Bipolar & Stigma: A Problematic Paradox

By Stephen Propst

Despite advances, diagnosis and treatment of bipolar still has a long way to go before capable, customized, compassionate care is the norm.

Today we have more reliable medications, with fewer side effects, than ever before. People with mental health issues can choose from every imaginable form of therapy, from interpersonal to cognitive to eclectic. More research has created an ever-expanding knowledge base.

Yet if you live with bipolar disorder, quality care can be difficult to access. Significant disparity in insurance coverage continues. Stable employment is elusive, despite the Americans with Disabilities Act. And if you do get hired, who knows if you’ll receive acceptance—much less accommodation—in the workplace.

It’s a real paradox. Despite all the advances, a person with a mood disorder still encounters a challenging environment where he is often seen as a second-class citizen. Capable, customized, compassionate treatment is not the norm. Far too much chaos and confusion continues.

Ken Kesey’s novel One Flew Over the Cuckoo’s Nest, published more than 50 years ago, depicted a mental health system that was inhumane and unjust. Patients today may not be dehumanized with labels like “Acutes and Chronics,” as in Kesey’s book, but similar contemporary terms like “chronically disabled” do nothing for a person’s sense of well-being.

If you remember the Jack Nicholson movie, you’ll recall that the same cassette music played over and over, evidence of the sickening, habitual, so-called “therapeutic approach” that could drive anyone mad. Today, we still have too many generalized, cookie-cutter approaches to achieving wellness and too few of the focused, client-centered type. We should all be tired of the same old song.

Decades after Kesey’s work, many people still spend years in treatment or therapy without a specific plan developed or a desired outcome discussed. Medications are often prescribed without proper education; moreover, inferior, cost-cutting drugs are often tried before a more desired option is prescribed. Pardon me, but that’s cuckoo!

Treatment issues aside, we still have a tremendous problem when it comes to making a proper diagnosis. On average, it takes 8–10 years from onset of symptoms for a person to receive an accurate diagnosis of bipolar disorder. Then, good luck finding a capable, caring psychiatrist who is taking new patients—not to mention who accepts your insurance.

Another problem is more basic in nature. Human beings, like snowflakes, are unique; however, people living with bipolar are often branded as uniquely different, leaving them feeling isolated and alone. They face tremendous stereotyping by the media, stigmatization by the public, and significant internal shame. The resulting self-imprisonment is sometimes worse than institutional incarceration. Many would rather seek refuge in a hospital than face an apathetic, even hostile, outside world.

Indeed, the bipolar condition itself is a paradox; it is biological in origin yet psychological in expression.

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