I don’t know this lady or her struggles, but the article paints a very clear picture of someone with childhood-onset bipolar disorder who has gone from manically creative highs to depressing lows.
Strangely, there was no mention of it, aside from “relentless anxiety and depression, eating disorders, exercise addiction, obsessive-compulsive tendencies.” All of these are common comorbidities in bipolar individuals.
That maybe important for a practioiner. But otherwise these labels don't have much meaning.
Obviously her situation is unique. Although it may fall under the umbrella of some DSM definition, but the meaning there is only for a medical perspective and not "a human perspective". We cannot be reduced to some statistical artefact. We may statistically significantly share some common traits with other people, but it doesn't make us the set of these common traits.
The model is not reality especially so for the DSM, which was built in a medically theraputic context. And should be taken as such.
Many therapists use the DSM only for insurance purposes, as insurance companies demand an official diagnosis before covering treatment. The DSM's role in therapy itself is highly questionable.
> But otherwise these labels don't have much meaning.
Hard disagree, the experience of somone with bipolar is a lot different than somone who's schizophrenic or only has major depression or generalized anxiety. Mania and the specific difficulties it causes for psychosis are radically different than what the others have to deal with and so is the general unpredictability of life (for planning and commitment purposes) and especially the types of effects it has on relationships. Each of the disorders have totally different profiles subjectively and objectively and different things they have to deal with. It's definitely not just a "statistical artefact" dispite the possibility of multiple diseases causing the same symptom clusters.
And these experiences usually can't be reduced to the symptoms list in the dsm. These lists are very simplified models that are useful for certain things.
Misdiagnosing bipolar disorder as a purely depressive disorder can have disastrous consequences, especially if prescribed antidepressants instead of mood stabilizers. [1]
Genetic testing for clotting. Autoimmune work up.
Spinal tap for pressure.
Make a list every symptom, and what affects your symptoms. Take it to every kind of specialist. Then keep repeating. Take an advocate. I would explain stuff, could see they had mentally written me off. The wife would start bawling. This would wake them up, and they would dig further.
A neuro-ophthalmologist was reading my list. Looked up and declared I had Sjogrens. He was right. Now he missed the clotting disorder.
Then have a clot in your lungs. Then you get taken seriously. That’s when they found factor 5 Leiden.
> disastrous consequences, especially if prescribed antidepressants
Viewed differently, this speaks to the extreme dangers of psychiatric drugs. They should be a tool (vital!) of last resort but are often used as a frontline therapy.
I agree. It should go without saying that you only get one brain.
Fundamentally, anything that modulates the brain should be used with extreme caution. Although the brain is remarkably resilient, sometimes drug-induced changes or side effects can be permanent.
For some, this may come as relief, yet for others, they may find that the solution was worse than the problem. As they say, caveat emptor.
The theory has been that if you could find a single underlying cause, you could just treat that, and then all the symptoms would disappear in one go. This would also let you treat symptoms that can't be treated directly (you can tranquilise away anxiety, you can't do much about hearing voices).
That theory has largely failed as we can't even really agree which groups of symptoms make which diseases. Hence the constant changes to systems like the DSM.
Full disclosure, I may be bias and I'm also an example: I have Major Mood Disorder. I used to have Severe Clinical Depression. Before that, I had Treatment Resistant Depression. Before that it was just Clinical Monopolar Depression (It's still called monopolar sometimes to differentiate it from Bipolar). My symptoms haven't changed. Nor has the treatments offered. But in the last 10y we've repeatedly renamed, recategorised, reshuffled etc just common depression. God knows what it's like in more complex, less common symptom sets...
The BBCs Life Scientific podcast discusses this very question in this episode if you're interested:
It amazes me how complex the brain is. We are barely equipped with the tools to understand its complexity. An article I read earlier today on HN stated that the brain contains up to 11-dimensional neural networks. [1]
I think we’ve been incredibly lucky to have the fields of psychology and psychiatry to fill the medical role, especially when the quantitative gaps in our understanding of the brain seem to be widening.
This kind of constant relabeling and recategorizing along with everyone I know who works in mental health fields constantly diagnosing everyone around them is why I am skeptical of the entire field of psychology/psychiatry.
