Joy Shang

David Battist & Stevan Harrell

HONORS 222B

May 5th, 2017

Mania and Melancholy: The Stigma Surrounding Mental Illness

INTRODUCTION

Waiting in an airport to fly out of San Francisco, Nic Sheff was approached by a young

woman who asked whether she could pray for him. Nic sensed a beam of energy shoot between

them as she murmured pleas towards the musty ceiling. In that instance, God came into

existence for Nic and following that day the two of them would talk on the phone for hours on

end. Nic arranged to join the womans church in Redding. However, his plans were thwarted

when Nic found himself unable to leave the fetal position on his bedroom floor (Sheff).

These extreme states of heightened emotions and crippling despair represent two sides of

the same mental illness: bipolar disorder. The extremely disruptive disorder affects over 2% of

Americans, coming to a total of about 2.3 million people (Krans & Cherney, Healthline

Editorial). However, despite the prevalence of bipolar disorder, it remains largely misunderstood

and stigmatized by the general public, with 70% of people with bipolar disorder having been

initially misdiagnosed (Healthline Editorial). While media coverage of bipolar disorder has

increased in the last decade and a half, boosting public awareness, dramatized narratives sour

perceptions of mental illness. Oftentimes, individuals wrestling with mental disorders internalize

these negative messages, which may lead to the denial of symptoms, refusal to follow treatments,
and intense self-deprecation. As such, for the psychological stability of those with bipolar, it may

prove beneficial to alter the tone of news reports and portrayal of fictional characters to become

less extreme, and more representative and hopeful. This may also encourage undiagnosed people

with bipolar disorder to seek treatment, which should be prioritized as 30% of this population

commit suicide (Healthline Editorial). In order to prevent more unnecessary deaths and improve

the quality of life for those receiving treatment, vested parties should target media sources as a

significant shaper of public perceptions. This paper will explore the societal issues surrounding

bipolar disorder by first describing its symptoms and subtypes, the progression of scientific

research, modern treatment methods, the effect of media on public perceptions, external and

internal stigma, and the role of religion in recovery.

DEFINING OF BIPOLAR DISORDER

The National Alliance on Mental Illness defines bipolar disorder as a chronic mental

illness that causes dramatic shifts in a persons mood, energy, and ability to think clearly. It

consists of cycling states of mania and depression that most commonly begin in ones 20s, but

can occur at any age (Krans & Cherney). Figure 1. details common symptoms and behaviours

associated with manic and depressive episodes.

Figure 1. (Healthline Editorial, Cirino)

Mania Depressive
Increased energy Extreme sadness, grief, and
Unusual talkativeness despair
Racing thoughts Uncontrollable crying
Little need for sleep Anxiety
Inflated self esteem Irritability
Over-the-top happiness Excessive guilt
Outgoing personality Loss of interest/enjoyment in
Feeling fidgety activities
 Impulsive behaviour Withdrawal from family and
Inability to focus friends
Spending sprees Difficulty remembering
Enhanced creativity things, making decisions, and
Starting many new concentrating
activities/projects Eating too much or too little
Feeling ambitious and Suicidal thoughts
inspired

Furthermore, psychology experts describe bipolar disorder as a spectrum and have identified

several subtypes within it, which are briefly outline in Figure 2.

Figure 2. (Krans & Cherney)

Bipolar I Disorder
1 or more manic and 1 or more depressive episodes
Bipolar II Disorder
Severe depression
Hypomania, a less intense form of mania consisting of high energy,
impulsiveness, and excitability
Cyclothymic Disorder
Less severe mood swings, consisting of hypomania and mild
depression
Rapid cycling with shorter episodes
Rapid-cycling Bipolar Disorder
4 of more episodes within a year, and multiple can occur within a
single day
Considered the most severe
More common with women

Research into bipolar disorder is ongoing, however, with additional classifications and precision

still being established.

HISTORY OF BIPOLAR DISORDER

Since bipolar disorder was first identified by humans, it has been a subject of social

scrutiny, confusion, and derision. The oldest mention of the depressive state of bipolar was found
in ancient Mesopotamian texts from around 2000 BC under the name melancholia (Nemade et

al). The writer of this text attributed the condition to demonic possession that could only be

cured through the holy healing power of priests. The term mania was later coined during the

golden age of Greece and Rome. In the first century AD, Aretaeus of Cappadocia linked the

conditions of mania and melancholia (Krans & Cherney). Unlike the majority of societies at that

time, which ostracized and executed those with mental illnesses, Grecians treated bipolar

disorder as a physical condition and discovered that lithium slat baths eased its symptoms. In

fact, lithium is still used in modern-day medications.

