The Bipolar Spectrum
Diagnosis or Fad?
By Joel Paris
Routledge – 2012 – 120 pages
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.
“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
Introduction. Part I: Concepts. The Bipolar Diagnosis. "Diagnostic Creep" in the Bipolar Spectrum. Affective Instability. Part II: Disorders. Differential Diagnosis of Unstable Mood. Bipolarity and Personality Disorders. Bipolarity and Childhood Behavioral Disorders. Part III: Implications. How Psychiatric Fads Develop. The Impact of Overdiagnosis.
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.