the media machine and its buddies in big business"

Pauling actually fell foul of the referees and editors of the top medical journals. If Vitamin C prevented colds, why would anyone not want to publish this?

See Wikipedia:

" In a 2013 article in The Atlantic, Paul Offit wrote that although Pauling was "so spectacularly right" that he won two Nobel Prizes, Pauling's late-career assertions about the benefits of dietary supplements were "so spectacularly wrong that he was arguably the world's greatest quack."

"As many as ... 70% of schizophrenics .. may have pyroluria underlying these conditions. But pyroluria isn’t limited to these populations. As much as 10% of the population may have this metabolic condition and not know it"

Assuming these figures are correct (which I very much doubt in the absence of up-to-date references), consider 1000 patients in a GP practice. About 10 would be schizophrenic, 7 with pyroluria. Of the 990 others, 99 have pyroluria. So only 7% of those with pyroluria would be schizophrenic. So not only would it be a waste of time and money for the GP to send people off for a pyroluria test for schizophrenia, it would be seriously misleading.

I believe bipolar disorder to be intermediate, or linking depressive disorders to psychotic disorders as well as linking mania to psychotic disorders.  I don't believe that bipolar disorder is closer to a depressive disorder or closer to a psychotic disorder, but bridges the gap between the two types of states.  Not only that but links mania to psychosis.  Persons experiencing bipolar disorder run the gamut from the depths of despair to the heights of mania, commonly leading to diverse types of hallucinations or delusional beliefs (e.g. grandiosity, delusions of persecution) and thus psychotic ideation.

What if the stress is the disorder not the behaviour that follows. In the past people lived in villages and survival was a shared consern. You grew up with or knew of  the person you married. Your basic living expenses were affordable, now your weekly groceries cost the same as an expensive pair of boots. Our culture is riddled with no hope disaster movies, doom and gloom in the media and crippling debt. When do environmental stressors, aprart from bullying, get looked at?  

When a living organism, large or small, is under dire stress it can go in one of two ways... shut down, sulk, sleep, lose appitite and in the case of many sick animals slink off into the night to die alone. Or it can become agressive, overerly assertive, lashing out, distressed and uncaring of consquence. What makes humans any different? We are not seperate from our environment nor disordered when in a state of overwhelm. This is where Open Dialogue is humanistic because it takes the disorder out of the person and looks at the bigger picture. It includes all those who are affected, the sufferer as well, and listens to all equally in the solution finding process. 

If you want a good review of the literature over the past 27 years (1980 to 2007) Look at "Manic-Depressive Illness: Bipolar disorders and Recurrent Depression" second edition by Frederick K. Goodwin and Kay Redfield Jamison.  I know that this topic is covered as well as every imaginable aspect of the headings stated in the title of the textbook.

Have a look at the other side of the argument for a counter argument... Authors to look at are Breggin, Bentall, Whitaker and many more. My most recent reading is Paris Williams Rethinking Madness 2012. Hundreds of studies show that there is no illness, apart from damage from extended use of medication. Spiritual emergence/emergency as a survival solution to counter untenable living situations and existential crisis, a breaking of social conditioning and a reordering through the process of chaos rings true for me. 

This is certainly what I experienced and although my episode on medication was aprox 5 years in total my actual time of being psychotic amounted to a mere 6 weeks of my 53 years. And only a two weeks could be described as negative, the other four were euphoric. I tried to make the DSM make sense during my degree in health science but nothing ever rang true. According to the DSM I had a life long 'disease' and would have little chance of recovery. Yet I resolved issues by amalgam removal, failed root canal removal and nutrition supplements to counter Pyroloria and I am fully recovered. 

As Paris found recovery rates are closer to 80% especially when medication was used to a minimum and most survivors say that they feel more whole and grounded after the experience. Unfortunately adverse mental health experiences are so often judged by those who care for those who stay in the system (aprox 20%) and are seen most by the mental health profession. Marketing through media certainly does not amount to science and the science itself does not stack up in the favor of the medical model. 

"my actual time of being psychotic amounted to a mere 6 weeks of my 53 years. And only a two weeks could be described as negative, the other four were euphoric. . According to the DSM I had a life long 'disease' and would have little chance of recovery."

Where does it say this?   DSM-5 says "Many individuals with bipolar disorder return to a fully functional level between episodes.."   This is an important point which makes it impossible to determine if recovery from a single episode is due to treatment or to natural fluctuation.

