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 Does Sherlock have a bipolar affective disorder?


In the last article I have many comments saying that I did not give enough information about Bipolar. So now I have completely rewritten the article. 



  • Syndromes and disease - an explanation of how psychiatric diagnoses work

  • Some myth busting regarding Bipolar and the differences between countries in terms of diagnosis

  • An evaluation of Sherlock's behaviour to see if he would be diagnosed with Bipolar in the UK

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Syndromes and Disease - A Step Back in Time

dropsy

In 1827 Robert Bright published a seminal paper describing patients with dropsy (oedema), albumin in their urine and high blood pressure. This constellation of symptoms was known for over a century as Bright’s Disease.


What Bright didn’t really describe was that some patients with Bright’s Disease died very quickly whilst others recovered; some eventually got blood in their urine, some were pregnant and others were children, some were in great pain, whilst others become confused and drowsy.


In modern medicine the name “Bright’s Disease” is never used anymore because it was not a disease but a clinical syndrome, and this syndrome describes not one but a wide range of different kidney diseases.  We now understand the underlying causes and disease processes of what Bright was describing and have no need for an archaic classification.


What does this have to do with Sherlock’s Bipolar or even psychiatry?


Psychiatry today is very much like what renal medicine was when Robert Bright worked at Guy’s Hospital. There is hardly any understanding of the pathology (disease process) behind the syndromes that we commonly diagnose people with. Instead diagnosis is centred on clinical syndromes. The DSM-IV and ICD-10 are merely giant checklists: if you have these symptoms, you therefore have “X”.


Psychiatric diagnosis is a prolonged exercise of putting people into predefined artificial boxes.


Bipolar Affective Disorder like many psychiatric “diseases” – is an artificial construct. This is not to say the symptoms of bipolar are not real, the symptoms can be devastating but like Bright’s Disease – what defines Bipolar is the constellation of symptoms and not an underlying pathology. The diagnostic checklist is incredibly subjective and there is no objective test for Bipolar – this puts the onus on the psychiatrist’s judgement.


In effect you have Bipolar if your psychiatrist thinks you have Bipolar. There are many people out there with the symptoms that have never been diagnosed. They are actually ill but they do not technically have Bipolar. Equally there are plenty of people with some features of Bipolar but not enough to satisfy the diagnostic criteria – they are still ill but they do not have Bipolar.


Bipolar is not like glomerulonephritis – even if you are not diagnosed, we can still demonstrate that you are undergoing the disease process. There is an objective test (kidney biopsy) and many ways of investigating the underlying cause.


In psychiatry there is no clear boundary between healthy and not-healthy, there are no absolutes.


Therefore what one psychiatrist thinks is healthy might differ completely from another. Some psychiatrists stick to the checklist, others play by their own rules. One method is not superior to another. Being labelled with a specific psychiatric condition does not change the nature of your condition – it does not make you more or less ill. It does however dictate what treatment you receive.


There are people who every psychiatrist would diagnose with Bipolar and many more who psychiatrist just can’t make up their minds about.


I have received a lot of comments from people suffering from Bipolar saying that my description of Bipolar does not match their experiences. Due the difference in opinion amongst psychiatrists of just who should be diagnosed with Bipolar the actually population of patients diagnosed with Bipolar would have incredibly diverse symptoms and clinical courses, just like the “Bright’s Disease” patients that Robert Bright studied.



Myth Busting


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Bipolar affective disorder sometimes called “manic depression” is one of the most common mood disorders in the world (after depression). However, unlike straight depression, it takes longer to reach a definitive diagnosis and can be harder to treat.


What is now known as Bipolar was first described by Aretius of Cappadocia in around 150BC.


The classical understanding of Bipolar is “periods of abnormally elevated mood and/or irritability followed by periods of depression”. Of course that is too simple:


The DSM-IV currently lists two recognised types of Bipolar: bipolar type I and bipolar type II (which was called for sometime “soft” bipolar)


…and then there is cyclothymia which is not Bipolar but belongs on the spectrum of Bipolar Illness.


