In
the fourth paragraph of the preface, Mitzi Waltz explains why she wrote this
book. "This book is intended to
bring together all the basic information needed by people diagnosed with a
bipolar disorder."

This was a formidable task to set for
herself, but in my opinion she is eminently successful. I recommend the book,
without reservation, not only to bipolar patients, but also to their families,
their friends, their caretakers, and to the clinicians who prescribe medicine
and other treatment modalities for them.

The
preface, chapters and appendices are all clearly written, without unnecessary
medical or psychiatric jargon. Each of the eight chapters is divided into
short, comprehensible sections with appropriate headings. There are over one
hundred of these sections, any one of
which can be meaningfully read by itself. Generally speaking, chapter subjects
fall into four categories: diagnosis; treatment; insurance and healthcare
systems; and strategies for survival with bipolar disorder.

One
of the most useful and interesting parts of the book is Chapter 7,
"Healthcare and Insurance." In a sub-section entitled "Making
insurance choices," seventeen practical nuts-and-bolts questions are
listed, for use in choosing an insurance plan. For example: How are the
insurance plan’s doctors paid–are they penalized or rewarded for referrals to
specialists, number of office visits, hospitalizations or any similar actions?
Does the plan pay for a second opinion if you request one? Does the plan have a
"gag order" which prevents doctors from informing you of all
treatment options?

In
the section entitled "Managing managed care," the author acknowledges
that HMO’s and their physicians are apt to consider patients with long-term
conditions as obstacles in the way of their profits. However, instead of
complaining about the injustices of these systems, she offers sound and
detailed advice as to how patients can profitably use them.. Some of the topics
covered are: fighting limits on psychiatric care; fighting denial of care;
resolving grievances; and filing appeals. In a sub-section titled
"Semi-sneaky tips" she suggests a method for penetrating the
interminable cycle of recorded messages in automated phone systems, in order to
establish contact with a real person.

Chapter
7 also contains descriptions of military healthcare coverage, Medicare,
Medicaid–including the possibility of waivers of certain income limitations under specific
circumstances–SSI, and state and local public health plans. This chapter also
describes healthcare systems in Canada, England and Scotland, the Republic of
Ireland, Australia and New Zealand.

Chapter
8, "Living with Bipolar Disorders," is also a treasure trove of
suggestions and recommendations about how to deal with the negative effects
bipolar disorders can have on people’s lives. Waltz refers to this body of
recommendations as "a guideline for self-care." The chapter contains
quotations from bipolar patients describing their personal experiences with
social, financial, professional and
occupational losses caused by bipolar episodes, and the strategies patients
have developed for dealing with and living with these losses.

One of
the strategies recommended is the journal method, "The mood and behavior
diary." This method I have
personally found to be effective for bipolar patients I have treated in private
and public psychiatric facilities. As the author describes, patients who make
daily notes about their mood and behavior learn to recognize early warning signs
of manic, depressive, or psychotic episodes and to take appropriate methods to
abort them. In this section is included a daily mood and behavior worksheet
containing thirty-one Yes/No questions.

The
following list of additional section headings will give some idea of the
breadth and scope of this chapter: "Bipolar disorders at college,"
"Bipolar disorders at work," "Housing," "Legal and
financial planning," "Family relationships," "Suicide
prevention," "Criminal justice and mental illness,"
"Maintaining your sanity," and "Hold on to hope."

Appendix
A, "Resources," provides addresses, telephone numbers, fax numbers
and email addresses of advocacy and support groups in the United States,
Canada, UK, Ireland, Australia and New Zealand. Public mental health agencies,
state and federal, are also listed for the same countries, as well as books and
publications, videos, and online resources. Contact information for some of the
world’s best-known diagnostic and treatment
centers is also included in this appendix.

The first three chapters are concerned
with the problem of diagnosing bipolar disorders. Chapter 1 proposes a
definition, discusses the various types, and explains some of the causes of
bipolar disorders. Chapter 2 explains how mental health specialists use
diagnostic interviews and tests to establish a definite and specific diagnosis.
Chapter 3 discusses the difficulty of differentiating bipolar disorders from
other diseases that contribute to the symptoms and tend to confuse the diagnostician. Some of the conditions
discussed are: ADHD; Anxiety; Conduct disorder; Cushing’s disease; Depression;
Diabetes mellitus; Fibromyalgia; Hormonal disorders; Hypoglycemia; Lupus;
Medication side effects; Multiple sclerosis; Personality disorders; Psychosis;
Rheumatoid Arthritis; Substance abuse; Schizophrenia; Schizoaffective disorder;
Thyroid disorders; Aids; Chronic fatigue syndrome; Hepatitis; Infectious
mononucleosis and Siezure disorders.

I am afraid that these detailed
discussions of diagnosis are more apt to confuse than enlighten the bipolar
patient. In my experience, even the most highly educated and broadly
experienced of us mental health specialists have difficulty applying the
convoluted diagnostic criteria of DSM-IV to individual patients. When I
reviewed medical records of patients admitted to a local crisis center, I
frequently found as many as ten different DSM-IV diagnoses for the same patient
by different specialists within a period of two or three years. In 1968, when
DSM-II was published, there were only four variations of manic-depressive
illness–the diagnostic forerunner of bipolar disorder. Now, in DSM-IV, there
are eight variations of bipolar disorder, which tends to increase the
difficulty of accurate differential diagnosis.

I also doubt the wisdom of the long,
involved discussion of the causes of bipolar disorder. That there is some
genetic predisposition is beyond doubt, given the increased incidence in
children of bipolar patients. However, our knowledge of brain structure and
function, neural circuits, neurotransmitters, chemoarchitecture, and the roles
of various enzymes and other "brain messengers" is till scanty and
incomplete.

Many philosophers have warned us against
the fallacy of believing that a mind can ever understand itself completely.
Shakespeare has Hamlet say "There are more things in heaven and earth,
Horatio, than are dreamt of in your philosophy." I think we should take
these caveats seriously and not pretend to ourselves and to bipolar patients that
we understand more about their condition than we actually do.

Bipolar patients will find invaluable
suggestions in this book about how to cope with their condition, how to obtain
treatment and how to pay for it. Family members, caretakers, and clinicians in
the US and other English-speaking countries can also learn a lot. Waltz
deserves a vote of thanks from all of us for the tremendous effort and
dedication she demonstrated by assembling all of this information into one
volume.

© 2003 Jack
R. Anderson

Jack R. Anderson, M.D. is a
retired psychiatrist living in Lincoln, Nebraska.

Categories: Depression, Psychology