Is my Bipolar Disorder a Mental Illness? Or is it a Disorder?

@theaveragejoe - I like your thinking and thanks for raising this. My take on it is we are constricted by words. We have to use words to describe realities. My reality as a person with a disordered mind is different to every other person with a disordered mind. Yet, somehow - we have to be able to discuss similarities.

I too have a cascade of disorder... Bipolar II, OCd, CPTSD, Anxiety... all switched on by childhood trauma.

The result = a quagmire of doing life very tough.

The historical concepts of mental illness is slow to shift - not so long ago people who live with physical and intellectual disabilities lives were defined by what we 'coudn't do". The insurance companies are always looking at what they think we "could do" and the doctors (in my experience) mostly just limit their knowledge to what medications thay can give us to try to do what no one else can do for us....

Bottom line i am do lally tat alot of the time, but manage to live, love and get on with life despite the huge backpack of bio-chemical cascades that leave me reeling from one moment, day, week, month to the next.

If all the diagnoses are 'disorders' I am one disordered being. Langauge though doesn't tend to discern much between 'disordered', dysphoric, illness. They are all words used to decribe the oppoiste of whole & health.

What outcome are you hoping for by this shift in language?

Hi MonGal,

If you look at the DSM, or Diagnostic and Statistical Manual (which has been greatly criticised this year), you will find that there is no reference to Mental Illness. They simply do not use it. Instead, they use Mental Disorders everywhere. Why? Because the psychiatrists know that it is actually scientifically impossible, by psychiatry's own standards, to be officially "diagnosed Mentally Ill." There is no Mental Illness in accurate science.

I am talking about accuracy here. Chemical and electrical imbalances in the brain, in my case, have been triggered by trauma as in PTSD.

This means that my brain is disorderly or that certain areas mulfunction at time as in distorted thinking. All of this, in my case alone, is indeed a set of disorders as you describe. My brain is in a state of diosrder. What has the word illness have to do with all of this if we are seeking accuracy? Can we speak of my condition as Illness?

The word illness is damaging in many ways: first it is good for pharmaceutical companies that have a good reason to sell medication and to train doctors and psychiatrists to sell medicaton. We have an illness here best to cure it with medicaton.

Secondly, It takes away some responsibility to help oneself from the hands of the sufferer. It takes the hope away. "Sure I have a mental illness, nothing I can do so let me accept the illness and just take medicaton."

A disorder is more hopeful, it speaks of something disorderly that could potentially come back to some order. In this sense it puts back some power into the hands of the sufferer.

I am pretty sure that if we move to mental disorders, rather than mental illness, this would also improve stigma. I would rather employ someone with a mental disorder than a mental "Illness". Illness sounds more permanent and malicious. Particularly because there is no virus, the word Illness in mental health gives the idea of an incurable illness, particularly since we do not have a virus to cure. It will go on indefinitely.

But there are many other reaons, some deep and complex. A disorder sounds better to me, less subject to stigma for all of the above reasons.

David Oak, director of the Mind Freedom International writes:

"The term "mentally ill" is very much a narrow medical model.

If you want to use that term about yourself that is one thing. But when anyone uses the phrase "mentally ill" about others, including me and other psychiatric survivors, the implication is that since an "illness" is the problem then a doctor ought to be part of the solution. "Mental illness" also says since the problem is like a materialistic physical illness, then perhaps the solution ought to be physical too, such as a chemical or drug or electricity.

I have put this up somewhere in some of my posts by R.D.Laings:

"Conventional psychiatry is plagued by a confusion that lies at the very center of the conceptual problem of all modern, scientific medicine. Instead of asking why ;a mental [disorder] occurs, medical researchers try to understand the biological mechanisms though which the illness operates"

Using the word Ilness we are invited to understand the biological mechanisms through which mental disorders occur rather than being preoccupated with its origins.

These mechanisms,rather than true origins, are seen as the cause of the disorder. The disorder becoms an illness since we are not concerned with the origins.

This is very bad for me with PTSD. It could have taken away the chance for me to recover, because I need, above all therapy. I improved with therapy and recovered. But for a while I had been convinced to take medicaton alone which never got to the source of my problems.

