[This is a complex area, and I originally wrote a much longer piece related to this topic. The material below is adapted from a small part of it. It helps show, if nothing else, that these problems are nothing we can make glib, easy generalizations about.]
A 1970 study by Ross J. Baldessarini
Ross J. Baldessarini, M.D., a clinical researcher long based at Harvard University’s medical school, published “Frequency of diagnoses of schizophrenia versus affective disorders from 1944 to 1968,” in American Journal of Psychiatry 127 (6), (1970), pp. 759-763. (Styling here isn’t fully AMA style.) This basically indicated that, in the U.S., psychiatrists had fairly systematically been diagnosing certain patients as schizophrenic, while British psychiatrists would have tended to diagnose the same patients as bipolar (or manic-depressive, as the term would have been then).
Ivan K. Goldberg also referred to the (more formal) Baldessarini study, in his August 1, 2005, lecture. He called it the “flying psychiatrists” study, because, as he said, psychiatrists in the U.S. and Britain were allowed to diagnose patients in each of their respective countries, then were flown into each other’s places to diagnose the same patients. This was how it was found there was such a systematic difference in diagnosing tendencies.
David Nathan, M.D., a psychiatrist based in Princeton, N.J., spoke on the finding by Ross J. Baldessarini, M.D. (regarding which Dr. Nathan may or may not have explicitly indicated a study published in 1970) that, in effect, meant that, in past decades, bipolar patients in the U.S. had fairly routinely been diagnosed as schizophrenic. (Dr. Nathan’s reference was in a lecture, January 11, 2004, at fundraising/educational meeting of DBSA Succasunna in Randolph, N.J. Part or all of this presentation may be on audiotape.)
Dr. Nathan may have been referring to the 1970 paper by Dr. Baldessarini, or may have referred to the findings from a more general sense of them.
The comparisons of schizophrenia and bipolar disorder by E. Fuller Torrey
Here is an example of how schizophrenia and bipolar disorder are today compared in writings by a popularly oriented but nevertheless in some way authoritative writer and researcher. First, a quickie opinion of mine: E. Fuller Torrey is a sort of barometer of mainstream thinking to some extent. Despite his faults—and I am not slow to focus on some of them for whatever purpose—he tends to promulgate a good reading of illnesses as currently understood and to work against bunk (either in understanding of illness or in treatments). But I disagree with some of his tactics in discrediting such people as, say, the admittedly controversial Peter R. Breggin, M.D., or even patients who opt to write books on their illnesses; I feel on this that his criticism is not always off-base as to merits but seems waspish and condescending in its tone and in its particular points.
However, let’s take a quick look at the most recent edition of his book on schizophrenia, which (in its first edition) was one of the first books Torrey published on a major illness (and which illness presumably he had greater expertise in, and regarding which he has had longer time with in the book, through successive editions, to hone his statements). (E. Fuller Torrey, Surviving Schizophrenia: A Manual for Families, Consumers, and Providers, 4th ed. [New York: Quill, 2001].)
We will also look at his 2002 book on bipolar disorder (an illness he elected to write a general book on only relatively late in his career, and with help from a coauthor). (E. Fuller Torrey and Michael B. Knable, Surviving Manic Depression: A Manual on Bipolar Disorder for Patients, Families, and Providers [New York: Basic Books, 2002].)
With both of these books, his interrelation and distinction of schizophrenia and bipolar disorder may leave us more confused than before about how much one is not the other and on how much there happened to be misdiagnosing of bipolar patients as schizophrenics in the 1960s and 1970s. (Page numbers below will be in parentheses.)
In the 2002 book on bipolar disorder
First, his remarks on the history of how schizophrenia and bipolar disorder were first differentiated, in the 2002 book: “It remained for German psychiatrist Emil Kraepelin to provide a definitive clinical description in his 1896 textbook and to baptize the disorder manic-depressive insanity—a name that, in slightly different form, is widely used to this day...” (12).
“Although most maniacal delusions are grandiose, they may also be paranoid in content. Many psychiatric professionals mistakenly assume that the presence of paranoid delusions automatically qualifies the person for a diagnosis of paranoid schizophrenia. [But a]s early as 1973, a study of patients with mania reported that 60 percent had grandiose delusions, 42 percent had paranoid delusions, and many had both. ... Other researchers, too, have reported that paranoid delusions are commonly found in manic-depressive illness” (27-28) [italics added].
In the 2001 book on schizophrenia
Torrey in his 2001 book: “Among psychiatric researchers, the relationship of schizophrenia to schizoaffective disorder and manic-depressive illness is just as controversial as the diagnostic borderlands discussed [earlier in the book]” (97).
“Textbooks of psychiatry and psychology usually imply that patients with psychosis fall neatly into either the schizophrenia or the manic-depressive category and that the two can be readily distinguished. Unfortunately, that is not always the case, as a large percentage of patients have symptoms of both diseases. Furthermore, it is not rare to find patients whose symptoms change over time, appearing initially as a textbook case of schizophrenia or manic-depressive illness, and a year or two later clearly exhibiting symptoms of the other disease” (99) [italics added].
“The resolution of the problem within the psychiatric establishment has been the creation of an intermediate disease category called schizoaffective disorder. [In the DSM-III, published in about 1979, it was] noted that ‘at the present time there is no consensus on how this category should be defined’ ” (99). (Following in his text is DSM-IV criteria-related information.)
