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Bipolar Disorder

So, You’re “Bipolar”

Stigma lives on among medical professionals.

Recently one of my patients visited her primary care doctor’s office for a routine checkup. A nurse practitioner saw her, looked at her history and medications, and said: So, you’re “bipolar”, lifting her two fingers in the air on the word bipolar.

My patient, a young woman in her early twenties, asked what the air quotes meant. “You don’t look bipolar,” the nurse replied.

When I hear stories like this, I always wish I could have been there to ask the offending nurse: Would you say to someone with tuberculosis, “You don’t look tubercular”? Or to someone with hypertension: “You don’t look hypertensive”?

Why should someone with a mood illness “look” like a mood illness? Some medical professionals apparently don’t realize that the nature of mood illnesses is that they are episodic and recurrent: they aren’t symptomatic, then an episode occurs – begins, ends – and then they are non-symptomatic again. They can be quite normal without any symptoms for years on end. Especially after treatment, such normality can last forever.

A little knowledge is a dangerous thing indeed: This nurse practitioner knew enough to know that people with bipolar disorder, when sick, can “look” sick; she didn’t know that they can be well, and when well, “look” well.

In this case, my patient had achieved a sense of wellness after years of struggle to find the right medication combination, including hospitalizations and times of severe depression and mania. She had looked sick; she no longer did, because she no longer was.

There is the stigma: people – even medical professionals – don’t realize that mental diseases like mood conditions are not things people “are”, overwhelming them entirely and all the time, so that they “look” ill. Mental diseases like bipolar disorder are things people “have”, just as they can have tuberculosis. They don’t look like their illness, because their illness affects only part of them, not their entire existence, and, further, illnesses like bipolar disorder are not even active or symptomatic most of the time (just like tuberculosis).

The most important source of stigma is not ill-humor or immorality: it's ignorance.