I'm Bipolar, You're Bipolar, We're Bipolar, They're Bipolar

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I'm Bipolar, You're Bipolar

Your mental illness is their financial gain.

Mikkel Borch-Jacobsen , 02 Mar 2011

Jim Hogshire (Feral House 1999)

Audio version read by George Atherton – Right-click to download

Early in the morning of December 13, 2006, police officers from the small town of Hull, MA, near Boston, arrived at the home of Michael and Carolyn Riley in response to an emergency call. Their four-year-old daughter, Rebecca, had been diagnosed with bipolar disorder two years earlier. When the officers reached the house, they found Rebecca sprawled out on the floor next to her teddy bear. She had died from an overdose of the medication cocktail prescribed to her by her psychiatrist, Dr. Kayoko Kifuji. At the time of her death, Rebecca was taking Seroquel®, a powerful antipsychotic drug, Depakote®, a no less powerful anticonvulsant and mood-stabilizing drug, and clonidine, a hypotensive drug used as a sedative.

Rebecca’s parents were charged with first-degree murder, but her doctor’s role must also be questioned. How could she have prescribed psychotropic medications normally intended for adults suffering from psychotic mania to a two-year-old? Yet the medical center where Rebecca had been treated issued a statement describing Dr. Kifuji’s treatment as “appropriate and within responsible professional standards.” In an interview with the Boston Globe, Dr. Janet Wozniak, director of the Pediatric Bipolar Program at Massachusetts General Hospital, went even further: “We support early diagnosis and treatment because the symptoms of [bipolar] disorder are extremely debilitating and impairing. […] It’s incumbent on us as a field to understand more which preschoolers need to be identified and treated in an aggressive way.” On July 1, 2009, a Plymouth County Grand Jury dropped all criminal charges against Dr. Kifuji.

How did we come to this? As the psychiatrist and historian David Healy points out in his latest book, Mania: A Short History of Bipolar Disorder (Johns Hopkins University Press, 2008), very few people had heard of bipolar disorder before 1980, when it was introduced in the DSM-III – the diagnostic manual of the American Psychiatric Association – and it was only in 1996 that a group of doctors from Massachusetts General Hospital, led by Joseph Biederman and Janet Wozniak, first proposed that some children diagnosed with attention-deficit/hyperactivity disorder (ADHD) might in fact suffer from bipolar disorder. But whoever googles “bipolar disorder” today is likely to learn that the illness has always been with us. It’s just a new name, we are told, for what used to be called manic depression, a severe mood disorder characterized by oscillations between states of manic hyperactivity and deep depression.

Healy has no trouble demonstrating that this is a retrospective illusion. “Manic-depressive insanity” (a term coined in 1899 by Emil Kraepelin) was a relatively rare illness – ten cases per one million people each year, Healy claims, or 0.001 percent of the general population. By contrast, the prevalence of bipolar disorder is supposed to be much higher. In 1994, the US National Comorbidity survey estimated that 1.3 percent of the American population suffered from bipolar disorder. Four years later, the psychiatrist Jules Angst upped the figure to 5 percent: 5,000 times higher than the figure suggested by Healy. Are we really talking about the same thing? Or did the name create a new thing?

Healy favors the second hypothesis. The term bipolar disorder, he explains, was simultaneously introduced in 1966 by Jules Angst and Carlo Perris, who proposed cleanly separating unipolar depressions from bipolar disorders (they were contradicting Kraepelin, who believed that both sets of disorders were presentations of one and the same manic-depressive illness). While their conceptual move has been hailed as a breakthrough, it is hard to understand what the point is – it muddles the diagnosis instead of clarifying it. In practice, how are we to distinguish a unipolar depression from a bipolar disorder in a patient who has yet to experience a manic episode? Nonetheless, instead of seeing this incoherence as a reason for rejecting the new paradigm, psychiatrists have since done their utmost to patch it up with all sorts of ad hoc innovations.

