“Is Bipolar Real?” Addressing A Mental Health Stigma

Mental health disorders have likely existed for as long as human beings have. Throughout history, different theories and rhetoric surrounding the origin of mental health symptoms have often been used to explain the changes and challenges that mental illness can present. However, many of these explanations have been rooted in false, misconstrued, or harmful assumptions about psychology. As a result, many people with mental health disorders find it hard to receive adequate accommodations, and some may believe they have to "prove" or justify their symptoms to be accepted in their jobs, homes, and relationships. 

Is bipolar real?

A mental disorder, like bipolar disorder, is a legitimate health challenge that can impact a person’s ability to function. However, proper treatment is available to help people with bipolar I disorder, bipolar II disorder, and bipolar depression. In addition to implementing healthy lifestyle habits and taking medication, talk therapy may be a helpful component of a bipolar treatment plan.

What is bipolar disorder (formerly called manic depression)?

Bipolar disorder is generally considered to be a mood disorder. It is typically characterized by periods of manic highs and depressive lows. There are three types of bipolar disorder: bipolar I disorder, bipolar II disorder, and cyclothymic disorder. 

To be diagnosed with bipolar I, an individual must experience at least one episode of mania. Manic episodes may be preceded or followed by major depressive episodes (though depression is not necessary for a diagnosis). For a diagnosis of bipolar II, both a depressive episode and hypomanic episode—a less severe period of mania—must be present. People with cyclothymic disorder typically experience periods of depressive and hypomanic symptoms that do not rise to the level of episodes of depression or hypomania. 

Symptoms of bipolar I and bipolar II disorder

Though the causes of bipolar disorder are not fully understood, people with a family history of bipolar disorder, major depressive disorder, or other mood disorders may be more likely to have the condition themselves. 

Symptoms of a manic or hypomanic episodes

• Abnormal levels of energy or mood changes; decreased need for sleep

• An exaggerated sense of confidence or well-being

• Risky decision-making 

• Unusual or increased talkativeness

• Racing thoughts or an inability to focus on day-to-day tasks

Symptoms of a depressive episode

• Insomnia or poor sleep

• Disinterest or apathy, even related to things that used to bring joy

• Significant changes in weight due to an increase or decrease in appetite

• Fatigue

• Depressed mood (feeling sad, empty, numb, etc.)

Depressive episode: Symptoms of cyclothymia

In cyclothymia, bipolar depression does not meet the criteria for a major depressive episode. However, depressive symptoms associated with this form of bipolar disorder can still present serious challenges. 

The effects of bipolar disorder

Bipolar disorder can impact people in virtually every aspect of their lives and may present challenges in relationships, work, school, and an individual’s personal life. Because bipolar disorder can be characterized by periods of intense activity and productivity, or extremely irritable mood changes, followed by a period of severe depressive symptoms, or, in extreme cases, psychotic symptoms, work performance can be alternately positively and negatively impacted, while relationships may be challenging to maintain due to the aggravated highs and lows of the condition.

Without continuous treatment or support, bipolar disorder may lead to lowered self-esteem. Those experiencing its symptoms may blame themselves for unusual shifts in temperament or uncontrollable behavioral changes that lead to instability. 

It can be helpful to remember that bipolar disorder is a legitimate mental illness, not a character defect. Its symptoms can be truly life-altering to those who experience it.

“Is bipolar real?”: Addressing stigmas associated with mental health disorders

• Mental health disorders aren’t real, are exaggerated, or aren’t significant.

Perhaps the most common and damaging stigma associated with mental health conditions is the assertion that people living with bipolar disorder or other illnesses are being dishonest or are "faking it." This can also be a reason people are not afforded proper care, as their experiences may be doubted, dismissed, or ignored. 

• Mental health disorders exist, but only in a certain way. All people with mental illnesses face the same challenges.

Often, there is a stigma around how a mental illness "should" look. As a result, people may cast doubt on someone who claims to have a mental illness but does not fit the mold they have created. For example, a person might incorrectly assume that all people living with eating disorders are very thin.

