I have ADHD the combined type and Bipolar One the manic type. Why is there no
information about these comorbid diseases as a single pathology?
That, Jeff, is an outstanding question. I think
you're way ahead of most psychiatrists I've heard speak on this; in fact I've
never heard anyone wonder aloud about whether these two diagnoses are actually
one thing in some way, at least in some people. At minimum I can tell you
that several patients of mine had "ADD" diagnoses and were on
stimulants, but after treatment for their mood instability they did not seem to
need stimulants anymore. However, several others (and I can't see what
makes one of these folks different from the others) whose stimulants I stopped
out of a concern about creating more mood instability did not do as well in
terms of concentration until I put the stimulant back in. On the other
hand, this is a very small number of folks and I'm still not convinced it's
really safe to take a stimulant for focus and concentration if you have bipolar
There are probably some ADD specialists out there who
would not appreciate hearing me talk like that. On the other hand, there's
Fredrick Goodwin, former head of NIMH, who said (paraphrasing) "I'd much
rather call someone bipolar and be wrong than call someone ADD and be wrong,
treat them with stimulants, and risk making their bipolar disorder worse"
-- so at least that well-known authority shares my concerns.
Anyway, the question about "co-morbidity"
versus "a single pathology" is definitely a wise one, but I've not
seen any writing on this either. It's frustrating to me too to hear people
continue to speak about "co-morbidity" as though the division between
the two entities is a foregone conclusion (anxiety in bipolar disorder is
exactly the same story, and even "OCD" sometimes merits the same kind
In my view, the bottom line is that we don't really
know what causes these various illnesses anyway -- so dividing them is arbitrary
until we know more, and if we forget that we have arbitrarily divided
them, we have forgotten something important. Of course there are some
clear benefits in trying to divide these things so we can classify them
better and try to understand them better.
Here's one quote you might like though.
Paraphrasing again: when it comes to flowers and such, there are botanists and
there are gardeners. The gardeners are content to look at "all blue
flowers" together as a group, regardless of genus/species/etc.
(Here's the direct quote part) "The DSM is for gardeners".
Thanks for the opportunity for that soapbox.
Published March, 2002