First a distinction was made between “bipolar disorder I,” which applied to patients hospitalized for both depressive and manic episodes, and a brand new “bipolar disorder II,” which referred to patients hospitalized solely for a depressive episode. In other words, any person hospitalized for depression could now be diagnosed as bipolar. Then the reference to hospitalization was dropped for bipolar disorder II, which meant it could now include less severe forms of depression and hyperactivity, as well as all sorts of neurotic disorders that Kraepelin would never have dreamed of calling manic-depressive insanity. One now speaks of a “bipolar spectrum,” which includes, along with bipolar disorders I and II, cyclothymia (a mild form of bipolar II) and bipolar disorder “not otherwise specified” (an all-purpose category in which practically any affective instability can be placed) – to which some add bipolar disorders II ½, III, III ½, IV, V, VI, and even a very accommodating “subthreshold bipolar disorder.”

The category has expanded so much that it would be difficult to find anyone who couldn’t be described as “bipolar,” especially now that the diagnosis is liberally applied to all ages. Conventional wisdom once had it that manic depression burns out with age, but geriatric bipolar disorder is now the talk of psychiatric congresses. Elderly people who are depressed or agitated find themselves being diagnosed with bipolar disorder for the first time in their lives and are prescribed antipsychotics or anticonvulsants that have the potential to drastically shorten their life expectancy: according to David Graham, an expert from the US Food and Drug Administration (FDA), these psychotropic medications are responsible for the deaths of some 15,000 elderly people each year in the United States. Likewise, it has been assumed since the work of Biederman and Wozniak that bipolar disorder can strike in early childhood and not just with the onset of adolescence. As a result, the prevalence of pediatric bipolar disorder multiplied by a factor of 40 between 1994 and 2002.

How, then, did we come to apply such a serious diagnosis to vaguely depressed or irritable adults, to unruly children and to nursing home residents? Is it simply that psychiatric science has progressed and now allows us to better detect an illness that had previously been ignored or misunderstood? Healy has another, more cynical explanation: The never-ending expansion of the category of bipolar disorder benefits large pharmaceutical companies eager to sell medications marketed with the disorder in mind. Psychiatric research doesn’t evolve in a vacuum. Behind the psychiatrists’ constant redrawing of the map of mental illnesses in a sincere effort at better understanding, there are enormous financial and industrial interests that steer research in one direction rather than another. For researchers, mental illnesses are realities whose contours they attempt to define; for pharmaceutical companies, they are markets that can, thanks to marketing and branding techniques, be redefined, segmented and extended in order to make them ever more lucrative. The uncertainties of the psychiatric field present in this respect a magnificent commercial opportunity, since illnesses can always be tailored to better sell a particular molecule under a particular patent.

In the case of bipolar disorder, this conceptual gerrymandering has involved stretching and diluting the definition of what used to be called manic-depressive illness so that it might include depression and other mood disorders, thus creating a market for “atypical” antipsychotic medications such as Lilly’s Zyprexa®, AstraZeneca’s Seroquel® or Janssen’s Risperdal®. Even though these medications were initially approved only for the treatment of schizophrenia and acute manic states, they were marketed for the treatment of bipolar disorder and by extension mood disorders in general. The same was done to anticonvulsant medications, which are strong sedatives prescribed for epileptic attacks. In 1995 Abbott Laboratories succeeded in obtaining a license to offer its anticonvulsant drug Depakote® for the treatment of mania. Depakote®, however, was marketed not as an anticonvulsant but as a “mood stabilizer” – a term without any clinical meaning that is misleading insofar as it suggests a preventive action against bipolar disorder that has never been established in any study.

In the wake of this brilliant terminological innovation, other anticonvulsants such as Warner Lambert/Parke Davis’s Neurontin® were aggressively marketed for mood disorders when they hadn’t been approved even for manic states. But what did it matter, since the meteoric success of the concept of “mood stabilization” made this step useless? The suggestion to doctors was that they prescribe anticonvulsants or atypical antipsychotics to “stabilize” the moods of depressive patients who had never before displayed any manic hyperactivity, the idea being that these people had been misdiagnosed as suffering from unipolar depression while in fact being bipolar. Anyone who knows how lucrative the market was for selective serotonin reuptake inhibitor (SSRI) antidepressants such as Prozac® or Paxil® in the 1990s will immediately see the point of the exercise. While most SSRIs are now off patent, the market for atypical antipsychotics is currently worth $18 billion – twice as much as that of antidepressants in 2001.

