BiPolar Good Stigma Bad

Mental Health Memoir by former Solicitor Chris Wainwright

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2 BIPOLAR STIGMA ATITUDES & MYTHS

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From time to time as a boy I remember one of the relatives telling us that there was “madness in the Wainwright family”.

I worked out that this had to refer to my uncle Ken. He was far from mad but had a great sense of the ridiculous. He was funny, liked people and didn’t take himself too seriously. He’d often put on a performance and always got a laugh. He was a bit of a showman good at jokes and leg pulling. If he had a failing it was that he could be over-familiar which is rightly said to breed contempt. When I was going through my first major depression at 21 I was bewildered (to put it mildly) and didn’t associate my problem with my uncle or as a family illness. When I was finally diagnosed at 35 I wondered why it had to be me that inherited the family gene! Things are developing quickly so I’ll have an explanation before long. Our knowledge of mental illness is much better but it has a long way to go and so do our embedded attitudes. It doesn’t surprise me that many of our leading mental illness experts disagree about so many important subjects. Time was mental illness was treated with an asylum so we’ve definitely moved on. In my own case I’m pretty good but after the crash left looking for the black box. It’s plain that mental illness treatment will eventually bankrupt the country. Heart transplants cost nothing until they were available. The cost of physical ailment treatments will pail into insignificance compared to mental health.

 

Over the years I had my fair share of injuries mainly from sport. They often made good conversation topics. Unfortunately people don’t react the same way if I bring up my bipolar type one! I wondered how cancer sufferers felt all those years ago when it was the ‘c’ word which couldn’t be said. Now thank heavens it’s no longer taboo! Same applies to HIV. Stigma is definitely the No1 enemy of bipolar. Usually worse than the illness itself stigma causes fear and spreads lies, exaggeration and misinformation. Unless you’ve been there you won’t understand what it feels like. Say you meet someone nice only to find out they have bipolar! Will you drop them but as subtly as you can? It’s a good reason why they might not tell you in the first place.

Approximately 2.5% of the population have Bipolar. It’s very likely you’ll know someone with it. On average they’re usually of above average intelligence and properly diagnosed and medicated you wouldn’t know it. They will be stable and well able to hold down a top job. You’d never guess they had a mental illness. Many of them will perform well to a high level but keep their bipolar secret to be sure it’s not held against them. The slightest whiff of even mild depression in the City will not be welcomed by a FTSE company. By comparison self-employed people with bipolar are in a better position because they can judge whether or not stigma will prejudice them. Some celebrities are prepared to go public. Every individual case is as different as a fingerprint. What’s right for one isn’t necessarily right for another. Whether your thinking about ‘opening up’ and revealing your bipolar or noticing how other people like you react to their medication, therapy or some other matter.

I spent fourteen years under the care of three GPs and a psychiatrist. They knew I had bipolar but decided not to tell me even though they knew it meant I was running the risk of suicide. Does that still go on? They were experienced professionals who had taken their professional  oath. It should worry everybody that doctors could behave like that. The same applies to employers and their duty of care. What prevents them from discriminating? Would the firm of Aylesbury solicitors I was articled to behave in the same way now? They knew from the psychiatrist as well as their own experience what my illness was. It was only my considerable distress at nearly shooting myself that made my GPs get me diagnosed. All I needed at that time was a competent and honest psychiatrist to give me a prescription for lithium/antidepressants. Let down badly by people with obligations no wonder I say they  abused me.

 

 

Having reached a point where I began to feel better I realised I had to rebuild my ego. My confidence and self-belief had suffered badly. I’d had some CBT on the NHS which had been very good but the stigma of my label was still a major problem. Self conscious often looking over my shoulder I continued to be ashamed about having a mental illness. I’d got used to it but realized I’d always be held back if I didn’t sort it out. It took years to admit to myself what had happened. It was denial. In other words I ignored my shame and blotted it out with alcohol and calorific snacks. They of course left me even more disappointed in my weakness which created an undercurrent of anger. My girls confronted me and opened my eyes to reality. They’d tolerated my moods while they could but they’d had enough. I was perfectly sane but I was angry about my bad luck and frustrated I didn’t seem able to fix myself. I decided to try some basic psychology. By process of elimination I worked out ways I might be able to feel more like my original pre- bipolar self. Noone else had ever suggested it or explained that bipolar symptoms might have damaged my ego. When I look back at the process it was commonsense. I was desperate to feel better and that was the motivation I needed. I knew I wasn’t to blame for bipolar ruining my life but I’d be at fault if I didn’t keep trying to put it right. I was on good medication without bipolar symptoms. The problem was I’d been well and truly deceived by the stigma. I’d conquered the actual illness fairly easily but the real enemy stigma had been hiding in plain sight. With hindsight I could have practiced as a solicitor again but in the circumstances it was expedient to stay where I was

 

Why did stigma affect me so badly? It clearly didn’t help that I was well known locally or that I’d been brought up by perfectionists and put on a pedestal by dad. I’d been fine when the going was good but being known to be suffering from bipolar was another matter. Bipolar came with significant stigma and that alone was the cause of the problem. The psychiatrists and doctors didn’t have the heart to tell me this and it’s true in general. I think it’s a big problem no one wants to break bad news. I needed treatment for it but since it wasn’t spoken about stigma seemed to fall in a category of its own – something to endure which can’t be helped! That’s definitely the way I read it unless someone who knows better can put me right. Provided I’m not wrong it seems there’s an evident major problem which even the experts don’t know how to fix. Newly diagnosed with bipolar patients are immediately at a disadvantage which will bring them down. Stigma will get them down as sure as eggs are eggs. Knowing this the medics don’t warn them. They’re left to work out this ‘incidental’ for themselves. I’d like to know how mental health professionals can work in what they know to be a broken system? I can imagine how Professor Geddes and his colleagues must feel. I am very sorry for them. It’s like teaching people to swim by putting them in at the deep end. 

