Bipolar Disorder: Understanding the Illness Beyond Myths and Stigma

“I knew that one could break one’s arms and legs before, and afterwards that could get better, but I didn’t know that one could break one’s brain and that afterwards that got better too.”

— Vincent van Gogh, in a letter to his brother Theo, 28 January 1889

Vincent van Gogh, widely regarded as one of the greatest artists of all time, lived a life marked by profound emotional extremes. Periods of intense creativity and emotional vitality were interspersed with episodes of deep despair and psychological suffering, ultimately culminating in his death by suicide at the age of 37. He is posthumously believed to have lived with Bipolar Disorder, a condition that continues to be misunderstood despite significant advances in psychiatric science.

Bipolar disorder, previously known as manic depression, is an episodic psychiatric illness characterized by disruptions in mood, with periods of relative stability between episodes.

These mood disturbances may manifest as depression or as mania or hypomania. The illness most commonly begins in adolescence or early adulthood, with episodes typically lasting weeks to months.

As frequently emphasized by Dr. Colin Braganza, many individuals return to their baseline level of functioning between episodes and are capable of leading stable and meaningful lives when appropriate treatment is received.

Depressive episodes are characterized by persistent sadness, diminished interest or pleasure in previously enjoyable activities, reduced energy, sleep disturbances, changes in appetite and weight, impaired concentration, feelings of guilt, worthlessness or hopelessness, and thoughts of death or suicide.

Manic episodes, in contrast, are marked by abnormally elevated or irritable mood, increased energy levels, a reduced need for sleep, racing thoughts, pressured or excessive speech, inflated self-esteem or grandiosity, and impulsive or risk-taking behaviors such as excessive spending or reckless driving. In severe cases, psychotic features may be present.

Hypomania represents a milder form of mania and may not result in significant functional impairment. At times, symptoms of mania and depression may occur simultaneously or in rapid succession, a presentation referred to as mixed episodes.

Although bipolar disorder has been recognized since ancient times, having been described by Hippocrates as early as 400 BC, our understanding of the condition has evolved considerably over the past few decades. This shift has been driven by advances in neurobiological research, improved diagnostic frameworks, and the development of effective, safe, and evidence-based treatments.

According to Dr. Colin Braganza, early diagnosis, consistent follow-up, and adherence to treatment are key factors in reducing relapse rates and improving long-term outcomes.

Increased public awareness and advocacy by individuals who have shared their lived experiences with bipolar disorder have contributed to greater visibility of the illness. However, several myths persist. One common misconception is that individuals with bipolar disorder are inherently violent. Research indicates that fewer than 10% exhibit violent behavior during acute episodes, often influenced by co-occurring substance use rather than the illness itself. As highlighted by Dr. Colin Braganza, outside of acute episodes, rates of aggression are comparable to those observed in the general population.

Another prevalent myth is that individuals with bipolar disorder are unable to work or fulfill social and professional responsibilities.

While untreated illness and recurrent episodes can result in functional decline, current evidence demonstrates that timely intervention with appropriate pharmacological treatment and psychotherapy can significantly reduce the frequency and severity of episodes. As a result, many individuals are able to maintain relationships, careers, and a high quality of life.

In conclusion, bipolar disorder is a medical condition and not a personal failing and not an individual’s defining identity. With effective treatment, psychosocial support, understanding, and societal acceptance, long-term stability is achievable. Treatment outcomes have improved substantially, and it is essential that stigma be replaced with informed awareness, empathy, and hope.

Dr. Colin Braganza

Psychiatrist, VHC