Graham sat in my office reeling off past diagnoses like a keen traveller recounting all the places they’d been. But he didn’t sound keen at all.

Graham continued: “Over the years I’ve been given so many different labels and treated with so many different drugs. It’s like I’ve forgotten who I am beneath all the conditions I’m supposed to have; all the medications I’ve swallowed.”

“Do you believe any of these diagnoses?” I asked. “I used to, because, well they’re the experts. But I’ve had so many things supposedly wrong with me over the years it’s like they’ve run out of ideas.”

For some it can feel like a relief to be told what’s “wrong”. It was for Graham. But there are dangers to being labelled. Dangers perhaps you need to know about.

The Power of Diagnoses

It’s a big thing to be diagnosed, told you ‘have something’ – to be persuaded by authority that you can only expect to ‘manage’, not cure, some condition you didn’t know you had.

Another major possible pitfall with being tagged with bipolar disorder (or any psychiatric label) is that so-called experts will also become biased in their perception of you. Any signs of individuality or personality may come to be seen as evidence of your bipolar illness.

Self fulfilling prophecies are powerful if you believe yourself to be sick. But so are professional expectations: “He/She is sick therefore everything they say or do is a sign of that sickness.” Psychiatrists and doctors can and do get it wrong and the consequences can be really bad.

Being Sane in Insane Places

The 1973 experiment in which psychologically healthy volunteers had a real problem convincing psychiatrists they weren’t psychotic and therefore getting released from hospitals, showed just how shaky so called ‘expert diagnoses’ can be. The psychiatrists believed those participating in the experiment were genuinely psychotic and once experts’ minds are made up they’ll tend to see anything you say and do as ‘evidence’ that you have what you’ve been diagnosed with – even, sadly if the diagnosis wasn’t correct.

So if psychiatrists can’t reliably tell who is psychotic and who isn’t, should we be so unquestionably trustful of their diagnoses – especially when we consider the powerful effects of labelling.

Maybe you genuinely do have bipolar disorder. But if you or someone you know has been given this tag I want you to read on and consider the possibility that you don’t.

Poles Apart

Someone is said to be suffering from bipolar disorder if they regularly swing between deep depression and hypo-manic states. These ‘high’ states can include psychotic delusions, hearing voices, seeing things that are not there, ‘disordered thinking’ wild spending of money, following unrealistic goals, believing oneself to be special or on a ‘special mission’. One manic man I knew believed himself to be the King of England when he was ‘up.’

In my experience of people suffering from this kind of bipolarity the person who is ‘high’ is often unrecognizable from the person who is ‘low’. On the way ‘up’ the sufferer may experience intense productivity and creativity. It’s when the productivity breaks free of all rational constraints problems occur.

After he swung down again he could do nothing. I really mean nothing. He sat in the same chair in the hospital for twelve hours a day before sleeping in his bed. He had no energy, no motivation for anything. The depression was just as complete as the high had been. This is what bipolar used to be.

With true bipolar disorder it really is all or nothing. What is now called bipolar disorder used to be known as ‘manic depression.’ So how did ‘manic depression’ come to be re-branded ‘bipolar disorder’ and why does it matter?

Inventing Illnesses

In the old days before medicine was driven so much by, what are essentially, enormous marketing companies, there would be a pre-existing illness and scientists would work hard to discover a treatment or cure for it.

But now pre-existing drug products are in need of more illnesses to treat. Imagine that. A drug exists but doesn’t have a big enough ‘market.’ One effective way around this business problem is to widen the definition of what is ‘ill’ so that a bigger market is created and more drugs can be sold.

This form of the illness is so powerful that sufferers often need to be hospitalized. The re-branding of manic depression as bipolar disorder was a marketing strategy – not a scientific discovery.

Ten people in a million is a paltry market if you have drugs to sell. But if you can widen the net, so as to gain more ‘customers’ you can have yourself a blockbusting, best-selling drug.

