I admit, whenever I see an advert for a programme about Bipolar Disorder on television, I am filled with anticipation. Sometimes this anticipation is rewarded, sometimes not, such is life. On Wednesday evening, a programme aired on Channel 4 called Being Bipolar. If you are based in the UK and haven’t watched it, you can find it here. If you’re based outside of the UK, I will give a brief synopsis of the programme below.
The documentary looked at three very different participants all living with a diagnosis of Bipolar Affective Disorder and tried to explore their experiences through the help of British based psychotherapist, Philippa Perry. Understandably, Perry’s view was that the individual’s mood states may be caused by traumas they had endured in their lives, therefore she spent a lot of time asking questions and trying to find evidence of such. To add a slightly more balanced view, we also saw Philippa speaking to the one of the participant’s psychiatrists, visiting Professor Ian Jones to discuss the genetic implications and discussing the theory of the chemical imbalance and drug therapy with critical psychiatrist Joanna Moncrieff.
Initially, I thought it would be useful to write about the documentary and perhaps pick it apart but I soon discovered that many had done this and additionally, the programme had created discourse and had been divisive. I decided that rather than simply repeating other articles, it might be better to look at what we can learn from Being Bipolar.
The number of people with Bipolar Disorder has risen three-fold in the last two decades, 2% of us are thought to have this serious mental illness. This was a statistic told to us by Perry at the beginning of the programme. We can look at this in different ways. Is this increase due to the number of people developing Bipolar? Is this increase due to people who were previously undiagnosed? Or, controversially, are psychiatrists over-diagnosing? All these factors are relevant including the over-diagnosis theory. In an article for the Guardian, Darian Leader points out that “in the early 20th century, the prevalence of manic depression was put at less than 1% of the population, but this figure exploded with the ramification of the bipolar categories.” With the constant broadening of these categories, there now exists an array of different types of Bipolar and this murky expanse allows psychiatrists to diagnose on the flimsiest of evidence.
One of the arguments Perry put forward was could the experiences of these three different individuals be put down to the same thing. Wary of the medical model, she tried to examine their lives using her specific discipline. Some watching the programme were angry, they felt that Perry forced her own views onto the participants, although all participants seemed entirely comfortable to explore her ideas. It is a bizarre phenomenon to become offended on someone else’s behalf when the other in question, isn’t put out in the least. This does seem to be the knee-jerk response amongst those who fully support psychiatry towards anyone who holds a different perspective. However, when one goes down this road, of being angry with another for imposing their view, whilst accepting the view of another re psychiatry for imposing theirs, things get considerably messy.
During the programme, Perry accompanied Sian, a 43-year-old woman with Bipolar Type II to see her Psychiatrist. Sian believed that her illness was the result of faulty genes and that the illness was impossible to control. Paul, a 54-year-old entrepreneur with Type I also believed that his illness was impossible to control, whilst the remaining participant Ashley, diagnosed with Type II and appearing to rapid cycle numerous times a day was more confused. The fact that he had an autistic spectrum disorder may have complicated the picture. Sian and Ashey both used psychotropic medications whereas Paul seemed to use cannabis. Whether he was self-medicating or to what effect the cannabis had on his mental health was not explored.
For me, the most uncomfortable part of the programme was when Sian’s psychiatrist decided to dish out the now established explanation for Bipolar Disorder, the chemical imbalance hypothesis and then explained how the drugs worked via the same reasoning. This theory is convenient for psychiatrists, allowing them to prescribe psychotropic medications to patients by using an argument that appears to have seeped into the collective consciousness. The fact that it doesn’t exist and has been the main argument profiteered by pharmaceuticals companies since the 1990’s to increase uptake of drugs and thus increase profit seems to be a fact widely ignored.
During the programme, Perry went to see two other professionals. With Sian, Professor Ian Jones from The Institute of Psychology Medicine and Clinical Neuroscience at Cardiff University. As Sian’s belief was that Bipolar was genetic, she was understandably concerned with passing it on to her two children. Professor Jones was able to explain “that there are many, thousands even of genes involved in decreasing or increasing ones risk to Bipolar Disorder” and further added “if one parent has Bipolar Disorder, there is a one in ten chance of a child developing it or more optimistically, a nine in ten chance of them not doing so. When asked by Perry if Bipolar could be purely environmental, Professor Jones concluded that genes did play a part and could not be overlooked. Separately, Perry went to see British based critical psychiatrist Joanna Monclieff. Asking about the chemical imbalance hypothesis, Monclieff responded by saying, “This has become a well established idea – there is no evidence that BP is caused by a chemical imbalance and no one knows what chemical causes BP.” When asked why patients think the drugs help them, she went on to say “Drugs work as they are mind altering substances in their own right and work well in calming someone down and dampening down emotions.”
