“Bipolar disorder”, the DSM-5, and Dreams for a Post-Psychiatry World

Originally published at Mad in America, May 2013

If, a little over three years ago, you asked me who I was, my one and only answer would have been, “Bipolar.”  It was the word that defined me, that explained my emotions and behaviors, that gave me answers to the questions, Why am I so unhappy?  Why do I want to die every day?  Why is it so hard to get out of bed in the morning, to shower and brush my teeth and leave the house and interact with the world?  Why do I find it impossible to keep a job, a relationship, a responsibility?  Why do I never feel OK? 

The answer always was, “Because I have Bipolar disorder.”  “Treatment-resistant Bipolar disorder”, to be exact, and that was the reason why I continued to get worse, more hopeless and suicidal, more dysfunctional and dependent on my family and my “treatment”, less and less connected to the world.  I knew this to be true, because it’s what Psychiatry told me, and as a good patient, I believed what I was told, even as the drug dosages and pill bottles and DSM diagnoses increased.  For all the chaos and muddled pain and confusion in my world, I knew with perfect clarity that I was “Bipolar.”  It was the only thing I truly knew.  That diagnosis was my anchor in the stormy sea of my life, though it took me nearly thirteen years to realize that internalizing a “Bipolar” identity did nothing to clear up my skies.  These days, the further I get from my psychiatric indoctrination, the more I realize how limiting and damaging, how much of a self-fulfilling prophecy, being “Bipolar” truly was.

During my most formative teen-aged and twenty-something years, I looked to the DSM, and to the psychiatrists who “cared” for me, as my beacons in the darkness.  They promised me answers, they promised me resolution to my pain, they promised to help me understand myself.  They promised to take care of me, to give me medicine that would help me not want to die or hide away from the world anymore, to help me learn how to manage my “illness” and function in the world in a way I could “handle”, given the severity of my condition.  These were powerful promises, promises I desperately wanted to believe, and did believe, for a long time, even as I got progressively worse.

I’ve been reflecting a lot on that time in my life with all the recent news surrounding the National Institute of Mental Health (NIMH), the American Psychiatric Association (APA), the DSM-5, themedical model of “mental illness”, and the very legitimacy of Psychiatry itself.  The NIMH has announced it will no longer support the DSM-5 because it “lacks validity.”  They and the APA have also acknowledged that despite years of neuroscientific research searching for the biological causes of “mental illness”, they have nothing to report.  Zippo.  Nada.  [Side bar: While the content of these announcements is a big deal— essentially, the governmental and professional representatives of the entire psychiatric Industry have conceded that there is no current evidence supporting the claim that “mental illness” is a valid, medical entity at all— I believe the reasons for the announcements are very ominous and worrisome, as the NIMH is leading the United States down an even more reductionist, dehumanizing path of neuro-based Psychiatry.  This is a topic for another time, however.]

Had this news about the DSM and the entire medical model come out just over three years ago, when I was deep under the spell of Psychiatry, I have no doubt that I would have been faced with a profound identity crisis (one that I have, in fact, worked through these last two and a half years in a much slower way).  What would all of this have meant for me at a time when my day-to-day life consisted of driving to my Intensive Outpatient Treatment program for “Borderline personality disorder”, sitting in intensive psychotherapy for “Bipolar disorder” and “Substance Abuse disorder” two to three times a week, and taking five psychiatric drugs every morning and every night?  What would those thirteen years of “treatment” have been for?  Those countless hundreds of bottles of pills?  The hospitalizations?  How would I have explained all those years of intense emotional ups and downs, scary and painful acts of self-destruction, thoughts of suicide, inability to stay in relationships, and complete disconnect with the human race, if they weren’t in fact “symptoms” of “Bipolar disorder”?  What would my life have meant?  What could it have meant, if I was never “mentally ill” to begin with?

