9 Myths of Bipolar Disorder

This is an excellent post – long over due.

My concern is that Bipolar Disorders – note the plural – are spectrum disorders. Who knows how the new DSM-V will describe them. Or how many they will describe. (I often wish that manual didn’t exist. And that diagnoses didn’t exist, as Harvard clinical and research psychologist Paula Caplan has discussed in her work.)

What I especially like about this post is that it stresses that there are many ways to treat the symptoms of a bipolar disorder diagnosis, depending on the individual.

What particularly pleased me was the fourth point. Bipolar Disorders and many other psychiatric disorders are not all “chronic illnesses” … I’m not particularly fond of the diabetes analogy that’s always trotted out.

There are many treatment tools and certainly medications are among them. There are others that go beyond symptom management and can lead to recovery. They’re not quick fixes, but they work in many cases.

Yes, recovery is possible in many severe psychiatric disorders, including Bipolar Disorders.

What concerns me is that “talking therapies” are not more widely used and stressed as mainstream approaches for mental or emotional disorders. In England, Australia, New Zealand and Germany, pharmaceuticals are de-emphasized as ways of dealing with mental health issues of all kinds.

In North America, we are wedded to an approach that treats symptoms instead of investigating the root causes of a disorder. This tendency is based on the widely held assumption that psychiatric problems are caused by “chemical imbalances in the brain” – which has yet to be scientifically proven. There are many causes.

I am really happy you posted on mythology. This should be an ongoing discussion. We are all different. I support and value celebrating “difference” and violently oppose trying to turn everyone into “square pegs”. Mental health issues and mental or emotional disturbances/disorders must be viewed very specifically to each individual.

There is much more to say and I hope you will continue saying it and drawing our attention to it, encouraging this open discussion.

Your previous commenter is absolutely right about mania. My mood disorder is unipolar – severe mania with psychosis. I have never experienced depression, but I’ve been hospitalized 20 times for mania.

It can be devastating, indeed. Luckily, one medication – Tegretol – has worked for me and I have not had a major manic episode since 1988. However, without psychotherapy which give me insight, I wouldn’t be able to manage my hypomanic tendencies nearly as well as I do.

Thank you, so much, for this post.

Is it really true that the mood swings of bipolar lessen in fregencey/severity?

If it lessens over time then is it possible that I DON’T have bipolar disorder? I ask because I seem to be getting worse.

Ha. Jan stole my diabetes analogy exactly. I’ll concede that it is incorrect to think that bipolar disorder ought to be treated entirely medically, but the fact that its etiology is not fully understood does not automatically mean that it is excluded from being “medical.” I have fluctuations in my mental state that respond very well to certain medications (and not at all to others). Because of that, and as far as I’m concerned, this is predominantly a biological condition. Medicine helps = medical. Therapy helps = mental. Can’t it be both?

I don’t understand why you feel that the ‘bipolar = medical’ line of thought is a myth that ought to be dispelled. Referring to mental illnesses as being medical problems helps to decrease the stigma surrounding them. If you take that away, it really is just “all in my head.” I don’t blame chemicals entirely – I have gotten a lot of benefit from some therapy – but I do feel very strongly that a medical disorder of sorts is the foundation of my troubles.

I have encountered opinions similar to yours in a couple of my therapists. They made little effort to hide their disapproval of my chronic medications until I’d have a medication or dosage change that completely changed my disposition. Then they would concede that there was a “biological component.” However, it was frustrating and discouraging to have something so life-savingly (literally) helpful to me be scorned in that way. Seriously, I would not have been in therapy at all if I thought the problem was purely chemical.

You can continue to disagree with me and Jan all you want, but for the time being, and until research definitively proves otherwise, I see no harm in letting the “medical” hypothesis linger.

I do agree Dr. Grohol.

