Bipolar Disorder

Three Things I've Learned About Mental Illness from Homeland

The inspiration for Carrie Mathison shows that Carrie's disorder is all wrong

Posted Oct 08, 2013

The most vivid figure on Showtime's award-winning Homeland is its protagonist, CIA operative Carrie Mathison, portrayed by the superlative Claire Danes.  A major feature of Carrie's personality is her bipolar disorder.  In the most recent episode, Carrie has decided to go off her meds because she feels they interfere with her work.  Meanwhile, the agency is intent on blaming her after it was bombed.  They are able to do this because of (a) Carrie's crazy behavior, (b) her sleeping with an undercover terrorist.

Carrie off her meds

Here are three things we know from watching Carrie on Homeland: unfortunately, none of them is helpful.

1.  It's great that bipolar is so frankly portrayed so that people can know that they have it and receive treatment.  "I feel the show’s creators, writers and producers, and Ms. Danes, have done us all a public service: perhaps, with the show’s glowing reception, Americans can finally talk openly about bipolar disorder."  That was from Jamie Stiehm, sister of Meredith Stiehm, a writer and producer of Homeland who based Carrie's mental disorder on Jamie. 

There's one main difference between Jamie and Carrie, however. Carrie has a chronic condition that frequently manifests. But the inspiration for Carrie, the real person, Jamie, had a "single manic episode" which she retold to her sister in preparation for the show. Wait a second—run that by me again. The real person is bipolar but has had only one manic episode in her life? How old was she when she had the episode, and for how long has she been mania free?  Do many people have only one manic episode? 

Here's Jamie Stiehm's explanation for her great outcome: "I have a mild case, so sleep, and lithium under the care of a doctor, have helped me stay healthy ever since."  Jamie makes sure to get good rest, and takes lithium, and she's fine.  Boy, those two things seem like very different approaches to the problem to me.  Would either one approach—rest or lithium—suffice?  Or would either one of them by itself be insufficient and cause her to relapse if she relied on it alone? Jamie, her doctor, and her sister will never know.

Here's psychologist Joseph Burgo's discussion of these issues, based on epidemiological data and the history of the disorder. 

Before psychiatric medications were introduced, the long-term outcome for those patients (formerly manic-depressives, now suffering from bipolar disorder) was fairly good. Only 50% of the people hospitalized for a first attack of mania ever suffered a second one. Studies have found that, in the pre-drug period, 75-80% of hospitalized patients recovered within a year and only half of them had even one more attack within the next 20 years.

In other words, Jamie Stiehm's outcome is typical, even without further medical treatment.  Would she have gotten better on her own?  We'll never know, since she is seemingly (permanently?) being medicated under a doctor's care. In this way, she embodies what Burgo describes as the result of our current approach to mental illness:

Today, Bipolar Disorder is a chronic illness, with patients spending years and years on psychiatric medications.  In other words, Bipolar Disorder was comparatively rare before 1980 and the prognosis for hospitalized patients was fairly good; today it’s 325 times more common than it used to be and has become a lifelong illness.

This argument—that the diagnosis and treatment of mental illnesses is often iatrogenic (self-feeding)—is being considered seriously by some serious figures (like Marcia Angell, formerly editor of The New England Journal of Medicine) in some serious places (like The New York Review of Books). One place it's not being considered is Homeland—where, when Carrie goes off her meds, she goes crazy. I wonder why the show and Meredith Stiehm don't portray Carrie as a nice, calm, recovered person like her actual sister, even when Carrie has the benefit of modern medication.  Not much of a storyline, I guess.*

* Do Jamie or Meredith have any concerns about Jamie taking a powerful psychiatric medication like lithium for ten, twenty, or thirty years?

 2. Mental disorders are pre-existing proclivities, not caused by conditions in people's lives. Here is the situation that led to Jamie Stiehm's one and only manic incident:

I was a reporter for The Baltimore Sun, and I was filing stories in the newsroom faster than ever before. It’s strangely fitting that I worked in journalism, which at its best also has its share of frenetic late nights, deadlines and homing in on people. As a reporter at The Sun once said to me, “This is a manic-depressive business.”

Didn’t I know it. A “hypomanic” state, which precedes an episode of mania, is in fact an enhanced, alert, productive mood where one can feel exhilarated and immune to life’s dangers. I seemed to see into people’s hearts when I smiled at them. My speech sped up so much few could understand me.

