Credit: Tobias Cornille

Carrie Fisher Noel Hunter bipolar disorder

Carrie Fisher, bipolar disorder, and the spread of false information

This article also appeared on www.madinamerica.com

I, like so many others, was saddened and struck with nostalgia upon hearing the news of Carrie Fisher’s untimely passing. As a child of the 80s, I had a childhood dream of growing up to be Princess Leia, and — of course — marrying Han Solo.  What I did not dream of was fighting an empire that seems only to grow over time, and with no Harrison Ford by my side to make it all better. The death of Carrie Fisher is heartbreaking; the news coverage of her life and suffering is a tragedy.

From Scientific American to Slate to the New York Times — all reputable news sites that have the prestige of rigorous reporting and the air of truth-telling — the stories all sound similar: ‘Bipolar Disorder killed her.’ ‘Bipolar Disorder is a real disease caused by a virus and/or a chemical imbalance.’ ‘Bipolar Disorder has nothing to do with one’s life circumstances.’ ‘Bipolar Disorder causes mood swings and brain damage.’ Some of these articles are written by psychiatrists and/or have support from prominent mental health professionals. Yet, all of these proclamations are 100% false. There is no truth to any of this and the illogic and dogmatic rhetoric infiltrating the public right now is doing everything that Carrie Fisher herself fought tirelessly against: increasing stigma for those who suffer emotionally.

To be clear, this article is not yet another effort to speculate on Carrie Fisher’s personal struggles or her individual experiences though there is ample evidence of early experiences that are sufficient to explain her later challenges. Rather, it is a brief attempt to address some of these untruths and provide some counter to those who are actually interested in what the science behind these claims are, versus ideological grandstanding. So, without further ado…

Bipolar Disorder is not a Real Entity

Let me be clear: People most certainly have very real experiences of mania and deep depressions, of cycling mood states, and of erratic and wild behavior that ruins relationships and many lives. The term bipolar disorder, however, is a term that simply describes these experiences. There is no entity of bipolar disorder that exists outside of these subjective experiences and behaviors.

Consider, perhaps, the experiences of pain in the head. Many would call this a headache. A headache might occur for numerous reasons: stress, dehydration, fatigue, the weather, inflammation, a brain tumor. One can take an aspirin and perhaps mask the pain, but the cause of the pain still has not been addressed. If it’s stress maybe that’s no big deal. If it’s a brain tumor, well, that’s probably going to be an issue. And no one, anywhere, is asserting that the headache is itself the cause of the pain.

But, in mental health, this is exactly what happens. Saying that bipolar disorder is itself the problem is akin to saying that one’s head hurts because one has a headache, and it is the headache that is causing the head to hurt. This logic, quite literally, gives me a headache.

Bipolar Disorder is Very Much Related to Trauma and Chronic Stress

Dr. Sally Satel, in an article for Slate, describes Fisher’s childhood as “tumultuous” and then goes on to state, authoritatively, “To be sure, a chaotic childhood is not a risk factor for bipolar illness.” This is not only completely untrue, but it is an invalidating and even dangerous statement for a psychiatrist to assert so confidently without any evidence to support it.

In fact, the relationship between a diagnosis of bipolar disorder and chaotic and traumatic childhoods is quite strong. Sexual abuse, specifically, is closely related to this diagnosis, with approximately 28% of women so diagnosed reporting a history of childhood sexual abuse involving bodily contact. Early parental loss increases the risk of being diagnosed with bipolar disorder by up to four-fold. Individuals with this diagnosis are three times more likely to experience interpersonal trauma, with 32% meeting full-criteria for PTSD. Overall, chaotic childhoods are 2.63 times more likely to have occurred in individuals carrying this diagnosis, with emotional abuse having the strongest relationship (an odds ratio of 4.04).

Bipolar Disorder is not due to a Chemical Imbalance

It is hard to believe that there are still media reports of chemical imbalances causing mental illness when even the most hard-lined biological psychiatrists have debunked this myth. Ronald Pies, an eminent psychiatrist, has expressed for years that this hypothesis is one that is an “urban legend” only promoted by uninformed individuals who should know better.

Yet, here we are, now the year 2017, and this uninformed urban legend continues to be perpetuated.

Bipolar Disorder does not cause Brain Damage

Putting aside for the moment the argument that there is no entity of bipolar disorder that can cause anything, there certainly is no evidence to confidently state that it causes brain damage. In an article for Scientific American, Tori Rodriguez suggests that bipolar disorder causes damage to the “hypothalamic-pituitary-adrenal axis and the autonomic nervous system, which are activated both by acute stress and by bipolar mood states.”

Now, this writer clearly understands that the HPA axis, inflammatory responses, and the nervous system are, indeed, affected negatively by stress. What is not mentioned is that these areas are altered by chronic stress throughout childhood (ya know, that chaotic childhood that has no relationship to bipolar disorder?) and that changes in these areas may lead to difficulties managing mood states and emotions. In fact, there has never been a study to demonstrate identifiable brain differences for ANY diagnostic category, nor is there any evidence of damaged brains in individuals carrying psychiatric diagnoses beyond those associated with childhood abuse.

Bipolar Disorder does not Kill People

Again, just as a headache does not cause anything (it is a description of an experience), neither does bipolar disorder. Yes, chronic stress can throw one’s body entirely out of whack and lead to earlier death due to problematic lifestyles, increased inflammation, autoimmune problems, ulcers, cardiovascular problems, etc. So, too, can a lifetime of drug use (illegal and prescription) cause physiological problems that can lead to death. Certainly, the drugs prescribed for many individuals diagnosed with bipolar disorder can and do kill (even if they do, also, help prolong life for some).

But, these are factors associated with a diagnosis of bipolar disorder, not some disease process itself. Such fairytales might make great sensationalistic headlines, but fairytales are all they are.

Sadly, these assertions, while likely stemming from well-intentioned sources, have the paradoxical effect of increasing stigma associated with bipolar disorder. Biological explanations of disease that are separate from one’s life circumstances have many positive aspects. For instance, they allow for a sense of validation for one’s pain and suffering, they decrease the sense of moral inferiority, and, in the words of Carrie Fisher, they “explain away my behavior.”

Everyone behaves the way they do for a reason. Usually, when one behaves in problematic ways it’s because something is wrong in their life and they are suffering. To decontextualize these behaviors, to absolve oneself of responsibility for their behaviors, and to “blame the brain” have been shown time and again to result in increased negativityprejudicesocial rejection, and fear towards those diagnosed.

As Yoda once wisely proclaimed: “Aah, hard to see, the Dark Side is.” Untruths, ideological rhetoric, and unsupported statements of fact are some tell-tale signs that the Dark Side is at work. Light comes from digging deep and finding truth.

4 replies
  1. Gina
    Gina says:

    An accurate diagnosis is required in order to obtain what so often is life saving treatment. I was fortunate to encounter an academically excellent and compassionate provider who called a spade a spade. I didn’t like the diagnosis at the time, but treating it with mood stabilizers has given me and my family a much better quality of life. My childhood was as close to ideal and trauma free as it gets. I don’t believe you would have helped me and I’d probably be dead. I am serious. Please don’t practice dangerously.

    Reply
    • Noel Hunter, Psy.D.
      Noel Hunter, Psy.D. says:

      I’m genuinely happy for you that you were able to find something that helped you and provided you with a higher quality of life. Not sure what in my article gives you the impression that I disagree that drugs can be helpful for some people some of the time, especially in the short term, but that is not my position. My article is based on science, not anecdotes. Diagnoses are not valid entities nor do they predictably lead to helpful treatment, regardless of how they might resonate with some (similar in many ways to our personal astrological signs). This is not opinion. A careful and collaborative conceptualization of what any particular individual is struggling with at a given time is necessary to identify what might be helpful…I’m glad you found someone who could provide that for you. All the best to you and hoping for continued joy in your life-

      Reply
  2. Janet Sheppard
    Janet Sheppard says:

    Thank you for your critical analysis. What you seem to be exploring in your article supports what I learned through experiencing what is called depressive/catatonic psychosis (freeze response to overwhelming despair) and manic psychosis (fight/flight response to overwhelming despair). Luckily, I found brave friends & professional helpers who helped me heal through the trauma & find my gifts. I also am a practicing trauma therapist.
    Your statistics on the relationship between trauma & bipolar disorder seem awfully low to me. I wonder if those studies included severe emotional neglect (AKA attachment wounds) in the emotional abuse category? And what does “an odds ratio of 4.04” mean? Thank you for your work. If I had met you in my early 20’s, I probably wouldn’t have taken so long to find my ground. Thank you for your writing also. I hope to collaborate with you some day.
    Janet

    Reply
    • Noel Hunter, Psy.D.
      Noel Hunter, Psy.D. says:

      Hello Janet,
      Thank you for your comment and sharing your story. It’s wonderful to hear that you’ve been able to take your experiences and provide help to others going through similar struggles. The statistics related to “trauma” (however one defines that) are always low, but particularly so with bipolar for many reasons. One reason may be related to how trauma is defined and/or measured. Additionally, much of what we call “mania” today often equates with “angry and temperamental”, which can arise for numerous reasons, not the least of which is simply living in an industrialized society. Further, “mania” is frequently induced through the use of psychoactive drugs, which have exponentially increased in usage over the last 2 decades. So the inflation of bipolar diagnoses is probably more related to the lower association numbers compared to some other categories than due to it not existing or because of how “trauma” is defined (though these are also considerations). An odds ratio means the odds that something will occur (in this case a bipolar diagnosis) given some exposure (emotional abuse) compared to the odds of it occurring without said exposure. In other words, a bipolar diagnosis is much more likely to be given if one has experienced emotional abuse than if they hadn’t.
      Best,
      Noel

      Reply

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