Heather, what do you mean by fully recovered?  It seems to me that in earlier posts under different but related questions you stated that you work part time and keep stress to a minimum.  That does not sound like you have completely resolved these issues through the above quoted claims, nor does it sound as though you are necessarily completely recovered if I am remembering earlier posts correctly. A large portion of the population not having bipolar disorder can work at least 40 hour weeks and remain mentally stable without keeping a close account of the stress that they allow themselves to be exposed to under surveillance.  Could you please clarify?  Thanks.  Sometimes it can take many years to have a relapse with this illness once it appears to be under control.  Our body chemistry over life changes and with these changes bipolar illness may also resurface even apparently when one is "fully recovered".  Also there may be numerous illnesses of different etiology that all look like "classic" manic depression.  I know for example that some folks have a seasonal affective component linked to the episodes that are experienced.  If that is true in your case, it has never been mentioned.  Are you sure that your psychotic experiences were due to true bipolar illness or true schizophrenia?  When one begins to tease out details of complex phenomena the superficial markers that cause a more general set of symptoms to appear to be the same illness start to disappear.

Hi Margaret, there is no such thing as true bipolar or true schizophrenia, both are clusters of symptoms during times of high stress and non coping. There is no illness as there are no biological markers apart from behaviour, there is no disease as there is no pathogens, viruses or bacteria's, there is no evidence of brain disease and chemical imbalance is simply a marketing slogan which has become urban myth... See the research and writings of the authors I mentioned.

Psychotic is psychotic, it is the end of the continuum of ill health before coma and death (including fever/delirium) or it is the other end of the continuum (drug induced or spiritual emergence or altered states of consciousness). I was at the high end, fully psychotic 7 times and I have never taken recreational drugs. It has many causes and pathways. We simply name patterns of its appearance by different names and these even change from country to country. Names were created for medical uniformity and insurance claims, not because we know something about them from anything by an observational perspective.  

Yes season comes into play as a stressor, there is much new evidence that low Vit D is highly implicated (see Natural News articles this week - they cite sources) . For people with Pyroluria anything that diminishes zinc like infection, mercury, copper and stress can promote positive expression of mental health issues. This is a condition not a disease, and its genetic. Recovered for me means living with management so that symptoms do not appear and the normal roller coaster of life resumes. A few supplements, low alcohol intake and good nutrition is hardly stringent management. Some might think I am weird for avoiding fluoridated water and flu vaccines but that's my choice.    

Sorry Anthony I dont know the DSM-5 well so shouldnt make statements about its claims about recovery. I was referring to the general perception and subtle messages we are given. If by treatment you mean medical suppression all that buys you is time. If by treatment you mean addressing causal factors then yes recovery is possible for 80 to 90% of people. Natural fluctuation could only really refer to season change. Other factors are human fluctuations... such as changing emotional stress, different relationships, healing of infection, avoiding environmental stress, addressing past trauma, maturing, giving up smoking, drinking, gambling, recreational drugs, better diets, more exercise etc.

Its interesting that if left 'untreated' by m/h drugs psychosis seems to sort itself out in aprox 40 days (Grof) with support and safety in place, and its funny how that number of days is important in the scriptures.... This seems to leave people in a better place than before the psychosis and results in radical personal growth (John Weir Perry). Recovery in some 3rd world countries well supparses 1st world as spiritual growth is honored. 

Recovery from the damage m/h drugs inflict, surviving withdrawal processes from the drugs, the treatment while unwell and stigma takes the longest to recover from. Where do we draw the line between unwell and well in this thing we call human? Who is the perfectly mentally well person we use as a bench mark? What if being psychotic is a human experience where by extreme states of being come into play to cope with extreme conditions that opens our 'Pandora's boxes' of unresolved emotions? (Arnold Mindell, Isabel Clarke, Rollo May, Irvin Yalom, Otto Rank, Ernest Becker). 

Ms. Howes:

"...there is no such thing as true bipolar or true schizophrenia, both are clusters of symptoms during times of high stress and non coping. There is no illness as there are no biological markers apart from behaviour, there is no disease as there is no pathogens, viruses or bacteria's, there is no evidence of brain disease and chemical imbalance is simply a marketing slogan which has become urban myth... See the research and writings of the authors I mentioned."

Mythos is constructed by those who are trying to understand the environment, circumstances, and events. There may be some mythos involved with the diagnosis of bipolar, but it has been seen as a pattern since Greek times or before.

Link: http://www.bphope.com/Item.aspx/162/through-the-ages-its-been-there

With that being said, I respectfully disagree with saying there are no biological markers. Circadian rhythm is affected, which is controlled by biological mechanisms. Sleep rhythms, glucose levels, and emotional responses to stress are affected. Granted, these are indeed observed by behavior.