In the UK psychiatrists do not use DSM-IV they use ICD-10 (no matter how much NICE guidelines might talk about DMS-IV). ICD-10 has only one diagnosis called Bipolar Affective Disorder (and then lots of subtypes including Biopolar II).


The general public have a rather strange misconception that “Bipolar Illnesses” are all the same and they cause people to very emotionally unstable – swinging between joy and sorrow many times a day. This is emphatically not true (unless you have ultra-rapid cycling bipolar which is a rare and incredibly severe form that requires hospitalisation. Not to be confused with rapid-cycling which is common).


For any type of Bipolar (but not cyclothymia) your “episodes” have to be persistent, consistent and last for more than 4 days each. If left untreated patients have episodes that can last weeks. Their mood is relatively stable throughout this period without any oscillation between high and low. The change from one episode to another occurs over days not minutes and once you are in an episode you stay in that episode for significant period of time.


It is also possible to have bipolar without depression and only periods of mania and hypomania (mania that is less extreme). You can also have a double dip kind of bipolar whereby you become depressed and then even more depressed. Alternatively you can have mixed episodes. This does not mean you are happy one minute and sad the next. A mixed episode is where you exhibit symptoms of depression and mania/hypomania but your mood is relatively stable – but just not your “normal” mood.   


Patients also a concept of “right” and “wrong” diagnoses. This is perfectly valid for disease that we understand the pathology of and can conclusively prove one way or the other, but in psychiatry we cannot do either of these things.


Patients who are diagnosed with Bipolar will often tick multiple other checklists just by virtue of symptom overlap but that does not mean they should be given myriads of different diagnoses - Bipolar the most appropriate i.e. the patient fits into the Bipolar box better than any others.


There is a move away from calling something the “correct” diagnosis – it is now called the “most appropriate” diagnosis. The diagnosis psychiatry only has meaning because it then prompts the doctor to give a specific form of treatment – so it is still important to give the most appropriate diagnosis.


It may take a great deal of time before the most appropriate diagnosis is reached. For example many people who go onto be diagnosed with Bipolar are first given a diagnosis of depression. Often depression was the most appropriate diagnosis at the time from the clinical history and hence not “wrong” – only with time do we realise that Bipolar is more appropriate.



Does Sherlock have Bipolar?



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How likely are you to get Bipolar?


According to the Oxford Handbook of Psychiatry the lifetime prevalence is 0.3%-1.5% (0.8% Type I and 0.5% Type II)


Research usually uses DSM-IV definitions because the American academic readership is very large and very influential. 


Lifetime prevalence (chance of developing the disorder over your entire life) of Bipolar Type I in European studies is 0.1%-2.4%.


Compare this prevalence for a depressive episode (as defined in ICD-10) among 16- to 74-year-olds in the UK in 2000 was 2.6%.


Bipolar type II prevalence calculations are compounded by the fact that some psychiatrists think the that diagnostic criteria at the moment for Type II is too “stringent” and have thus come up with their own much broader definition (which is not recognised).


Although the criteria for Bipolar is artificial and somewhat arbitrary (why 4 days? Why not 3 days or 5 days or a week?) – it is still the recognised standard as signed off by the leading members of the psychiatric community from around the world.


Making a much broader definition that is less stringent is a bit like a hospital manager saying: “everyone with shortness of breath and cough is now on the lung problems register” leaving the cardiologists thinking: “what about my patients with heart failure? They have those symptoms but there’s nothing wrong with their lungs.”


Even with a broader definition – the life time prevalence in European studies is calculated to be 0.2%–2.0%. Hence you are not more likely to be diagnosed with Type II.


