I just had a chance to catch up on 4OD today with the Channel 4 documentary Being Bipolar. I wasn’t watching it when it was first screened on Channel 4 earlier this week, but it’s sparked off quite a few reactions on social media, most of them negative. Charlotte Walker and Laurie Hastie have both written negative reviews of the show on the Mind blog. Meanwhile Henrietta Ross has given a more mixed review at Madness Matters. Given these responses, I decided to see for myself and watch the show.
There’s clearly issues with the style of the show. Even when valid points were being made, they had a tendency to be presented in a way that felt quite jarring. Such as when the opening voiceover asks, “Who are these people?” as though they were Martians. Or when presenter Philippa Perry referred to somebody as having been “released” from a psychiatric ward (the correct terminology is discharged). Or when Perry incedulously asked, “So these drugs don’t actually cure anything?” (So what? insulin doesn’t cure diabetes and anticonvulsants don’t cure epilepsy, but people still take them to manage their conditions so they can get on with their lives.)
Possibly the jarring style that seems to have irritated so many people could be summed up by the presenter. Perry is a psychotherapist who comes as across like pretty much what you’d get if you phoned up Central Casting and asked for someone to play “kooky psychotherapist”. She clearly favours psychodynamic explanations, and for some reason spent much of the show dressed like a cross between Velma from Scooby Doo and a plum. She refers to a “growing suspicion” that bipolar disorder is a result of life experiences, as though this wouldn’t be exactly the line of thinking one would expect from someone of her modality.
She initially starts looking for these life experiences in a way that comes across as rather clumsy, asking two participants in the show if they had a childhood trauma. Both reply no, but she continues to fish for explanations in their prior backgrounds. Along the way, an interview with Cardiff University’s Professor Ian Jones forces her to – reluctantly – concede that genetics play at least some role in the risk of somebody developing bipolar disorder.
In her interviews with participants, she discovers some aspects of their backgrounds that she suspects may explain how they developed their symptoms. Paul was previously a high-achieving businessman and athlete who simply could not accept second place in anything. She suggests this inability to tolerate the pain of failure caused him to become manic and develop grandiose delusions. Ashley has not only rapid-cycling bipolar but also autistic spectrum disorder. She suggests that the isolation cause by his autism led him to lose control of his mood.
Perhaps these hypotheses may have some validity to them, but as she was saying them other hypotheses were running through my own mind. Perhaps Paul’s record of high-achievement was the result of an over-active brain. Given that Paul freely admitted to use of multiple recreational drugs, perhaps this had affected his brain chemistry. Then again, perhaps Paul was simply trying to self-medicate his difficulties with whatever was to hand. Perhaps Ashley’s non-neurotypical development led to abnormalities in the way his brain regulates mood. Perhaps all of these hypotheses could be true and interacting with each other, or perhaps none of them are. Perhaps, perhaps, perhaps.
Perry also interviewed Dr Joanna Moncrief, a controversial psychiatrist who’s always struck me as rather ideological in her views. She suggests that psychiatric medications don’t really treat the symptoms of bipolar disorder, but simply sedate the individual. There can be at least a grain of truth to that in some cases, but all the time? She didn’t supply any evidence for her assertion, going on to say that drugs are “not a good way to deal with feelings you can’t tolerate.” So, what’s the alternative? Be stuck with intolerable feelings, possibly leading people to self-medicate from Threshers or the amateur pharmacologist down the road, as Paul seems to have wound up doing?
Some of the conclusions were ones that struck me as rather uncontroversial. Genetics, life experience and environment can all affect somebody’s mental state to varying degrees. People with bipolar disorder don’t all present in the same way, and it’s important to treat people as individuals rather than simply according to diagnosis. Meaningful activity and reducing social isolation can be useful as well as medication and/or psychotherapy. It’s possibly to be well within the paradigm of orthodox psychiatry and agree with all those statements.
Ultimately bipolar disorder is a hugely complex subject, and one that would have been difficult to cover in its entirety during a single 45 minute TV show. It probably didn’t help that Perry was clearly wedded to one particular theoretical model. Though it’s probably fair to say that there’s plenty of instances where the issues have been presented in an equally over-wedded way to biomedical explanations.
Ultimately, the lesson I took from Being Bipolar was that in talking about a difficult, tricky area like mental health, no single theory is ever likely to suffice. It’s a set of problems that requires multiple ways of trying to address and understand them.