I wonder how many people this past week have asked themselves these same questions, faced with the incredibly painful and confusing realization that what they’ve been told by Psychiatry is, in fact, not true.  I’ve had some time to work through all of this and make sense of my Self and my life in a new way; it has been the scariest and most difficult time of my life, but also the most incredibly transformative and beautiful.  I wish I could hug each and every human being out there who’s believed the “mental illness” story told so persuasively by Psychiatry, and trusted in it, just like I did.  By the time I was twenty-seven, Psychiatry— my psychiatric labels, my psychiatric “meds”, and my therapy— defined my entire world, and shaped the lens through which I saw and made meaning of everything I was experiencing.  I was lucky enough to have a family who never gave up on me, no matter how dark things got, but I believed that because they weren’t doctors, they didn’t know how to truly help me… only Psychiatry did.  I look back to that old ‘me’ and feel deep love for her, for she was kept so in the dark by an Institution that promised to never cause her harm.  If only she saw that it was the “care” she sought from Psychiatry, as well as the internalized “Bipolar” identity, that caused most of her suffering, and the majority of her “symptoms” throughout that time.

Today, in my human family, there are millions of people who wake up every morning to their bottles of pills and their calendars of doctors appointments and their mood charts and their DBT distress tolerance skills and their monthly phone calls to the pharmacy with the elevator music on repeat while they wait on hold.  At least, I can imagine that might be what people’s days look like, for those were my days, and that was me, for many, many years.  That is still me, today, only now it’s a part of my past, a part of the foundation of who I’ve become.  I can never forget my relationship to Psychiatry, nor do I want to, because if I do, I’ll forget what it was like to believe deeply enough in an institution that promised to help me that I was willing to sacrifice my humanity for it.  I see myself in the faces of those who believe in Psychiatry today, whether as patients or as “mental health” providers, and I feel so much love and empathy for them, for the fear and insecurity they might be feeling, for the panic at what life would look like without “mental illness.”

Every day, I awaken to a society under the influence of Psychiatry.  I see evidence of this intoxication in newspapers, on television, on the radio, in conversations overheard on subways and coffee shops, in voicemails and emails from friends, on Facebook status updates, on flyers seeking research subjects, on ad campaigns plastered above the highway, in Homeland and Silver Linings Playbook and Demi Lovato and Catherine Zeta-Jones.

Every day, words are written, read, or purchased in the name of Psychiatry, in books, journals, textbooks, essays, articles, and Industry-funded studies.  Every day, Psychiatric knowledge is created and disseminated on the mass scale, solely to expand the breadth and depth of its social control disguised as medicine.

Every day, hundreds of thousands of people are educated by the knowledge institutions of Psychiatry, surrendering their minds to it, whether as high school students, college undergraduates, graduate students, medical students, residents in training, fellows, teachers, instructors, or professors.

Every day, hundreds of thousands of people go to work for Psychiatry, whether as mental health workers, counselors, social workers, psychologists, or psychiatrists.  Primary care doctors, too.

Every day, families say, “I am the proud family member of a person with mental illness,” and every day, families and self-declared “mentally ill” people fight against the so-called “stigma of mental illness.” [For more on this, see Sera Davidow’s great post.]  International non-profit organizations thrive on these campaigns, raising millions of dollars for Psychiatry and the Pharmaceutical Industry.

Every day, thousands and thousands of institutional spaces pump energy into and create profit for Psychiatry, from clinics to day treatment programs to group homes to outpatient programs to inpatient units to detox facilities to buildings in general hospitals to private and public psychiatric hospitals to prisons, and to schools.

Every day, millions and millions of people surrender their bodies, their minds, and their human spirit to Psychiatry as patients, consumers, and clients, whether “voluntarily” or “involuntarily”, whether through overt or covert force, whether they realize it or not.

Today, Psychiatry, bolstered by the psychiatrically dependent industry of “mental health”, is society’s master storyteller about the human experience.  It has effectively constructed medicalized language out of thin air, taught this language to the Western (and, more and more, the non-Western) world, and reinforced its pseudoscientific tenets so subtly, yet with such insidious force, that those who hear these stories receive them with no hesitation, no question, no push back.  Psychiatry thrives on passive acceptance, because people desperately want the story that suffering is a medical “condition”, treatable with a pill and a doctor, to be true.  I know I once did, so very much.

Psychiatry has, with brilliant success, taught our human family to forget its humanness.

