When Lucy Johnstone began working in mental health nearly 20 years ago, bipolar disorder - or manic depression as it was known then - made up a small fraction of her workload.
‘Now, every other referral is someone with suspected bipolar disorder,’ says Johnstone, a consultant clinical psychologist for Cwm Taf Health Board in Wales.
‘More people turn up with it because they hear about it in the news. They go to their GP saying: “I think I’m bipolar.” ‘
This confirms the effect of what some feel is the ‘fashion’ among celebrities for being labelled bipolar, a condition the Royal College of Psychiatrists claims affects one in 100 people at some point in their lives.
The latest high-profile name is Hollywood star Catherine Zeta-Jones, who was reportedly admitted to a clinic for five days suffering from depression and mood swings brought on by the stress of her husband, Michael Douglas, battling throat cancer.
She joins household names, such as Stephen Fry, Sting, Ben Stiller and Jean-Claude Van Damme, in declaring publicly that they suffer with the condition.
But what is bipolar disorder, and is there really a hidden epidemic? Or is it a Hollywood fad for blaming the stresses of ordinary life on a mental illness?
And could this trend be misleading ordinary people into thinking they, too, have a psychiatric illness when they are experiencing what psychologists describe simply as ‘extreme mood variations’?
The term manic depression was used to describe people whose moods swung from elation to despair and hopelessness.
It’s a condition which, during the manic phase, makes people feel invincible and bursting with exciting ideas.
Their speech accelerates, they sleep no more than a couple of hours a night and they can lose all sense of financial responsibility - sometimes running up huge credit card bills.
But in the depressed stage, they struggle to make the simplest decisions and sometimes feel suicidal. Research suggests it is mostly genetic, but is triggered by a stressful experience, such as job loss, bereavement or physical illness.
Sufferers can experience ‘rapid cycling’, where their mood swings from one extreme to the other every few weeks.
In 1980, when psychiatrists were updating the psychiatric profession’s ‘bible’ - the Diagnostic And Statistical Manual Of Mental Disorders - they changed the name to bipolar disorder.
They chose the term to reflect the fact that the elation and desperation patients feel are the polar opposites of each other.
Also, manic depression had become associated with psychotic behaviour, where the sufferer hallucinates and hears voices. In fact, very few experience this.
But as well as changing the name, psychiatrists have fine-tuned the definition, so it has gone from covering only extremes of mania and depression to milder behaviour patterns which, sceptics claim, border on normality.
Today, the umbrella term of bipolar disorder covers two forms.
Bipolar disorder one is when the patient has suffered at least one manic episode - where they become highly excitable, barely sleep, talk rapidly and lose their inhibitions - which has lasted for longer than a week, followed by severe depression.
Bipolar disorder two, the kind with which Catherine Zeta-Jones has been diagnosed, is where there may be long periods of moderate depression punctuated by mild attacks of mania.
It is characterised by hypomania, where a person can be in a semi-permanent state of excitement that may be mistaken for sheer energy and enthusiasm by those around them, before slumping into a depression that can vary from debilitating to so crushing they can’t get out of bed.
Even for psychiatrists, bipolar two can be difficult to distinguish from depression.
‘When someone is manic, they are very high and often deluded,’ says Dr Peter Byrne, director of public education for the Royal College of Psychiatrists.
‘It’s obvious they need to be sectioned under the Mental Health Act. But with hypomania, you may feel confident and good about yourself. It can be hard to persuade someone with it that they need medical help.’
It was this aspect of his condition that prompted Stephen Fry, in his BBC programme The Secret Life Of The Manic Depressive, to declare he ‘loved’ having it because he believed it provided ‘the energy and creativity that perhaps has made my career’.
The association with artistic genius is thought to be a key motive for some who seek out a bipolar diagnosis.
It is also seen as a more acceptable term than manic depression.
‘People are happier to be labelled bipolar,’ says Dr William Shanahan, medical director of the private Capio Nightingale Hospital in London. ‘It seems kinder, while manic depression depicts someone running down the road screaming.’
But the steep rise in the use of the bipolar label has caused a rift in the mental health community.
Many psychologists are alarmed at the apparent over-use of the bipolar label and fear it is playing into the hands of those who want to blame life’s stresses on a medical condition.
There is also concern that those experiencing bipolar-type symptoms as a result of chronic drug or alcohol abuse may court the legitimacy of a medical diagnosis to hide their problems.
Drug or alcohol abuse can produce erratic behaviour, sleep deficiencies and depression - similar to symptoms of bipolar.
The British Psychological Society (BPS) has questioned whether some people are being wrongly labelled as mentally ill.
‘Many people experience periods of depression and also periods of elation and overactivity,’ it says in a new report on the issue.
‘Mood can affect how we feel about ourselves. At times we may feel extremely positive or even grandiose about our own abilities, while at other times we may feel we are a complete failure.’
It says some people seek medical help because they mistakenly perceive these mood swings as unnatural. Once they do, they are likely to be diagnosed as bipolar because the criteria are so broad.
But the BPS adds: ‘Not all mental health professionals accept the idea these experiences are caused by an underlying illness.
‘Some people who experience extreme mood states find it useful to think of themselves as having an illness. And mental health services assume that once someone experiences problems with unstable mood, they are likely to recur.’
The BPS wants a shift in the way bipolar disorder is perceived and treated. It agrees that patients in a manic state need potent drugs to stabilise their moods. But many more, it argues, would recover without medicine and would avoid being stigmatised by mental illness and potentially jeopardising their future job prospects.
‘Traditionally, medicine has been the only type of help offered,’ the report states. ‘But there is increasing evidence that talking treatments can also be useful.’
Psychiatrists, on the other hand, point out that talking techniques, such as cognitive behavioural therapy, serve little or no purpose when someone is in a frightening and potentially dangerous manic state.
‘For milder depression, many people may not need medication. But if they have bipolar, it is likely they will,’ says Dr Peter Byrne.
Dr William Shanahan insists drugs have a role to play because it can be impossible to predict how each individual will respond to their violent mood swings.
‘You can get some bad news and feel really down. Those feelings may go away or they may get worse. But at what point do you stop telling yourself to ‘‘pull yourself together’’? Even those with slight depression can end up killing themselves.’
###
By Pat Hagan
Daily Mail