Look at it this way. Turbulence is an observable phenomenon that you may have experienced while riding an airplane.
Modern fluid dynamics cannot adequately explain turbulence. Richard Feynman has described turbulence as the most important unsolved problem in classical physics.[1] We don’t dismiss fluid dynamics because turbulence is ill-defined, and we also don’t deny that turbulence exists just because we lack a thorough mathematical understanding of it.
This is analogous to psychology/psychiatry and mental illnesses. If we had magical brain oscilloscopes that we could hook up to visualize every mental disorder, we’d use them. Until those exist, we must rely on qualitative and statistical approaches to provide treatment.
A unipolar depression is very different from a bipolar depression in many regards. E.g. likeliness to eat less vs. likeliness to eat more.
And a unipolar depression can possibly be treated and then be gone. (If the treatment works out.) If one has bipolar disorder, it won’t go away. One has to live with it the the whole life.
It's not strictly impossible, but it's highly improbable. If she was capable of writing that at 5 her whole life would have been on a different trajectory.
Sylvia Plath was publishing complex poetry at 8 and was already showing the intense and dark themes she's become an icon for at 14.
If you haven't dealt with what Plath or this woman has, or are some credentialed authority on early childhood development of exceptional children (or poetry), I can't understand why your speculation on this is worth listening to.
I know mental health is not HN’s primary focus, but the lack of attention to this story is (in my opinion) reflective of the state of mental health stigma in the US.
Even with Bernstein achieving the ever-elusive “American dream”, conversation surrounding this particular article’s topic is wearisome to some and even warrantless to others.
We need to do better. Publishing and discussing stories like this is just a start.
Mental health is real, and if you are struggling, please know that you are not alone, never will be, and should seek help to make you as happy as you deserve. There is nothing wrong with this, just like the maintenance necessary for anything utilized routinely.
I have bipolar disorder and I would generally tend to agree with you, but this article reads more like a PR piece for her toy company. "Existential Depression" is more of a pop diagnosis. If you google it you'll see a lot of articles about gifted people and existential depression - it's the depression you can feel good about because it implies you are gifted.
> But when she did Bernstein was able to stop hiding — and hating — so much of herself. “My therapy has been in accepting the paradox that light doesn’t come without dark and highs don’t come without lows,” she says. “That if I want to be creative to the extent I am, then it’s going to have a dark side. And it does.”
I think the big danger in trying to put a medical diagnosis on everything is that it gives a false sense of what is normal and abnormal. When I hear statements like xx% of people have issues with depression, one thought is, what if depression isn’t an illness, but just a variant of normal.
Throughout history many, many of the great people, especially creatives struggled with depression. The Greeks actually had melancholy as one of the 4 humors and accepted that a certain percentage of people would be melancholic.
Modern psychiatry and psychology seems to have a norm in mind and people who don’t fit that norm have an illness. See for example back when the DSM classified same sex attraction as a mental illness. Now we realize that it is just a normal variant of human sexuality and not an illness to be treated. Similar thing with ADHD. We are seeing 3 and 4 year olds put on medication. If you look at the life of Thomas Edison it seems he may have had what we would today call ADHD. If he had been medicated to be “normal”, would he have been able to do all those prodigious accomplishments?
Sometimes, there can be great benefit in seeing something not as a disease but just a variant of normal with some advantages and disadvantages compared to the typical, and accepting it.
There is also the consideration whether the abnormality causes distress to the patient.
As an example, the average gay person may not be distressed about being gay. However, the average trans person may feel uneasy about their physical body. This is why the DSM-V describes gender dysphoria, previously known as gender identity disorder. [1]
Feelings be damned, I think that anything that causes a person to feel bad, particularly bad feelings that stem from internal causes, should be considered a disorder. This is not a bad thing, since recognizing a problem is usually the first step to fixing it.
I listened to a lecture on psychology by The Great Courses and the lecturer said historically they stopped labeling gay people as having a mental illness because the patients did not respond to treatment, so the logic at the time was not whether the patients were not suffering.
The lecturer pointed out this made no sense because in other contexts doctors would not say if they can't treat it, it's not a disease.