It is easy to see that the redefinition of manic depression into the much wider concept of mood disorders neatly mirrors the marketing of anticonvulsants and atypical antipsychotics as mood stabilizers. The question, of course, is whether the pharmaceutical industry’s marketers actually created bipolar disorder or merely exploited tentative psychiatric research. Strictly speaking, we must grant it was opportunism: The research of Angst and Perris on bipolar disorder dates from 1966, well before the development of atypical antipsychotics and “mood stabilizers.” But the reality of the contemporary medical-industrial complex is that their hypothesis would not have survived, let alone prospered, had it not been “recruited” at a particular moment by the pharmaceutical industry and thrust forcefully on the public with the help of the most sophisticated marketing and advertising techniques.

This is what Healy calls the “manufacture of consensus”: By subsidizing one research program instead of another, one conference or symposium, one journal, one publication, one learned society and so on, the pharmaceutical industry doesn’t just make precious allies among the “key opinion leaders” of the medical establishment, it also gains a very efficient means of steering the academic discussion toward the illnesses that interest it at any given moment. Healy provides a detailed description of how bipolar disorder was launched at the end of the 1990s, from the avalanche of publications ghostwritten by specialized PR agencies to the sponsoring of bipolar patient advocacy groups and the creation of websites where people could fill out “mood assessment questionnaires” that inevitably dispatched them to the nearest doctor. Following this marketing blitz, no one could ignore bipolar disorder any longer. As a Practical Guide to Medical Education intended for industry marketers explains, “It is essentially like setting a snowball rolling down a hill. It starts with a small core of support: maybe a few abstracts presented at meetings, articles in key journals, focuses for discussion amongst ‘leading experts’ […] and by the time it reaches the bottom of the hill the noise should be coming from all sides and sources.” Pharmaceutical companies today launch diseases in the way fashion companies launch a new brand of jeans: creating needs that align with industrial strategies and the duration of patents.

The techniques Healy describes are the same as those used by the pharmaceutical industry to sell, or oversell, conditions as diverse as depression, osteoporosis, hypertension, social phobia, metabolic syndrome, high cholesterol, attention-deficit/hyperactivity disorder, fibromyalgia, premenstrual dysphoric disorder, panic attacks, restless leg syndrome and so forth. In each case the existence and risks of one condition or another are amplified in order to better persuade us to swallow chemical products that may be either useless or, often, potentially toxic.

In the case of bipolar disorder, the medications on offer come with significant risks. Anticonvulsants are liable to cause kidney failure, obesity, diabetes and polycystic ovary syndrome, and they are among the most teratogenic drugs. Atypical antipsychotics, once reputed to be less toxic than first-generation “typical” antipsychotics, are now known to have very serious side effects: significant weight gain, diabetes, pancreatitis, stroke, heart disease and tardive dyskinesia (a condition involving incapacitating involuntary movements of the mouth, lips and tongue). They can, in some circumstances, cause neuroleptic malignant syndrome, a life-threatening neurological disorder, and akathisia, whose sufferers experience extreme internal restlessness and suicidal thoughts. Prescribing such toxic medications to patients suffering acute mania may be unavoidable, but as a prophylactic to be given to depressed pensioners and hyperactive kids?

A series of prominent lawsuits has been brought over the past few years in the United States against the manufacturers of anticonvulsants and atypical antipsychotics for having hidden their side effects and for having marketed them “off label” to patient populations not approved by the FDA. The sums paid out in fines or settlements by the companies involved are staggering (a total of $2.6 billion for the illegal marketing of Zyprexa® by Lilly, for example), and they give an idea of how disastrous the effects of the medications actually have been. In a related development, Dr. Joseph Biederman, director of the Johnson & Johnson Center for Pediatric Psychopathology Research at Massachusetts General Hospital and the main academic advocate of pediatric bipolar disorder, has been subpoenaed in a federal investigation to account for the $1.6 million he received between 2000 and 2007 from Johnson & Johnson and other pharmaceutical companies likely to benefit directly from his research.

But the marketing of bipolar disorder itself has not been put on trial, and probably never will be. This is the perfect crime. Bipolar disorder I, II, III, etc., remain on the books and doctors continue to exercise their freedom of judgment in prescribing Zyprexa® and Seroquel® off label to their “bipolar” patients. An extended release version of Seroquel®, Seroquel XR®, was approved in December 2009 by the FDA for the treatment of depression. As for sales of Zyprexa®, they are up 2 percent compared to 2007, when the medication generated $4.8 billion in sales.