The distinction between disorders and medical diseases can certainly be skewed or blurred by an inability to correctly utilize terminology and facts. I can still see, however, why depression and BPD would be viewed or stated as being a “medical disease.” It is very often the symptom that acccompanies a physical illness or any sort of medical/neurological disease such as migraines. It has a medical component; although the psychological and social components must not be ignored I agree. It can get tricky!

Additionally, there may be some positive psycholgical effects to using the term “medical” in referring to bipolar disorder. It does indeed reduce stigma (while perhaps misleading the person suffering from the disorder), but it may work to encourage the person to seek help because they see the disorder in a medical sense and not a pathological or neurobiological perspective.

I am BIG on terminology and an advocate for watching out for marketing (even with the NIMH,NIH,WHO,etc.) in the scientific realm. It’s as detrimental as a shark and has unfortunately confused and misled a lot of the public.

I appreciate someone’s effort in compiling these 9 myths. It might be good for discussion at a dinner party. I have been bipolar for 27 years at least. I agree that I am not crazy but I admit to acting crazy on occasions. I may not be on medication for the rest of my life but not many doctors would support me in stopping. I would need to be in a controlled environment. I stopped my meds twice with disastrous consequences. I never stopped because of feeling better. It was because of side effects or because my life was in turmoil. I certainly hope that something I have taken explains my weight ballooning. I would have like some expamples of Atypical antipsychotoics. Finally, the tenth myth is that anyone knows a damn thing about Bipolar Disorder.

I found this treatment somewhat weighted towards the pychological professional. Other than supportive therapy or CBT in depression, bipolar disorder is poorly served by depth psychotherapy, which can actually worsen the symptoms.

Further, our understanding of simple strep pneumonia is not much better than our understanding of bipolar disorder; why 30% of us carry the bacterim, much like meninogococcus, and never succumb is a mystery. Mood management can very much resemble controlling one’s blood sugar, with maintenance and adjustments.

As for the question of “medication” for the rest of one’s life, most studies aver that it will be necessary, but you don’t have to tell the patient that; medication compliance is hard enough without this added burden.

In all, a good article, but a little loose around the edges from the perspectivhe of a doctor and long time sufferer.

C. E. Chaffin M.D. FAAFP (third-generation bipolar)

This article infuriated me as did some of the comments below. I agree with Jan that the author is perpetuating his own myth here.I have coped with my husbands bipolar disorder and a close relative’s severe depression and psychosis for many long years and observed their epiosdes both severe depressions , and manic / hypomanic or mixed episodes literally come out of nowhere overnight ,after sleeping without any obvious trigger at all just like a hypoglycaemic attack in diabetes can sometimes do even if the person is taking their medication and not doing anything to destabilize their illness, especially if their medication combination or dosage is not right.

I have 28 years qualified medical experience .The fact that children can develop bipolar disorder or diabetes for that matter in perfectly healthy well balanced, happy homes in happy children and healthy eating children and parents with no disturbance, it can be nothing to do with their lifestyle often without traumatic events, just as Diabetes comes on in children out of the blue. Bipolar Disorder can also come on in children though more commonly in mid to late teens or early twenties out of the blue. It is hard to find anyone nowadays who at some point in their life has not had stress or some kind of personal family or social trauma if yiu look hard enough for one, so I feel it may well be more often coincidental that they develop Bipolar disorder ,and may well have come on later anyway without traumatic triggers, as many do not appear to have had any such traumas, but Do have a family history ( genetic )even without growing up with that person or being affected by their behaviour.

Obviously if their is trauma, the biological impact and connection is obvious. It causes a flood of stress hormones which is a normal primitive flight or flight response such as the release of corticosteroids and adrenaline etc, and , maybe the surge of these into the brain at critical and sensitive timess in a persons life and development such as adolescense or childhood when brain tissue is still developing or after viruses in any age or in the menopause, male or female , when there are distinctive drops in hormonal levels, this may well add to an already genetically vulnerable and challenged brain.