Unfortunately, religious views of mental illness prevailed until the 1700s when

inquisitive aristocrats began to study them from a scientific perspective. For instance, Theophilus

Bonet used his observations from performing autopsies to demonstrate a biological connection

between mania and melancholy, dubbing their combined condition manico-melancolicus

(Krans & Cherney). Research on bipolar disorder continued to creep along, with Jean-Pierre

Falret, a French psychiatrist, establishing a more concrete connection between the two states in

1851. He published an article describing the switching between severe depression and manic

insanity, which Falret called la folie circulaire or circular insanity (Krans & Cherney). This

was considered the first modern diagnosis of what is now known as bipolar disorder and Falret is

also reputed for his mention of a possible genetic connection. However, it wasnt until over a

hundred years later, in 1980, when the American Psychiatric Association adopted the term

bipolar in their Diagnostic and Statistical Manual of Mental Disorders, as opposed to the

phrase they had used previously, maniacs (Krans & Cherney). This transition represents a shift

within the medical community from treating bipolar disorder as an aberration to a mental illness

that can be studied and treated. Yet, even though people with bipolar disorder no longer face
their untimely deaths on the end of a burning stake, they are often still considered maniacal by

the general public.

SCIENTIFIC CAUSES AND TREATMENTS

While significant research has been conducted to determine the causes of bipolar

disorder, no direct source has been found. As a mental illness, it comes by no surprise that

bipolar is associated with a region of the brain, specifically the hippocampus (University of

Texas). The hippocampus also plays a part in multiple mood disorders, perhaps for its role in

regulating serotonin, dopamine, and noradrenaline, where the malfunctioning of these hormones

may induce bipolar disorder (Bressert, Causes). Stress may also trigger someone who is

genetically predisposed with these hormonal irregularities to experience their first manic or

depressive episode. A specific bipolar disorder gene has yet to identified, and it would be more

likely that a combination of genes is involved, but research has demonstrated that mood

disorders are inheritable. For instance, children with one parent that has bipolar disorder have a

10-15% chance of inheriting it, and when both parents are bipolar the child has a 30-40%

likelihood (Bressert, Causes). That being said, traumatic events, altered lifestyle, alcohol and

drug abuse, or even taking antidepressants can trigger bipolar disorder, even in those without a

genetic relation.

Once an individual has been diagnosed with bipolar disorder, they cannot be completely

cured but their symptoms can become significantly more manageable through various forms of

treatment. The most effective regimens include a combination of medication and psychotherapy,

often varying as patients experience different phases of the manic-depressive cycle. Mood

stabilizing drugs include lithium, which has few side effects, or artificial psychotics, that reduce

symptoms more significantly but are accompanied by additional side effects (Bressert,
Causes). Psychotherapy addresses the behavioural aspect of bipolar disorder by helping

patients to develop coping skills and unlearn harmful thought processes or behaviours. In

addition to these well-established treatments, several therapies are still being tested for their

effectiveness. One such treatment includes echo-planar magnetic resonance spectroscopic

imaging a bran scanning technology similar to MRIs which improved the mood of

participants experiencing a depressive episode by 77% (Collingwood). As additional studies are

conducted, more effective treatments will hopefully be implemented and improve the quality of

life for people with bipolar disorder. Unfortunately, under the sometimes euphoric influence of

mania, many patients abandon their treatments only to return after hitting the low of a depressive

episode. Despite these flaws, however, if properly following a treatment regimen someone with

bipolar disorder can manage their symptoms and achieve a productive and happy life.

INFLUENCE OF THE MEDIA

Among the general public, the primary dissemination method for information on bipolar

disorder, and other mental illnesses, is through news and entertainment media, such as television,

movies, and newspapers. News stories wield the most influence between these mechanisms,

covering incidents involving people with mental illnesses. However, the nature of the media

leads to practically all news stories involving violent or aggressive behaviour from people with

mental disorders, which represent a slim minority of the entire group. Furthermore, media outlets

often sensationalize already rare events to attract a higher viewership, skewing impressions even

farther. Rarely do stories featuring functional people who have recovered from mental illness

receive any attention to balance this negative image. Mention of mental health experts are also

notably lacking in publications, being included in less than 15% of articles involving mental

illness (Stuart). As research into the role of media on public perceptions of mental disorders
remains limited, regrettably, the statistics cited in this and following sections will refer to mental

illnesses in general. To better understand specific attitudes towards bipolar disorder, additional

studies should be conducted.