Who remembers Rebecca Riley now?

Mikkel Borch-Jacobsen teaches comparative literature at the University of Washington. His latest book is Making Minds and Madness: From Hysteria to Depression (Cambridge University Press). A longer version of this article was published on October 7, 2010 in the London Review of Books.

AlterNet.org

More on Police Departments' Collusion in Defense of 1%: Who's the Organization Coordinating Those Crackdown Calls?

By Geov Parrish | Sourced from Booman Tribune

Posted at November 19, 2011, 7:46 am

Interesting report this evening in the San Francisco Bay Guardian suggesting that big city mayors have not been the only ones making conference calls in an effort to coordinate crackdowns on Occupy Movement encampments:

...a little-known but influential private membership based organization has placed itself at the center of advising and coordinating the crackdown on the encampments. The Police Executive Research Forum, an international non-governmental organization with ties to law enforcement and the U.S. Department of Homeland Security, has been coordinating conference calls with major metropolitan mayors and police chiefs to advise them on policing matters and discuss response to the Occupy movement. The group has distributed a recently published guide on policing political events....

The coordination of political crackdowns on the Occupy movement has been conducted behind closed doors, with city officials and PERF refusing to say how many cities participated in the conference calls and the exact nature of the discussions. Reports of at least a dozen cities and some indication of as many as 40 accepting PERF advice and/or strategic documents include San Francisco, Seattle, New York, Portland [Oregon], Oakland, Atlanta, and Washington DC....PERF coordinated a November 10 conference call with city police chiefs across the country – and many of these cities undertook crackdowns shortly afterward.

We can take an educated guess at "the exact nature of the discussions" by looking at the leadership of the Police Executive Research Forum:

PERF’s current and former directors read as a who's who of police chiefs involved in crackdowns on anti-globalization and political convention protesters resulting in thousands of arrests, hundreds of injuries, and millions of dollars paid out in police brutality and wrongful arrest lawsuits.

These current and former U.S. police chiefs -- along with top ranking police union officials and representatives from Canadian and British police -- have been marketing to municipal police forces and politicians their joint experiences as specialists on policing mass demonstrations.

Chairing PERF's board of directors is Philadelphia Police Commissioner and former Washington D.C. Metro Police Chief Charles Ramsey, who was responsible for coordinating the police response to protests against international banking institutions including the World Bank and International Monetary Fund. Those protests, and Ramsey's response to massive anti-war demonstrations in Washington DC in the lead up the the Iraq War, often resulted in preemptive mass arrest of participants that were later deemed to be unconstitutional.

Ramsey's predecessor as organization chair is former Philadelphia Police Commissioner and former Miami Police Chief John Timoney, who is responsible for the so called “Miami Model,” coined after the police crackdown on the 2003 Free Trade Agreement of the Americas protest. The police response to protesters in Miami lead to hundreds of injuries to protesters. The ACLU won multiple suits against the Miami P.D. over abuse to protesters and free speech concerns....Timoney arrived in Miami with plenty of baggage. At the 2000 Republican National Convention, Timoney coordinated a crackdown that resulted in more than 420 arrests with only 13 convictions, none of which resulted in jail time. As in Miami, there was well documented abuse of some of the people arrested.

Also among PERF's directors is Minneapolis police chief Tim Dolan, who was responsible for the crackdown on protesters at the 2008 Republican National Convention. That event also resulted in lawsuits, protester injuries and an outcry from the national press about police brutality and the preemptive nature of the police action.

PERF has also been sharing its expertise other ways:

As the occupation movement grew, PERF began circulating a publication titled Managing Major Events: Best Practices from the Field. The manual...amounts to a how-to guide for policing political events, and gives special attention to policing “Anarchists” and “Eco Terrrorists” at political events.

The guide encourages the use of undercover officers and snatch squads to “grab the bad guys and remove them from the crowd.” It urges local law enforcement to use social media to map the Occupy movement.

