Tuesday, February 26, 2013

Silver Linings Playbook & Bipolar

I watched Silver Linings Playbook last night for the first time, and am somewhat disappointed in myself that I really didn't love it. Honestly, I was constantly worried.

I was worried what others thought about bipolar disorder and what their, whether it be those around me, or the general public, impressions were. I don't have bipolar, but do have friends with it and have met many people through therapy and at the hospital with it that I just wasn't able to make a connection between what I see in them versus the character in the film. After I was done with the film and was researching a bit, I think the main difference that stopped me from connecting was Bradley Cooper's character, Pat, has some psychosis (delusions, in this case) as well.

Those of you who don't have a lot of experience with bipolar disorder, there's five different diagnoses. The most common is Bipolar II, with Bipolar I being second. Bipolar I is a swing between states of depression and mania, Bipolar II, mania is replaced with hypomania (a less intense form). I think most people know what depression symptoms can be like, mania being basically the opposite: excessive happiness, hopefulness, and excitement, restlessness, increased energy, and less need of sleep. Mania can also give you sudden changes from being joyful to being irritable, angry, and hostile.

Then comes the psychosis part. Taken from Julie Fast at Healthyplace.com, some percentages.
  • Bipolar psychosis is always attached to either mania or depression. It doesn't exist on its own.
  • Up to 70% of people in a full blown manic episode experience psychosis. (People with Bipolar II rarely experience psychosis.)
  • Though studies vary, it's estimated that 50% of people with bipolar depression experience psychosis. Though it's more common in severe depression, it can be present in moderate depression as well.

I think every person with bipolar that I've known has Bipolar II, and psychosis wasn't something that came or comes up. My worry is taking a very popular film like Silver Linings Playbook, not doing the research on a diagnosis the main character had, and making an assumption that because someone has bipolar, no matter which form, they are going to be psychotic as well. I have a real fear of psychosis - not those who have it, but more a fear of if I ever were to lose touch with reality myself.

There's a specific scene where Cooper's and Lawrence's characters are discussing which medications they take or took (Lithium, Seroquel, Abilify, Xanax, Effexor, Klonopin, & Trazodone), all of which I've taken at one time or am currently taking as well. Again, I almost constantly worry about what others think, and even though I tweeted and made a status about that connection last night, thinking it was kind of funny at the time... I now worry someone's going to make a connection of me with a character who doesn't have much of anything in common with me.

However, I do have to commend David O. Russell (screenplay writer/director) on how bipolar was treated throughout. Again, my worries are much more pointed at how it's perceived by others, not what Russell did himself. The family of Pat is supporting without being preachy, and shows their struggle as well as Pat's. Russell was also able to be comedic about it. I think being able to laugh at mental illnesses, without invalidating what they are and how people have to deal with them, is extremely helpful to those who are going through it.


  1. What I hear in this post is some thoughts about the stigma that surrounds mental health. My experience with all my patients is that no two patients are exactly alike despite having the same diagnosis. In my Master's program my professors emphasized that a 'diagnosis' at its core is simply a description of symptoms. It does not even mean that a person is even afflicted with all the symptoms possible for that particular diagnosis. Another problem with diagnosis is it is a description of symptoms at one point in time. It is not forever, or static, but rather dimensional. Patterns of behavior move from diagnosis to 'syndrome'.

    Therefore, my point is although a diagnosis is not meant to label and stigmatize a person that is what the public ultimately does with it. For instance, how much fear and stigma now surrounds the diagnosis of Asperger's Syndrome due to the tragedy of Sandy Hook and the media. The media sensationalizes the mental health 'problem', but the real problem is every individual case is different and how many resources are available.

    To your point though I agree categories and labels can be dangerous when it comes to the lay person caught up in today's media.

    1. I was probably being too broad or lazy to make that point that it's not all about diagnosis. I went with the psychosis part and probably could've gone much further when talking about not able to connect the character with those I know, but stopped myself, but I do definitely agree with you that diagnosis isn't everything.

      Although, with bipolar specifically, I think it's a little different. I was talking to a woman when I was in the hospital last, so as a patient and someone who has been dealing with her bipolar for many years, I look at her experience as very credible (also when bouncing her idea off of friends with bipolar as well that strongly agreed).

      She said that once you are diagnosed with bipolar disorder, no matter which type, you are no longer able to feel. That's with therapists or doctors or friends or anybody. You can't be happy because then you'll just be told, no, that's mania, or hypomania, and you should let others know what you're thinking, and make sure not to make any irrational decisions. You can't be sad, because that's just the depression state.

    2. That is an unfortunate experience for these folks that you know. I hear your point, and I would say their providers and treatment team have been jaded by one of the more potentially severe disorders. It is not fair that care providers have made them feel that way.

      In my experience, even a severe disorder such as bipolar still sits on a dimensional spectrum and it is disappointing to hear people experiencing that kind of stigmatization. In my day to day working with mental health I try very hard to pay the closest attention to what is happening right now, rather than focus on near and past 'dysfunction'. I think providers who do that do not see the forest through the trees.

  2. Alot of times, persons with chemical abuse problems are wrongly diagnosed. This happened to me. Once i got sober my diagnosis changed. I do have severe anxiety issues and a high stress level, but, being an alcoholic, I can't take many medicines as they are addictive. My only option was to find another outlet.

    I do agree. There is a stigma attached to mental health issues. Everyone just assumes you are Bipolar I and will flip out at the tiniest of issues. Great read.