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Disease or Madness: Society's Perception of Bipolar Disorder

aeraeber's picture

“Mania is...constant anxiety, constant irritability, having everything be raw, being brittle, crying but feeling nothing, and really . . . just you never know” (Anon). Though it refers to a something that Western society generally characterizes as a mental illness, this statement is more applicable to madness than a medical condition. It is no small wonder that the stigma associated with bipolar disorder, once called manic depression, have endured far more strongly than that of many other mental illnesses.

Bipolar disorder affects as many 27 million people worldwide, but it is not particularly well understood (Owen). It is characterized by extreme shifts in mood, from periods of mania, to periods of depression. Like schizophrenia, it is a mental illness that Western society still looks upon in many ways as a form of madness. Because we do not know what is going on in the brain of a person with bipolar disorder, we, as a society, don’t know how to react to them. And those who have this disorder may very well feel as mad as others find them to be (Behrman).

Several theories exist to explain bipolar disorder, and medications have been found to treat it, most commonly in the past lithium salts, and currently an anticonvulsant medication known as Lamictal®. The mechanisms of these medications are not well understood, and gaining an understanding of how they work would be a step in the direction of understanding bipolar disorder. Often, a combination of medication is used to manage the disorder, mood stabilizers, antidepressants, and sometimes antipsychotic medications.

There is no cure for bipolar disorder, and the treatments that exist are not particularly reliable. Though Lamictal® is considered highly effective in the management of bipolar disorder, by lengthening the time between episodes, it is not effective in 42% of those who are treated with it (Bipolar Disorder). And even for those who are helped by mood stabilizing medications, they are not a cure. For most people, symptoms persist despite whatever help medication and therapy may provide. It is from this that the stigma of bipolar disorder arises. The vast majority of mental illnesses are static conditions; their symptoms can be predicted and compensated for, either through medication or a change in behavior. Such is not the case with bipolar disorder; the changes can be sudden and incomprehensible.

Bipolar disorder is often misdiagnosed, most commonly as unipolar depression, but also as schizophrenia. Many people wait as much as a decade for a correct diagnosis (Hirschfield). Those with bipolar disorder who are treated only with an antidepressant often report an increase in manic symptoms. With this comes an increase in stigma because of the unpredictable of mania. The behavior of the individual during a manic episode is very unlike their normal behavior, but it is memorable, unlike behavior during a depressive episode.

Both depression and mania are related to over activation or under activation of a neurotransmitter, though which one(s) has yet to be determined. Variances in the production of neurotransmitters affects cell functioning. It was once thought that depression corresponded to the under activation of one or more neurotransmitters in specific areas of the brain, and mania corresponded to over activation of those same neurotransmitters in the same areas of the brain, but the available evidence now suggests that the mechanism is more complicated. The disorder also has some genetic base, since individuals who have siblings (especially twins) who display bipolar disorder, are more likely to develop it themselves. The evidence suggests that, like every other part of the biology of bipolar disorder, the mechanism of inheritance of the genes related to it is complex. New research indicates that differences in brain anatomy may contribute to the development of bipolar disorder and that neurotransmitter imbalances may be capable of changing the brain (Bipolar Disorder: Aetiology).

For the outsider observer, the family member, the friend the shifts between moods can be as difficult to deal with as the extremes of mood themselves. How can a person go from a depressive episode to a manic episode? How can they possibly predict the behavior of their friend or family member? Depression alone is difficult enough to deal with, but mania is even more bizarre. The actions of a person during a manic episode have no logic to the outside observer and perhaps not even to the person themselves. Western society has learned in recent years to deal with depression, to expect it even, but mania is still very alien. It is everything that Western society does not want of people: making snap decisions, starting projects without finishing them, having a short temper, being euphoric at odd time, even saying things that aren’t in the realm of socially acceptable. As such it, it carries much more stigma than depression alone.

Humans fear what they do not understand, and bipolar disorder is one of the least well understood mental illnesses, a group of medical conditions that are, in general, not well understood. The brain is still a mystery, and until better technology becomes available to explore it, the explanations put forth for bipolar disorder and other mental illnesses are unlikely to become much less wrong. Nevertheless, possible explanations do currently exist. They simply tend to become lost in the wake of everything that is not understood, and downplayed because they have not been “proven.” A more detailed explanation of the biological causes of bipolar disorder should alleviate most of the stigma associated with it. If it can be linked to specific biological processes or structures in the brain, bipolar disorder will cease to be madness. It will cease to be a mysterious affliction out of the pages of Alice in Wonderland and become instead, a manageable, perhaps even curable illness. Whether or not such an explanation is possible remains to be seen, but that certainly does not mean that anyone should give up on the search.