An earlier PERF guide, Police Management of Mass Demonstrations, advocates the use of embedded media to control police messages, the use of undercover cops to infiltrate protest groups, the use and pitfalls of preemptive mass arrest, an examination of the use of less-than-lethal crowd control weapons, and general discussion weighing the use of force in crowd control.

Dollars to cop donuts this just scratches the surface of the sort of back-channel, hidden-from-public-view communications that have been triggered by the alarming - to some - emergence of the Occupy movement as a force with which much of the American public sympathizes. In addition to a political (mayors) and law enforcement (PERF) response, undoubtedly there is a communications strategy unfolding, too, and fine journalistic efforts such as those Booman cites are likely a product of it. Certainly they all sound oddly similar.

The ante in all of these arenas has been upped considerably in the last week, with camp evictions and police confrontations across the country. In general, thanks to images like this, those crackdowns have not played well with much of the public and likely have only redoubled the determination of protesters. Following on actions marking Thursday's two-month anniversary of the original Zuccotti Park occupation, Saturday is planned as yet another day of widespread actions. It will be interesting to see whether cities and police pull back, fearing a PR backlash, or double down on the repression.

If history teaches us anything, it's that the repression can get a lot worse. As Glenn Greenwald noted astutely today,

Law enforcement officials and policy-makers in America know full well that serious protests — and more — are inevitable given the economic tumult and suffering the U.S. has seen over the last three years (and will continue to see for the foreseeable future). A country cannot radically reduce quality-of-life expectations, devote itself to the interests of its super-rich, and all but eliminate its middle class without triggering sustained citizen fury.

The reason the U.S. has paramilitarized its police forces is precisely to control this type of domestic unrest, and it’s simply impossible to imagine its not being deployed in full against a growing protest movement aimed at grossly and corruptly unequal resource distribution.

Put another way: "Dancing With the Stars" can only keep so many people anesthetized for so long. Or, as Gandhi described it, in a situation where people knew they'd been colonized: "First they ignore you. Then they laugh at you. Then they crack down..."

We know what happens after that.

By Geov Parrish | Sourced from Booman Tribune

Posted at November 19, 2011, 7:46 am

AlterNet.org

The Economic Collapse / By Michael Snyder

Extreme Poverty Is Now at Record Levels -- 19 Statistics About the Poor That Will Absolutely Astound You

In 2010, we were told that the economy was recovering, but the truth is that the number of the "very poor" soared to heights never seen previously.

November 8, 2011 |

According to the U.S. Census Bureau, a higher percentage of Americans is living in extreme poverty than they have ever measured before. In 2010, we were told that the economy was recovering, but the truth is that the number of the "very poor" soared to heights never seen previously. Back in 1993 and back in 2009, the rate of extreme poverty was just over 6 percent, and that represented the worst numbers on record. But in 2010, the rate of extreme poverty hit a whopping 6.7 percent. That means that one out of every 15 Americans is now considered to be "very poor". For many people, this is all very confusing because their guts are telling them that things are getting worse and yet the mainstream media keeps telling them that everything is just fine. Hopefully this article will help people realize that the plight of the poorest of the poor continues to deteriorate all across the United States. In addition, hopefully this article will inspire many of you to lend a hand to those that are truly in need.

Tonight, there are more than 20 million Americans that are living in extreme poverty. This number increases a little bit more every single day. The following statistics that were mentioned in an article in The Daily Mail should be very sobering for all of us....

About 20.5 million Americans, or 6.7 percent of the U.S. population, make up the poorest poor, defined as those at 50 per cent or less of the official poverty level.

Those living in deep poverty represent nearly half of the 46.2 million people scraping by below the poverty line. In 2010, the poorest poor meant an income of $5,570 or less for an individual and $11,157 for a family of four.

That 6.7 percent share is the highest in the 35 years that the Census Bureau has maintained such records, surpassing previous highs in 2009 and 1993 of just over 6 percent.

Sadly, the wealthy and the poor are being increasingly segregated all over the nation. In some areas of the U.S. you would never even know that the economy was having trouble, and other areas resemble third world hellholes. In most U.S. cities today, there are the "good neighborhoods" and there are the "bad neighborhoods".

According to a recent Bloomberg article, the "very poor" are increasingly being pushed into these "bad neighborhoods"....