I ran around Baltimore’s Inner Harbor at high speed, exulting in all my energy. For several days, I woke up at dawn to see the sunrise and take pictures of it.

Wait another sec. Was she in an intensely stressful period of her life?  Could that have explained Jamie's breakdown?  Or, do some professions encourage bipolar disorder?  And is it possible that in some jobs such an activated or intense state of mind can actually be functional?  Because that would explain a lot on Homeland.  If jobs can encourage aberrant mental states, then being a secret agent—where paranoia is almost a requirement—is surely one of them.  (By the way, is waking at dawn to see the sunrise a symptom of bipolar disorder?)

NO! According to Homeland that's all wrong!  There's no relationship between how people with a disorder behave and the demands of the situations they face and the traits they need to cope with them.  The Atlantic devoted its post on the latest Homeland episode to making this absolutely clear: "Last night’s episode, 'Uh... Oo... Aw...,' portrayed Carrie at her most self-destructive; there was no upside to her issues." But wouldn't you be a little tense if your closest associates—who are extremely clever intelligence officials who are colluding with your psychiatrist—were trying to frame you for blowing up the CIA, a crime for which I'm sure the penalties are quite stiff?

Carrie didn't catch her disorder on the job in Homeland.  According to TV reporter Monique Nazareth

Dr. Ellen Leibenluft, Chief of the Section on Bipolar Spectrum Disorder in the Emotion and Development Branch of the NIMH says Carrie’s bipolar disorder, as characterized by episodes of mania and depression, were “extremely well portrayed.” 

Leibenluft cites the scene in the Season 1's penultimate episode, "The Vest," in which Carrie—deprived of her medication while being treated at the hospital for a concussion and facial lacerations—is manically seeking a green pen.

In other words, Carrie was forced off her meds, so, what would you expect?  The only possible way to interpret Carrie's experience is that she has a brain disease.  Brain diseases aren't responses to situations (other than ceasing a medication).  Dr. Leibenluft asserts the need to for us to think this way:

"Things have gotten a lot better, with people being more open with bipolar disorder and public campaigns. But I think there are still issues in terms of people being comfortable with these illnesses being brain diseases. This is a disease of the most complex and arguably most important organ of our body, the brain."+

+ A woman sufferer wrote in to inform me that "neither autism or bipolar are diseases. Bipolar is a disorder and autism is a syndrome/disorder. Calling them diseases implies they are contagious."  As I pointed out, my post questions the disease status of these things.  The bad news is that the chief NIMH official in charge of bipolar disorder asserts that it is a brain disease and dismisses anyone who thinks otherwise.

3. Having wild, casual sex is a symptom of a mental disorder for a woman (but not for a man). Thankfully, television warns women away from wild sex, which is a sure sign that they're mentally disordered or, per Dr. Leibenluft, diseased.  And we know that not only due to Homeland

In Homeland, a significant sign of Carrie's mental disorder are her sex escapades—getting drunk and having wild sex with Brody, the then underground terrorist; going to the liquor store when off her lithium and picking up a guy to screw on her stairs. What goodno, I mean sensible, no sanewoman would behave this way?

That such sex is mentally disordered is clear from another female protagonist, this one on FX's The Bridge. The woman detective in this series, Sonya Cross, goes to a bar to pick up a guy for casual, hot sex.  Sonya is autistic.  But the diagnosis doesn't matter—the symptom of the disorder is the same.  And we can tell that hot sex isn't a sign of a mental disorder for men.  Cross's partner on The Bridge, a male detective, has passionate sex with an attractive woman he meets on the job.  But he's not mentally ill—you see, he's happily married to a beautiful wife with whom he has children he loves. "Wait a second," you say. "Isn't his sexual behavior far more disturbing to himself and others than his single partner's?"  And he acts haphazardly, passively, while Sonya picks her partner according to her needs.

Don't be crazy. It's only women for whom sex-for-the-sake-of-sex is a marker of bipolar disorder and autism. Just like only men are allowed to dance dirty on stage!

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P.S.  (October 27): Uh-oh, Carrie threw her meds away after leaving the hospital!  How come Jamie loves taking her meds, and Carrie hates taking hers?  You know, quite a few people have Carrie's reaction.  It's funny that we have to discourage some people from taking some drugs, and force others to take the ones we want them to, which we believe help them.