Joe, I hear what you are saying, and to be sure it's possible to point to cases - perhaps such as your own - where causation of the condition is not necessarily the same as the current biopsychophysical mechanism that perpetuates it. On the other hand, there are also cases where the origin of the condition seems clearly to be biochemical. I'm thinking in particular of psychotic disorders that arise de novo purely from, for example, an excess of dopaminergic activity in the prefrontal cortex in the absence of any predisposing life circumstances. It could fairly handily be argued that this is, in fact, an illness - and further, is demonstrably one that is most effectively treated with antipsychotic medications that antagonise dopamine transmission in the affected regions of the brain. All the counselling and psychotherapy in the world will not diminish psychosis.

Having said that, in the majority of conditions current best evidence points to a combination of pharmacotherapy and talk therapies for the best outcome. There are few conditions where the combination does not provide a synergistic and superior effect than either type of approach singly.

I'm not sure the distinction between "illness" and "disorder" is necessarily helpful, and I do wonder along with MoonGal what outcome you hope for in emphasising the difference? I understand your points regarding accuracy (although, to my mind, it raises questions of subjectivity and interpretation of the words), but I struggle to get on board with the points you made in your reply to MoonGal. If my brain is simply disorderly, and I just need to reorder it in order to become well, then I should be able to achieve this by myself, or at least with a little help from a professional. Yet, I cannot. My condition persists despite medications and therapy, and despite best attempts at reordering my thinking. Indeed, I have had significant success in changing my thought life for the better... yet have experienced little relief from my symptoms. "Illness" certainly does not automatically predicate "medication" as the cure. Consider for example neurodegenerative disorders for which physiotherapy is prescribed. Multiple sclerosis is most certainly an illness, and medications can alleviate symptoms, but a multi-disciplinary approach provides the best results - even if not a cure.

Your depiction of complete abdication of personal responsibility and involvement for someone with an "illness" I think is a caricature and perhaps even inadvertently disrespectful of those with bona fide illnesses who nonetheless battle against them with all their available resources. Consider cancer sufferers, who frequently engage very actively to battle their illness, often in the face of a poor prognosis.

The conceptualisation of "illness" as being something permanent or immutable is I think difficult to support. Gastroenteritis is unarguably an illness - as are influenza, pneumonia, tinea or motion sickness - and they are all transient and mostly curable. Disorders on the other hand - Down syndrome, autistic spectrum disorder, colourblindness - tend to be intrinsic and intractible. I think if you are looking for terminology that gives hope for cure or resolution, "illness" actually offers more hope than "disorder". A disorder tends to be something that the sufferer needs to learn to manage, to live with - a chronic condition - which actually turns out to be the case for many of us with psychiatric conditions.

For my money, meaning tends to be that which we imbue into the subject of our consideration. If I view "illness" to represent a narrow, biomedical interpretation of a subject, then it does - for me. But maybe that's not a universal truth, notwithstanding David Oak's opinion. Further to his opinion about an "illness" suggesting medical involvement - damn straight a doctor should be involved in assessing a mental illness/disorder, even if it's to determine that medical intervention is not going to be helpful. Why? Because in the cases where pharmacotherapy is transformative, it would be absolutely negligent not to have properly explored that option. For some people, medication is very literally life saving. For others (like me) it has done nothing at all to help - but I wouldn't have known that without investigating it first. If the opposite had been true (i.e. a medication could have given me back normality) but I avoided doctors, I would be denying myself a virtual cure for the sake of ideology.

I guess at the end of the day psychiatry/psychology is such an inexact and empirical science (if indeed it is any kind of science at all) that black-and-white thinking turns out rarely to be useful in contemplating the many and complex issues involved. In my experience "it's this" or "no, it's that" rarely turn out to be true - often it's actually a bit of this and a bit of that mixed in together.

