Below is a link to my Google Doc version with correct citations.
https://docs.google.com/document/d/1_0mw2wn8SnWMfE0c7MuanOOGlPvwQWgfJNHg4znLbWc/edit?usp=sharing
Hello, my name is Theron Gertz and I will be discussing the modern history of bipolar misdiagnosis
As trite as it is to start a project with a definition, I find it essential here due to the key terms and varied history implicit within it. To begin this project without discussing these would be like starting a presentation on astrophysics without first defining gravity or electrons. Doing so also grants us a conceptual home base from which to branch outward and connect back new topics and information, such as the many biographies and medical journal entries this project will draw upon. The Mayo Clinic defines bipolar disorder as “a mental health condition, formerly called manic depression, that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).”
The first thing we might notice first about the Mayo Clinic definition is that bipolar disorder was formerly known as manic depression. The term “bipolar disorder” was only penned around 1966 by psychologists Jules Angst and Carlo Perris, which is why texts before this period show no sign of it. In fact, the term did not appear on the DSM until its third edition, published in 1980. Still, there is no doubt that individuals have been aware of these symptoms for thousands of years. As “Bipolarity from ancient to modern times: Conception, birth and rebirth” points out, Greek physicians from the Classical Period––notably Hippocrates––identified mania and melancholia as early as 400 BCE.
Connecting this back to the Mayo Clinic’s definition of this word, we again see the term “mania” (including hypomania as a sub-category), this time followed by a new descriptor word for melancholia, depression. One of the most contentious issues when diagnosing someone with bipolar disorder is how long they must show either of these symptoms to qualify. Far from “showing excitement” or “feeling bad,” these symptoms must be present in patients for a continuous and extended period. While generally agreeing on that front, many physicians have conflicted feelings about exactly how long that period must be. Overall, “one week” seems to be the norm. However, personal opinion and clinical experience lead to variance between practitioners.
The discussion of a bipolar spectrum may also further abstract this issue. While very likely dangerous, we would be remiss in not first exploring some of this idea’s positive aspects as outlined by its proponents. For example, many support the creation of conceptual spectrums for disorders like B.D., autism, and schizophrenia due to their ability to represent people better. Mental health diagnoses/treatment strategies are notoriously rigid and may not fully speak to a person’s lived experience. Thus, this concept possibly encourages people in the early stages of the disorder or who present somewhat differently to seek out diagnosis or treatment. It may also significantly reduce stigma by moving away from the stereotypical, extreme-end depictions we so often associate it with.
Still, physicians are generally wary of it for a good reason. Mainly, they fear that the belief that people don’t need to fit all the diagnostic criteria for B.D. may lead to erroneous self-diagnosis. Unlike previous eras, the late 2010’s onward have seen mental health issues borderline-glamorized in popular media.
Websites like Tumblr, Instagram, and TikTok are notorious for fostering groups that seemingly promote mental health issues and may lead to rampant self-diagnosis. The latter of these apps––TikTok––will appear later in this project under the Misdiagnosis and Future Concerns sections.
Another confounding factor in the history of misdiagnosis is that the chance of comorbidity is remarkably high for most mental disorders. For example, the comorbidity rate of ADHD is estimated at around 70%. While bipolar disorder’s rate is slightly lower, (10-60%, depending on which disorder is being discussed), it still very likely contributes to clinicians missing something if only considering a single diagnosis.
Bipolar disorder symptoms can also present as shockingly similar to other disorders such as borderline personality disorder, major depressive disorder, and schizophrenia. Looking at each of these individually, we quickly gain an understanding as to why. Borderline personality disorder presents itself very similarly to bipolar disorder, with individuals showing rapid mood or personality shifts, and high suicidality. Major depressive disorder is often ascribed to incipient bipolar patients mainly due to how notoriously difficult manic symptoms are to identify (false positive).
Lorraine Blackburn outlines this experience firsthand in her memoir Alive With Bipolar, in which she discusses her initial misdiagnosis of major depressive disorder, and how it negatively affected her life. Much of the book covers blame-placement for this event, although it tends to surprisingly empathize with the family members and practitioners involved. Perhaps partly, this may be due to the fact that Blackburn herself was unable to notice her BD symptoms for so long.
Discussing why all this is important, there is the obvious answer that misdiagnosis is harmful. Individuals with bipolar disorder who are misdiagnosed may rapid-cycle or display worse manic symptoms as a result. However, we must note that improper diagnosis is especially damaging in the case of bipolar disorder due to its unique chemical makeup. Discussing false negatives––those being cases where an individual is falsely diagnosed with another disorder or none at all––, we must note that early medical treatment of bipolar disorder is crucial. Unlike other diseases, symptoms of bipolar disorder often deteriorate/exacerbate over time.
In The Dark Side of Innocence: Growing Up Bipolar, author Terri Cheney discusses her experience with delayed diagnosis, stating that her image as a high-achieving, all-American girl made it difficult for those around her to perceive anything wrong with her. As she explained, only the worsening of her symptoms led to crucial medical treatment. Hypersexual episodes, slipping grades and suicidal ideation were only a few of the consequences of such a late diagnosis, as she explains it.
