Being Bipolar Documentary by Philippa Perry on Channel 4
Rant about Being Bipolar Documentary by Peter Smith
The documentary being bipolar by Philippa Perry suggested there is no chemical basis to bipolar syndrome and that bipolar syndrome is just a label; the program did not warn people not to come off their meds and went on to encourage people to explore their subconscious trauma in psychotherapy. I’m a great fan of psychotherapy I have bipolar syndrome and psychotherapy helped me but I still need treatment and if people come off their treatment they can get serious trouble.
On more than one occasion Mr Perry said I’m interested to find out more about bipolar syndrome, well I wish she had found out more about being bipolar before she went on national television and presented her very narrow and potentially harmful views, I think she misrepresented how serious bipolar disease can be, that chemical treatments are important and represented psychotherapists like mental health amateurs.
If that sounds harsh let’s not forget that bipolar syndrome not only ruins lives but it actually kills people. Whilst I strongly advocate resolving childhood trauma ongoing psychological conflicts and stress it’s not enough to treat bipolar syndrome on its own and Ms Perry is being naive to think that what drives bipolar mood swings is just psychological conflicts and trauma. She didn’t present any case histories of people made well from psychotherapy and clearly hasn’t treated any bipolar patients long-term herself.
About 3 decades ago I rejected the diagnosis of bipolar syndrome and believed that if I just had enough psychotherapy eventually I wouldn’t need any meds, I kept trying to stop my meds but would get sick and promptly need to start them again; but when I decided to embrace the diagnosis of bipolar syndrome and the implication that I have an imbalance in my brain chemistry it led me to explore how I could work on restoring the health of my brain -as well as the health of my psychology- and now I have the best mental health I’ve ever had. Good psychotherapy took some of the crazy thinking out of the mania but it didn’t stop me getting high, it removed much of the painful and negative memories/trauma my mind would latch onto and dwell on during depressions, so the depressions were milder but I would still have the depressions, only balancing my brain chemistry brought the manias and depressions to a stop.
For my regular readers this page isn’t self-help information like my other pages this is a rant about a biased misleading TV documentary (Being Bipolar shown on the UK TV Channel 4 on 4th of March 2015).
Ms Perry suggests that bipolar syndrome is just a label and because there’s so many diverse manifestations (type I, type II etc.) it can’t all be the same thing and in her final summing up to camera she acknowledges that learning about the types of bipolar may be useful to help some people understand their moods but then makes the assertion without the qualifier in my opinion that
“…being labelled bipolar too often marks the end of self-exploration when in fact it should really be the beginning.”
Does being labelled bipolar mark the end of self-exploration??
Well in my individual case it was after more than 15 years rejecting the diagnosis of bipolar syndrome and believing that self-exploration in psychotherapy would heal me when I embraced that I have an ongoing chemical imbalance in my 40s that led me to explore the brain chemistry of bipolar. In the documentary we see the psychiatrist Juana Moncrieff say there is no evidence for the chemical basis of bipolar syndrome and they can’t even agree what chemical might be involved, well it’s true that more than one brain chemical has been suggested as playing a role in the bipolar brain and there may not be a simple scientific consensus but experimenting with the main known chemicals on own brain resulted in me achieving a better level of mental health I’d ever had before. When I stop treating my brain chemistry it goes out of control and today I take control my bipolar brain chemistry as opposed to it controlling me.
I’m well aware that the only people I see in my practice are people that take the diagnosis of bipolar syndrome with a pinch of salt (ideally lithium salt). and set out to look for individual solutions rather than just a one size fits all drug or ECT treatment.
At one point in the show she says:
“… is the diagnosis of bipolar useful because there are so many different types and surely we should approach everyone as individuals with unique issues”.
I have no argument there but does Ms Perry really believe that only she and her psychotherapy colleagues understand that everyone with bipolar syndrome is a unique individual and should explored their own unique and individual therapy options? I teach my clients to modify and adapt their meds to their own unique individual condition and recommend they have individual therapy. If that what he really believes why not just come out and say that directly, ideally to some of the people or practitioners she thinks use the label of bipolar syndrome in a way that narrows or limits people’s self-exploration, and then allow the “limiting labellers” to respond.
