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Comment by blame_lewis | Hacker News Reader

Thank you for that! I hadn't seen it before.

I'm a little nervous about the idea of coming to conclusions about individual outcomes based on national surveys of self-reported diagnoses. It seems like there are vast opportunities for outside factors to mislead attempts at analysis.

For example, the proportion of people who were misdiagnosed to start with; the increased openness over time when it comes to accepting or speaking about the diagnosis; the improvement in mental health resources meaning more diagnoses; the possibility that patients decompensate and lose insight or reject diagnoses over time; etc etc.

If you're thinking "that sounds like a No True Scotsman", you're right. The disease is clearly progressive for some people. Declaring that people who don't demonstrate that progression don't have the disease is semantically useless but may be clinically useful.

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I think a large part of the problem lies in the difficulty of accurate diagnosis, coupled with people's personal experiences with misdiagnosis.

I've been misdiagnosed as bipolar in the past, and the medication regime I was put on lead to schizoid delusions and incredibly unstable emotional state that only resolved once I stopped taking the medication (under the monitoring of the psychiatrist who initially prescribed them).

My mother was also misdiagnosed as bipolar, leading to her actual condition of Borderline Personality Disorder going untreated until she attempted suicide (she died 6 months after because of complications relating to the attempt).

A friend of mine who is schizophrenic was also misdiagnosed as bipolar, because his delusions and paranoia were fairly minimal. In his case, the misdiagnosis was probably more helpful than not, as the medications were helpful in stabilising his mood.

My point here isn't that the medical establishment is bad or that doctors are stupid. It's that disorders related to mental illness are very, very difficult to diagnose and treat, even for incredibly intelligent trained professionals. Many disorders have significant overlap with other disorders. An effect whose impact is only made worse by the fact that a bunch of these disorders are highly co-morbid. Mix in the fact that the borders between healthy and unhealthy are not especially well defined, and it's easy to see where a lot of the contention comes from

I'll add that someone who might be (self-)destructively bipolar in one environment, might be able to 'manage' in another, even without medication.

I've had multiple friends with diagnosed bipolar disorder, and harrowing and heartbreaking stories of how this affected their lives well into their twenties or even early thirties.

All of them have found ways to 'manage' their condition, without medication, through a combination of lifestyle changes, (odd) environments, and, perhaps most importantly, a group of friends who can deal with it or provide support in various ways. Some of them have been on medication for periods, and much prefer their current, imperfect situation.

By no means would I advocate avoiding medication, and I'm absolutely not saying that this can work for everyone. I'm also not arguing that their lives are just peachy now. It's a serious disorder.

And I do agree that people making statements like "we're all a little bipolar/autistic/borderline/etc." are often not helping and often actively harming those who are any of that more than 'a little'.

I've been diagnosed with autism and it's maddening how often, when I open up about it, people will say stuff like "well isn't that 'just' <x>" or "everyone has that". At this point I usually don't even bother trying to explain that there's a difference between, say, being punctual and curmudgeonly about it, and having a borderline-meltdown when plans change.

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