But this is still medical and physical even with psychological and mental presentation because it is the brain it is affecting. The brain is responsible for higher mental functions, cognitive etc , ( as well as all essential organ control / hormone control) and emotions/ behaviours which come broadly under psychological and cognitive headings Many behaviours are learned through observing others function, by example by copying in infancy and childhood, though some are automatic such as feeding instinctively at birth and defecating. These are not really behaviours but functions and essential survival behaviours if you like. We just learnor are shown or habituated into how we will carry them out differently in our own distinctive ways in life, such as hurrying our meals or rushing around too much to be able to sit down for long enough to defecate effectively.

If these are affected it is still all medical. The brain is just one of our organs with a specific role to play. Learning,Thinking, behaving , feeling, expressing ourselves by communication in many forms , appropriately hopefully and controlling essential bodily functions automatically. If the brain is not functioning due to tissue damage or chemical depletion, interruption or chemical imbalance or faulty signalling betwen neuromessages, this will be manifested in all the above mentioned functional areas, naturally. Common sense. So ofcourse Bipolar Disorder is a medical, physical condition which is manifested in all the these areas of function due to brain malfunction ! Fact !

Lets face it how often to the psychiatrists actually hit on just the right drug or amount for someone. It can take years to establish what works and how much chemical medication is required, and is trial and error for a long time for most people, though some do have very effective medication treatments, and self manage very painstakingly and responsibly to enhance that, in addition to having supportive and educative psychotherapeutic help, which is all they do, but they help people cope anf come to terms with having an illness, and how to manage it, all of which reduces stress by increasing understanding and examining lifestyle impacts too, such as sleep, activity and what we put into our bodies all of which will affect our chemistry directly. Still Medical !

I would say that only people with mild bipolar disorder can possibly manage with therapy and self management , lifestyle adjustmets alone. The majority with moderate to severe illness do need some medication as it is clear their brain chemistry is obvioulsy more disfunctional than someone with a very mild or milder forms. Nevertheless , milder forms that go untreated for years often develop later in life into full blown or more severe forms of Bipolar Disorder, 1 or 2,which will most likely need medication treatment as well as all the complimentary therapeutic approaches .

This illness does not just go away even if people have years of apparent remission. For some their pattern is to only have very infrequent swings, and for others its every few months, weeks or days or hours depending on whether they have Classic Bipolar 1, or Bipolar 2, cyclothymia, Rapid , ultra rapid or Ultradian Rap Cycling which is the cycling every few hours or minutes type.

There is a lot of variance and compliance with medication and other self management is also affected by ones level of mental insight into eoisodes, particularly when high, ( manic or hypomanic ,as judgement usually is significantly diminished very early on in even in Hypomania once the mental Insight goes. Complinace is alos affected by the level of intelligence as it is a lot to take on board and understand, and by the level of support that the individual has from mental health services and in their home or social or work environments. This can all have an impact on how they learn about their illness, accept it, manage it and cope. The severity and pattern or frequency of their individual bipolar Disorder can also affect outcomes and compliance with treatment.

Bipolar disorder can vary alot as it a spectrum disorder, but is still a medical illness. Spectrum disorder just means that their is a scale and range of symptoms and degrees of severity, and people often have the illness presentation at different stages on that scale along that spectrum. However , that can change throughtout their lives, becoming more severe or less severe, and better managed, managed worse. It all interplays.

The same applies for any chronic illness be it physical or mental in presentation, they are all still MEDICAL. THe brain is just another bodily organ with a specific function like all our organs. When they don’t work we have a medical illness, and the brain is no different in this respect. If our kidneys were responsible for thought processes, then our symptoms would be urinary. THe brain has a job to do and it can’t do that job properly if something in it is malfunctioning, and it is as simple as that.

Emotional, Psychological, behavioural difficulties are all dependant too on brain functioning and part of that function is cognitive, to do with learning , that includes behaviour. Stressors in life have a direct effect on brain tissue development and stress hormones all of which affect memory and behaviour, so ofcourse environment plays a part and early experiences but only in so much as they either allow the brain to deveolp normally or they hinder it from growing and being able to store healthy information to enhance effective learning and appropriate behaviour. IT has been proved that brain tissue actually shrinks in response to repeated negative abusive comments and behaviour towards children or grows in response to positive praise and encouragement and coninues to grow and deveolop well with positive reinforcement.