From 10 in a Million to 1 in 20

Purveyors of drug products have convinced doctors (those at the front line of prescription) that the normal spectrum of ‘mood disorders’ (another term made up by marketeers) are really indicative of an ‘underlying’ case of bipolar disorder, so it’s best to catch this genetic illness early so that it isn’t allowed to wreck lives. No reasonable person could argue with that. Fortunately, I’m not reasonable.

From a financially unprofitable ten in a million we now have one in twenty who are supposedly bipolar. But be clear, the new bipolarity wasn’t discovered by psychologists, it was concocted by marketing people. Obviously, one in twenty people aren’t having the dizzying highs and crushing lows I described earlier.

The Unstoppable Rise of ‘Mood Stabilizers’

Once you start peering into the world of pharmaceutical treatments you start to see what an upside down, back to front Alice-through-the-looking-glass kind of world it really is. Take the so-called ‘mood stabilizer’ drugs for instance.

As mood stabilizer drugs were developed the apparent prevalence of ‘mood disorders’ rose sharply. A real coincidence! Millions more people were labelled (or as the pharmaceutical companies would have it “recognized as having”) bipolar disorder.

Dapakote was approved by the FDA (US Food & Drug Administration) but only for the manic phase of what used to be called manic depression. But why did Abbott dream up the phrase ‘mood stabilizer?’ (just to re-emphasize; this wasn’t initially a psychological term but a marketing one).

Here’s why: Because the FDA ruled that Dapakote wasn’t a prophylactic (which means it doesn’t prevent mood swings). So if Abbott had claimed their wonder drug could prevent mood swings they would have broken the law; although as it turns out they did, so how do they get around this and imply that Dapakote does prevent mood swings? They invent the phrase ‘mood stabilizer.’

Mood Swings in Babies?

So the huge pharmaceutical juggernaut that is Abbott Laboratories didn’t just market their new drug product; they marketed a whole new condition. Suddenly the world and his dog are now being diagnosed as bipolar. And it gets scarier.

Of course pregnant woman should never take Dapakote because of multiple risk of birth defects but crazily, some marketeers have even recommended in-vitro scanning for bipolar disorder to see whether foetuses have the condition!

How We Medicalized Being Human

So if you have been wrongly diagnosed (by however convincing and esteemed an expert) with this once rare illness in its new, re-branded and now hugely financially rewarding guise does that mean there is nothing wrong at all?

Not necessarily. This isn’t to say that people branded as bipolar don’t have emotional problems. They very likely do. Their emotional difficulties are what perhaps led them to seek help in the first place.

Labelling others as bipolar because they sometimes have emotional problems is like saying someone has ‘gigantism’ or ‘dwarfism’ because they’re either a bit taller or shorter than the average height.

We weren’t put here on this earth to serve the monetary needs of pharmaceutical companies.

So If You’ve Been Told You Are Bipolar, Are You Really?

Well you might be bipolar in the sense that you may now fit the new criteria. In the same way that if we were told the average IQ level was now 200 (instead of 100) we might all then fit the criteria of being of below average intelligence.

“But look! You fit the symptoms!” is no good if the ‘symptoms’ have been engineered to capture a big share of the market.

So if you have been told you are bipolar, the chances are that you aren’t – not really. If you don’t have a history of the kind of wild mania I was describing, hallucinations, and wildly fluctuating energy, bouncing between body-paralyzing despair then back up to the heady mountain peaks of psychotic delusion, then what you have may be a healthy dose of the human condition. Period.

Think Twice

Be sceptical, especially if someone is trying to ‘sign you up’ and convince you to take medication long term. And while we’re at it, when did doctors become drug dispensers above and beyond all else?

Graham didn’t have manic depression but he might have fitted the criteria of someone with a ‘mood disorder’ – widen the net and you catch more customers.

Together we helped Graham manage stress better, understand what his needs were and how to meet them healthily, how to spot the very first signs his mood might be changing and what to do to stop himself going all too deep into despondency or anxiety.

Graham did start to feel strong, healthy and was bit by bit able to genuinely deal with his life problems with enough support. He started to feel that there was nothing wrong with him, not essentially. “I’m alright, aren’t I?” he announced one day.