In practice Bipolar Type I is more likely to be diagnosed earlier and more appropriately. Hence people who are diagnosed with Bipolar Type I are less likely to have their diagnosis changed. This makes Bipolar Type I patients the majority of all Bipolar patients (at least in the UK)


Sherlock as an individual would be more likely to get Bipolar if:



  • Family history - if he has a first degree relative with Bipolar he is 7 times more likely to develop it

  • Studies in identical twins show 30% - 50% concordance - so genetics plays a significant part


Sherlock lives in London – No?



london


Given that Sherlock lives in London, he’s much more likely to see a psychiatrist on the NHS rather than a private psychiatrist who has trained abroad and is penchant for DSM-IV.


So what does ICD-10 say about Bipolar Affective Disorder.


“A disorder characterized by two or more episodes in which the patient's mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of an elevation of mood and increased energy and activity (hypomania or mania) and on others of a lowering of mood and decreased energy and activity (depression). Repeated episodes of hypomania or mania only are classified as bipolar.


What the ICD-10 doesn’t do is spell out what hypomania/mania in a convenient checklist like DSM-IV does. If you are a psychiatrist – it is perfectly acceptable to use the DSM-IV checklist for mania/hypomania as long as it doesn’t contradict ICD-10 – it’s your personal choice.



What is mania?



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ICD-10 classifies a manic episode without psychotic symptoms as:


“Mood is elevated out of keeping with the patient's circumstances and may vary from carefree joviality to almost uncontrollable excitement. Elation is accompanied by increased energy, resulting in overactivity, pressure of speech, and a decreased need for sleep. Attention cannot be sustained, and there is often marked distractibility. Self-esteem is often inflated with grandiose ideas and overconfidence. Loss of normal social inhibitions may result in behaviour that is reckless, foolhardy, or inappropriate to the circumstances, and out of character.


What About Hypomania?


“A disorder characterized by a persistent mild elevation of mood, increased energy and activity, and usually marked feelings of well-being and both physical and mental efficiency. Increased sociability, talkativeness, over-familiarity, increased sexual energy, and a decreased need for sleep are often present but not to the extent that they lead to severe disruption of work or result in social rejection.


 Irritability, conceit, and boorish behaviour may take the place of the more usual euphoric sociability. The disturbances of mood and behaviour are not accompanied by hallucinations or delusions.


Does Sherlock have Bipolar? – Come on Answer the Question!



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Before I give my semi-professional opinion: the important point to remember is that during a Bipolar episode “the patient’s mood and activity must be significantly disturbed”.


In terms of mania:


If the patient is usually reckless, restless, aggressive and irritable, he must demonstrate that these characteristics become significantly more severe without any logical reason during a prolong period of time.  Seen as Sherlock’s elevated moods almost always coincide with either pursuing or solving a case, we can conclude that Sherlock has a very logical reason to be happy and his mood is not “out of keeping with his circumstances” 


We have no idea regarding Sherlock’s sleeping habits. He does not appear to suffer from insomnia – a lack of sleep is not alluded to in the series, so it is unfortunately that we cannot comment on whether he has decreased need to sleep.


Otherwise – Sherlock does not become persistently and markedly distracted during a specific period of time. His concentration does not appear to be affected by his elevated moods.


The general picture is not one that fits well with a manic episode.


However he does display some signs of hypomania i.e. “persistent mild elevation of mood, increased energy and activity”. The elevation of mood has to be minimum 4 days (borrowed from DSM-IV criteria). Given we do not have a good idea of the time scale of Sherlock’s cases in the series, it is hard to calculate how long Sherlock’s mood elevations last for. On the other hand he almost always has a great deal of energy on or off a case. It is improbable that Sherlock has been in a hypomanic state for 18 months but it’s not impossible)


There is no marked increase in sociability or over-familiarness and we do not know enough about Sherlock’s sex life to comment on his libido during periods of elevated mood. Otherwise it is difficult to see a distinct fluctuation in his talkatively. Sherlock appears to talk a lot when there is a lot he wants to talk about.


He does fit the description: “Irritability, conceit, and boorish behaviour may take the place of the more usual euphoric sociability” but once again he does not display these behaviours for a limited and specific time period and then reverts back to a significantly different set of behaviours.