On top of all this we also have genetic abnormailities of specific protiens in the brain that have been found in those with Bipolar Disorder and which respond to Lithium and other mood stabilizers. Research has been done to show exactly how Lithium works on these protiens and explains why it is effective though I can not explain that here as I am not a neurobiologist or chemist .

All these findings confirms that Bipolar Disorder is without a shadow of a doubt a medical Disorder which is why it responds to medical treatments such as medications. If the route cause is faulty brain chemistry then the route back is to normalise those chemicals even if we still need to do a lot of work to refine and improve them and make them less toxic or work on finding what has caused them to be depleted or malfunctioning in the first place, but malfunctioning they are without any doubt.

That makes this a medical Condition with its presentation found in the functions directly related to the organ affected and responsible for those functions. If Bipolar Disorder were a gastric disorder, it would present with gastric symptoms. Because it is a brain disorder of function it shows itself in those functions the brain would normally carry out, emotions, thought processes, and behaviour. This is so obvious but rarely stressed or explained.

Emotions, thought processes and behaviours are all functions regulated by the brain, therefore if the brain function is disrupted in any way chemically or otherwise so will these higher functions appear to be affected. Hence faulty thinking, difficult, distressing, inappropriate behaviours, and grossly distorted moods and emotions . Speech , behaviour and capacity to recall , ability to organise normal tasks or even regulate bodily functions can all be effects of bipolar brain malfunction hence all the physical symptoms of the illness too. It can be experienced very physically, not just psychologically or emotionally or cognitively. It can affect all other systems which even adds to the fact that it is a brian functional problem and can over stimulate or understimulate lots of other organs leading a whole range of symptoms that are not imagined, such as chronic unexplained pain , appetite changes, nausea, skin sensations, constipation, visual disturbance, olfactory , gustatory or visual or auditory hallucinations all connected with faulty direction of sensory nerve signals going to the wrong parts of the brain leadng to expression of psychosis ( false thoughts and beliefs , thats all it is )which is just false perceptions or faulty thoughts which lead to a disturbed reality . But it is very real to the person because their brain is creating these things.

Bipolar Disorder is without any doubt a Medical disorder of brain malfunction of Dopamine regulation primarliy and other neurotransmitters such as serotonin which are either depleted or not signalling properly with other chemical messengers. If it were not a medical problem individuals would not respond as quickly or as effectively as they do once given the “right combinations” of chemical treatments and in “adequate dosages” ,which they often are not , of medications which restore the brains chemical balance and restore functioningin all the affected arease. As chemicals affect thought processes and cognitive functioning, and thoughts lead to emotions which in turn lead to related behaviours which seem relevant to the individual experiencing the real or false emotion.

Of course along the way people will have deveopled maladaptive ways of coping and behaving too with their undiagnosed or poorly treated illness as well as in some cases other troublesome behaviours or beliefs due to their upbringing . This will further complicate bipolar disorder if they have never been taught apropriate behaviour which they can return to in the first place, or have difficulties expressing emotions.

