Bipolar Disorder
Reflections on Bipolar Disorder
A Personal Perspective and inquiry into a complex illness.
Updated May 2, 2025 Reviewed by Kaja Perina
Key points
- Society as a whole and the medical community at large still do not fully understand bipolar disorder.
- The disease affects an estimated 5.7 million Americans.
- Using alcohol and drugs could also be an attempt to self-medicate and relieve emotional pain.
“Killing yourself at any age is a seriously tricky business. But when I was seven, the odds felt insurmountable.”—Terri Cheney, The Dark Side of Innocence: Growing Up Bipolar
Bipolar disorder, formerly called manic depression, has had a long twisted, history and a punitive social stigma that dates back to the ancient Greek physician Hippocrates (460-370 B.C.), often called “the Father of Medicine.” Hippocrates, notes WebMD, “was the first to document two extreme moods: feeling extremely low (what we now call depression) and feeling extremely energized or excited (mania).”
Society as a whole and the medical community at large still do not fully understand the disease—far more of a medical Black Hole than Alzheimer’s (from which I suffer), other dementias, various forms of cancer, strokes, diabetes and the like. And there doesn’t seem to be a lot of champions in the general public for greater understanding of bipolar disorder, given its chilling stigma.
Writes Terri Cheney in her New York Times bestseller on bipolar disorder, “As a child, I knew nothing. I had no diagnosis. All I had was a vague and gnawing awareness that I was different from other children, and that different was not good. Different must be kept hidden.”
Bipolar disorder is deeply personal to me. I’ve had close friends over time who have suffered terribly from the disease and I’ve suffered along with them. I know the desperation of deep depression. Twice, years ago in my Alzheimer’s, cancer and genetic depression, I contemplated suicide. I’m not proud of that. Through the grace of God, I didn’t act on the despair, with a promise spiritually to support and encourage others along the way in these treacherous valleys.
The history of bipolar disorder is as complex as the illness itself, experts agree. It was common in ancient times for those with this condition to be executed under the assumption that they were possessed by demons.
Lisa Genova, Harvard PhD-educated neuroscientist and a New York Times bestselling author, whose recent novel More Or Less Maddy puts a discerning spotlight on bipolar disorder, says in an interview with the Cape Cod Times: “Historical treatments included drilling holes in the skull of an afflicted person to let out the evil spirits, presumed to be causing the illness, a means of escape. Or you might have been accused of being a witch because of your aberrant behavior, and you'd have been burned at the stake or hung. The history of the treatment of bipolar disorder is not very civilized. Today, we do much better, but we're still not at the age of enlightenment.”
The disease affects an estimated 5.7 million Americans, reports the Cleveland Clinic, and that doesn’t take into consideration those who have not yet been diagnosed yet.
“Those numbers have to be under-represented,” says Genova. “It takes a certain level of privilege to be able to navigate our expensive healthcare system to arrive at a diagnosis. A lot of people also shy away from receiving the label due to stigma and fear of being outcast.”
Simply put, Genova says, "This disorder, a life-long condition, is an impairment in the brain's ability to reliably regulate mood, energy, emotion, sleep, impulsivity, and thought.”
Treatment today of bipolar disorder is not a precise science, yet long term treatment is essential.
“We still don’t know enough,” says Genova. “Drugs used today to treat bipolar disorder were not designed specifically for bipolar, which is one reason why there are so many unwanted and often difficult-to-bear side effects. Lithium, the anti-epilepsy drugs, and anti-psychotics used to manage bipolar are wildly imperfect, but they can also be incredibly effective and save lives, especially when they're used in combination with cognitive behavior therapy, recognizing early warning symptoms, and triggers like changes in sleep. Establishing a balanced routine that supports stability, and openly seeking medical help and support from family and friends is essential in treatment."
Other treatments include a combination other mood stabilizers, antipsychotics, and therapies that focus on altering the distorted views one has in this disease. As experts note, mood stabilizers work to prevent sharp mood swings. During a manic episode, mood stabilizers are effective in reducing symptoms. These medications can also be used as maintenance treatment to prevent relapses, as prescribed medically. But check with your doctor.
Up to half of those with bipolar disorder, Genova says, will develop a substance use disorder (SUD)—an inability to control their use of drugs or alcohol. According to the Substance Abuse and Mental Health Services Administration, she adds, both bipolar disorder and SUD might stem from problems with areas of the brain that control impulsivity and experiences of reward. Using alcohol and drugs could also be an attempt to self-medicate and relieve emotional pain. Whatever the cause, having SUD can make bipolar disorder more difficult to treat.
Impulsivity is a hallmark of manic episodes, says Genova, noting that it is not uncommon for someone who is in the middle of one of these periods to spend money recklessly, gamble it away, make risky or impulsive business decisions, or all of these. Unchecked spending, Genova adds, puts a strain on personal and family finances. Thus treatment is crucial.
Trust in treatment, experts say, is vital in this journey, but as author Terri Cheney writes in her book: The Dark Side of Innocence: Growing Up Bipolar: “Trust is as fragile as fairies’ wings and almost as hard to find.”
