In the recent documentary, The not so secret life of the manic depressive: 10 years on, (see previous post), Stephen Fry's psychiatrist changes his diagnosis from cyclothymia to bipolar I. The implication seem to be that Fry's problems, which may have previously been put down to his personality, are now seen as being due to a real mental illness, whatever that is.
Does this make any sense? Psychiatric formulation should be about more than a single word diagnosis (see previous post). This doesn't always happen in practice (see another previous post) and patients often complain that psychiatrists don't listen to their story and are just interested in "the diagnosis" and medication. I have also mentioned before my concern about how the diagnosis of bipolar disorder has expanded over recent years (see eg. another previous post), so that its meaning is less clear. Maybe Stephen Fry should resist the extension of his diagnosis.
The programme makes a distinction between Stephen Fry's symptoms, which tend to be internal to himself, and the presentation of Alika (see his story), which led to him being detained under the Mental Health Act in a manic state. By the way, Alika recovered from this episode, whereas Fry still talks about the problems he has with his "mood swings". Maybe it's better not to classify Fry's presentation in the same way as Alika's, which is what the change to bipolar I might imply.
Whether Stephen Fry's diagnosis is better understood as cyclothymia or bipolar I, the psychological formulation of his problems in terms of aetiology is still the same. In a way, the single-word diagnosis is the less important part of a formulation. It's only a word used to try and pigeon-hole his difficulties. It doesn't really help him to make sense of them.