Hi there @BeeGee

first of all let me start by saying that you have misunderstood what I have written. I never said what you think I said. You wrote:

"Your depiction of "complete abdication" of personal responsibility and involvement for someone with an "illness" I think is a caricature and perhaps even inadvertently disrespectful of those with bona fide illnesses who nonetheless battle against them with all their available resources. "

What I said is that we can help ourselves in some ways and that how we travel is very important.

a) If I take drugs, dring alcohol avusively, eat all the wrong fatty, non nutritious food, and do not exercise a little then this will surely make my mental disorder, in my case Bipolar II, much worse than what it is.

b) if I don't find a suitable therapist to help me I will surely not be able to fees as I feel now.

c) talking about my problems helps a real lot so that even this is good.

These are all things that can help me and I am pretty sure that these would help anyone. It does not mean that the ability to cure my mental illness is in my hands but that I can do things to help me.

In this sense, part of us feeling a little better, perhaps for some people not for all naturally, is in my hands and in the hands of others like me. This is now much more accurate. We know that there are severe cases that do not respond to anything but these, fortunately are rare and I was speaking of people who have the ability to help themselves.

As far as Illness or Disorder I have posted here that the DSM has decided to go with disorder because the psychiatrists believe that a condition like Bipolar cannot be an illness. Also Dvid Oaks, the Dirctor of MindFreedom International explain why Mental Illness is damaging and why we should find other worlds. He has an article titled Let's Stop Saying Mental Illness. Indeed in America and Europe thare are a few groups of organized people that are calling for the abolition of the term Mental Illness.

Thank you for your long post but please beofre you accusing to being disrespectul to the people, which is not a nice things to say, you could have asked what I exactly meant. I would have to be studpid to say that we have to power to cure ourselves that that is in our hands. Do you really think that I would say this? There is no cure only recovery and recovery is not to become suddenly cured. It is much different.

I have been honest with you here, no disrespect on my part.

Thank you again

Dear @BeeGee,

I have a few friends with psychosis who function reasonably well. Some are academics. They too have been able to recover. Professor Elin Saks [I have never met this professor but simply read her books] has written some wonderful books. She suffered with severe psychosys and paranoid schizophrenia and was hospitalized a number of times till she recovered. I have read some of her books which clearly state that even people with the most severe psychosys can sometimes recover. Carl Jung had psychosis. And there are many out there. She is a great advocate for schizophrenia in America.

As I said, it is not how serious the condition is, for most sufferers, it is how we travel inside, towards recovery [recovery does not mean cure] or towards hopelessness and despair. SOme people, even with the most terrivble schizophrenia, are able to recover. Why? I don't know. Perhaps some people are genetically resiliant and others are not. I certainly am resiliant and so is my wife who suffers with Bipolar 1 and has had psychosis in the past. She probably still has a bit of psychosis but she can cope well with it.

I'm sorry if I have misconstrued your intent. When you said "Secondly, It takes away some responsibility to get well from the hands of the sufferer. It takes the hope away. "Sure I have a mental illness, nothing I can do, let me sit here,give up on life, and take medicaton and bugger to everything."" that seemed to suggest to me that you are conflating a conceptualisation of illness with disempowerment, and I just don't see that. I don't see any difference in the ability of a person to actively engage with treating and managing their condition whether it is labelled as an illness or a disorder. Indeed, my point was that "illness" can suggest more hope for cure than "disorder". At the end of the day, it's just semantics, and my main point was that how each of us views these two words is highly subjective and I wonder whether insisting that there is a global and uniform perception of the semantics and semiotics of the words really contributes greatly to assisting people to move forward with their conditions.

I'm familiar with the DSM-IV, DSM-IV-TR and DSM-V. I think what you are identifying with regard to terminology in these volumes is more related to an attempt to standardise the terminology rather than an identification of what is most correct... although I'm open to correction here if you have better information. I would also be careful about treating the DSM as science, or factual. It is an attempt to get greater levels of rigour and consistency in the discipline of psychiatry by mandating standardised ways of defining conditions. These definitions though have been arrived at by population-based observation and interpretation; they change from revision to revision, and could best be described as statistical rather than scientific. It's a helpful attempt to improve the practice of psychiatry, but the field is still quite embryonic relative to the rest of medicine. Its scientific underpinnings are by no means as well established as in other fields. That's not a criticism, just an observation of our current state of knowledge.