I felt being bipolar illustrated the typical misguided bias that many psychotherapists have against accepting the role of the brain in depression and bipolar syndrome and their beliefs limitsexploration of better solutions for living well with mental illness.
I know Miss Perry does not deny the existence of the suffering I’m sure she’s an empathic and good therapist but she is denying the existence of the illness as an entity, when she calls it a label it’s demeaning and offensive to me; saying you have bipolar syndrome is not labelling yourself if supplying shorthand label to a medical condition you live with.
Ms Perry filmed a short conversation with a not particularly articulate psychiatrist to explain the chemical basis for bipolar syndrome and then followed this with a longer clip by a highly articulate psychiatrist (Joanna Moncrieff) and controversial critic of psychiatry who made the most ridiculous assertion that there is no evidence that bipolar is caused by a chemical imbalance. I’ve read Moncrieff’s work and I agree with it in part where she says that bipolar drugs are largely used because they are sedatives and calm down uncomfortable emotions and that they don’t actually cure the underlying problem; this is true but it doesn’t mean that we should write off the usefulness of drugs for example a woman with schizophrenia told me without medication she had multiple voices screaming insulting obscenities about her in both ears! with the medication she heard less voices and they were quieter or further away.
Also different drugs with sedative effects calm the brain down in different ways, for example people with anxiety will tell you that although alcohol is mind numbing it doesn’t quell anxiety in the same way that benzodiazepam can do, nor will antidepressants, on the other hand people with depression will tell you that and benzodiazepam and antipsychotic drugs don’t stop the depression as well as antidepressants and people who suffer from bipolar depression like me can be flipped up into mania by antidepressants but people with unipolar depression are not. Furthermore if you acknowledge that any drug or chemical can alter emotions as Moncrieff does (who doesn’t) why would you think that when emotions are altered as they are in bipolar illness that this spontaneous alteration does not involve brain chemicals.
I have rapid cycling bipolar so about 6 times a year my bipolar syndrome tries to hijack my brain with a condition remarkably similar to a few lines of cocaine and tequila, I know this because in the past I’ve taken cocaine and tequila; drugs show us that alterations in brain chemistry alter emotions and mental states. With the swift application of appropriate remedies I can prevent the mania hijacking my mind and ruining my life swiftly followed by a crippling depression that threatens to end my life. I tried for over 15 years to prevent this happening with hundreds of hours of psychotherapy and although the psychotherapy took away a lot of psychology that would fuel the manias and depression it did not stop them; I wanted the psychotherapy to cure me and I believed that it would but on it didn’t.
In the documentary Philippa Perry spends some time with 3 people with bipolar syndrome and quickly unearths psychological issues that they could work on in therapy and probably they would feel much better for doing so as I did, but she’s simply misguided if she believes that this is enough for people with bipolar syndrome to recover sufficiently to live well.
When I meet psychotherapists who try to argue that mental illness is purely psychological, not a chemical imbalance and therefore only needs psychological treatment I ask them have you ever drunk alcohol and felt the ethanol alter your mental state? Did it make you happy, sad, nostalgic, horny, giggle hysterically, aggressive, regretful, all of the above? Would you work with a client if they turned to a session drunk? If a person was manically high on cocaine would you focus their mind on the possibility that subconsciously they were manifesting the manically high state as a compensation against painful feelings of inadequacy, low self-esteem, the pain of failure etc. etc. OR would you postpone the therapy and wait until their mind was no longer chemically altered? Could you use talking therapy on a drunk person and make them sober? And if not doesn’t imply that chemistry overrides psychological states and not the other way around.