Studies from UCCS have shown that there are biological markers.

Link: http://www.uccs.edu/biology/mood-disorders/bipolar-disorder.html

UCLA also reports different markers and genetic links: http://newsroom.ucla.edu/releases/coming-soon-249997

Psych education reports differences in brain sizes, white and grey matter saturation or deficiency, in comparison to normal samples, in emotional regulating areas of the brain. In the brain, we are realizing that size of certain parts does matter.

Link: http://www.psycheducation.org/BipolarMechanism/introduction.htm

Thus, to say that there are no biological markers is completely inaccurate.

We are still learning.

I agree that we need to take better care of ourselves with nutrition and limiting toxin intake. Yet, to say that the disorder does not exist on its own at all is to deny people's experiences and fights to limit people getting the help they need in times of stress.

My aim is to broaden the discussion away from the tired old medical paradigm that survivors can not relate to as in hindsight it simply will not fit no matter how hard it is pushed. I believe that it takes many straws to break the camels back and as a dynamic organism no one thing is isolated as it will affect the next biological system. Poor self medication for many is drinking and smoking which only adds to systemic stress. Mental health issues are syndromes called diseases and illnesses, this does not take the distress away. It may afford help to some but it can also anchor a person into hopelessness for the rest of their lives. 

Yes abnormalities in brain structure is a hypotheses which has been around since Kraepelin first suggested it. This was expanded in the 1970's with CT scanning... However more recent scanning have challenged this theory as many things cause volume change including alcoholism, childhood trauma, water retention, pregnancy, age and the biggest of all mental health drugs which can came hand in hand for many with loss of work and self reliance. 'The brains of the majority of individuals with schizophrenia are normal as far as researchers can tell at present' Lewine 1998. 'Many healthy people, with no history of m/h problems have ventricular enlargement and other abnormalities that are similar to those with sz' Siebert 1999. 

Psychologist Paris Williams is the author I am reading at the moment. He has explored the research less often touted by the mental health industry. Even for me he does not explore the areas I am researching. I believe there are biological markers..... Again here is the list I have found so far when it comes to causes of mental/emotional overwhelm leading to anomalous experiences. I have posted it many times yet there are not many who will add to it... please feel free to.

Childhood trauma, grief and loss, accident, abuse both physical and sexual, hormonal turmoil of adolescence, relationship distress, overwhelm, depression, loss of meaning, substance abuse, addictions, gambling, dramatic change, seasonal, childbirth, financial worries, over work or shift work, jet lag, loss of job/home/parents, illness, cancer, chronic pain, dental infection, natural disaster, war, post traumatic shock, hormone imbalance, menopause, loneliness, self neglect, dementia.

Even so called positive events such as dramatic life changes, infatuation, sudden large financial gain, spiritual emergence, sudden fame, near death experiences and too much sunshine can have a causal component to a change in mental health. Chronically low sunshine and Vit D being discussed recently.

Rabies, Toxoplasmosis (very common and caught from cat excrement), Lymes disease, Pyroluria, Porphyria, parasites, syphilis, heavy metal exposure (mercury, lead and others). Head injury, fetal alcohol syndrome, autisms, epilepsy and vaccine damage, high fever, dehydration, sleep deprivation, nutritional and mineral deficiency.

Side/direct effects from illegal stimulants, mental health and other medical drugs (an example is Tamiflu induced suicide in Japanese adolescents). Over 800 medical drugs list depression as a direct side effect. Withdrawal from any of these including ADD drugs and antidepressants. ADHD medication causes psychosis when taken by an adolescent whose physiology has reached adult, now its speed as it loses its dampening effect. 

Incorrect use of nicotine patches, post-operative psychosis, post natal distress, physical illness, toxic poisoning, direct food allergies, gastrointestinal infections, extreme physical and emotion stress and distress. Blood sugar imbalance, over or under thyroid function, faulty methylation and B vitamin deficiency, essential fats deficiencies, histamine excess, serotonin deficiency, adrenal imbalance, acetylcholine imbalance, bladder infection, metallothionein deficiency, extreme hyperthermia.