 

Stigma, Stigma and more Stigma it’s never far away! It reared its ugly head in a place you’d never expect! I’d had a highly successful knee replacement at a local private hospital within the NHS system. I was delighted to be discharged within 24 hours completely pain-free and able to move around quickly on crutches. I’d had my other knee replaced 15 years earlier and the pain was excruciating. I was in for ten days and saw grown men in tears it was that bad. It seemed like a miracle! Surgeon Sam McElroy was outstanding. I’d not noticed the anesthetist but seeing me cheerfully chatting away she marched up telling me I was manic! Taken aback I assured her very clearly that I wasn’t. She’d seen ‘bipolar’ on my notes and leapt to a conclusion. Realising she’d made a fool of herself she turned and left without apology. Her misjudgement was an insult. I had a case for slander but decided just to write and complain to the hospital. The anesthetist showed no contrition and refused to accept any fault. She assumed that because I was in a good mood I must have been manic yet it never occurred to her to speak to me or my surgeon first. Perfectly true the incident proves bipolar stigma is embedded. I hold hospital consultants in the highest regard. On this occasion the anesthetist  was also rendered senseless!

 

ATTITUDES
Have peoples attitudes towards bipolar disorder improved since my issues began nearly fifty years ago? Some people still think you might be a threat even though many mental health professionals think most people have some sort of mental health issue! Brains are complex and no one knows precisely how they work. Until then we’re fortunate to have medications. Mental issues and personality disorders are widespread. Bipolar is only a small part.
Noone nowadays should feel uncomfortable talking openly about their mental health. Men are improving and would do well to learn a lesson from women. My family and friends aren’t afraid to talk honestly. Many years ago mental illness was considered shameful. I grew up in that era and paid the price. Nowadays I try to get conversations going but it’s still quite common for people to clam up. As a former lawyer I was used to discussing difficult  embarrassing subjects so I’m open minded and aware there might be need for discretion. Most of us know someone with a mental health problem and it pays to remember that they’ve rarely done anything to deserve it. Do we look down on them thinking they’re substandard? Ignorant people might but they’re a small minority usually lacking in themselves. The time’s come where we must encourage others. Until quite recently I kept my own bipolar 1 illness hidden for fear of being considered inferior. The thought of mentioning my issues in public once filled me with horror. How would you want people to react if you or a loved one had bipolar or similar? Wouldn’t you want people to rally round? Why should anyone be ashamed because they did nothing wrong?

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MYTHS & FACTS

The example I mentioned about the stigmatised hospital anesthetist is the tip of the iceberg. It goes without saying that doctors must treat patients with consideration and respect. It took me years to accept my mental illness so being accused of instability like that was a shock. I regard the stability of my mental illness as very important. I was very offended by the suggestion that I was unstable. Wouldn’t the anesthetist be upset if I made offensive allegations about her in front of people? Bipolar unfortunately is an easy target. To put it plainly if someone stigmatized knows you have bipolar they can blame anything about you on your illness. Lively or dull personality, loud or quietly spoken, facial features, angry or happy disposition you name it! The consultant should have put her hands up to her error. An apology at the time would have been enough. To carry on lying in an effort to exculpate herself is inexcusable.

It seems that wherever I look mental illness is stigmatized. It’s often said that if you have bipolar you’ll be more likely to be violent. That’s absolute rubbish. Even if you’re depressed or going through a manic episode it’s not true. I’ve been in good mental health and ‘stable’ since my diagnosis in 1991 and before. Like any sensible individual I take my prescribed medication without fail. I’m extra diligent because people know I have bipolar and I should set an example! Why is it then that on the internet people often misrepresent the illness? Search for 'BiPolar Disorder' and you'll get all manner of unwarranted claims and assertions. Bona fide medical websites when you find them provide accurate details and reassurance such as;- “Diagnosed and properly medicated anyone with bipolar disorder can lead a normal life free from depression and manic episodes”. Why all the scaremongering? You’ll come across discussion pages where unqualified contributors write about their experiences. The headlines are often titled as click-bait. Like the wild west before law and order was established you have to be careful. There are altruistic authors on some website pages who have trustworthy experience to pass on. You know to avoid scamming so use the same approach to information which may be misleading.

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DIAGNOSIS

Of all mental illnesses bipolar disorder is said to be the most difficult to diagnose. As well as sharing symptoms with other disorders it’s not that practical for GPs to keep detailed notes in the time available. Consequently the tell-tale patterns of depression/mania/moods can be missed. A patient who has experienced a first or uncharacteristic depression should always be flagged-up. With only 10 minutes per patient how can a GP make accurate notes for future reference? If notes are too brief then bipolar indicators might be missed. The latest evidence shows conclusively that patients must be seen by an expert as early as possible. The more delay the worse it can be for careers and prospects. Recovery times will be longer and unsurprisingly the risk of suicide rises. After 35 years I’m still waiting to hear why my diagnosis took so long.

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