Why is bipolar still misunderstood?

It is frustrating so see that Bipolar is still being dismissed or downplayed so much in society. While public perception of mental illness has come a long way in the last twenty years since my husband was first diagnosed with a psychotic episode, we still have so far to come in understanding and accepting the various forms that it takes.

I still come across prejudice and ignorance, something that has cut quite deeply considering how much I have been through to get to a place where I can advocate for those who can no longer speak on their own behalf. People like my husband who committed suicide.

It has cut deeply in responses like the Huffington Post Australia's Editor in Chief, Tory Maguire, who told my publicist and friend that she found the fact that my husband wasn't officially diagnosed to be "problematic", and downplayed the fact that we still have so far to come in educating the public on the very fact that this is the most misdiagnosed and misunderstood of mental illnesses. Her perception is that "ten years isn't that long."

How sad that a media outlet with such influence and reach has a representative who still holds these views. *

But is she so very different from the average person?  In fact, the lack of awareness in society of understanding how to spot signs and symptoms of bipolar disorder is the very reason I wrote this book. In my book I describe my husband being medically diagnosed early on with a psychotic episode and how we were warned it could lead to schizophrenia (a common misdiagnosis and the first that I knew of). When he was found by police in his car after committing suicide, he had a bottle of antidepressants with him. A doctor had diagnosed him with depression (the second misdiagnosis), which according to Headspace Australia is a common misconception of the disease.  

According to Headspace, bipolar disorder is the most misdiagnosed affliction of all the mental illnesses. Overall, about 50% of people who develop bipolar disorder will do so by the time they are in their early to mid 20s. Bipolar disorder in young people may sometimes be misdiagnosed as depression. Australian researchers have found that from the average age of symptom onset (17.5 years), there was a delay of approximately 12.5 years before a diagnosis of bipolar disorder is made.

Furthermore, it is important to note that antidepressants do not work on bipolar disorder, in fact they can exacerbate suicidal ideation. Bipolar needs to be treated with mood stabilisers.

So it's not unusual for someone like Tory Maguire to completely miss the point of my book. Let's take a deeper look at this disease and educate ourselves a bit better. Even better, if you come across someone who doesn't understand the disease, send them a link to this blog!

What is Bipolar Disorder?
According to the Black Dog Institute,  bipolar disorder describes a set of 'mood swing' conditions, the most severe form of which used to be called 'manic depression'.

Bipolar disorder I is the more severe disorder in terms of symptoms - with individuals being more likely to experience mania, have longer 'highs', be more likely to have psychotic experiences and be more likely to be hospitalised.

Bipolar disorder II is diagnosed when a person experiences the symptoms of a high but with no psychotic experiences. These hypomanic episodes tending to last a few hours or a few days.
The high moods are called mania or hypomania and the low mood is called depression.

Read more at the Black Dog Institute page on Bipolar Disorder here.

Why is Bipolar Disorder so easy to miss?
Bipolar disorders, especially Bipolar II, is not easy to spot, even  by professionals (as my husband and I experienced first hand). Most people will present while they are in a depressive state, and sometimes the mania does not manifest until after the person is in their early 20s, by which time they are often diagnosed as having unipolar depression.

What makes it harder to spot is that bipolar depression can look like a regular major depression. They share many of the same symptoms (e.g., feeling hopeless, sad, chronically tired, mentally sluggish, and loss of pleasure). Nonetheless, there are some important differences between the two that involve character of mood and intensity of symptoms.

Patients and carers are not always able to provide physicians with sufficient information to make a bipolar diagnosis, because of a lack of understanding of their mood, energy and activity levels when they feel bad versus good.

Hypomania can also appear quite normal, especially in Bipolar II. What are symptoms of mania can often be misunderstood as the person simply being optimistic, highly productive, interested in people and activities, have a lot of good ideas, mental clarity, and motivated to start new projects.

What's not to be happy with that state of  being? Especially after a long period in a depressive state.
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How can you spot Bipolar in a loved one?
This is where I don't proclaim to be an expert. Several psychologists told me my husband is likely to have had Bipolar Disorder from my description of his symptoms and our problems. However, looking at the checklist below, he checked every one of the criteria. 

Use this checklist (which I have sourced from Psychology in Everyday Life website) to see whether aspects of a person’s personal, family, mental health, work and relationship history that may point to a Bipolar disorder. If you think your loved one may display some, or all of these, talk through your concerns with them, and encourage them to see a  mental health professional.

1. Have they had depression in childhood, adolescence or as a young adult? The pattern of the depressive episodes is important, here. If they have frequent episodes of depression or are sad a lot of the time (at least once a year), there is a strong likelihood that it is a part of a bipolar disorder.

2. Is there a genetic basis to their moods? A family history of psychiatric illness, such as a nervous breakdown, alcoholism, depression, mania, or psychosis is also a red flag for bipolar disorder. Is there a parent, sibling, aunt, uncle or cousin who has bipolar disorder or another mood disorder? Has a family member ever been hospitalised for severe depression or mania?

3. Have they been hospitalised for depression or mania? 

4. Have they had periods of hypomania in their life? 

5. Do others see them as the “artistic type” (temperamental, moody, highly strung, quirky, hypersensitive, emotionally fragile or unstable)? Dramatic shifts of mood, energy and activity levels affects one’s attitude and self-image that leads others to see them as fickle, temperamental and moody.

6. Do they have a history of fits and starts of uncompleted projects? In particular those with Bipolar II start many projects in a hypomanic state. They have many good ideas that the negative symptoms of hypomania (hyperactivity, errors in judgment, and distractibility) may not let them complete. Or, bipolar depression takes them over before they can fulfill the projects started in a hypomanic phase.

7. Do they have trouble in work and personal relationships? Their swings of mood, energy and activity levels do not allow them to work productively with other people. They may chronically show up to work late or have irregularity of job performance.

8. When they feel well, do they engage in risky behavior? Hypomania can lead to over optimism, faulty judgment and an overinflated self-esteem. This can lead to excessive spending, sexual activity, gambling and alcohol and substance abuse.

9. Are they sensitive to stressful changes? This includes internal (illness, hormone shifts, or change in lifestyle habits) and external (job and relationship changes, conflicts, pressures) changes. 

10. Do they mention dying or taking their life? Suicide is a high risk for Bipolar I and II people. The mortality rate for bipolar illness is higher than many forms of heart disease or cancer. As many as 1 in 5 people with bipolar disorder have committed suicide. This is a rate approximately 30 times greater than that of the general population.

To learn more about me and my experience living, loving and leaving a husband with bipolar, visit the About the Author page, to learn more about Marrying Bipolar go to About the Book. If you want to purchase a copy of my book, you can visit the store, each book is delivered signed with a personal message from me to each reader.

More information:
Persistent myths about Bipolar Disorder
99 Bipolar Disorder Facts
Bipolar II Disorder: Misunderstood and Misdiagnosed
45 Truths People with Bipolar Disorder Wish Understood


*In an email exchange with my publicist, who gave Tory the facts about bipolar misdiagnosis and urged her to reconsider, she responded "I stand by the decision and will not reconsider."