Author: Madeleine Russell
Stigma around bipolar disorder can be gradual and subtle, but with very harmful effects. Bipolar affects 1 in 50 Australians and tends to run in families. Stigma is a well-known driver of poor health outcomes, yet continues to permeate perceptions of the disorder and the individuals who experience it. Chances are, this affects someone you know.
By enacting stigma through misconceptions about bipolar, we uphold an oversimplified view of a highly nuanced and complicated condition. We devalue the unique challenges, perseverance and unimaginable triumphs that some families face. And we censor our ability to truly engage with their hardships, that deserve, at the very least, our recognition.
This we can change. As someone intimately acquainted with bipolar-related stigma, let me point you in the right direction. Here are five common misconceptions and how to dismantle them, including resources from Australia’s leading mental health organisations.
- The ‘bipolar as negligence’ assumption: A person’s bipolar has developed from a failure to take proper care to prevent or avoid it.
Response: Personal negligence is a serious misconception about the ‘aetiology’ or causes of the disorder. Risk factors for developing bipolar, or factors that can act as a trigger for the first episode, include:
- Having a first-degree relative with bipolar disorder (such as a parent or sibling)
- Periods of high stress, such as the death of a loved one or other traumatic event
- The ‘too little, too late’ assumption: A person should have been diagnosed sooner by seeking help earlier; that is, after their first episode or during symptom free periods (euthymia).
Response: We must remind ourselves that help-seeking barriers for young people are various and complex. Prominent barriers include incomplete mental health literacy and balancing the need for help with the need for autonomy.
Promptly seeking out a diagnosis relies on know-how of risk factors and warning signs, and the ability to recognise symptoms as symptoms by their association with a particular mental health condition. This is a highly specialised skill. Can you tell me about the early warning signs of bipolar, beyond changes in mood?
On top of all this, insight – an awareness of having a mental health condition and understanding the signs and symptoms – can also be affected by co-occurring neurodevelopment conditions and variations in cognition that impact learning, memory and reasoning (during euthymic periods as well as episodes).
Did you know that diagnosis delays for bipolar are common?
According to 2020 research, the average delay between onset and diagnosis of bipolar disorder is 6.46 years. Factors contributing to a delayed diagnosis have been identified as:
- A reliance on detailed life history and corroborative information from carers and family, which takes time and care to collect
- Misdiagnosis with other mental health conditions (especially depression), resulting in inappropriate treatment
- The ‘hasty generalisations’ assumption: One person’s bipolar will present in the same way as another person’s bipolar.
Response: Examining just one or very few examples, and generalising that to be representative of the whole category of experience or phenomena, is faulty reasoning. Simple as that.
The tendency to view people within a diagnostic category as a homogenous group can obscure important information and individual differences. Did you know that bipolar occurs on a spectrum and there are several different types? A good place to start is to read about the difference between bipolar I and II.
- The ‘biological deterministic’ assumption: “But I have a first-degree relative with mental health issues and I don’t have bipolar.”
Response: Mental ill-health is not so cut and dried. Even though bipolar and other complex mental health conditions (like schizophrenia) tend to run in families, having a family member with lived experience doesn’t mean that you are going to develop a condition yourself. The physiological processes associated with vulnerability, expression and course of bipolar are complex, multifactorial, and not fully understood.
- The ‘soiled identity’ assumption: A person with bipolar can (and needs to) fundamentally change, rather than manage their symptoms.
Response: Symptoms (and associated harms) reflect a person’s condition not their identity. Viewing bipolar symptoms as personal traits that arise from blemishes of character, and require fundamental change, is inaccurate and counterproductive. Identifying affective states, not traits, is likely to support self-management strategies and improve health outcomes.
Black Dog Institute: https://www.blackdoginstitute.org.au/
Orygen Youth Health: https://oyh.org.au/
SANE Australia: https://www.sane.org/
Find Support (Australia)
People needing support can contact Lifeline (24 hours a day) on 13 11 14 or chat to a Crisis Supporter online at lifeline.org.au (7pm-midnight).