Usually that’s enough to prick their bubble but I can go on, people with mechanical injury to the frontal lobes of the brain can become incapable of controlling their impulsive anger which on the one hand clearly demonstrates the role of brain imbalances in emotional states, that’s not to say however that psychotherapy could not help the person with brain injury better manage their condition. Brain scans show altered blood flow and shrinkage in the brains of people with major depression and bipolar syndrome, the amygdala (that stores or processes memories of trauma) can be enlarged in PTSD, certain anxiety disorders and the white matter connections between the amygdala and the anterior cingulate (involved: reward/anticipation and impulse control, major issues in bipolar syndrome), there is robust evidence that the HPA axis/stress response (a channel that conveys stress from the mind into the body) is altered and overactive in bipolar and major depression, the output of the neurotransmitter phenylethylamine is shown to be lower in people with depression and bipolar depression but elevated in people with schizoaffective disorder and highly variable in people with bipolar mania and mixed states, vanadium levels are higher during mania and choline levels are diminished.
When I’m manic my biological clock literally moves my sleep cycle into a different time zone, I’m in London but my sleep cycle moves to New York and research has identified genetic differences in the functionality of the biological clock/ sleep cycle in people with bipolar syndrome; interestingly the key enzyme that runs the biological clock needs lithium as a cofactor and for I used to use an ultra low dose of lithium just to help reset the timing of my biological clock.
I’ve saved the most interesting new physiological model of depression and bipolar syndrome till last. It’s called the BDNF hypothesis of depression but it also appears to have significance for the causation and treatment of bipolar syndrome. In a nutshell BDNF hypothesis is that the overproduction of stress hormones causes a damaging inflammatory condition in the brain and either reduces or at least overwhelms ability of the BDNF protein to protect and maintain key brain structures involved in mood, these structures shrink and become damaged which you can see in brain scans. Recently mechanism has been shown to not be the full story but I believe it is still an enormous step forward and I use it in my practice.
I believe the BDNF hypothesis of depression/bipolar brings together psychotherapy and physiology in a way that has never been done before. Genetic differences have been identified in some people’s ability to protect their brain against the damaging effects of stress hormones making them more susceptible alterations in brain function as a result of stress and for them reducing stress responses has a positive therapeutic effect. A key technique for reducing excessive stress responses is psychotherapy to unearth and remodel painful memories and trauma.
I believe the BDNF hypothesis of depression/bipolar has implications for both doctors and psychotherapists:
I believe mainstream doctors need to go beyond the neurotransmitter model of these conditions, consider the overall health of the brain in relation to shrinkage of key structures that control mood and value the importance of deep and profound internal stress reduction to prevent ongoing stress induced inflammation in the brain causing damage to and preventing recovery of the serotonin and dopamine pathways.
Next I believe the psychotherapists need to get on board with the latest understanding that depression/bipolar syndrome do involve physiological changes in the brain and when working with people with major depression and or bipolar syndrome focus the goal of the therapy on identifying and remodelling traumatic and stress-inducing psychology. So the primary goal of psychotherapy for major depression and bipolar syndrome should be to change stressful psychology that causes the stressful physiology that causes the damage to key structures seen in the brains of people with major depression and bipolar syndrome. In addition to reducing harmful excess stress responses psychotherapy can play a useful role in improving a person self-awareness, coping skills, relationship skills etc etc.
I’m not looking any of this up if I started to look the evidence that there are chemical and physiological differences in the brains of people with bipolar syndrome I could add hundreds of citations within an hour, if you googled is bipolar real or is bipolar a chemical imbalance you’ll see lots of psychotherapists saying it isn’t, but if you go to database of science research papers like http://www.ncbi.nlm.nih.gov/ and put in bipolar syndrome you can find over 25,000 research papers, admittedly not all about chemical or physiological differences but thousands are. In the show the psychiatrist Moncrieff says science can’t even agree which chemical is out of balance in bipolar syndrome, to which I simply say so what that doesn’t mean there isn’t a chemical imbalance, you know we are talking about the human brain the most complex piece of matter in the known universe.
