Bipolar Disorder as a Social Entity

It’s time to impart the knowledge that bipolar disorder is, indeed, a social entity, and must be treated as one.

The modern era entails a novel discussion on diseases of the body and mind through a social lens, whilst simultaneously acknowledging the biological forces that perpetuate such conditions (Healy). Yet, social norms, ideals, and practices are still often negated in a discussion of any disease. This is inclusive of bipolar disorder, also known as manic depression, which is a mental health condition that involves mood swings from a state of mania to that of depression (NHS). Physicians have taken note of episodes of extreme sadness followed by exhilaration among human civilizations from as far back as before the Middle Age (Healy). However, bipolar disorder today exists differently in one aspect: the manner in which it is triggered, experienced, and treated (Healy). Due to the ever-changing nature of social ideals, each era becomes embedded with divergent social intruders of the body and mind (Healy). ‘Social intruders’ can be used synonymously with ‘social determinants’, referring to the influence of society and social structures on disease (Marmot). In this day and age, one major social intruder is the detrimental view of disease as a bodily or physical defect, entirely ignoring the possibility of social contributors (Healy). This disallows patients to fully understand their condition and properly seek help from external bodies and themselves, as they will not be able to separate themselves from the silent, hidden wounding social systems that surround them (Healy). In other words, they are made unaware of the social conditions that perpetuate their suffering (Healy). There exist a plethora of social intruders, including the bureaucratic nature of our modern world, the mass media and advertising, business plans and tactics, and of course, government policies (Healy). Regardless of which social intruder impacts an individual with bipolar disorder, the converging outcome is that they each do contribute. Ultimately, bipolar disorder, and diseases in general, must no longer be confined to a biological standpoint. They must simultaneously be treated as social entities.

The aforementioned information acts to continue disseminating the valid notion of disease as a possible product of social factors, and the following article attempts at maintaining this discussion by providing information fixated on social interactions. Also, to acknowledge the variance in the causes, experiences, and treatments of bipolar disorder, this article proposes content that is solely applicable to the modern era. It cannot be negated, however, that even individuals living in the same era will face differing realities of bipolar disorder. In consideration of this, a more general account of bipolar disorder and the way it manifests itself today will be provided.

Signs of mania and depression

It is common for individuals with bipolar disorder to be unaware when in a state of mania or depression, especially when in the former phase (NHS). It is thus fundamental to be educated on the symptoms of both states of mind, as this equips individuals with the ability to detect the condition if signs appear within themselves or within others they know.

During a period of depression, an individual often feels sad and lethargic (NHS). That is, they lack energy, feel empty and worthless, and lose interest in carrying out their daily routine. Individuals also feel hopeless, cannot concentrate, find it difficult to sleep, and may even experience suicidal thoughts (NHS). On the contrary, the manic phase of bipolar disorder often entails feelings of euphoria and hyperactivity (NHS). Individuals may also become unprovokedly aggravated, easily distracted, or even begin to have hallucinations and irrational thoughts, which is known as psychosis (NHS).

An imperative symptom of mental health conditions, including bipolar disorder, is the appearance of suicidal thoughts and feelings, which seems to be relatively more prominent during the early stages of the disorder (NHS). Research has provided evidence that the risk of suicide for individuals with bipolar disorder is 15 to 20 times greater than the general population, while approximately half of all people with the condition attempt suicide at least once. This quintessentially accentuates how crucial it is to observe for such a symptom. It must be acknowledged, however, that for some patients, self-harm is not a product of suicidal thoughts, but it may be a predecessor to them. This is because, for some, self-harm means repossessing the power that their mental distress takes away from them (NHS). For others, it may serve as a distraction mechanism for their suffering (NHS). They thus have no intention to commit suicide, but this is not to say that such thoughts are not detrimental and could not eventually lead to the emergence of suicidal tendencies. To avoid this, circumstances must be in place to allow for early detection of the condition, so that an individual can get the necessary aid they require (NHS).  Different means of finding help are later mentioned; however, many countries have suicide hotlines that specialize in listening, providing support, and offering guidance to those in need of it.

There are many more symptoms of both states of mind that although may not be typical, still appear at a significant amount for consideration.

Patterns of mania and depression

For patients living with bipolar disorder, the length of an episode of depression need not be equivalent to that of mania, nor is it necessary that each period is experienced at an equal consistency or regularity (NHS). That is, phases of depression and mania are highly asymmetric for such individuals. Likewise, for some patients, there may exist an interval between both states of mind in which they remain in a ‘normal’ mood (NHS). Others, in a phase known as rapid cycling, recurrently experience both episodes without a ‘normal’ period, while some may experience what is coined a ‘mixed state’ (NHS). This entails a concurrent presence of the symptoms of depression and mania (NHS). Finally, it is also possible for mood swings to last a while, but with effects of insufficient severity to be diagnosed as bipolar disorder (NHS). In such cases, an individual is diagnosed with a mild form of bipolar disorder, termed cyclothymia (NHS). Experiences of bipolar disorder are thus not universal, and this is precisely due to the possibility of innumerable patterns of mania and depression.