Lisa Cooper similarly states that her early bipolar symptoms were difficult to identify due to childhood trauma. While complex PTSD is most often conflated with BPD, it is not unreasonable to assume the same could happen with bipolar disorder. Specifically, with Cooper, she saw her decision to run away from home and live on the road as a lucid decision––which it might have been––that was free of neurochemical influence––which it might not have been.
Looking into both of these stories, we come across the very real fact that clinicians may have issues separating adolescent angst from genuine signs of disease. As one TikToker posting under the #bipolar feed explains, her therapist allegedly conflated her extremely reckless behavior and excessive sexual episodes with simple teenage happiness.
Such an instance may bring to mind past clinicians’ tendency to misdiagnose or overdiagnose women with BPD by conflating it with supposedly troubling but typical female behavior.
One thing we must remember when discussing misdiagnosis is how rarely people regret receiving the correct treatment for their conditions when viewed in the long run. In Carlton Davis’s memoir Bipolar Bare: My Life’s Journey with Mental Disorder, he associates his years of drug use and reckless lifestyle with untreated bipolar disorder. Similarly, Gray Chavannes’s Tale from the Depths of a Bipolar Mind: A Journey beyond Imagination denotes a fall from grace resulting from his mania and depression. As he explains, he lost his job, home, and loved ones due to these symptoms.
Still, one contributing factor to a lack of diagnoses is that people experiencing manic episodes either feel that nothing is wrong or perceive it as extremely pleasurable. As many with the disorder would attest, these symptoms often present like extremely lucid, creative, near-religious experiences. In his memoir, Am I Bipolar or Waking up? author Sean Blackwell uses the time he voluntarily left a mental asylum to seek out the true meaning of his “once in a lifetime blessing” to outline how intoxicating and elusive the disease can be.
One thing we might learn from these latter two cases is that misdiagnosing individuals with bipolar disorder risks further legitimizing their manic symptoms, leading to worse outcomes later on.
Perhaps adding some more credibility to this discussion, I feel compelled to admit that I was misdiagnosed with bipolar disorder freshman year of college, as was seemingly my sibling earlier this year. Speaking on my behalf first, most of my misdiagnosis came from the fact that––following a suicide attempt––Snowden’s outtake protocol effectively demands that a psychiatrist label you with a disorder. After this, you are given a prescription and told to go about your daily life. Pharmaceutical industry diatribes aside, this practice is clearly perfunctory. As many scholars have noted, diagnosis takes time and a deep patient connection, which busy mental health ward psychiatrists seldom possess.
Speaking about my sibling quickly, the most flagrant discrepancy between their diagnosed BD symptoms and true symptoms lies in their frequency. The average person with this disorder will suffer from two manic episodes a year––give or take. In cases of individuals who rapid-cycle, this number may be significantly higher; but notably, not enough research exists for clinicians to set a definitive range, making diagnosis of it very contentious.
Future Concerns
As a brief aside regarding future misdiagnosis, there has been a concerning rise in social media posts––mainly on the app TikTok––claiming to diagnose individuals within a few easy steps. Overall, there is a concern between making people more aware of BD diagnostic criteria and overdiagnosis.
Bipolar creators have overwhelmingly ridiculed the most popular videos appearing under the #bipolar tag. One YouTuber, named Hiba Azeem, spent several minutes of a video in which she reacted to TikToks to correct one that claimed bipolar people are ‘extremely high and low from minute to minute.’ As Hiba states, a quick google search would have proved this inaccurate. She reacted similarly to another video in which a user––ostensibly––proudly claimed that she dealt with her BD through excessive marijuana use instead of taking her prescribed medication. Again, Hiba denounced this behavior, identifying it as problematic.
There are also harmful stereotypes, such as those seen in the currently viral #Bipolar TikTok challenge. As one could probably guess, this trend has nothing to do with an active presentation of the disorder and has everything to do with putting your face in your hands and luridly crying before switching to an energetic dance and smiling. While it is difficult to know what truly counts as “viral” anymore, a YouTube compilation of this trend has amassed over 793,000 views since this documentary’s recording.
Online services like BetterHelp are another facet of current media to be scrutinous of. According to their now-infamous YouTube ads, this company aims to make therapy more accessible to everyone. While this intention is honorable, they have repeatedly come under fire for hiring unqualified therapists with very little screening. To quote their own rarely-read terms of service, “We do not control the quality of the Counselor Services and we do not determine whether any Counselor is qualified to provide any specific service as well as whether a Counselor is categorized correctly or matched correctly to you.” This fact should obviously concern anyone hoping to see people diagnosed with the correct disorder.
As conceptually pleasing as it would be to break down bipolar disorder’s modern history into decades, the fact is that most of these failures temporally overlap––if not, fold onto each other outright. In looking at the history of bipolar misdiagnosis, we see that many of its biggest contributing factors seem inextricably tied to the disease’s inherent complexity. Although certain things could be helped, such as better physician understanding of teenage––particularly female––BD symptoms, all of these issues seem to require greater research and time to be truly ameliorated. The inclusion of a bipolar spectrum may serve as food for future thought, but currently, its sticking points outweigh any potential positives. With that in mind, it seems the best we can do is to remain skeptical of potential cure-alls, but open to new treatment methods, and––as always––empathetic to the people truly dealing with it.