There is a wealth of genetic, neurobiologic, neuroanatomic (neuroimaging), sleep and circadian rhythms data suggesting the existence of manic depressive illness in the form of bipolar I, bipolar II, schizoaffective and recurrent depression disorders condensed from research findings up to the year 2007 in the voluminous writings, describing bipolar disorders and recurrent depressive disorder over recorded history, by Frederick Goodwin and Kay Redfield Jamison.  The condensed scientific studies are covered in over 290 pages (chapters 13 through 17) under the heading of pathophysiology in the massive work titled "Manic-Depressive Illness, Bipolar Disorders and Recurrent Depression" by the aforementioned authors.  This is the second edition.  I am certain that much progress has been made in the last six and one half years with the new information generated in each of these fields of research considering the explosions in techniques and advances in molecular biology, bioinformatics, neuroimaging and sleep studies executed by dedicated scientists and clinicians.

We clearly read different authors... I own Madness Explained, Psychosis and human nature by Richard P Bentall (Winner of the British Psychological Society Book Award 2004). In his research he has picked apart scientific research and concludes that we cannot define madness as an illness to be cured like any other. Its heavy reading but its important to put things into a humanistic context rather than a medical context as mental health/distress is an exaggeration of the mental foibles to which we are all vulnerable.

Personally I dont really care so what medical people call emotional distress as long as 'treatment' does not involve drugging to the point that a condition called tardive psychosis or super-sensitivity psychosis is created whereby the brain attempts to compensate for the effect of drugs thus creating a real imbalance and the very distressing 'revolving door of relapse and withdrawal' (The Chicago study and Chouinard)  conveniently called Bipolar? The NIMH Chicago study (1992 and still cont.) found the longer a person is on antipsychotics the worse their outcome. Short term use of up to 6 weeks seems to be beneficial... much like a plaster caste on a broken leg. 

Margaret, I just saw who you work for... Perhaps you should avoid the authors I suggested, reading independent work could cause you some distress. I am off for a tropical holiday scuba diving and enjoying my freedom of both body and mind. 

Heather,

To be honest I don't believe that all antipsychotics or any specific entity in a class of drugs are equal in their effectiveness or beneficial (all drugs have their side effects and they are specific to each individual: a drug is only useful if the benefits outweigh the risks of the product) just as I believe that it is distasteful to defend the virtues of such products that clearly have more risks than benefits for the majority of the population.  All substances can be poisons given the proper conditions.  Even too much water can cause dilutional hyponatremia that can lead to a potentially fatal disturbance in brain functions that results when the normal balance of electrolytes in the body is pushed outside safe limits by over-hydration  A fact of life, you must make decisions based on risks versus benefits because nothing is one hundred percent certain in any choice.  The politics of corporate America do not interest me so don't make assumptions based on my place of employment.  I am a scientist and have no stake in defending a harmful drug.  The decision of whether the benefit of a drug outweighs its risks is up to the FDA.  I do however trust the scientific leads that are obviously substantiating the idea that there is a biological basis in psychosis, manic depressive illness (i.e. bipolar I, bipolar II and recurrent depression), and schizophrenia.  There is also increased evidence of linkage to regions of prior overlap in linkage between bipolar disorder and schizophrenia. This overlap perhaps suggests commonality of  susceptibility genes involved in conferring bipolar I and schizophrenia.  I am not threatened by reading the authors that you have suggested if they offer any substantial scientific evidence for their claims.  At this time I have plenty of reading material that is of great interest to me and so I must delay your suggested reading material. One example that you have entreated:  I do take heed to your suggestion that vitamin D could be beneficial for seasonal affective disorder, however I would be careful in pursuing that avenue because vitamin D is a fat soluble vitamin and in excess could be toxic since it is stored for long periods of time in the body.  Some side effects of taking too much vitamin D include weakness, fatigue, sleepiness, headache, loss of appetite, dry mouth, metallic taste, nausea, vomiting, and others.  I hope that you enjoy your trip.

"There is no illness as there are no biological markers apart from behaviour, there is no disease as there is no pathogens, viruses or bacteria's, there is no evidence of brain disease and chemical imbalance is simply a marketing slogan which has become urban myth.."

The same applies to many other conditions, e.g.  depression, migraine, OCD, autism, ME/CFS, back pain, motion sickness, etc.

"Psychologist Paris Williams is the author I am reading at the moment."

Especially in this internet age,  people immerse themselves in a filter bubble, reading only books or articles consistent with their prior beliefs.  It is more useful in the long run to read literature that challenges one's beliefs.    

"the longer a person is on antipsychotics the worse their outcome."

This comment can be accessed via Google by any psychotic person.  So, before they stop taking their drugs and relapse, this statement needs strong backing up from authoritative up-to-date experts.   And surely, the longer a person is on antipsychotics the worse their illness or psychotic predisposition would have been in the first place.