At least 2.2 million more Americans, a 33 percent jump since 2000, live in neighborhoods where the poverty rate is 40 percent or higher, according to a study released today by the Washington-based Brookings Institution.

Of course they don't have much of a choice. They can't afford to live where most of the rest of us do.

Today, there are many Americans that openly look down on the poor, but that should never be the case. We should love the poor and want to see them lifted up to a better place. The truth is that with a few bad breaks any of us could end up in the ranks of the poor. Compassion is a virtue that all of us should seek to develop.

Not only that, but the less poor people and the less unemployed people we have, the better it is for our economy. When as many people as possible in a nation are working and doing something economically productive, that maximizes the level of true wealth that a nation is creating.

But today we are losing out on a massive amount of wealth. We have tens of millions of people that are sitting at home on their couches. Instead of creating something of economic value, the rest of us have to support them financially. That is not what any of us should want.

It is absolutely imperative that we get as many Americans back to work as possible. The more people that are doing something economically productive, the more wealth there will be for all of us.

That is why it is so alarming that the ranks of the "very poor" are increasing so dramatically. When the number of poor people goes up, the entire society suffers.

So just how bad are things right now?

The following are 19 statistics about the poor that will absolutely astound you....

#1 According to the U.S. Census Bureau, the percentage of "very poor" rose in 300 out of the 360 largest metropolitan areas during 2010.

#2 Last year, 2.6 million more Americans descended into poverty. That was the largest increase that we have seen since the U.S. government began keeping statistics on this back in 1959.

#3 It isn't just the ranks of the "very poor" that are rising. The number of those just considered to be "poor" is rapidly increasing as well. Back in the year 2000, 11.3% of all Americans were living in poverty. Today, 15.1% of all Americans are living in poverty.

#4 The poverty rate for children living in the United States increased to 22% in 2010.

#5 There are 314 counties in the United States where at least 30% of the children are facing food insecurity.

#6 In Washington D.C., the "child food insecurity rate" is 32.3%.

#7 More than 20 million U.S. children rely on school meal programs to keep from going hungry.

#8 One out of every six elderly Americans now lives below the federal poverty line.

#9 Today, there are over 45 million Americans on food stamps.

#10 According to the Wall Street Journal, nearly 15 percent of all Americans are now on food stamps.

#11 In 2010, 42 percent of all single mothers in the United States were on food stamps.

#12 The number of Americans on food stamps has increased 74% since 2007.

#13 We are told that the economy is recovering, but the number of Americans on food stamps has grown by another 8 percent over the past year.

#14 Right now, one out of every four American children is on food stamps.

#15 It is being projected that approximately 50 percent of all U.S. children will be on food stamps at some point in their lives before they reach the age of 18.

#16 More than 50 million Americans are now on Medicaid. Back in 1965, only one out of every 50 Americans was on Medicaid. Today, approximately one out of every 6 Americans is on Medicaid.

#17 One out of every six Americans is now enrolled in at least onegovernment anti-poverty program.

#18 The number of Americans that are going to food pantries and soup kitchens has increased by 46% since 2006.

#19 It is estimated that up to half a million children may currently be homeless in the United States.

Sadly, we don't hear much about this on the nightly news, do we?

This is because the mainstream media is very tightly controlled.

I came across a beautiful illustration of this recently. If you do not believe that the news in America is scripted, just watch this video starting at the 1:15 mark. Conan O'Brien does a beautiful job of demonstrating how news anchors all over the United States are often repeating the exact same words.

So don't rely on the mainstream media to tell you everything.

In this day and age, it is absolutely imperative that we all think for ourselves.

It is also absolutely imperative that we have compassion on our brothers and sisters.

Winter is coming up, and if you see someone that does not have a coat, don't be afraid to offer to give them one.

All over the United States (and all around the world), there are orphans that are desperately hurting. As you celebrate the good things that you have during this time of the year, don't forget to remember them.

We should not expect that "the government" will take care of everyone that is hurting.

The reality is that millions of people fall through the "safety net".

Being generous and being compassionate are qualities that all of us should have.

Yes, times are going to get harder and an economic collapse is coming.

That just means that we should be more generous and more compassionate than we have ever been before.

Michael Snyder is an attorney, a blogger, a writer, a speaker and an activist. He is currently the publisher of The Economic Collapse blog.