Just there is no misunderstanding let me be clear I absolutely love psychotherapy, I think it’s fantastic, it really helps, its powerful stuff, it saved my life at times my mental illness was trying to kill me but I still have bipolar syndrome. At one point Ms Perry says after meeting someone with profound ultra-rapid cycling bipolar and some degree of autistic spectrum “but it strikes me how talking even the little seem to help him”. Define help. Do you mean right there and then the conversation picked him up a little, or do you mean that type of talking would lead to long-term changes whereby he wouldn’t have ultra-rapid cycling manic depression mood swings with autistic spectrum when you the therapist aren’t there talking to him? Maybe he was knowingly or subconsciously manipulating you into feeling that you’d helped him because to make you feel better back off and protect himself from having his painful feelings probed; who haven’t ever done that in therapy?
Ms Perry kept saying how she was fascinated to find out more about the bipolar condition and to be blunt and critical I think she should have before she made a programme about it; she never said in my practice I treated many people with bipolar syndrome and… so she’s just hypothesising and doesn’t site any evidence, case histories or have any clinical experience of people with bipolar syndrome making significant recovery using psychotherapy. If you’re going to bring someone onto your show to say there is no evidence of a chemical imbalance in bipolar syndrome it would be nice if you could come up with some evidence that it’s purely psychological and psychotherapy has been tried and found to be effective; being struck how one person seem to pick up from one conversation is not enough.
I did well over 700 hours of psychotherapy, I believed I suffered depression because of challenging childhood experiences and my manic energetic states were a psychological compensation or defence mechanism against those painful feelings. Psychotherapy made moderated my condition and gave me coping skills but without any rhyme or reason my brain can be just hijacked by a manic high that’s like cocaine and tequila. Oh and please don’t write to me and suggest if I just did more therapy and dug a bit deeper into my subconscious I would find the triggers and underlying issues; I had good therapy. I think psychotherapists like Philippa Perry should dig a bit deeper into their own subconscious to find the driving forces behind their belief systems, what is it that make them feel so uncomfortable with accepting the notion that there is a chemical/physiological basis to our emotions and psychological states that it blinds them to thousands of pieces of scientific information showing alterations in the brains of people with bipolar syndrome compared to the brains of people that don’t have bipolar syndrome.
In the meantime while you’re analysing your subconscious beliefs systems some of us have to live with bipolar syndrome and what matters to us is solutions not theories but solutions, practical, usable, current hands-on effective solutions with as little side-effects as possible please. I’m sure Ms Perry has good intentions but good intentions are not enough and anti brain chemistry belief system held me back.
In my late 20s I became manically obsessed about healing my depression, which was actually a good thing but people around me including psychotherapists persuaded me that I was being too obsessed with all of this self-healing stuff and I should try giving it up and just being normal, so tried coming off all my treatments and within a couple of months I climbed over a cliff in Wales onto little ledge and sat there trying to get the courage to jump. I’m sure the people that advised me had good intentions just like Ms Perry but when my brain when out-of-control they’re not there.
To be fair at no point did Ms Perry directly suggest anyone should stop taking their meds, but by presenting the argument that there is no chemical basis for bipolar syndrome and it’s just a limiting label I think that does suggest that treating brain chemistry is not the solution for bipolar syndrome. If she’d done her homework she would know that an enormous problem with bipolar syndrome is people stopping their treatment then getting into trouble sometimes really serious trouble. Given the potential serious consequences I think she should have said even if you do start seeing a psychotherapist don’t stop your treatment.
By my early 40s following observations made me accept that there is a brain chemistry aspect to bipolar syndrome:
No matter how much psychotherapy I did my bipolar syndrome still tries to hijack me with the mania or depression about 6 times a year and I have to aggressively jump on it with chemical not psychological treatments.
Over the years when a hijack attempt was in progress I always instinctively turned to my brain chemistry remedies to fix the problem and not the psychotherapy, so I wouldn’t call my therapist and say I’m having a difficult time can I have an extra session this week, because in the short term no therapist ever lifted me out of depression and if you’ve ever had melancholic depression you’ll know why.
Furthermore adjusting my brain chemistry was consistently effective and worked quickly and I absolutely do not believe that the type of medications I use suppressed my emotions and inhibited the psychotherapy.
After years of therapy I could stop it without getting sick and when I start it up again I don’t really notice significant changes any more, on the other hand however if I stop my prescription I only last about 5 days before recognising clear warning signs of mania or depression beginning to return.
