Dr. David Henderson

Ever seen that movie, What About Bob? One of the funniest scenes in the movie is also one of the most glaring proofs of how ignorant many people are about mental illness. Bob has been placed in a sanatorium by his analyst, and he sits casually telling a joke to the hospital staff. “Roses are red. Violets are blue. I’m a schizophrenic and so am I.” Many people still believe that schizophrenia is a disorder of split or multiple personalities. It’s actually not that at all. For the DSM-V diagnostic criteria of Schizophrenia, click here.

Another misunderstood diagnosis in psychiatry is called Bipolar Disorder. You yourself may have been accused of being Bipolar if you’ve changed your mind on an issue recently, become suddenly sad or angry for no apparent reason, or chosen to do something foolish on a whim. I see many clients who ask to be evaluated for Bipolar Disorder, so I know that it is a real concern for many. If you believe that someone you know may suffer from it, I hope to clear up the most common misconceptions. Please note that this blog post does not substitute for a thorough psychiatric evaluation nor does it provide all of the various diagnostic criteria to make a diagnosis of Bipolar Disorder. The internet provides basic information about the disorder, but this is no substitute for a medical evaluation by a trained professional.  With that CYB (Cover Your Butt) disclaimer, here are the top five most common misconceptions I’ve heard:

  1.  People with Bipolar don’t sleep well. This is true but only part of the truth. Many people who do not have Bipolar disorder experience insomnia. When daylight savings time rolled around, I was struck by how many people on facebook reported several nights of insomnia as a result. We all have times of poor sleep for a number of reasons. Stress, worry, depression, too much caffeine, exercising too close to bed time, indigestion, a lousy mattress, or a snoring spouse all can interfere with our sleep. What constitutes a positive symptom of Bipolar disorder is a decreased NEED for sleep. If most of us have a few bad night of sleep, we are out of commission for the next day. We feel lethargic, unmotivated, and miserable. Not people with Bipolar Disorder. During a manic episode, a patients will not want to sleep, forget to sleep, or feel they are wasting time by sleeping. Even if patients want to sleep, their bodies say no. They have so much energy and drive; they can do without sleep for several days or weeks at worst.
  2. People with Bipolar are moody. Mood changes, as the old name implies (Manic-depression), constitute part of the criteria for the disorder.  However, these changes in mood are distinctly different from the individual’s normal personality. Some people are prone to moodiness by nature. They may be up one minute and down the next. These shifts of emotion are usually the result of circumstantial stressors. By definition, however, a manic episode must last at least seven days (4 for a Type II diagnosis) or require immediate hospitalization due to the severity of the shift. Depressive episodes must last at least 2 weeks. These changes are drastically different from the affected individual’s normal disposition. So if you’ve ever said to someone, “You’re so Bipolar,” you are probably describing a personality trait rather than a feature of a true mental illness.
  3. People with Bipolar have racing thoughts. Again, this is true only in part. Many people complain of racing thoughts, but what they really mean is “I feel anxious.” A person who feels anxious can have a subjective sense that their mind is racing. Someone with Bipolar disorder, however, actually has an increase in the flow of ideas rushing through their brain as a result of excitement, overstimulation, and excessive energy, not worry or fears. In fact, individuals in the midst of a manic episode tend to feel grandiose or invincible, as if they could conquer the world. They are more likely to be impulsive as a result. Because of the racing thoughts, they are easily distracted. Their speech is pressured and fast. You might have trouble keeping up with their train of thought. Don’t confuse the racing thoughts of an anxious person with the racing thoughts of a manic person.
  4. People with Bipolar Disorder are drug addicts. This is an unfortunate stigmatization of Bipolar patients. Many individuals who have a first break episode of mania or depression have never even tried alcohol, let alone hard drugs like cocaine. Is it possible for drug-use to mimic the symptoms of Bipolar? Absolutely. It is also common for someone with Bipolar Disorder to have a comorbid (co-occurring) addiction. At times it can be difficult to distinguish the two from each other. The key difference is that people with Bipolar Disorder experiment with drugs because of the grandiosity, invisibility, and pleasure-seeking desires they feel during a manic episode. The egg comes before the chicken in this case. In many instances, proper treatment of the disease reduces the addictive behaviors.
  5. People with Bipolar Disorder are dangerous. Though it is true that in the midst of a manic or depressive episode, people can be a danger to themselves or to others, they are not evil, scary, criminal, or crazy as pop-culture might like to portray them. With the proper education, treatment, and follow-up, most people with Bipolar Disorder live very normal lives. Indeed, some of the most powerful, creative, and influential people in society have had Bipolar Disorder. I would encourage anyone who would like a first-hand report of life with Bipolar Disorder to read Kay Jamison’s book, An Unquiet Mind.

If you or someone you love suffers from Bipolar Disorder, check out The Bipolar Survival Guide for more helpful information and tips on how to control it.

Question: What are some of the other common misconceptions about Bipolar Disorder that you have heard? What is our role as a society to help those with mental illness? How can we better equip people to understand and relate to people with a mental illness?