In any case, mention of mental illness has also increased within entertainment, including

in one fifth of American prime time programs (Stuart). Among characters with mental illness,

included in 2-3% of shows, half physically harm others and a quarter commit murder (Stuart).

They are also often depicted as disenfranchised, being distanced from their family, and jobless.

The culmination of these negative traits, coupled with the fact that the only exposure some have

had to people with mental illness may be through entertainment, will likely lead to an unfair

perspective towards people with mental disorders.

SOCIETAL STIGMA

Exposure to only the worst aspects of mental disorders not only forms a negative image

among the general public, but manifests itself in discrimination towards otherwise normal

members of society who happen to be managing a mental disorder. The term societal stigma

describes this prejudice disseminated through out the general populace. In fact, research shows

that most people drastically over estimate the danger they are exposed to when interacting with

someone with a mental disorder (Stuart). This unwarranted fear allows others to feel justified in

behaving with hostility, such as coercive treatment, bullying, or even legal action. Indeed, a

study conducted in the UK found that 25% of surveyed mental health patients said that they

experienced hostility in some manner from their neighbours due to them having a mental illness

(Stuart). A third also said that their own family members and friends treated them differently

because of media coverage, which 75% described as unfair, negative, and unbalanced. In reality,
someone with a mental illness is more likely to be the victim of a violent act than the perpetrator

(Stuart).

Adding on to negative stigma towards people with mental illnesses, media coverage also

influences public perceptions of psychiatric treatments. After all, the typical representation of

treatments in media appear ineffective or horrifically violent and archaic, in the case of

entertainment. Beyond influencing lay people, this aspect proves particularly concerning when

policy makers are involved. Indeed, one is unlikely to support or make more accessible a system

believed to be ineffective. Therefore, skewed reporting and narratives not only contribute to

discrimination towards individuals with mental disorders but may impede on their ability to

receive treatment.

INTERNALIZED STIGMA

In addition to altering the way people regard others with mental disorders, it also changes

how those with mental disorders regard themselves. For instance, in a UK study on individuals

using mental health services, 50% said that media coverage negatively affected their mental

health (Stuart). They also reported that the media directly impacted their ability to pursue self-

advancement, discouraging a third from applying to jobs or volunteering. Fearing the social

repercussions, people with mental illnesses often refrain from telling others about it and may shy

away form social interactions altogether. In this way, increased media coverage made people

with mental disorders feel more isolated, rather than understood or accepted. The internalized

shame individuals subject themselves to also contributes to a denial of symptoms, refusal to seek

treatment, and lack of motivation to follow through with treatments after they have been

prescribed (Stuart). Due to this, stigma that people with mental disorders develop towards
themselves may be even more damaging than external derision as it discourages them from

pursuing options to ease their symptoms and pursue a healthy life.

CHANGING PERCEPTIONS

In light of the harm that media has had on those struggling with mental disorders, it is

imperative that effort be made to balance the largely negative stories about mental illness with

positive ones emphasizing recovery, normalcy, and functionality. Furthermore, spokespeople

with mental disorders need to be fostered in order to associate a face and personality to the

nameless, deranged masses of mentally ill people constructed by the media. Celebrities

disclosing their mental disorders boosts this effort as they are already known figures who have a

pre-established public image. For instance, pop singer Demi Lovato, among others, publicly

shared her experience with bipolar disorder and produced a documentary on mental illness,

Beyond Silence (Weaver). In fact, bipolar disorder may be particularly well represented mental

disorder among celebrities, as it is associated with high childhood IQ and heightened creativity

(Cirino). Stigma relating to mental disorders may also be lessened by emphasizing its genetic

connection, which removes blame from individuals and puts it in chance.

In addition, attention should be put into reducing negative perceptions directed towards

mental health caregivers, who deserve respect for their work improving the lives of others and

not suspicion for promoting ineffective or torturous treatments. Further research needs to be

conducted on public perceptions of mental illness, the role of media, and the impact on patients.

Many of the studies conducted so far are of low quality, using small samples that were selected

based on convenience and do not accurately represent the demographic composition of the

general population. Studies also lack an established methodology to compare perceptions of

mental illness in different cultures, regions, and over time. With the current state of research on
mental illness, and bipolar disorder specifically, it would be irresponsible to come to any

definitive conclusions.

