As a child of the 80s, I had a childhood dream of growing up to be Princess Leia, and — of course — marrying Han Solo. What I did not dream of was fighting an empire that seems only to grow over time, and with no Harrison Ford by my side to make it all better. The death of Carrie Fisher is heartbreaking; the news coverage of her life and suffering is a tragedy.
From Scientific American to Slate to the New York Times — all reputable news sites that have the prestige of rigorous reporting and the air of truth-telling — the stories all sound similar, conveying the message that: Bipolar Disorder killed her. Bipolar Disorder is a real disease caused by a virus and/or a chemical imbalance. Bipolar Disorder has nothing to do with one’s life circumstances. Bipolar Disorder causes mood swings and brain damage. Some of these articles are written by psychiatrists and/or have support from prominent mental health professionals. Yet, all of these proclamations are 100% false. There is no truth to any of this and the illogic and dogmatic rhetoric infiltrating the public right now is doing everything that Carrie Fisher herself fought tirelessly against: increasing stigma for those who suffer emotionally.
To be clear, this article is not yet another effort to speculate on Carrie Fisher’s personal struggles or her individual experiences — though there is ample evidence of early experiences that are sufficient to explain her later challenges. Rather, it is a brief attempt to address some of these untruths and provide some counter to those who are actually interested in what the science behind these claims are, versus ideological grandstanding. So, without further ado…
Bipolar Disorder is not a Real Entity
Let me be clear: People most certainly have very real experiences of mania and deep depressions, of cycling mood states, and of erratic and wild behavior that ruins relationships and many lives. The term bipolar disorder, however, is a term that simply describes these experiences. There is no entity of bipolar disorder that exists outside of these subjective experiences and behaviors.
Consider, perhaps, the experiences of pain in the head. Many would call this a headache. A headache might occur for numerous reasons: stress, dehydration, fatigue, the weather, inflammation, a brain tumor. One can take an aspirin and perhaps mask the pain, but the cause of the pain still has not been addressed. If it’s stress maybe that’s no big deal. If it’s a brain tumor, well, that’s probably going to be an issue. And no one, anywhere, is asserting that the headache is itself the cause of the pain.
But, in mental health, this is exactly what happens. Saying that bipolar disorder is itself the problem is akin to saying that one’s head hurts because one has a headache, and it is the headache that is causing the head to hurt. This logic, quite literally, gives me a headache.
Bipolar Disorder is Very Much Related to Trauma and Chronic Stress
Dr. Sally Satel, in an article for Slate, describes Fisher’s childhood as “tumultuous” and then goes on to state, authoritatively, “To be sure, a chaotic childhood is not a risk factor for bipolar illness.” This is not only completely untrue, but it is an invalidating and even dangerous statement for a psychiatrist to assert so confidently without any evidence to support it.
In fact, the relationship between a diagnosis of bipolar disorder and chaotic and traumatic childhoods is quite strong. Sexual abuse, specifically, is closely related to this diagnosis, with approximately 28% of women so diagnosed reporting a history of childhood sexual abuse involving bodily contact. Early parental loss increases the risk of being diagnosed with bipolar disorder by up to four-fold. Individuals with this diagnosis are three times more likely to experience interpersonal trauma, with 32% meeting full-criteria for PTSD. Overall, chaotic childhoods are 2.63 times more likely to have occurred in individuals carrying this diagnosis, with emotional abuse having the strongest relationship (an odds ratio of 4.04).
Bipolar Disorder is not due to a Chemical Imbalance
It is hard to believe that there are still media reports of chemical imbalances causing mental illness when even the most hard-lined biological psychiatrists have debunked this myth. Ronald Pies, an eminent psychiatrist, has expressed for years that this hypothesis is one that is an “urban legend” only promoted by uninformed individuals who should know better.
Yet, here we are, now the year 2017, and this uninformed urban legend continues to be perpetuated.
Bipolar Disorder does not cause Brain Damage
Putting aside for the moment the argument that there is no entity of bipolar disorder that can cause anything, there certainly is no evidence to confidently state that it causes brain damage. In an article for Scientific American, Tori Rodriguez suggests that bipolar disorder causes damage to the “hypothalamic-pituitary-adrenal axis and the autonomic nervous system, which are activated both by acute stress and by bipolar mood states.”
Now, this writer clearly understands that the HPA axis, inflammatory responses, and the nervous system are, indeed, affected negatively by stress. What is not mentioned is that these areas are altered by chronic stress throughout childhood (ya know, that chaotic childhood that has no relationship to bipolar disorder?) and that changes in these areas may lead to difficulties managing mood states and emotions. In fact, there has never been a study to demonstrate identifiable brain differences for ANY diagnostic category, nor is there any evidence of damaged brains in individuals carrying psychiatric diagnoses beyond those associated with childhood abuse.
Bipolar Disorder does not Kill People
Again, just as a headache does not cause anything (it is a description of an experience), neither does bipolar disorder. Yes, chronic stress can throw one’s body entirely out of whack and lead to earlier death due to problematic lifestyles, increased inflammation, autoimmune problems, ulcers, cardiovascular problems, etc. So, too, can a lifetime of drug use (illegal and prescription) cause physiological problems that can lead to death. Certainly, the drugs prescribed for many individuals diagnosed with bipolar disorder can and do kill (even if they do, also, help prolong life for some).
But, these are factors associated with a diagnosis of bipolar disorder, not some disease process itself. Such fairytales might make great sensationalistic headlines, but fairytales are all they are.
Sadly, these assertions, while likely stemming from well-intentioned sources, have the paradoxical effect of increasing stigma associated with bipolar disorder. Biological explanations of disease that are separate from one’s life circumstances have many positive aspects. For instance, they allow for a sense of validation for one’s pain and suffering, they decrease the sense of moral inferiority, and, in the words of Carrie Fisher, they “explain away my behavior.”
Everyone behaves the way they do for a reason. Usually, when one behaves in problematic ways it’s because something is wrong in their life and they are suffering. To decontextualize these behaviors, to absolve oneself of responsibility for their behaviors, and to “blame the brain” have been shown time and again to result in increased negativity, prejudice, social rejection, and fear towards those diagnosed.
As Yoda once wisely proclaimed: “Aah, hard to see, the Dark Side is.” Untruths, ideological rhetoric, and unsupported statements of fact are some tell-tale signs that the Dark Side is at work. Light comes from digging deep and finding truth.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.