We know ecstasy stimulates serotonergic activity in the brain, cocaine stimulates dopaminergic activity in the brain and amphetamine mimics the action of phenylethylamine or PEA, having taken ecstasy, cocaine and amphetamine in the past I know from personal experience what those drugs feels like and what thecomedown feels like when the serotonin, dopamine or PEA pathways are depleted and temporarily burnt out. I believe deficiency in these 3 key neurotransmitters produces quite easily recognisable and distinctly different types of depression (see elsewhere on this site) and by selectively targeting the right neurotransmitter imbalance in my brain I got to the point where I could typically terminate a depressive attack within 10 hours and mania within a day; these days however I have become so proficient at recognising the early warning signs that my brain is going out of balance and rebalancing it that I can nip the depressions and manias in the bud before they even get off the ground. I also believe however that without psychotherapy I probably wouldn’t have the self-awareness skills to be able to do keep on top of my brain chemistry, but it is the brain chemistry remedies that actually keeps me healthy. Continuously rebalancing my brain chemistry is not a cure and I still have bipolar syndrome but by managing it in this way I live symptom-free and I can get on with my life. It’s early days but actually last year (2014) after doing my new BDNF boosting brain regeneration protocol only had 2 attempted bipolar hijackings, a reduction of two thirds.
What I think psychotherapy can do
Part of bipolar syndrome involves grandiosity fantasies that you’re fantastic or the best and in my therapy I did what Ms Perry proposed I looked for painful or intolerable feelings of inadequacy that might produce the grandiosity fantasies as a compensation or protection against the painful feelings; this did actually deconstruct those thoughts but -and this is the rub- I still get a speeded up, energetic, insomniac manic cocaine high it’s just that now it’s either without the grandiosity fantasies or I can see straight through them.
With regards to depression, psychotherapy cleaned out so to speak the painful negative memories that my mind would attach itself to when I had the depressions. These negative memories were like ammunition or fuel for the fire and eventually there wasn’t so much negative psychological material for my depressions to get a hold of and fan the flames.
Also in psychotherapy I developed improved self-awareness that I now rely on to recognise my manic behaviour and adjust my prescription, but it emphatically didn’t stop me needing chemical support. I think psychotherapy is fantastically helpful for bipolar syndrome but bipolar syndrome is a neurophysiological brain imbalance. You know the expression it looks like a duck and it walks like a duck and quacks like a duck it’s a duck, get over your bias, psychotherapists like Miss Perry need to wake up and smell the coffee.
The programme introduces us to someone with bipolar type I someone with bipolar Type II and someone with ultra-rapid cycling and Ms Perry makes a great point of the difference saying “can their very different problems really all have the same underlying cause”, as if anyone is suggesting they do. Everyone in the field of bipolar syndrome research is now suggesting that Bipolar Type I and bipolar Type II are different conditions with different aetiologies, like I said I wish Ms Perry had bothered to research the condition before she went on to national television, I think it will be helpful for people to know that science considers them to be different conditions with different aetiologies. I suggest people like Ms Perry would benefit by reading the book Freakonomics and embracing the philosophy of questioning hypotheses both your own and those of others, research your facts and be prepared adjust your own belief system no matter how uncomfortable it may be to do so.
Further evidence of her lack of research was demonstrated when she challenged a geneticist with the argument that we inherit learnt psychological behaviour from our parents and was robustly corrected that there is sufficient evidence ruling out parental psychology (adoption and twin studies) to show beyond a reasonable doubt that bipolar is genetic and can be inherited. Disappointingly she didn’t develop the discussion about the role of epigenetics, I don’t know this myself, are there any known epigenetic factors that alter the expression of the genes that encode for bipolar syndrome? In other words can we switch off bipolar genes?
Disengaging rant mode … :-)
The above was not intended to be a personal attack against Miss Perry but rather a critique of the typical psychotherapists lack of understanding of the nature of mood disorders which perpetuates a professional war between psychologists and physiologists. I welcome a rebuttal from Miss Perry and promise to paste it in full below…