So basically although he fulfils some of the hypomania criteria – the long duration and lack of fluctuation in his behaviour appears to suggest that he is not actually experiencing episodes of anything. What we are seeing his is “normal”.


However - Sherlock demonstrates symptoms that could allow him to be included into a group called (rather disingenuously) “soft” Bipolar II or broadly-defined Bipolar II. 

These are patients who have some symptoms of Bipolar but do not fulfil the entire criteria. A debate rages over whether the diagnostic criteria should be changed so that these people are also included under the title of Bipolar.

The question is, as we see him now, does Sherlock benefit from a psychiatric diagnosis? 

The Flip Side of the Coin

Going back to the Bipolar Affective Disorder “and on others of a lowering of mood and decreased energy and activity (depression)”, technically you need a period of depression in order to qualify for a diagnosis but as I said psychiatrists come in pedantic and not-so-pedantic varieties so even if you don’t have low moods you can still get a diagnosis of bipolar.


I am convinced that Sherlock has never displayed signs of a depression episode. Clinical depression (depression episode ICD-10) is not just characterised by abnormally low mood, it also requires ahendonia (not enjoying the things one usually enjoys) and low energy. Sherlock has never displayed the latter two symptoms even during periods where he has low mood e.g. TRF. In TRF Sherlock has every reason to have low mood, he’s about to fake his own death and devastate his only friend. I would be worried if he was happy – because that would actually be a sign of mania. Sherlock is still able to functional perfectly well and enjoy solving cases to the same extent as usual during times when he is “down”, in fact cases are the perfect antidote to his low mood, which shows that he is not actually depressed - he is merely sulking. As anyone who has been depressed will know, it takes time and a great deal of effort to lift yourself out of depression. It will not happen instantaneously due to one set of stimuli.


As a commentor pointed out there are other types of low mood disorders: including atypical depression which has mood reactivity. Mood reactivity means that you are able to experience enjoyment in response to perceived positive stimuli – but you revert back to the “low”. However the majority of Bipolar episodes with low mood are depression episodes.


Additionally if Sherlock truly had bipolar, his episodes would not coincide perfectly with his work schedule. The majority of patients have no control over when or how their mood cycles.


I also think it is unlikely that Sherlock has a purely manic or a purely depressive type of bipolar disorder (some psychiatrists refuse to diagnose patients with Bipolar).  




The usual pattern contains periods of time where Sherlock should essentially be in remission – i.e. behaving “normally”. However we do not see periods (even short ones) during which Sherlock behaves significantly more calmly or more “normally”. It is more likely that what we see of Sherlock is not one extremely long hypomanic episode but rather what we see is his norm. He is naturally brimming with energy, self-esteem and recklessness.


Of course Sherlock may have had bipolar in the past, and is now on medication which controls his symptoms but I discuss in the next article why Sherlock might object to treatment if he had bipolar.

I would not diagnose the BBC version of Sherlock with bipolar affective disorder if he presented at any time during the series. I really don't think labelling Sherlock with any type of psychiatric condition is helpful or conducive to improving his quality of life. 

If he has symptoms - he does not appear to find them a) dysfunctional or b) debilitating. Sherlock appears to be well-functioning and generally living a full, meaningful life. What can we add by labelling him "bipolar" or "asperger's" or "psychopathic"?


As for ACD Holmes – there is somewhat more convincing evidence that he may be displaying signs of hypomania and depression. I read a great scientific paper a long time ago on why ACD Holmes could be diagnosed with Bipolar but I cannot find it on pubmed anymore. If anyone else knows the link please tell me so I can added to this section. 

Comments

( 13 comments — Leave a comment )
hoppytoad79
Feb. 6th, 2013 09:48 pm (UTC)
Two people have questioned the possibility of my having bipolar, the first being the Board Certified therapist who diagnosed with me ADD and a generalized anxiety disorder, and briefly wondered if I might be bipolar but quickly dismissed the idea because the one instance that made her wonder was a fluke and there was nothing else in my history to support a diagnosis of bipolar.