“Yes,” I winked at him, “but keep that quiet as some might say even thinking that is a symptom of not being.” He laughed, but told me he was sad for the pharmaceutical cul-de-sac he’d travelled down for so long.

“Graham,” I said. “Normal humans feel sad sometimes.” And we both took a minute to think that through.

The thing is, if Brandon were a real child, he would have just been misdiagnosed with bipolar disorder.

Also known as manic depression, this serious condition, involving dramatic mood swings, is increasingly being recorded in American children. And a vast number of them are being medicated for it.

How did this strange, sweeping misdiagnosis come to pass? How did it all start? These were some of the questions I explored when researching The Psychopath Test, my new book about the odder corners of the “madness industry”.

Freudian Slip

The answer to the second question turned out to be strikingly simple. It was really all because of one man: Robert Spitzer.

I met Spitzer in his large, airy house in Princeton, New Jersey. In his eighties now, he remembered his childhood camping trips to upstate New York. “I’d sit in the tent, looking out, writing notes about the lady campers,” he said. “Their attributes.” He smiled. “I’ve always liked to classify people.”

The trips were respite from Spitzer’s “very unhappy mother”. In the 1940s, the only help on offer was psychoanalysis, the Freudian-based approach of exploring the patient’s unconscious. “She went from one psychoanalyst to another,” said Spitzer. He watched the psychoanalysts flailing uselessly. She never got better.

Spitzer grew up to be a psychiatrist at Columbia University, New York, his dislike of psychoanalysis remaining undimmed. And then, in 1973, an opportunity to change everything presented itself. There was a job going editing the next edition of a little-known spiral-bound booklet called DSM – the Diagnostic and Statistical Manual of Mental Disorders.

What nobody knew when they offered Spitzer the job was that he had a plan: to try to remove human judgement from psychiatry. He would create a whole new DSM that would eradicate all that crass sleuthing around the unconscious; it hadn’t helped his mother. Instead it would be all about checklists. Any psychiatrist could pick up the manual, and if the patient’s symptoms tallied with the checklist for a particular disorder, that would be the diagnosis.

For six years Spitzer held editorial meetings at Columbia. They were chaos. The psychiatrists would yell out the names of potential new mental disorders and the checklists of their symptoms. There would be a cacophony of voices in assent or dissent – the loudest voices getting listened to the most. If Spitzer agreed with those proposing a new diagnosis, which he almost always did, he’d hammer it out instantly on an old typewriter. And there it would be, set in stone.

“Post-traumatic stress disorder,” said Spitzer, “attention-deficit disorder, autism, anorexia nervosa, bulimia, panic disorder…” each with its own checklist of symptoms. Bipolar disorder was another of the newcomers. The previous edition of the DSM had been 134 pages, but when Spitzer’s DSM-III appeared in 1980 it ran to 494 pages.

DSM-III was a sensation. It sold over a million copies – many more copies than there were psychiatrists. Millions of people began using the checklists to diagnose themselves. For many it was a godsend. Something was categorically wrong with them and finally their suffering had a name. It was truly a revolution in psychiatry.

“The pharmaceuticals were delighted with DSM,” Spitzer told me, and this in turn delighted him: “I love to hear parents who say: ‘It was impossible to live with him until we gave him medication and then it was night and day’.”

Spitzer’s successor, a psychiatrist named Allen Frances, continued the tradition of welcoming new mental disorders, with their corresponding checklists, into the fold. His DSM-IV came in at a mammoth 886 pages, with an extra 32 mental disorders.

Now Frances told me over the phone he felt he had made some terrible mistakes. “Psychiatric diagnoses are getting closer and closer to the boundary of normal,” he said.

“Why?” I asked. “There’s a societal push for conformity in all ways,” he said. “There’s less tolerance of difference. Maybe for some people having a label confers a sense of hope – previously I was laughed at but now I can talk to fellow sufferers on the internet.”

Part of the problem is the pharmaceutical industry. “It’s very easy to set off a false epidemic in psychiatry,” said Frances. “The drug companies have tremendous influence.”

