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Schizophrenia vs Bipolar Disorder

© Ian Chovil

Schizophrenia and bipolar disorder are at a minimum, in the same family of mental illnesses. They are almost on a continuum with a significant number of people with symptoms from both types, and a separate diagnosis of schizoaffective disorder. It is a diagnosis psychiatrists are reluctant to make, because bipolar disorder is considered a mood disorder and schizophrenia is more of a thought disorder. Bipolar disorder is characterized by a cycle of mood swings, from mania to depression. In extreme mania a person is essentially psychotic and indistinguishable from someone with schizophrenia in a psychotic episode. There is a lot of reality distortion, although researchers have commented that the reality distortion in extreme mania of bipolar is more concrete then in schizophrenia.

About 40% of the people with schizophrenia also experience depression, and there is often some difficulty in making accurate diagnoses when schizophrenia or bipolar looks something like the other. Bipolar disorder is usually a much less disabling disorder then schizophrenia, and schizoaffective disorder is often more disabling the bipolar but less disabling then pure schizophrenia, if there is such a thing. It is more realistic to think of people falling somewhere on a continuum between bipolar and schizophrenia, perhaps clustering to some degree at either end.

One of the more interesting pieces of evidence that schizophrenia and bipolar are related is in genetic histories. You could have a grandfather with schizophrenia, and a brother with bipolar who has a daughter with schizoaffective disorder, etc. etc. They appear to be variations of a genetic theme.

There is often a great difference in the experience of bipolar disorder and schizophrenia though. People with schizophrenia would generally give their left arm not to have schizophrenia. People with bipolar tend to feel very differently. I recently gave a presentation with a young man with bipolar to a multifamily education session. I asked him about the film "Mr. Jones", in which Richard Gere plays a man with bipolar disorder. It gives him a lot of trouble, but when he has been brought to a hospital by the police and strapped down to a bed, and the doctor tries to explain to him that he has an illness, he yells out in reply "This is not an disease, this is who I am!"

The young man I made my presentation with felt the same way. He identified with his illness much more then I did. My illness makes me do things, my illness interferes with my attempts to do things, my illness is the pits. It has literally wasted my life before my very eyes. Sometimes I wish I had never been born. The young man felt that he was who he was because he had bipolar disorder. He was very proud of who he was. People can be very productive in a state of mild mania. The disease itself is associated with high intelligence and creativity.