Few question Psychiatry’s story that certain emotions, thoughts, and behaviors are “symptoms” of “mental illness.”  That our genetic makeup determines whether or not we have these “mental illnesses.”  That there are life-saving “medicines” out there that will act “against depression”, “against psychosis”, and “against anxiety”, and that will pharmaceutically ease people back to emotional and psychological “wellness”.  That people who hear voices, or go days without sleep and become God, or think about life and death on a daily basis, or have anxiety so intense they want to rip their skin off, are faced with life-long “conditions” that must be accepted and managed with Psychiatric “help”.  That despite decades of failed neuroscientific research, it somehow remains an unquestionable fact that these experiences are in fact brain “diseases” caused by biomarkers that will, some day in the future, be found.

That the human experience, the human mind, and the human soul, can somehow be reduced to neurotransmitters and “brain circuitry.”

Since the dawn of humanity, there has been suffering in the world, and modern Psychiatry has effectively disconnected us from its environmental causes.  On the grand scale, Psychiatry has worked hard to ensure we forget that suffering, so-called “psychosis” and “mania”, and other “abnormal” experiences are healthy responses to racism, sexism, homophobia, poverty, religious persecution, war, exploitation, violence, and trauma.  That it is completely healthy to feel disoriented, profoundly sad, anxious, and afraid when faced with the loss of a job, the death of a loved one, the pressure to pay bills and put food on the table, the societal pressure to look a certain way physically, or to be financially successful.  That emotional and psychic pain are a healthy response to being a child or adolescent in the world, as well as to puberty, bullying, pressure, school stress, witnessing divorce, physical, verbal, or sexual abuse, social isolation, or just being “different” from the entirely socially constructed concept of “normal” (whatever the heck that means, anyways).  What does any of this have to do with “chemical imbalances”, biomarkers, and “brain circuitry”?  Why do we think that the true explanation of these experiences must lie in the hands of medicine?  What expertise does Psychiatry have on each of our unique human lives?  Why have we come to believe that human suffering is somehow only seen as valid when it’s been translated into medical, psychiatrized language?

Upon learning about the NIMH and APA announcements, someone asked me yesterday, “Well, if this is true, what should those people out there suffering do?  Where should they go?”  A very valid question, one to which I believe there’s no easy answer.  What I can say for myself is that I started to find these answers when I discarded the idea that I was broken, “ill”, “diseased”, or faced with a life-long “condition.”  The answers came to me when I remembered that I was a human being, and that life on life’s terms is meant to be hard, painful, confusing, and scary, and that there’s nothing “abnormal” about experiencing emotional and psychic pain, however agonizing it may be.  They answers came to me with the recognition that suffering is not something to be dismissed, denied, numbed, drugged, or “treated”.  That suffering carries a deeper message I should take the time to explore and understand with people who treat me with dignity and respect.  That pain can be a catalyst for growth.  That there is inherent importance to the experiences we as a society have deemed “unacceptable” and thus “abnormal”, like sadness, anxiety, panic, fear, or so-called “mania” and “psychosis”, and that these experiences never just happen out of thin air, even when there may be no apparent causes for them.  Just being alive in today’s industry-driven, patriarchal, selfish, and violent society is enough of a reason, in my opinion, to experience any of what Psychiatry would cause “mental illness.”

Thomas Insel, the leader of NIMH, recently said, “Patients with mental disorders deserve better.”  What I will say to this is that human beings who’ve been psychiatrically labeled deserve better.  They deserve the right to be human, just as they are, without being called abnormal.  They deserve to be supported (and only if they desire to be supported) by people who will not claim expertise on their experience of the world, and by people who will not pathologize them or see them as brains with flawed biomarkers or lists of symptoms.  They deserve to be given the opportunity to find their own inner wisdom, instead of sacrificing their agency to doctors who know nothing of their life stories.  I know I deserved that when I was fourteen, instead of being told by a psychiatrist that the intense anger I felt towards myself, my family, my school, and my town was a sign of “mania” and that I was “Bipolar.”  The suffering that we as human beings experience is worthy of dignity, exploration, understanding, and human support; to call it “symptomatic” of a phantom “illness” is to do just the opposite.

I have dreams for a future in which our collective humanity will fully embrace being human for all its pain, beauty, individuality, and opportunity for transformation.  A future in which we don’t need categories, classifications, and medicalized language to describe the often indescribable experience of being alive on this planet.  A future of acceptance, unconditional support, and human rights for each and every one of us, no matter how we feel, think, or experience reality.  I know I’m not alone when I dream this dream.