Believing and thinking in response to a false perception of reality when insight is lost will have a huge impact on how they cope with what goes on around them. Naturally this aspect of the illness may well be helped back to normal or acceptible behaviours by therapy such as CBT or psychotherapy, or behavioural therapy to more normal and appropriate ways of behaviour andthinking if unhealthy patterns of responses have become a habit, but this still all stems from a medical problem of brain function in the same way that someone would feel , think and behave if given intoxicating substances or alcohol which would temporarily disturb their brain function. It alters their chemistry and affects behaviour out of their control just in the same way bipolar brain chemistry is out of the individuals control. Obviously if this becomes a dual problem alongside the Bipolar Disorder as an attempt to self medicate or in a manic / hypomanic period where insight is lost and the most sober of people start suddenly taking things they would not usually take in quantities totally out of chatacter for them, then this won’t help, but they are ony behaving this way either to try to escape symptoms of depression or anxiety if low, or if high have become disinhibited and lost their judgement due to the mania and doing things automatically , impulse driven. It is not a matter of choice. The choices made are dependant on the brain chemistry at the time. Alcohol or drugs taken at that time will add further to even more loss of judgement. But Bipolar Disorder when manic is almost like being drunk and behaving inappropriately like that even without any alcohol or substance taken. It is not within the person s control and can come on spontaneously, perhaps after prolonged stress which has tripped the braines chemical circuit, or after missed medications, or with the wrong medications being prescribed or taken by thev individual, before the illness is diagnosed so when there is no treatment in place yet anyway, and it just comes on.

The same brian chemistry disturbance is occurring spontaneously without having taken anything, or it it is added to by actually taking something such as drugs or alcohol or too much caffeine once judgement is impaired . If this were not the case individuals would not respond as effectively to chemical treatments if the illness had no basis in chemical abnormalities or imbalnaces. There is also clear evidence of brain differences in scans and at autopsy in those with Bipolar Disorder , Therefore identifying Medical anomolies .

Though it can be affected by external stressors or body clock or social rhythms disruption , stimulants such as caffeine, sugar or CNS suppressants such as alcohol, ( all of which by the way have a direct effect on corticosteroids and other hormones that are released in to brain cocktail to help disregulated ) generally the abnormality is already there and these stress hormones or external substances once ingested will not help and will bring out the abnormailirt or agravate the symptoms further. They are not the cause. They just worsen or prolong or kick start the illness which would have emerged at some point from its dormant or early stages. This illness come son in people with no history of any substance or alcohol abuse or excesses of other stmulants or stresses, such as children and adults laeding perfectly healthy and nornmal lives. Likewise many people in their adolescence or early twenties often indulge in all these unhealthy excesses yet do not develop Bipolar Disorder, unless there is genetic, familial predisposition . Therefore, it is medical condition which can strike anyone at any age at any time in any circumstance like any other medical condition. However obviously looking after our all aspects of our physical and mental wellbeing as we age , attending to rest and diet, what substances we put into our bodies, activity and happiness might I am sure help ptotect people on some level who might or might not develop it later in life, just like we can help protect ourselves from Cancer with a healthy lifestyle. Bipolar is Medical illness which we may or may not develop or avoid if we are lucky as it can be devastating. get the best treatment you possibly can and follow it. Good luck to all with this medical condition. It can be very well managed with commitment to treatment, and support and education.

The fact is that bipolar is a disease of the brain.

If someone wants to go metaphysical and ponder the “why” of any disease they have that freedom.

Psychotherapy does not aid, or resolve what is centered in the brain. For some it may be helpful to have a support person.

If anyone would like to educate themselves on the disease of bipolar and abnormalities in the brain there are many opportunities to do so.

Promoting a belief as fact is very dangerous.

After suffering all my life with severe insomnia resulting in hallucinations, speed-talking, wild thinking—and trying every psychological “treatment” including Primal Scream therapy, talk therapy (Freudian & Jungian), art therapy, prayer, meditation, biofeedback—NOTHING worked until I got medication. Depakote & seroquel stopped the endless manias and made the suicidal thoughts Stop after I’d been on both meds for 6 weeks. I am able to stay stable by meeting with an MD & staying on my meds. Talk therapy did Nothing. Meds helped so much. I also have to be sure to exercise, not drink alcohol (I never did “street drugs”) and stay away from negative people. No one can convince me that meds are bunko. They saved my life. I was 45 when diag. with bipolar. I had suffered from Day One. My father has this. So did his mother. It is a physical condition. Psychologists may want it to be a “mind issue” so they can get paying clients. But I am living proof that suicidal thoughts & super manias can be successfully treated with Medications.