Bipolar, Language, & Stigma: Can We Change the Narrative?

Education resolves ignorance and can overcome stigma, especially when it comes to brain-based health conditions like bipolar disorder. But what happens when the way we educate others is biased and flawed?

Bipolar Stigma & Education

Lately, I’ve been taking stock of my own different perspectives on bipolar. I’m drawing on what I’ve learned through educating myself, what I’ve learned through lived experience, and even what I remember from my outsider’s perspective (life before diagnosis). I suppose the ultimate consideration for me here is addressing stigma.

Wouldn’t it be great if everyone were fully educated on everything? That would probably reduce stigma in all directions. But even if we were all fully educated on everything, people would still find reasons to be judgy about one another. So, let’s set out to reduce stigma but also understand that it is a battle that is not 100 percent “winnable.” Some folks are looking to judge others harshly, and that’s just their personality. I don’t think that’ll ever truly be eradicated from society (but it sure would be nice).

Education does seem to be key in reducing stigma, though. I guess that’s because—to paraphrase Maya Angelou—when you KNOW better, you DO better. I’m a firm believer in that. But this reckoning of perspectives has me wondering if the education itself could be a factor here. Is there something about the language we are using about bipolar that enables stigma?

I don’t know if you’ve noticed, but scientists have a lot to say. They like to hammer out minute details and demonstrate their findings. They like specifics. They like diagnostic tools that work for all people all the time. They like to be able to say IF you do this and that, THEN you will get the same result I did. This works out great for society and public health, because without validated medical practices our wellness would be up to the whims and experiments of undereducated individuals.

Bipolar Symptoms: Moods & Feelings

So, what do scientists say about bipolar?

Since they can’t identify mood disorders with a verifiable blood test or brain scan (which is the ultimate goal in internal medicine), scientists mostly discuss how it feels for us. They talk about mania and depression. Sadness, risky behaviors, delusions, irritability, overindulgence, dangerous thoughts—the whole ugly lot of bipolar symptoms gets trotted out.

Here’s some perspective on “symptoms”: Take a group of random people and ask them if they’re experiencing any symptoms of any kind. Most answers would be things like, “sore throat,” “a rash,” “a headache,” or maybe “none.” But if a person with bipolar is in the group, shall they report their racing thoughts, their dark ideations, their overindulgence?

I think this is part of what can make bipolar difficult or uncomfortable to talk about—for everyone. As people with bipolar (what I call PWB), we have to trot out our “symptoms,” which are also called “moods” or “feelings” while everyone else gets to keep those things to themselves.

Here’s a thought, docs: moods and feelings are inherently private. That is just the natural order of things for all humans. One’s mood is not publicly announced for everyone to hear; it’s a silent thing that happens within each individual’s mind. So, any discussion about one’s bipolar diagnosis is already an intrusion on their intimate space from the get-go. That’s a tough spot to be in! Such is the case for anyone diagnosed with a mental health condition, I suppose.

Bipolar vs. Neurotypical “Symptoms”

Another reason I take issue with focusing on moods and feelings in general “intro to bipolar” literature is that any person can experience any mood or feeling as a normal, natural response to what’s going on in their life. There’s a near-infinite range of human moods and emotional responses, and access is limited only by an individual’s brain chemistry.

With the exception of psychosis, so-called “bipolar symptoms” can happen to anybody. PWB (and people with major depressive disorder, or MDD) are not the only ones to experience depression; it can enter any person’s life if their environment or circumstances are “bad enough.” We are not the only ones who experience racing or self-defeating thoughts; plenty of “normal” people have had moments in which their life’s conditions brought them to a similar headspace.

PWB are not the only ones to make mistakes with our relationships and/or responsibilities; everybody’s human, and mistakes are a part of normal human development. We are not the only people who overindulge; plenty of “normal” (neurotypical) people fall into that trap as well. All of these “bipolar symptoms” are considered neurotypical if/when they can be linked to an external cause.

So, outsiders get caught up trying to imagine the way it must feel to experience depression or mania. Or they think about that time they overindulged (and paid the price), or that time they felt really energized, or that time they felt really down. Many people just get stuck spinning their wheels in this spot. How could you blame them, really? We’re telling them about a cognitive process as if it’s something foreign to them, but it’s not—all humans experience feelings, moods, ups and downs, phases, bounce backs, etc., to some degree throughout their lifetime.

Comparisons & Stigma

Metaphor time! Let’s say we’ve asked a group of people what is the loudest thing they’ve ever heard in their life. Some might say, “an explosion,” or “a jet engine,” or … “a toddler.”

Now, is there any way for us to know whose experience was the loudest? No, not really, because there are so many variables involved, like how many decibels the sound emitted; the person’s distance from the loud thing; the environment the loud thing happened in; and even the structure of the individual’s eardrum. But people like comparing themselves with each other, so the group is likely to try to hash out whose was truly the loudest.

To me, this feels like a good metaphor for what happens when mainstream medical literature about bipolar leads with a focus on the feelings that PWB experience. Everyone ends up comparing notes about how they’ve felt and who felt worse and there’s no definitive conclusions about anything. It paves the way for stigma.

It’s generally good to talk about feelings, and talking about feelings is a great way to describe bipolar disorder. But feelings are just naturally a “you-had-to-be-there” type of experience; and I think it probably is most fulfilling to discuss them with people who are more likely to have “been there” themselves (i.e., our bipolar peers). I also think it’s probably most productive to discuss them with a therapist.

Bipolar Disorder’s Range & Variability

It’s called a “mood disorder,” but the “problem” of bipolar isn’t as simple as our feelings or mood—it’s our brain chemistry’s way of regulating these things. I think the secular core of what makes our experience as PWB different from the average person is the more diverse range and more frequent variability of our moods. These changes are demonstrable on an individual basis with documentation and professional evaluation.

Personally, I’ve found that thinking about bipolar in terms of range and variability helps me focus more closely on what makes us awesome. For example, due to our experiences with fluctuating cognitive processes, we are able to see life through many different lenses. We can harness these different perspectives to help ourselves and others get through difficult situations. We also experience a lot of internal changes. Navigating these changes builds our resilience and self-knowledge.

I’m wondering if talking about bipolar more in terms of mood range and variability could help outsiders see past the emotional content of the symptoms and find a better understanding of the basic mechanics.

It’s not that I think mania and depression shouldn’t be part of the public conversation, or that those words (and other emotionally charged words) aren’t reflective of our experiences. I’m just taking a step back to look at the language we are all using to discuss bipolar, and how it affects the overall discourse and understanding.

What do you think?

Originally posted September 6, 2022

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