It is worrying how widespread the belief of the chemical imbalance has become and how a theory with no evidential basis has become the accepted explanation offered by psychiatry and more importantly drug companies. Many people who buy into the medical model of mental illness always refute the idea that pharmaceuticals have any part to play, concluding that psychiatrists are impartial. Some counter that as Britain tends to use the ICD (International Classification of Diseases), there is less corruption going on than in America where they use the DSM. I think this is a rather naive perspective, as Will Self in an article for the Guardian states “psychiatrists become influenced by what psycho-pharmacological compounds alleviate given symptoms, and so, as it were, “create” diseases to fit the drugs available.”
If the chemical imbalance is a myth, then why are drugs being prescribed to millions of people under the premise of its existence? How many people would trust a doctor who when dealing with a physical compaint openly told them lies? Would you happily be told you had broken your arm because your foot had fallen off?
One of the complaints heard over the last day or two is about Pill shaming. Some seem to think that by questioning there use, Perry was condemning those who used them. This phenomena happens a lot in mental health circles, people objecting to anyone questioning their reality or their use of drugs and generally going on the attack immediately. I understand that many people feel stigmatised due to the drugs that take and/or often have to deal with unhelpful attitudes from family and friends and I appreciate that this is distressing. Nevertheless, to decide that anyone questioning the helpfulness or veracity of medications is somehow shaming you, rather than showing respectful curiosity and furthering discussion is to be ignorant of the need for any discipline to move forward.
If Bipolar Disorder is a complex result of genes and the environment rather than a chemical imbalance then this means the way we are currently dealing with it is by treating the symptoms, not the cause. We know little about the role these drugs play or their effects on the brain. Many anti-psychotics as Monclieff said, dampen down emotions or quieten the mind. This means that rather than dealing with the underlying problem, which is surely the point of pharmacology, all one is doing is pacifying people and at the same time robbing them of an intrinsic part of self. It is imperative to remember that Bipolar has always existed and just because since the 1950’s it has been treated with drugs and before that lobotomies and insulin induced coma’s, does not mean that this approach is correct.
Bipolar Disorder per se is simply a name given to a set of symptoms. It is quite new historically, in the same way that Manic Depression as a term once was. From early times, the Chinese and the Greeks noticed these behaviours in people and just like now, there were different interpretations as to the cause. Even today, whilst we may be taught that medications and isolation in psychiatric wards is the only way to treat mental illness, we need to be aware that is generally a western response and that others cultures handle these things very differently.
I was disappointed by the documentary but not necessarily for the same reasons as others. An hour is far too short to explore something as complex as Bipolar Disorder, it is far too short an amount of time to look intimately into someone’s life and so I was left….wanting. However, I also felt thankful that another person had taken the time to explore the complex world of Bipolar and offer up different views.
At the end of the programme, Philippa Perry said that rather than applying a label it might be “more helpful to approach everyone as individuals with unique issues. Being labelled Bipolar may help some people make sense of their moods, but often marks the end of self-exploration, when in fact it should really be the beginning”. Whether labels are helpful or not is down to the individual but what I find most ironic is people claiming to still be exploring their own inner reality whilst lambasting the programme for offering an alternative explanation that doesn’t fit with theirs. If we can only hold one view of ourselves in our minds at any one time and feel offended by another questioning it, then I think the programme reached an objective.
One of the important things to arise from this documentary is the level of conversation and engagement that has occurred. What living with Bipolar feels like, how it affects a person, their understanding of it and how it needs to be treated is often diverse and complex. Ultimately, it does not matter what pole you represent, whether you enjoyed the programme or whether it angered you, whether you prefer the medical model, therapy or a whole range of other alternatives. What we have seen is that there are many views as to what Bipolar Affective Disorder is, rather than one united view. It is the multitude of perspectives that will propel scientific research forward and one day, perhaps sooner than we realise, there may be some hard scientific evidence and a new way forward.
© Copyright Henrietta M Ross