Anon. "Neurotics build castles in the sky, psychotics live in them, and psychiatrist collect rent." Message to Ali Raeber. 11 Feb 2010. E-mail.

"Bipolar Disorder." National Institute of Mental Health. 16 Oct 2009. NIH, Web. 28 Jan 2010. <>.

"Bipolar Disorder: Aetiology." Brain Explorer. Lundbeck Institute, Web. 15 Feb 2010. <>.

Behrman, Andy. "Dump the Stigma and Focus on Recovery." 26 June 2007. Web. 22 Feb 2010. <>.

Hirschfield, RM, L Lewis, and LA Vornik. "Perceptions and impact of bipolar disorder: how far have we really come? Results of the national depressive and manic-depressive association 2000 survey of individuals with bipolar disorder." J Clin Psychiatry 64.2 (2003): 161-74. Web. 15 Feb 2010. <,f1000m,isrctn>.


Asra's picture

My husband diagnose with

My husband diagnose with bipolar but he refuses medication.and he controls me .I'm in laws don't support husband abuses me.I'm thinking for divorce.I have 2 kids.plzzzz suggest.

Serendip Visitor's picture


RL6YYNo one can understand how we feel, what drives us and how we cope with the constant struggle within ourselves to 'stay sane'. This is not understood at all. My family know, bit they do not know how to cope, instead becoming confrontational when I am on 'one', which makes it worse. The problem is that, regardless of platitudes, they simply do not understand the amguish and pain. It is as simple as that.

Minnie Mouse's picture

BiPolar Disorder

If society would just try to understand the lives of people living with bipolar we would all be living in a better world. No one on this earth is perfect except for "God". God loves everyone and so should everyone in this country regardless of what illness you think a person may have or have been diagnosed with. If a person doesn't try to help someone then how does a person know if they can help a person or not? When a person denies another person of anything, you may be the exact person that this person truly needs.

I have been bipolar for 25 plus years and have many family member who just don't want to care or deal with the issues of having a bipolar sibling. People don't want interruptions in his or her lives. I have been married for 28 years and have a child and they accept me for who I am and support me in all matters, no matter how many time my spouse and Childs lives are interrupted they are by my side regardless. I feel I am truly blessed and even having to live with "Crohn's Disease" of 25 years and still on going. As of 2015, I am 47 years old.

Many people do not get the full support that they need and this is where the problem comes for our society. If we all want to live in a more loving and safer world, then you have to care about everyone and be willing to help those in needs.

We can't continue on allowing people to be dropped off onto the streets just because they don't have any friend or family support when they are leaving a mental hospital facility after days of overnight stays. This is where these people become harmful to themselves or if not harmful to others. The states need to be finding these people permanent places to live whether it's a group home or opening back up state mental institutions.

Everyone has a right to have a roof over his or her head, healthcare, necessary medications, ongoing medical treatments, food, clothing, proper sanitation and hygiene, food and a good nights rest etc....

As a society we are denying millions of mentally ill people the rights to live a productive life just like everyone else, if we can't supply them with the basic needs in everyday life just to where they can have a chance to function normally. Millions are tossed out onto the street like pieces of trash! Shame on us! These people are helpless, on medications, unrested and don't get nutritious foods or the ongoing treatments that they need so desperately.

For anyone who knows of anyone who is bipolar just be there for them. These are the most vulnerable people who need to have friend and family support. This is an important factor for people to know when they are having issues so they can get the help they need and as soon as they need it before they harm themselves or someone else.

When a person is mentally ill living on the street they are 100% having to defend for themselves. The problem is these people can't defend for themselves because they are not mentally capable of doing that. The people who are sane in this world need to take the lead in taking care of the mentally ill by just being support of them and not leaving them, this is also to include our states and our government. As states and our governments, shame of you for closing down "Mental Institutions"! Mental Hospitals facilities, shame on your for thinking it's ok to be dropping people off at homeless shelters! As a country we are not doing enough to help and support the people who are mentally ill.

Everyone needs to start doing a better job to help the mentally ill people and stop thinking about yourselves!!!!!!!!!!!!!! If you think your problems are bad, try living a day, a week or even a month if you can survive it, in the life of a person who has bipolar. You will be counting your blessings.

Blessings, this is something god wants for everyone and not just the sane the insane as well.

God bless. Please pray for the mentally ill, the friends and family who loves them and the friends and family who have left them
behind to fend for themselves and for the future of our country to bring everyone together to be able accept everyone regardless if a person is sane or insane.