EFFECTS OF RELIGIOUS BELIEFS

Since the stake-burning ages of old, religions relationship with mental illness has

evolved into a neutral or even beneficial role. For instance, during the 19th century when those

with mental disorders were largely neglected or treated with contempt by governmental

institutions, such as in insane asylums, priests welcomed the mentally ill into their monasteries.

There those with mental disorders were treated with compassion and allowed to live somewhat

normally, without binds or padded rooms to restrain them. While the church no longer plays this

role, research indicates that religious affiliations may benefit the health of those with bipolar

disorder and other mental disorders.

When faced with a life-altering and somewhat debilitating mental illness, many find

reassurance and encouragement in believing in a higher power. In a study conducted by the

Center of Psychiatric Rehabilitation at Boston University, 54% of patients with bipolar disorder

reported using meditation as a coping mechanism, and 41% prayed (Koenig). These behaviours

may help lessen the stress of dealing with a mental disorder and foster a sense of peace within

patients through cultivating ones spiritual characteristics, appealing to a religious power, and

reaffirming ones sense of purpose. Indeed, multiple studies have found that patients that

regularly practice their religion have lower suicide rates than their non-religious peers (Koenig,

Dervic et al). However, this will to live may also be motivated by the discouragement of suicide

by Christianity and Catholicism, among other religions, where it is regarded as a sin. Another

university study found that depressed bipolar patients who were religious experienced their first

manic episode and first hospitalization due to bipolar disorder later in life, but experienced major
depression earlier than other patients (Dervic et al). As before, it is unclear whether the culture of

their particular religious group had an effect on when these signs were first reported. Regardless

of measured benefit, it is likely that people with bipolar disorder involved in religion receive

support from their communities and ease of mind that lessen the hardship associated with

managing a mental illness.

On the other hand, religious beliefs can also impede the treatment of bipolar disorder and

even worsen its symptoms. A questionnaire received by 81 participants with bipolar disorder

indicated that self-identified religious people were less compliant with following their

medication regimens (Mitchell & Romans). These participants said that they would stop taking

their medication after a spiritual leader told them that they had been healed through the power of

god and no longer needed it. Indeed, 19% reported that they were given conflicting advice from

medical and spiritual counselors (Mitchell & Romans). While prematurely refusing to take

medication certainly harms the recovery of a patient with bipolar disorder, religious delusions

can prove even more detrimental to their overall well-being. Religious delusions were found to

affect 15-22% of religious patients in a UK study, resulting in intense hallucinations and

delusional thoughts (Koenig). Chris Cole experienced such a delusion as a freshman in college

when he woke up feeling a oneness with the universe and began attempting to recruit his

friends to become his disciples and perform miracles for them. Not only are these psychotic

episodes extremely disruptive, landing Cole in jail, for instance, but those who experience them

often face more severe symptoms, have a lower ability to function, and require higher doses of

medication (Koenig). While delusions are not isolated to religious patients, the higher likelihood

of experiencing them as well as receiving encouragement to stop taking medication significantly

decreases the ability for people with bipolar disorder to recover.

CONCLUSION

Bipolar disorder throws those who suffer it through alternating cycles of exhilarating

mania and paralyzing depression. Yet, through a combination of medication and psychotherapy,

many of those with bipolar disorder are able to control these intense mood swings and achieve

productive, healthy, and peaceful lives. Bipolar may also prove a boon to some by increasing

their creative capabilities, and outreach from such high-profile celebrities improves public

perceptions of the mental disorder. Indeed, the intentional proliferation of positive messages

need to join the conversation currently surrounding mental illnesses, which is dominated by the

violent actions of a few individuals or exaggerated fictional narratives. Research has shown that

these unfair messages infiltrate into peoples psyches and worsen the way those with mental

disorders are treated, perhaps even leading to them sabotaging their own recovery. The role of

religion in managing bipolar disorder remains debated, with some perceived benefits but also

increasing the chance of experiencing extreme delusions and refusing treatment. As a whole,

more research is needed to determine the effect of media, stigma, and religion on people with

bipolar disorder, as well as into the causes of the condition itself. Genetics will likely play a

significant part in future research and lead to revolutionary new treatments. Until that utopian

future where bipolar disorder can be cured with micro robots replacing tiny segments of DNA in

human cells, however, some will be left to battle these cycles of mania and melancholia.
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