“So maybe the diagnosis is good?” “No,” Frances said. “And there are very good reasons why not.” His main concern is that children whose behaviour only superficially matches the bipolar checklist get treated with antipsychotic drugs, which can succeed in calming them down, even if the diagnosis is wrong. These drugs can have unpleasant and sometimes dangerous side effects.

Knife Edge

The drug companies aren’t the only ones responsible for propagating this false epidemic. Patient advocacy groups can be very fiery too. The author of Brandon and the Bipolar Bear, Tracy Anglada, is head of a childhood bipolar advocacy group called BP Children. She emailed me that she wished me all the best with my project but she didn’t want to be interviewed.

Anglada’s friend Bryna Hebert has also written a children’s book: My Bipolar, Roller Coaster, Feelings Book. “Matt! Will you take your medicines please?” she called across the kitchen when I visited her at home in Barrington, Rhode Island. The medicines were lined up on the kitchen table. Her son Matt, 14 years old, took them straight away.

The family’s nickname for baby Matt had been Mister Manic Depressive. “Because his mood would change so fast. He’d be sitting in his high chair, happy as a clam; 2 seconds later he’d be throwing things across the room. When he was 3 he’d hit and not be sorry that he hit. He was obsessed with vampires. He’d cut out bits of paper and put them into his teeth like vampire teeth and go up to strangers. Hiss hiss hiss. It was a little weird.”

“Were you getting nervous?” I asked. “Yeah,” said Hebert. “One day he wanted some pretzels before lunch, and I told him no. He grabbed a butcher knife and threatened me.” “How old was he?” “Four. That was the only time he’s ever done anything that extreme,” she said. “Oh, he’s hit his sister Jessica in the head and kicked her in the stomach.” “She’s the one who punched me in the head,” called Matt from across the room.

It was after the knife incident, Hebert said, they took him to be tested. As it happened, the paediatric unit at what was then their local hospital, Massachusetts General, was run by Joseph Biederman, the doyen of childhood bipolar disorder. According to a 2008 article in the San Francisco Chronicle, “Biederman’s influence is so great that when he merely mentions a drug during a presentation, tens of thousands of children will end up taking it.” Biederman has said bipolar disorder can start, “from the moment the child opens his eyes”.

That was 10 years ago and Matt has been medicated ever since. So has his sister Jessica, who was also diagnosed by Biederman’s people as bipolar. “We’ve been through a million medications,” said Hebert. “There’s weight gain. Tics. Irritability. Sedation. They work for a couple of years then they stop working.”

Hebert was convinced her children were bipolar, and I wasn’t going to swoop into a stranger’s home for an afternoon and tell her they were normal. That would have been incredibly patronising and offensive. Plus, as the venerable child psychiatrist David Shaffer told me when I met him in New York later that evening, “These kids can be very oppositional, powerful kids who can take years off your happy life. But they aren’t bipolar.”

“So what are they?”

“That’s an enormous label that’s going to stay with you for the rest of your life. You’re being told you have a condition which is going to make you unreliable, prone to terrible depressions and suicide.”

The debate around childhood bipolar is not going away. In 2008, The New York Times published excerpts from an internal hospital document in which Biederman promised to “move forward the commercial goals of Johnson & Johnson”, the firm that funds his hospital unit and sells the antipsychotic drug Risperdal. Biederman has denied the allegations of conflict of interest.

Frances has called for the diagnosis of childhood bipolar to be thrown out of the next edition of DSM, which is now being drawn up by the American Psychiatric Association.

A Tragic Case Study

The autopsy revealed that Rebecca’s parents had given her an overdose of the antipsychotic drugs she had been prescribed for her bipolar disorder. They had got into the habit of feeding her the medicines to shut her up when she was being annoying. They were both convicted of Rebecca’s murder.

Rebecca had been diagnosed as bipolar at 2-and-a-half, and given medication by an upstanding psychiatrist who was a fan of Biederman’s research into childhood bipolar. Rebecca had scored high on the DSM checklist, even though like most toddlers she could barely string a sentence together.

Shortly before her trial, Carolyn Riley was interviewed on CBS’s 60 Minutes show by Katie Couric:

Key Insights from Both Articles