Author and psychiatrist James Phelps presented a thought provoking presentation about the notion of a mood spectrum (from very unipolar to very bipolar) and how that idea is changing the way that clinicians work with people with depression.
The title of the presentation was “A More Nuanced View of Hypomania” but the talk itself is broader than that.
The spectrum that Jim is talking about goes from “pure unipolar” depression on the left to “pure bipolar” disorder on the right.
On the far left would be people who live exclusively in a world of varying shades of grey or black: sometimes they may be only slightly depressed, and sometimes they are very depressed.
The goal of treatment for these people is to do whatever is possible to counteract the forces that make them depressed.
On the far right are people who go from extremes of mania to extremes of depression. All too often this is the view of bipolar disorder that the public and, sadly, even mental health professionals, have in mind.
For these people clearly the goal is to help them to achieve stability and to reduce the extreme fluctuations of mood.
In the middle are people who have varying degrees of bipolarity. From those who have recurrent hypomanias (mild manias) that are clearly identifiable, to people who have less clear shifts of mood into varying states of increased energy. States that may be hard to distinguish from their “normal” not depressed state.
One important point that Jim makes early in the presentation is that the reason our diagnostic system (DSM-5) does not focus on a dimensional approach is not because of some drive to “label” people that is unique to psychiatry. It is because the nature of language, and communication, is that we have to have short cuts for describing things.
He quotes Eduard Vieta –
“Dichotomies are useful for education, communication and simplification…
Unfortunately simplification is useful but untrue — whereas complexity is true but useless.”
To put it another way, if I strive to perfectly capture the uniqueness of an individual’s experience of mood, that process will take a great deal of time and will not allow me to form any conclusions about what to do to help that person. To make treatment suggestions I have to be able to match a person up with others who are similar enough that the experiences of treatment with those people can inform my treatment of the person I am seeing.
I urge readers to watch the presentation…