The second was an intern at a free medical clinic. It was the first and only time I'd seen him. I was there to get lab results on some bloodwork and I was hoping my thyroid values would finally be off enough the doctor I was talking to that time (I never knew which one I'd be talking to when I went in) would say, "Yeah, it looks like you might have hypothyroid. Let's try you on some medication" because I was SO DAMN SICK AND TIRED OF HAVING NO ENERGY AND WANTING TO SLEEP ALL THE TIME AND GAINING MASSIVE AMOUNTS OF WEIGHT AND THE DOCTORS SAYING IT MUST BE SOMETHING PSYCHIATRIC LIKE DEPRESSION. It had been two or three months of dealing with it at this point and getting nowhere and I was. Incredibly. Frustrated, so when the intern looks at the values and one of the thyroid values is low (again) and he says it's fine and no big deal and dismisses my wanting to try some thyroid medication, I was just a wee bit snappish and aggressive about saying I. Want. To. Try. Thyroid. Medication. Please. And. Thank. You. He says something about checking values again in three months all I could think was, 'I have to deal with all this shit for ANOTHER THREE F'ING MONTHS?!?!?!' and wanted to just burst into tears right then and there. Like I said, I was so frustrated and sick of it all, and he wants to wait another three months? God in heaven, would there be no relief? I forget if I asked if there was anything he could do, or what, but I said something, and I know it came through in my voice and my expression that I was close to tears. Anyway, I moved out of that area not too much later and got a copy of my records for my doctor in the area I moved to. Of course, I read over the notes from the free clinic, and the intern made a note in there that he thought I might have bipolar. *snorts* Right. Not bipolar, you stupid ijit, just a woman who's sick and tired of dealing with stupid morons who refuse to consider the problem's with her thyroid, not her brain. Oh, the doctor I started going to after I moved? I told her the history of symptoms when I went in to see her and she was like, "Oh, yeah, subclinical hypothyroidism. We can take care of that." Praise Jesus for competent medical care! I got on levothyroxin and FINALLY had energy back w/in 48 hours. Oddly, getting on meds didn't do anything about the weight I gained. Still struggling with that. If there weren't so many pesky negative side effects with tapeworms, I'd buy me one of those. ;p
bootoye
Feb. 8th, 2013 03:24 am (UTC)
Hey, I understand what you mean. At one time my anemia had me 'close to death' as my doctor and family said and I was ranting that I want to die rather than take more meds or do more surgery...but I know and everyone who really know me know that I am not and have never been depressed nor suicidal...I was just fed up, stressed and suffering an almost non-existant blood count.

I'm all better now though XD

I feel sorta O.o when writers have depressed or autistic Sherlock unable to relate to humans at all.
hoppytoad79
Feb. 8th, 2013 04:22 am (UTC)
With what I (think I) know about autism, doesn't ability to connect with others depend on where the autistic person falls on the spectrum?

I can only shake my head at Depressed!Sherlock being unable to connect with others. Depression has nothing to do with a person's ability to connect with other people. Ugh! I can't stand the vast majority of armchair psychiatry because the people have no idea what they're talking about, which is bloody dangerous. I take great pleasure in blowing huge holes in bullshit armchair psychiatry, bringing in things like the DSM-IV and I've used the personal experiences of myself and friends/family who have various mental illnesses as evidence that the armchair psychiatrist spouting off didn't know their arse from their elbow. I always tell people to talk to a licensed/certified/registered psychiatric professional because they're the ones with the experience and knowledge (which is what everyone I know who has two brain cells to knock together agrees is the only intelligent thing to do).

