Written by: Dr.
E. Fuller Torrey (Note: moodswing.org has added
the photos and some of the more recent medical research references in
History of the Scientific View on Bipolar Disorderas
a Disease: It has been suspected for over a century that both schizophrenia
and manic-depressive disorder (bipolar disorder) are diseases of the brain.
In 1837, Dr. W.A.F. Browne, the best-known English psychiatrist of his
"Insanity, then, is inordinate or irregular, or impaired action
of the mind, of the instincts, sentiments, intellectual, or perceptive
powers, depending upon and produced by an organic change in the brain."
In that same year, Dr. Amariah Brigham, one of the founders of American
psychiatry, also wrote that insanity "is now considered a physical
disorder, a disease of the brain."
It would be 150 years, however, before these statements could be proven.
Since the early 1980s, with the availability of brain imaging techniques
and other developments in neuroscience, the evidence has become overwhelming
that schizophrenia and manic-depressive disorder are diseases of the
brain, just as multiple sclerosis, Parkinsons disease, and Alzheimers
disease are diseases of the brain. [our emphasis added] The brains
of individuals with these diseases are measurably different from individuals
who do not have these diseases, both structurally and functionally.
A brief summary of some of the evidence that proves this point follows.
Enlaged Ventricles in the Brain:
Individuals with bipolar disorder and schizophrenia, including those
who have never been treated, typically have enlarged ventricles in the
brain, as demonstrated in over 100 studies to date.
above: MRI imaging showing differences in brain ventricle
size in twins - one schizophrenic, one not. (image courtesy NIH - Dr.
Daniel Weinberger, Clinical Brain Disorders Branch)
Enlarged Amygdala: Individuals
with manic-depressive disorder have an enlarged amygdala and increased
numbers of white matter hyperintensities.
Neurological Abnormalities: Individuals
with manic-depressive disorder and schizophrenia, including those who
have never been treated, have more neurological abnormalities, as shown
in over 25 studies.
Impaired Cognitive Function:
Individuals with schizophrenia and manic-depressive disorder, including
those who have never been treated, have more neuropsychological abnormalities
that impair their cognitive function, including such things as information
processing and verbal memory.
A Sample of Recent Relevant Research:
Impaired Awareness of Ilness: Approximately
50 percent of individuals with schizophrenia and manic-depressive disorder,
including those who have never been treated, have impaired awareness
of their own illness. This has been shown in at least 50 different studies.
Such individuals do not realize that they are sick, and they will, therefore,
usually not accept treatment voluntarily. Studies suggest that this
impaired awareness is probably related to the decreased function of
the prefrontal area.
These individuals are thus similar to some patients who have had a
stroke and, because of brain damage, are unaware of their disability
and deny it. The lack of awareness of illness in individuals with schizophrenia
and manic-depressive disorder is the most common reason that they do
not take their medication. [as can be seen in the research below, the
part of the brain that is resonsible for self-analysis seems to be one
of the areas most damaged by schizophrenia; the brain that is damaged,
cannot frequently recognize that it is damaged]. This is a problem is
because increasingly schizophrenia research is suggesting that the sooner
a person with this brain disease is treated, the better the outcome
for the person. Delays for treatment result in much worse outcome (see
recent research below).
A Sample of Recent Relevant Research:
Additional Information on the Disease Process of Bipolar: