I had lived with bipolar for years when I first came across the term, “diagnostic overshadowing”, in an online forum discussion about mental illness. It means where a clinician may privilege mental illness diagnosis over what the person is saying and other symptoms, assigning them to your mental health condition. Perhaps because I am articulate, assertive and white I had only experienced this sort of bias at the hands of a single OH doctor in the days before the Equalities Act (2010). As a result of her clumsy questions (Are your parents still married? – where is that in the text book, I wonder?) and judgement I was offered a job advertised as permanent, on a one year contract, to be renewed if I didn’t have a bout of depression (and time off) in that time. When my contract was extended at the end of that year I talked to my (wonderful) GP about making a complaint. He advised against – lots of effort, for little reward, given that I had made it through the year and secured the job.
Are people with mental illness mad or bad?
Some attitudes to mental illness have moved on since then and awareness campaigns, for all their faults, coupled with soap opera storylines and popular celebrities with lived experience such as Robbie Williams, Frank Bruno and Dusty Springfield, get a sympathetic hearing. The perhaps less well-regarded include Mel Gibson and Kerry Katona – I’d be interested to read some kind of analysis and correlations of media representations with public attitudes towards celebrities living with bipolar, subject as they are, to media scrutiny.
When I was diagnosed in the early nineties, there was a lively debate about whether people with mental illness are mad or bad. Vestiges of that debate still colour popular opinions. I was also told by a nurse on the ward that bipolar was common in “creative people” – another prevalent view at the time – but what if you are not creative and not bad, just struggling to live a life where you and your motives can so easily be misunderstood?
Oh, Lord, please don’t let my bipolar be misunderstood
I am very aware that people other than medics can view your opinions and actions through the lens of mental illness which in turn are interpreted as signs of instability, impulsivity, illogicality or oversensitivity. I was out with friends recently: two of them within minutes of each other referred to “nutcases” they have encountered locally. When I pointed out to them that I might be viewed as such a nutcase by some of my neighbours, who witnessed my last episode years ago, when I was taken away from my house by police and ambulance crews. I was cheerfully dismissed. Do you have to have lived it to understand it? I don’t think so.
Recently I became next of kin for a friend when they acquired sudden and unexpected disability. Always a glass half-empty person, I anticipated, from my own experience of grief as a trigger for depression, how hard theirs might be and have tried to advocate to ensure their mental health is addressed (not dismissed in diagnostic overshadowing) alongside more obvious care for physical disability. My motives are not well understood, yet I feel if I tell care home staff that I had several years of untreated depression and wouldn’t wish it on my worst enemy, it might not pay off, rather designate me to the “not to be taken seriously” file, with all the connotations of green ink.
Is perfectionism a bipolar trait?
I recently completed a University of Southampton research questionnaire exploring perfectionism in people with bipolar. I have written elsewhere about helping with bipolar research. I had never considered perfectionism as a characteristic of bipolar before, but am doing so now. In my working life, I considered myself good at my job, not perfectionist but with high standards that, in the teams I worked in and led, we achieved (including the job of the one year contract). I do remember at a leaving do, early in my career, a colleague, whose dry wit I love, saying they thought I might destroy things in the office that weren’t up to scratch, such was my professionalism… so perhaps I have been in denial all these years.
Another more recent colleague characterised me as dynamic and that they enjoyed working with me precisely because of this. My latest psychiatrist gave a paper at a recent meeting of the Royal College of Psychiatrists Evolutionary Psychiatry SIG and believes the case for evolutionary benefits are stronger in bipolar than some other mental illnesses, if I understood correctly. I am still hoping to read something more about this – there are so many mystery ingredients to this bipolar soup: heredity, upbringing, stress, diet, brain, psychology, health inequalities, poverty, education, discrimination in all its guises. In his recent memoir David Harewood powerfully describes the impact of othering, which I know something about.
So my insight is that bipolar can come with advantages and disadvantages on top of any personality traits (more research please). But be aware, those who don’t know your diagnosis, may find your “bipolar superpower” as some call it – your ability to get things done, your quick thinking and if you have it, your creativity – a bit confusing, daunting, irritating or threatening.
Further information
- Debate: diagnostic overshadowing: Royal College of Nursing website
- Older with bipolar – a double whammy
- Taking part in bipolar research