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.
Table of Contents
Part I: Concepts
History of the Bipolar Diagnosis: Reviews what we know about the neurobiology, epidemiology, outcome, and treatment response of bipolar disorders.
The Bipolar Spectrum: Presents a detailed critique of what the author calls “bipolar imperialism,” or the theory that “soft bipolar” symptoms point to the presence of a pathological process lying behind other diagnoses in psychiatry.
Affective Instability: This chapter will show how affective instability differs from bipolarity, in relation to BPD.
Part II: Disorders
Bipolarity and Psychosis: Examines recent evidence that vulnerability to psychosis crosses over from bipolar disorder to schizophrenia, challenging the Kraepelinian dichotomy.
Bipolarity and Depression: Presents a detailed critique of the evidence suggesting that some patients with unipolar depression have some bipolar symptomatology.
Bipolarity and Personality Disorders: Examines the over diagnosis of bipolar disorder, especially the borderline type and makes the case that patients with BPD respond best to specific and structured psychotherapy—which will not be prescribed as long as they are seen as bipolar.
Bipolarity and Impulsive Disorders: Like the previous chapter, this one will examine the relation between bipolar disorder and various impulsive disorders, such as substance abuse and eating disorders.
Bipolarity and Behavioral Disorders of Childhood: This chapter will examine research on bipolar disorder in children. The author will use this research to make the case that children do not show the characteristic symptoms of the adult disorder, either in childhood or on long-term follow-up.
Part III: Implications
How Fads Develop: This chapter will look at diagnostic fads parallel to the bipolar fad and show why they eventually faded from view. The author will also make the case that only an evidence-based perspective can protect us from faddish diagnosis and treatment.
What Happens to Patients: This chapter will explore the consequences of over-diagnosis along with the side effects of medications and atypical neuroleptics. It will also include a statement on the focus on pharmacotherapy, as opposed to psychotherapy.
What Needs to Change: This chapter will summarize the main points of the book and present the message that psychiatry needs to be more humble about what it knows and does not know.
Joel Paris, MD, is Professor of Psychiatry at McGill University. He is also a Research Associate at the SMBD-Jewish General Hospital, and heads personality clinics at two hospitals. He is Editor-in-Chief of The Canadian Journal of Psychiatry.
“We are in the midst of a mania for Bipolar Disorders that rivals any of the stock market manias of recent years. … Joel Paris’ Bipolar Spectrum is for anyone negotiating mental health care today but also should alert everyone else to a growing lunacy at the heart of modern healthcare.” - David Healy, Professor of Psychiatry, Cardiff University, Wales, UK
“A must read for every psychiatrist who treats bipolar disorder and wants to better understand the risks of the bipolar spectrum concept. Dr. Paris identifies the conceptual and empirical limitations of the bipolar spectrum and the salesmen who have oversold the data.” - Mark Zimmerman, MD, Director, Outpatient Psychiatry, Rhode Island Hospital and The Miriam Hospital; Associate Professor, Brown Medical School, USA
“…In this deceptively provocative book on the bipolar spectrum, distinguished clinical academic Joel Paris masterfully charts the current climate change of diagnostic creep and the consequential ‘soft psychiatry,’ dissecting determinants of psychiatric imperialism that risk blurring illness with normality.” - Professor Gordon Parker, Executive Director, Black Dog Institute; Scentia Professor, School of Psychiatry, The University of New South Wales, Australia