Bipolar Affective Disorder: The Fight For The Middle Ground


After the revelation that Robin Williams suffered with bipolar affective disorder, a rush of articles about creatives and mental health problems sprung up all over the shop. Last week – not for the first time – a young man sat in an assessment with me and said he didn’t want medication to take away his “creativity”.

So, now seemed like a good time to talk about what bipolar affective disorder is and what it isn’t, and how Hollywood and the media often get it wrong.

What is bipolar affective disorder?
Also know as manic depression, bipolar affective disorder is a mental health problem consisting of cycles of two opposite moods: manic/high phases and depressive/low phases. In between episodes, people sit somewhere in a mood state that is “normal” for them – which may run slightly high or low, depending on the person. A person with “rapid cycling” disease has four or more episodes per year.

Bipolar depressive episodes look a lot like depression – aka unipolar depression. The main difference is that bipolar depression does not respond as well to antidepressants, and people more frequently experience psychosis.

Manic episodes are what set bipolar affective disorder apart from other mental health problems. Mania is a state of “high” mood, associated with disinhibition and living really, really fast. This is often portrayed as living in one very exciting party 24/7. Some people do experience their manic episodes in this way – which is one reason why some people really hate taking medication for them. Highs can be a lot of fun.

But they can also be really ugly. Some people don’t experience manic episodes as happy highs but irritable, restless periods, which is increasingly likely as folks get older with the disease. People also make huge errors of judgement – sleeping with many different partners when they’re usually monogamous, spending money they don’t have, and crashing their cars. Mania can also come with psychosis – believing they have special powers, hearing the voice of God, thinking they can fly.

Suicide risk is high in people with bipolar affective disorder, but actually moreso in a high phase. The combination of inescapable agitation and lowered barriers leads to more likely suicide attempts.

The Stephen Fry Effect
First off, before I go further, I will saw this: I greatly admire Stephen Fry as an artist, as a man and as a person struggling with a mental health problem. This is in no way an attack on the man or how he chooses to lead his life. But it is important to recognise the impact of celebrity on mental health stigma.

Bipolar affective disorder, of all mental health problems, carries a certain level of desirability. In private healthcare, it is often given to patients who would be better served with a different diagnosis or no diagnosis at all. There is something attractive about this disease.

This may be down to the “party time” reputation of high episodes. However, I feel it’s also due to the creativity myth – i.e. bipolar affective disorder is the disease of creatives, funny men and artists. With your brain running faster than the rest, you’ll be faster with a witty retort. On a deadline? You can pull several all-nighters in a row to finish that novel and then go out for drinks.

Stephen Fry is the poster child for this attitude. Even though he now takes medication, he is renowned for not taking medication since 1995 until this recent change. This is the most-frequently cited argument I have heard against medication for mental health problems – “it will ruin my life/personality/creativity. Look at Stephen Fry.”

This is, of course, bollocks. No medication changes your personality. Medication of various kinds can be sedating and can affect concentration. If your brain runs at a slightly-high normal, medication can bring it down to a lower baseline, which some people experience as slowing. However, all the evidence suggests that people with stable bipolar affective disorder are more productive than those off treatment. This is because they are more consistent, and not constantly disrupted with too-high or too-low swings in their mood.

Writing Bipolar Affective Disorder
Bipolar is not sexy. It is not fun. It is not a party. And it’s not Jekyll and Hyde, or Two-Face, or any other “split personality”.

I’d like to see more realistic depictions of bipolar affective disorder. I’d like to see mania not portrayed as a party, but as a brutal experience with real-life consequences beyond a hangover. I’d like to see characters with bipolar who predominately experience depression. And I would like to see more smart, well-adjusted characters who are like “yeah, I have bipolar, and?”. Because a person with stable bipolar affective disorder can be a high-functioning professional with no external signs of illness, like a person with well-controlled asthma need only carry an inhaler.

Stigma is fought be showing good mental health as well as mental illness. Bipolar affective disorder is no different.

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