My Response to Channel 4’s ‘Being Bipolar’

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

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19 thoughts on “My Response to Channel 4’s ‘Being Bipolar’

  1. Great post. My ex wife has bipolar. It was difficult bit I completely agree with the frustration of the chemical imbalance stuff. It is such a difficult lune to follow. She didn’t have her medication when pregnant and it was a difficult time to say the least. So I can see the argument on the balance but that wasn’t the issue either. There definitely isn’t a unified view on it. As someone who had lived with someone with it I’m really intrigued by it so will take a watch. She’s always keen to see what blogging has brought forward so will send her a copy of this as I know she’ll be equally interested. The most important thing is that a programme like this and a post from you will bring this out more and whatever your view that’s the main thing.

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  2. Well done for producing such an excellent, insightful response to this programme. I also found that it left me wanting and agree that this is probably due to trying to cover a complex subject in much too short a time, so that it was inevitably shallow and unsatisfying. I understand that Philippa Perry was trying to challenge the traditional view by exploring positive alternatives to diagnosis and drug treatment, and I commend her for that, but the programme would have benefitted from a more thorough exploration of the pros and cons of medication and psychotherapy. There was a clear bias towards the latter – that’s fine, Perry is a psychotherapist so we might expect that to be her agenda. But, for example, Sian’s statement that she would be dead if she hadn’t been on medication wasn’t pursued, and while her first psychotherapy session went well, we have no idea whether she continued to attend and how successful it ultimately proved to be. We also don’t know how Ashley fared in the long term by increasing his social contact. These points may have been a more interesting focus for the documentary.

    Clearly, responsible prescribing of medication can help a lot of people, but it is not 100% effective, and psychotherapy may be part of the answer, if it can be accessed by those who need it, which is by no means guaranteed to happen quickly. I can understand the frustration of those who feel comfortable with having a diagnosis on which to hang their symptoms – being able to give a name to what is happening to you may be reassuring. I also understand why they might be uncomfortable with the suggestion that the effectiveness of the medications on which they rely is being questioned. Some have produced very thoughtful and interesting reviews explaining their responses. I think that the debate provoked by the programme shows the importance of treating everyone as an individual, with different needs. Some will be receptive to alternative approaches to the diagnosis and treatment of their symptoms, and some will not. Provided they are made fully aware of all the options open to them, and the benefits and drawbacks, they can make an informed decision that best suits their needs, based on all the information.

    Overall, it was good to have mental health explored on mainstream TV and for the participants not to be treated as freaks, which often happens. Although this particular programme could have been better, and really didn’t give much insight into what it is like to live with bipolar disorder, it did acknowledge that this is not a straightforward nature-nurture condition, and challenged the chemical imbalance theory – yes, I shouted at the TV when Sian’s psychiatrist came out with that little gem, which I assume was the intended response! Best of all, it has got people discussing mental health.

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  3. Excellent balanced response to this programme. Like you, I felt that it was far too short to do such a complex subject justice, and I also thought it would have benefited from a wider selection of opinion and experiences – both from people with bipolar, and researchers/medics and other health professionals. But this would have needed a series, not a short documentary.

    I’m surprised at some of the extremely negative reaction to the programme, and as a person with bipolar myself, I can’t understand why questioning the efficacy of medicine should provoke such angry responses. The take-home message for me was what Philippa Perry said at the end (which you quote) about it being important to see people 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”.

    Drugs save lives when people are in crisis and in this role they are crucial, but they are blunt, imprecise tools aimed a disorder that is not properly understood and varies dramatically between individuals and across lifetimes. We need to keep talking.

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  4. I just want to say what a relief it is to read a blog post about mental health issues that doesn’t descend into invective. And thank you for helping me to clarify some of my own thoughts about the programme.

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  5. I very much concur with your analysis of the programme, Henrietta. As someone who has managed bipolar for 15 years now without either medication or psychotherapy, I would tend to side with Joanna Moncrieff’s view regarding the medication’s efficacy and purpose. I probably needed some form of sedation to bring me down from my hypermanic state in the year 2000, though the antipsychotic / neuroleptic drug, haloperodol, was – to be frank- a rather extreme experience that I could have done without. What works for me? A good relationship, for starters. Then there’s my twice weekly visits to the gym. I tried looking into narrative therapies but found they tended only to reinforce the trauma (depending on your definition of trauma). The best therapy for me was to write. I found I could effectively exorcise my demons in this way, park the problem, and move on. I’ve had no repeat hypermanic episodes to date and I don’t get depressed. Psychiatrists label such a dysfunctional/euphoric state as “unipolar-manic” (!)

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    • Thank you John. I have lived it with it for twenty years myself. Initially I went down the psychiatric route and was conveniently pumped full of drugs. It may well have pacified me but it taught me very little about self and how to live with BP, but that, I guess is the idea. Glad to hear you are doing well and living life in a way that fits your paradiym, rather than the established consensus.

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  6. Thank you for this intelligent, thought provoking blog. I have lived with bi polar from the age of 15. I’m now 52. I tried medication, a mix of anti psychotics and anti depressants for around 3 years. Many people feel they are helpful, however, for me the anti psychotic seemed to deaden me to the point of losing any sense of who I was. It is great that you are reminding people that the chemical imbalance idea is not a hard fact. I feel sad that many people just do as their psychiatrist says in their desperation to feel better. Bi polar is a terrible illness but their is hope. We can take responsibility by doing things that we know support us. I know by experience of teaching yoga and mindfulness in psychiatric hospitals and prisons that we can naturally change our physiology through exercise, breathing techniques, meditation, mindfulness, feeling safe, eating well, sleeping and resting. (Add your own personal favourites here.) Observing friends and clients with this illness, it seems people with bi polar have an extreme reaction to stress and trauma and the more we can nurture, nourish and relax ourselves the more well we feel.

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