Letter to the Psychiatric Times editor: Mania and Hypomania: The Latest Thinking on Duration of Episodes and Other Features

Dear editor,

In response to the October 29, 2019, article by Dr. David Osser, I would like to share insight into diagnostic modeling from the patient perspective.

https://www.psychiatrictimes.com/article/mania-and-hypomania-latest-thinking-duration-episodes-and-other-features

I’ve got bipolar. Both I and II. And schizoaffective disorder. And . . . anything else diagnosed in that 15 minute span of presentation at the ER, which is where I received each of these diagnoses.

For me, an initial diagnosis is a great place to start deciding how to treat my symptoms. After that, the game plan is to treat my specific symptoms and not the diagnosis. Providers sometimes miss this essential progression in treating peers because of adherence to diagnostic criteria.

My significant issue with bickering about manic durations is that showing symptoms for too short a span (it appears 7 days for mania and 4 days for hypomania) serves the primary medical rationale “We might treat it wrong if we don’t have the proper diagnostic definition.”

I’ve been riding this rodeo since 1987, diagnosed in 1999. I’ve had rapid cycling with frequencies every hour and not days. Some providers question the existence of mixed episodes. I’ve had a provider insist I treat psychosis first because of the schizoaffective diagnosis, when the psychosis is consequential of severe depression. Treat the depression, the psychosis goes away.

In all this time messing about with treatment, there is one constant:


All mental health treatment is trial and error.


So, does it really matter about the duration of mania in treatment? I’m showing mania-oid symptoms that happen to last three days. Try me out on some LiCO3. If my mania-oid symptons abate, bam, good job. It’s mania. If not, then . . . let’s trial and error other treatment options.

Being practically cynical, adhering to a minimum episodic duration means peers like me won’t receive the proper treatment of mania because I don’t meet the diagnostic criteria. This is exactly the contrary argument being debated for a revised two day episodic duration . . . even with the proposed revision, my true treatment needs again fall outside the diagnostic capture zone.

Being fully cynical, I often believe the DSM is a billing manual more than a diagnostic treatment manual. This is borne primarily from years of trial and error treatment efficacy frustrations and probably isn’t a reflection of actual purpose.

All said, my sincere recommendation for providers is treat the person and the empirical symptoms and not the diagnosis and diagnostic criteria. This is what works best for me in my recovery journey.

Kindest regards

Steve Bringe
Founder, Stand Up To Stigma

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