As for the idiot intern who thought I might have bipolar and wanted me to talk to the clinic's quack psychiatrist (couldn't stand the man; thought he was at least a decade overdue for retirement but that's another story or two) about possibly being depressed, before my app't to see the shrink, I went to the library, pulled the DSM-IV diagnostic criteria for clinical depression and dysthmia off the 'net, pasted them into Word, and then went through and, point by point, spelled out which ones did and did not apply to me and why. For the ones that did, I listed possible other causes than depression. I printed it off, took it with me when I went to see the shrink, and explained to him what it was at the beginning of the appointment. That was the beginning and end of THAT discussion! *G* He did suggest taking B12 to help with my energy levels. I smiled and nodded and went on my way.
missyvortexdv
Feb. 9th, 2013 04:55 pm (UTC)
I have Hashimoto's and have had both underactive and overactive periods with my thyroid function, doctors often clueless on it so I read a lot of research myself on it. Because of that reading around I recall I've read quite a few times in research on thyroid issues that thyroid issues can often get confused with Bipolar and vice versa. I think advice on one of the UK Bipolar charities websites I read was quick to point out Bipolar can often be misdiagnosed as thyroid issues, But then the Thyroid charities are quick to point out the reverse too, so I imagine it happens both ways.

I'm guessing that's because there's a blend of depression for both over or underactive thyroid, and also potential mania expressed with overactive more commonly, but also with more severe cases of hypothyroidism ('myxedemic madness' a hypothyroid psychosis being possible at the very extreme end) . I'd imagine it's especially possible since long term mis/untreated/undiagnosed hypothyroidism can also be complicated by low adrenal issues which I know from experience can cause symptoms that felt like anxiety/possible mania much like when I'd been hyperthyroid despite clearly not being overactive but instead underactive according to my bloodwork.

It is really gruelling how medics so often seem to see the depression side of thyroid issues and ignore other symptoms, citing it as anxiety and/or depression and nothing more. And I have had that happen to me, the sly implication it's really in my head - the 'have you tried to worry less, get more exercise' - even in the face of most definitely abnormal thyroid levels and already having a definite diagnosis of autoimmune thyroditus. *sigh*

Really glad to hear you finally found a doctor that could diagnose your thyroid problem (though I'd add if weight loss isn't happening despite many efforts you should, if it hasn't already been, check your freeT3 levels in case conversion of T4 to T3 isn't optimal)
hoppytoad79
Feb. 9th, 2013 05:17 pm (UTC)
The intern who thought there might be bipolar had never seen me before and had spoken with me for not quite even fifteen minutes when he made that decision. He didn't know anything about my history other than what was scribbled in the notes, which didn't include anything about mania or anything from the staff psychiatrist about depression (I know this because I read all the notes over later when I had a copy to give to my new doc after I moved) and the lab reports. Whatever he thought indicated bipolar, he had no idea what he was talking about and was unwilling to consider trying any therapy for hypothyroid.
missyvortexdv
Feb. 9th, 2013 06:04 pm (UTC)
That sounds really quite bizarre a conclusion for him to have drawn in that case on so very little!
hoppytoad79
Feb. 9th, 2013 08:32 pm (UTC)
No kidding. That's why I'm assuming it had to have been the mood swing from aggressive attitude when I was pushing for thyroid meds and questioning why he wasn't going to prescribe them to being almost in tears after he mentioned rechecking my thyroid level in 3 or 6 months time. What he said to me was he wanted me to talk to the clinic shrink about being depressed. *snorts* I. Was. Not. Depressed! I went to the library, got the DSM-IV diagnostic criteria for depression off the 'net and copied/pasted it into Word, went through and, point by point, explained how each criteria did (not) apply to me and if one did, I explained how and any other possible explanations. Gave that to the shrink when I had my appointment. He didn't look at it when I said I was not depressed and I knew I wasn't. *shrugs* I was slightly annoyed he didn't even bother to look at what I'd done, but he didn't press the issue and that's what matters.
ariadnechan
Feb. 7th, 2013 05:12 pm (UTC)
Everything you said of him above fit him more and more as asperger.

I really like your metas!!