I respect that people like David Oaks have their opinion on the subject, and it's good to get a conversation happening around these issues; I'd be wary though of taking someone's opinion (even a prominent someone) as gospel. I accept that he, you and others find it helpful to frame the discussion in this way; I'm just suggesting that maybe it's not absolute truth for absolutely everyone and that insisting that it should be may be counterproductive.

Hi @BeeGee,

thank you for you reply and yes I understand how what I wrote was a little inadequate and insensitive. I do write a lot and in a hurry so that I am not perfect. But as you have pointed out I wrote: Secondly, it takes away some responsibility to "feel better" or to help oneself in some ways ( get well is inadequate, my mistake) from the hands of the sufferer. I will go to the spot and change this because it is not accurate, getting well is wrong, we probably never get well completely but we can recover and help ourselves to feel better. Thank you for pointing this mistake out to me. I am sorry for this.

About Illness vs. Disorder it is an interesting area of discussion. I would be glad to discuss this with you further and with an open mind. I never state to be right, I entertain the idea that I can be wrong. But by discussing things I learn.

I would like to continue the discussion with you since you seem to be well informed.

As far as the DMS, I have criticized it a lot and don't think that it is an accurate book. It is just a guide that tends to favour the medical profession in the biological sense. They may use the word disorder but don't be fooled... 🙂

Hi @BeeGee, and the other people interested, I continue my case for the removal of "Mental Illness". IN this sense I really like this website, the SANE site, the only problem is that everytime I come here I see Mental Illness. Mental Illness is real, or similar.

I must be honest, don't feel at ease when I read this and so I am asking for the possibility that this may be changed to Mental Disorder is Real or Mental Disorders are Real. Knowing that pharmaceutical corporations donate money to SANE, I don't think that it is going to happen amytime soon. And yes, as a member that writes on self help websites, I would love to write on a website that does not accept money from pharmaceutical corporations (I see it also as conflict of interest).

But, unfortunately, such world does not yet exist. Even political parties get donations from pharmaceutical industries just like Universities and many other powerful institutions. Certainly this does raise a number of important ethical questions. But, this is the world we live in so that we have to accept it.

Reading Mental Illness is Real immediately gives me the impression that this is a pharmaceutical website for medication. Of course, I mean no disrespect to the SANE website and its people.

I am transparent and honest in everything I do. Some undesrstand me and welcome me, others don't which is fine and perfectly understandable.

I would continue to write if it is not possible to change and continue to be part of this site. But I would feel strange everytime I read "Mental Illness." I don't have a mental illness I have a disorder that was caused by childhood trauma.

Because I read a real lot, I have read about a particular kind of research in America called the ACE study (or adverse childhood experiences), a huge scale research that was conducted to establish the main causes of Mental Disorders.

It was found that in about 85% of all cases studied, subjects's disorders had traumatic origins that occurred during childhood.

Many mental health professionals that are in practice as therapists agree with this, that childood trauma is mosft often the source that triggered the mental disorder. Ask any therapist and they will probably agree that a great percentage of thei practice has clients with a history of childood traumatic experiences. My therapist agrees with this and so does my wife's therapist. In addition, while no longer a student, I still go to my university and I have asked this question to my department of psychology. They also agree with this, unanimously.

No doubt that childhood traumatic experiences make up the great majority of mental disorder cases. Most probably, amongst us, there will be a great number of people that have been traumatised during childood. Already in the many posts this isapparent.

If this is so, and we accept the Ace research findings, then to say that I have a mental disorder seems to make it perfectly reasonable to entertain the idea that the mental disorder may have been triggered by trauma, in my case trauma during childhood. It makes me feel better to say that I have a mental disorder because by saying this there is room for me to blame my trauma during my childhood days. The word Disorder is compatible with this and it works well.

But what if I say I have a mental Illness? People would immediately think that it is a purely biological problem, nothing to do with my history. Nothing to do with my alcoholic parents. Nothing to do with my trauma. Nothing to do with the fact that I am sensitive. Just a biological illness, a genetic problem that need medication alone. This takes away the social responsibility to understand the origins of my mental disorder and for society and the people to assume some responsibility in that we should better protect our children and understand the consequences of childhood trauma.