Asking for help

The stigma surrounding several diseases, especially mental health conditions, makes it difficult to expect anyone to instantaneously seek professional aid. But guidance from an expert is not always the perfect remedy. Having conversations on mental health with one’s family, friends, charities, or support groups may lead to a better understanding of the condition and its consequences. In fact, many organizations conduct self-help groups that emphasize the importance of intimate discussions between people with bipolar disorder. Such constructive exchanges are, if you may, a form of catharsis; a way to express sometimes inexpressible thoughts and have epiphanies that are otherwise disabled by social stigma. There are numerous international organizations, such as the International Bipolar Foundation (IBF) and the International Society for Bipolar Disorders (ISBP), but there are also organizations localized to countries, such as Bipolar UK, the Canadian Mental Health Association (CMHA) in Canada, and even The Scarabaeus Foundation for Sustainable Development (TSF) in Egypt. The mutuality lies in the fact that each organization serves as a helping hand for individuals with bipolar disorder. They each assist either through confidential support groups, vital support resources, or through much needed education and advocacy. Some have even created cybernetic spaces, such as the *Bipolar UK* eCommunity, for relevant communities to have difficult-but-doable discussions without feeling disquieted by the sometimes-intimidating experience of face-to-face discussions.

Besides self-help groups, there also exists self-management programs, such as ***Self-Management UK***, that train patients with bipolar disorder to be active contributors to their recovery process (CDC). Patients are taught coping strategies and, essentially, how to resist the controlling pursuits of their mental health condition (CDC). This fundamentally improves these individuals’ lives, enabling the once thought-to-be impossible possibility of a happy existence.

Remaining active with a balanced diet has also proven to be immensely utile for patients with bipolar disorder (NHS). Not only does this reduce the depressive symptoms of bipolar disorder, but it also provides routine and serves as a healthy distraction, better termed a coping strategy (NHS). Once a patient feels ready to cross any barriers to treatment – whether that be a stigma or another obstacle – they may be prescribed medicine that causes weight gain as a side effect (NHS). Other side effects may even include a heightened risk of developing diabetes or worsening the condition of already-diabetics (NHS). Physical exercise and a healthy diet would act to circumvent such side effects, which is why they are highly recommended by health professionals (NHS).

It is advised that the aforementioned self-help techniques be used in conjunction with professional aid, as the benefits of the latter cannot go unnoticed (NHS). it has been substantiated that an untreated patient may experience bipolar-related mania for 3 to 6 months and depression for 6 to 12, but if effectively treated, would show significant improvements in a matter of approximately 3 months (NHS). Nevertheless, as explained previously, seeking external assistance requires the sufferer to be willing to seek it. If an individual feels supported enough by their surroundings through, for instance, having needed conversations and constructive realizations, they may feel more inclined to seek professional aid if their mental health continues to deteriorate.  In such cases, it is important to be aware of the numerous treatment options available, as individuals will certainly have preferences. As this article aims to perpetuate a social approach to disease, the treatments to be proposed will not be medicinal, but rather psychosocial. This is inclusive of psychoeducation, an intervention which attempts at educating the patient and their loved ones, so that they are able to better understand the mental health condition and possibly find its root (Bauml). This ultimately enables them to foster coping mechanisms that lessen the effects of their condition (Bauml). Cognitive-behavioral therapy (CBT) has also been increasingly used as a psychological treatment, which concentrates on confronting and altering damaging ideologies, ameliorating control over one’s emotions, and once more, developing coping strategies (APA). Lastly, family therapy has been used to mend the damage done to family relationships, so as to create unity within families and allow a collective effort to improve the mental state of the patient (NHS). Once again, although medicine was not discussed, many patients find such psychological treatment to be vastly effective when utilized together with medicine, so its benefits must not be discounted (NHS).

The Carer

Carers of patients cannot be disregarded in a discourse on bipolar disorder or any health condition for that matter. Although this is not always the case, during episodes of mania and depression, an individual’s personality may be altered, which could make domestic abuse and violence a carer’s reality (NHS). This may necessitate interventions from social workers or even the police, which could further perpetuate domestic discord. Therefore, the mental health of the carer must also be a priority, as such conditions of living could instigate damaging internal conflicts, such as a feeling of helplessness or loss (NHS). Although there exist support groups for such carers, specialist relationship counselors have also been shown to significantly help in lessening relationship difficulties (NHS).

Towards a more fitting narrative

According to the NHS, 1 in every 100 people will be diagnosed with bipolar disorder at any given point in their life. This, in itself, underscores the need to amend the current approach to tackling the condition. In other words, along with the already-present science-oriented discussion, the social structures that surround a patient must be considered in discourses of bipolar disorder. It is unrealistic to expect an individual to recover from any mental health disorder without providing them the opportunity to separate themselves from a social scene that possibly perpetuates their condition. It’s time to impart the knowledge that bipolar disorder is, indeed, a social entity, and must be treated as one.

To learn more and access some important resources, check out our references here!