• People with mental health disorders are lazy, undisciplined, or lack the willpower to overcome their symptoms. If they just “tried harder,” adopted the right attitude, or changed their habits, they could feel better.

This stigma fails to recognize the uncontrollable nature of many mental health symptoms, as well as how many mental illnesses affect brain structure. It may also be used to diminish a person's needs or worth. A person going through a depressive episode may require more than willpower to manage their symptoms.

• Mental health disorders are abnormal, strange, or scary. The people who experience them are unpredictable or unsafe.

Believing stigmas often results in discrimination, bullying, and similarly dangerous attitudes toward others. Assuming that a person is nothing more than their mental illness often stems from a lack of understanding or outdated beliefs. Some mental health conditions, like anxiety disorders, are common and often undetectable to others. 

How are people with mental health disorders adversely affected?

Stigmas associated with mental health can negatively affect people living with mental illness. They may develop low self-esteem, struggle feeling comfortable with seeking help, or harbor negative feelings about their own symptoms. The result may be worsened symptoms, failure to pursue necessary treatment, isolation from others, and unhealthy coping mechanisms, like excessive substance use.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

How can the stigma be removed?

One of the most effective ways to raise awareness and remove stigma can be to speak openly about mental health. Although mental illness has often been hidden and gone undiscussed in public spheres, talking openly about mental illness can help others feel less alone and may show those who are misinformed that their ideas may be rooted in false presuppositions. 

Removing mental health stigmas

Stigma can also be removed by increasing understanding of mental illnesses, how they work, and how they develop. Because so many people may consider mental illness to be a choice rather than the result of phenomena beyond an individual’s control, education regarding the true nature of psychological disorders may be the best tool we have to promote change. For example, helping people understand bipolar disorder may help alleviate fears and inaccuracies about the condition.

Finally, by acknowledging these beliefs as the harmful assumptions that they often are, it may be possible to empower more people living with mental illnesses to stand up for their right to be accepted, accommodated, and understood. 

Treating a manic or depressive episode

One of the most significant consequences of stigma may be its ability to hold people back from seeking an accurate diagnosis and pursuing treatment for mental health symptoms. Whether it be for bipolar disorder, depression, PTSD, or something else entirely, professional mental health treatment is often necessary. The very stigma that tends to pressure people to manage their symptoms may be the same stigma that can prevent people from seeking mental health care.

Therapy for people with bipolar disorder

Bipolar disorder is usually treated with psychotherapy, such as cognitive behavioral therapy (CBT), and pharmaceutical intervention as necessary. Because the condition is usually known for its changes in symptoms, pharmaceutical treatment typically seeks to create a level mood rather than trying to treat depression and mania alternately. Depending on a person’s symptoms, a health care professional may prescribe mood stabilizers and/or antipsychotic medications. Clinical studies suggest that lithium and lamotrigine are effective first-line mood stabilizers, while the antipsychotics quetiapine and olanzapine can alleviate symptoms like hallucinations and delusions. A doctor or psychiatrist can provide detailed information about different medications before you begin treatment.

Can online therapy help with bipolar symptom management?

Living with a mental illness can be draining due to its related symptoms, but having to combat stigma can make things seem even more daunting. Mental health professionals can offer advice, guidance, and support that may not only treat symptoms but also undo some of the harm that stigma can cause. Those who are uncomfortable speaking with a professional face-to-face may benefit from resources like online therapy, which allows you to connect with a provider from the comfort of your own home through video conference, phone call, or online chat. You can also switch therapists as needed until you find a professional that suits your needs and preferences.

Exploring affordable options for effective online therapy

In addition to being an approachable, less intimidating way to seek treatment, online therapy may be a more sustainable option due to its lower cost. One review of 17 studies focused on online cognitive behavioral therapy (CBT) generally found it to be a more cost-effective option for clients than in-person therapy. The same review also discovered that online therapy could be just as effective as traditional therapy for treating mental health symptoms, specifically those related to depression.