Had you seen Sherlock of Jeremy Brett? From Granada television??
I think he fitsmmore a bipolar personality or at least depression than Sherlock bbc. He is really lost in some cases even with visions. And he has more normal self and more maniac self, being him depress or hiperactive so i think he could be bipolar or depressive. But our Sherlock BBC is more asperger,

He sulk a lot and is bored to hell when he had not his object of attention to occupy his mind...
He play a lot with his hands do spins with his coat or he sway some times. When he face the wall or go to his room he is steaming.

And his talk when he is talking about his object of atention 'the work' is different.

He has relationships with people offcourse because he is not autistic perse, he is asperger, aspeger people can and do relationship, that is why he has one with mrs Hudson, and with other in some meassure. But he doesn't manage social clues perfectly and he doesn.t care at his age...he is blunt because he diesn't understand that sometimes is bad, John is the first one who teach him why. He manage irony because he is not an 5 years old asperger, that in his family was easy to learn at early age, and even master.

So, he is an adult asperger who was never diagnosed, he doesn't need the diagnosis now either, but his life could be easy if he was at chilhood.

John is helping him with his too much blunt issues, and societal naivities, and Sherlock is receptive to him.
But poor Sherlock had a really hard time in Uni and in school and he ended in heavy drugs because he had not help and he was all alone in his real diagnosis. Also he is too genius for his own good, and it made his life more cruel before he grew up and found his place in the world and learnt to live in it.

But he does not do love relationships because that part he doesn't figured out yet.

The thing about being asexual, gay with low drive, living a secret very active sexual life, or sexual torrid past, virgin or not really is not relevant. We can do all of that and not be in a relationship.

Personally i don't think he is a virgin or asexual.

Not a virgin especailly with his drug abussing past at least. It would be a real miracle that i don't bealieve.
-----------

But i think romantically he had never did one. Because maybe he doesn't know how to aproach tha subject, and that's why the word "friend" is out of his list he thinks a friend is more an intimate conection that the one he has with Mrs. Hudson or Lestrade, because he doesn't understand the concept too well.

So maybe friend for him is more like "brother in arms, other part of my soul" then only John.

So i think Sherlock is not bipolar but asperger.
An asperger who was not diagnosed as a child when he needed most.
He survived the worst part even considering he is also a genius and this always work in his disadvange socially.
He off course learnt a lot in his life like irony who he mastered, his family is a great factor in it.
He is always learning social nieceties especially now he had John.
Before he only mimic his sorroundings for cases, rolplaying some undercover.
He doesn't need the diagnosis now, because he will not accept it, or help him. But he would be a worls turning if he had been diagnosed as a child.




bootoye
Feb. 8th, 2013 03:28 am (UTC)
Since you mentioned ACD Holmes do you think something was wrong with him other than narcissism the way he tricked Watson (empty house)and took control of the Yard's cases (esp. the big reveals) and such. Was he the real sociopath?

Esp. with poor Watson waiting so long and getting shot to realise that Holmes actually cared for him.
wellingtongoose
Feb. 9th, 2013 11:26 am (UTC)
Lots of people have asked about Sherlock narcissistic personality disorder. DSM-V is actually going to take the diagnosis out of the manual because it simply applies to far too many people.

I for one, think that ACD Holmes does not suffer from any mental illnesses - he just has an odd life style and is slightly obsessive. The ranks of scientific academia are filled with ACD Holmes - he is the prototype hardcore scientific researcher 100 years before it became a career choice.
metanewsmods
Feb. 9th, 2013 01:59 am (UTC)
Us again! Can we link this at metanews?
wellingtongoose
Feb. 9th, 2013 02:37 am (UTC)
Yes of course! You don't have to ask really, you can link any of the stuff I publish.
labellecreation
Jun. 20th, 2013 09:20 am (UTC)
I have Bipolar II. It took ten years for them to diagnose, and as you say my first diagnosis was clinical depression. This was down to the fact as is probably the case with most patients, I only presented for medical treatment when depressed. I don't think as someone with the condition I would diagnose him with it myself, although I certainly see recognisable signs in him.
( 13 comments — Leave a comment )