God Bless!

Be Strong's picture


Diagnosed with Bipolar I--My dad had similar symptoms, however in the 70's very little was known about this disease. Instead of being admitted into regular hospitals, he was put in state hospitals. My mother did not help the situation being the fact that she was very controlling and unsympathetic. So, I can understand the receiving end as well as the giving. In my teens I did not feel right and as I entered the 20's that feeling got stronger, but just noticeable to myself (especially during pregnancy and PMS). Raising 4 children(3 under 3) was difficult, but I kept my composure. The 30's, symptoms became more noticeable (now, to the loved ones--not really society) I was working all along full-time and able to hold a job just fine. Ok, the 40's all kinds of physical and mental symptoms were getting stronger. The physical more than likely were from an abusive marriage but also from medication. Early 40's I had a nervous breakdown--in hospital for about 4 days. When I get bad I continuously cry or throw things. Now, I make it a point to get to the(VA) E.R. and not take chances. Medication has been apart of my life since my early 30's, starting out with one or two prescriptions, and I was very faithful taking medication. As years went by I required more medicine, now being 50, my medication consists of approx. 100-125 pills a week. It is very difficult to keep a job, seriously I have had approximately 15 jobs in 13 years. My memory is getting bad, especially with numbers. After not working for 1 year (got a great guy) I found a job that I was able to figure out ways to handle and compensate for my weaknesses, but I was sexually harassed, reported it and then retaliation--filed a law suit and it was accepted. So, now what!

Hopefully, some day a cure for this disease is found. I struggle every day and tell myself "it is not them, it is me", no one except for psychiatrists, psychotherapists, and a people with bipolar understand what you are going through. It is really hard to explain--it just feels like your going to "blow up--inside of your body" My one daughter is mad because I am not working and said just "suck it up". The other daughter says "just keep looking you'll find a job you like" I wish I could because I've always been an extremely hard worker and have a hard time sitting still. I have for the 2nd time applied for disability--they don't understand. Maybe one day society will understand and not think we are weird or crazy!

I hope this is of help for someone--Have lots of experience.

Thank you,

Be Strong

Serendip Visitor's picture


Mr. Cyclothymic,

when were you diagnosed?
Everything you said in your comment I can relate too.
How long were these things happening before you turned to your doctor.

Mr. Cyclothymic's picture

Answer to Caitlyn

The problem is, that even if you live with bipolar disorder it can be hard to explain how it feels. The moodswings aren't typically caused by anything, now how do you explain that?
I suffer from cyclothymic disorder which is a mild form of bipolar disorder type II.
The thing about it is, when your mood changes, nothing really happens in your head. It just changes like the wind and people can't understand that, because there's got to be a reasonable explanation to why it changes and how it feels when it changes right?
The problem is, there is no explanation. There was a time where I was really hypomanic and I was listening to really loud music and when the song i was listening to stopped, after a few minutes, it was like every feeling in my body just left, and all there was left was this emptiness inside of me. Few hours after that, I'm crying hysterically and I'm really depressed.
And all of this happened because of absolutely nothing.
So even if you're struggling with that mental illness, or any other mental illness, it doesn't mean that you're an expert when it comes to that mental illness.

Not all chinese people knows karate you know.

EDDY OBWALE's picture


What are the sociological management of mania?

Caitlyn's picture

If people want to understand

If people want to understand bipolar disorder, why don't they just ask someone with it???

Serendip Visitor's picture

No more madness !

No more madness !

Jake Baxter's picture

anyone else checked out

anyone else checked out english artist michael fitzgerald at saatchi
truly eye opening stuff

Paul Grobstein's picture

mania, stigma, and research

"The actions of a person during a manic episode have no logic to the outside observer and perhaps not even to the person themselves. Western society has learned in recent years to deal with depression, to expect it even, but mania is still very alien. It is everything that Western society does not want of people: making snap decisions, starting projects without finishing them, having a short temper, being euphoric at odd time, even saying things that aren’t in the realm of socially acceptable. As such it, it carries much more stigma than depression alone."

Maybe the "problem" has at least as much to do with the expectations of Western society, and of individuals in Western society as it does with anything in the individuals themselves?  Do we really want a culture in which no one says socially unaccceptable things, makes snap decisions, etc?  For more along these lines, see Brain and cognition: the significance of culture? and discussion/links there.  Maybe at least some research might go into finding out more about the relation between "mental illness" and culture as opposed to making "mental illness" disappear in individuals?