I'm guessing the patients thought they were going to hell, or thought society was going to abuse them, or they wanted to be heterosexual so they could have kids or whatever and said "please make me not gay, doc". So they were suffering.
If "treating the gay" worked it might still be considered an illness today I guess.
My point is only the disease labels are arbitrary. And there's a downside to labeling things, especially thing you cannot effectively treat. Also, trusting Doctors without a dose of skepticism can be a mistake.
"I think that anything that causes a person to feel bad, particularly bad feelings that stem from internal causes, should be considered a disorder"
What if someone feels bad when they hurt someone else?
Should that be considered a disorder?
This is not just a theoretical question, as I've read that the military has been funding research in to whether drugs can be used to assuage feelings of guilt and distress some of their trained killers suffer from when they hurt/kill other people.
The military wants their soldiers to be more efficient killers and pesky feelings of guilt or suffering when they hurt/kill others gets in the way of that.
So should every source of negative feelings be extinguished, and should we all try to live life with a smile on our faces even when we engage in unethical or hurtful actions?
But Melissa in the article clearly isn’t debilitated. She functions better than 99.9% of all the people out there. In fact her depression, may actually contribute to what makes her so successful.
Here's a radical idea: except for drugs with a high abuse-liability, all psychoactive medications could be allowed "behind the counter" like pseudoephedrine. The psychiatrist's role becomes strictly advisory (coupled with medical malpractice waivers), and the patient is free to experiment with whatever substance they like so as to find their best fit. People already "self-medicate" for focus and arousal with xanthines in coffee and chocolate, and for anxiety with anxiolytics like gabanergic ethanol in alcohol and partial serotonin agonist cannabidiol in cannabis. This is just opening the floodgates a bit more for those who aren't afraid to learn about psychopharmacology and work closely with their doctor in managing their mood and attention.
If this sounds crazy or spurious, then you'll probably agree that fixing abnormal psychology is actually as complicated as debugging the world's most complex software system.
From a standpoint of value in a capitalist society she’s not debilitated if she makes money. From a standpoint of living a life where one is fulfilled and has peace of mind, money isn’t the relevant metric.
Form the article, it seems she has a happy relationship with her husband and 6 children.
She is able to do something that she truly loves and is good it (designing toys, which the article mentions gives her euphoria).
She has brought joy to thousands ( if not millions) of children through her work.
Herb toys are actually beneficial to children in terms of stimulating their imagination and creativity unlike a lot of other things that are marketed to children.
Even apart from the money, she has had a good life. And it seems, from the article, that she has embraced the way she is (both the good and the bad) and has found peace with it.
She called it dark side. And by the sound of it, she would happily do without dark side. Which is why she finally went to therapy.
> She battled eating disorders, exercise addiction, obsessive-compulsive tendencies, a nagging sense of worthlessness, doubts that life had any meaning or purpose, and the routine emergence of suicidal thoughts. [...] By junior high she’d learned how to starve herself. [...] suffered a mental breakdown and seriously considered suicide
That happy marriage and kids were heavily affected too. Yes she loved them. Read this:
> It was imperative for them to be the very best athletes, brightest students and most popular of their peer group to ensure my sense of wholeness,” she writes, rather than — as she puts it — “choosing to be average.”
She was not happy nor in peace with herself. She was deeply unhappy, using activity and perfectionism to prevent mental descent into darkness.
> Modern psychiatry and psychology seems to have a norm in mind and people who don’t fit that norm have an illness.
This isn't it. The diagnoses usually have criteria for the symptoms being a problem for the persons functioning. People don't seek help because they're a bit diffeent but because they're suffering to the point of having difficulty living.
Make sure you don't empathize with her, because there's no possible reason to discuss her mental illness in public except for PR purposes. You can tell, cause she's rich.
I don't agree with that sarcastic statement, but I have been noticing lately that most of the really popular accounts of depression tend to come from really successful people, and I do wonder if their narratives might be distorting what depression is like for the rest of us... and particularly for those who are very far from being CEO's, famous actors/actresses, bestselling authors, etc.
Strangely, there was no mention of it, aside from “relentless anxiety and depression, eating disorders, exercise addiction, obsessive-compulsive tendencies.” All of these are common comorbidities in bipolar individuals.