Am I Still Bipolar? Emerging from the Shadow of the DSM
I am excited. Almost as excited as I was the day the Berlin wall fell or Nelson Mandela was released from jail. For me, the current debate around the utility of the DSM5 and psychiatric diagnosis feels that big. It feels that big because I have been personally touched by a madness from which I was told I would never recover. My only sibling has likewise lived in the shadows of diagnosis, similarly labelled and without any real hope for much of his life. I was labelled bipolar 1 and he as schizophrenic. Of the two labels, I must confess to preferring mine. Bipolar is somehow a bit sexier than is schizophrenia – in these days of celebrity confession, anyway.
But a quarter of a century ago when I was first given my diagnosis, I was a manic depressive and there didn’t seem much that was glamorous about that. Celebrities did not then come out of the closet and admit to their diagnoses or discuss their trials in Hello. It was only historical geniuses like Virginia Woolf and Hemingway who were found on lists of the similarly afflicted. And that was only because they were dead.
Admittedly I was more fortunate than most. As a writer, people chalked up my creativity and productivity to my ‘illness’ and I was forgiven some of my foibles. Editors still liked my work, not always realising that some of it was produced in a haze of lithium and sometimes from within the confines of a psych ward. It sold, nonetheless.
So why am I excited? I’m excited by the fuss over the DSM and by the breathtaking possibilities within the charge that psychiatric diagnoses lack validity. If mental illness is not primarily caused by biology I’m left wondering if I’m a fairly normal person after all? What if I’m someone who was extremely distressed at times or someone who just has bigger moods than most? That seems a bit like saying that some people tan more easily in the sun than others. And so what if they do?
It might mean that my family was like many other families, except that we were stressed. Most of us were distressed and two of us got labels. Certainly the criss-cross double-bind communication within my family could have driven anybody mad. Perhaps, more tellingly, we couldn’t talk about our distress and it had to be hidden. Well-functioning middle class people weren’t expected to behave that way. While our genes may have made ‘madness’ more likely is that really so bad?
If psychologists are right that the primary causes of mental illness are psychosocial rather than biological, my family narrative can be re-written. We can emerge from our closets of shame and take our rightful place on the continuum of acceptable human experience.
That possibility feels good, but it can’t erase the fact that my family has been shamed and defamed by psychiatric diagnosis. Our lives, historical and present, are forever affected by it. We have felt different. We have felt defective and unacceptable. We felt that our genes were inadequate and shouldn’t be reproduced. We felt that our diagnoses had to be hidden because others might think us dangerous or unpredictable. At times, we felt so ‘other’ that we had to hide our experiences even from one another. We lived with secrets and silence that reached into every corner of our lives.
Our communications were difficult and inauthentic as a result. My parents would bring me gifts when I was in hospital and take great care to ensure that I had all that I needed. My long-suffering husband was chastised by my mother for not ‘doing enough’. We would speak about everything bar the fact of my being there. Neither parent ever breathed the words of my diagnosis to me. We discussed the weather, interest rates, the neighbour’s dog… Everything but the reason why I was periodically unable to function. That both their children were ‘mental patients’ was a deep source of shame and guilt.
Both my parents died before the dawn of this new era of DSM deconstruction. They died believing that they had brought deficient children into the world. They died believing that they were fundamentally flawed, perhaps even irresponsible in becoming parents. When they were here, I tried to tell them that it wasn’t their fault: that none of us could have predicted our fate.
It was never enough. Psychiatry was too powerful and our insecurities intertwined with its diagnostic labels to keep us locked into our shameful dance. Neither my brother nor myself was given any hope of recovery. We were told that our illnesses were incurable, that we could expect to live lives of pain and disability. To some extent, we have. But if we have been unable to re-write our diagnoses, our prognoses were more within our control. My brother has gone on to make a functional recovery, while I have remained medication-free for the past thirteen years. I no longer identify with the label ‘Bipolar’.
Backed by Big Pharma, powerful careers have been fashioned from the biological theories. Psychiatry, embarrassed though it may be by its failings, will not easily loosen its monopoly on the meaning of mental illness. But it’s labels can have no lasting meaning for those determined to recover and live the best lives that they can. That is where the real power lies – and it’s possibilities must be snatched up whenever and wherever possible.