Tomorrow, March 30, is World Bipolar Day and its aim is "to bring world awareness to bipolar disorders and eliminate social stigma", to quote the website of The International Society for Bipolar Disorders.
This particular date was chosen because it is the birthday of Vincent Van Gogh, who was posthumously diagnosed to have bipolar disorder and has since been turned into an icon of the tragic melding of genius and mental illness.
The putative association of creativity and extraordinary achievements with mental illness has long been a subject of popular fascination and scholarly studies. There is a fairly long list of individuals who have shaped history, science, culture and the arts who were thought to have been afflicted with bipolar disorder: Isaac Newton, Abraham Lincoln, Winston Churchill, Theodore Roosevelt, Florence Nightingale, Johann Goethe, Edgar Allen Poe, George Frederic Handel, Ludwig von Beethoven, Virginia Woolf and Ernest Hemingway.
Since bipolar disorder is probably as old as humankind, having persisted generation upon generation, it suggests that it confers some evolutionary advantages. In a paper published in the British Journal Of Psychiatry in August last year, researchers linked high childhood IQ to an increased risk of experiencing bipolar traits in later life. "There is something about the genetics underlying the disorder that are advantageous," said Daniel Smith, the lead investigator of the study. "One possibility is that serious disorders of mood - such as bipolar disorder - are the price that human beings have had to pay for more adaptive traits such as intelligence, creativity and verbal proficiency."
The finding of this study is consistent with previous research showing that people with an increased genetic predisposition to bipolar disorder are more likely to have a repertoire of intellectual and creative abilities which can certainly be advantageous in leadership roles and in the various artistic pursuits.
One of the earliest accounts of bipolar disorder comes from Aretaeus, a Greek physician who was believed to have practised in Alexandria and Rome in the second century, and had left behind a clear description of how excited and depressed states might alternate in an individual. However, the disorder was not clearly recognised nor given a name for centuries.
It was only in 1896 that Emil Kraepelin, a German psychiatrist, called it manic-depressive psychosis, having observed that the peaks of frenzied excitement and periods of abysmal melancholy were usually separated by intervals during which the person seemed normal.
In 1957, another German psychiatrist, Karl Leonhard, introduced the word "bipolar" for people who experienced mania and depression, and "unipolar" for those with depression only.
The term "bipolar disorder" has since replaced "manic-depressive psychosis" in the lexicon of psychiatry.
One end of the polarity of this disorder is mania which is an abnormally expansive and euphoric mood state that can unpredictably erupt into explosive anger. There is often a shedding of the person's normal inhibition; an urge towards potentially harmful activities such as spending sprees or sexual indiscretion or foolish business ventures; an unbounded energy with decreased need for sleep; a loquacity that permits no interruption; and a sense of inflated self-worth that can sometimes morph into grandiose delusions of fabulous wealth or special powers.
There is a rich literature of autobiographical accounts of what it is like to live with bipolar disorder, and one of the most eloquent is Kay Redfield Jamison's An Unquiet Mind. A highly regarded clinical psychologist, Jamison writes of her first attack when she was a senior in high school: "I lost my mind rather rapidly… I raced about like a crazed weasel, bubbling with plans and enthusiasms, immersed in sports, and staying up all night, night after night, out with friends, reading everything that wasn't nailed down, filling manuscript books with poems and fragments of plays, and making expansive, completely unrealistic, plans for my future."
Being in the grip of a storm of such seething energy can give the illusion of power, brilliance or genius. "I felt not just great, I felt really great," writes Jamison. "I felt I could do anything, that no task was too difficult. My mind seemed clear, fabulously focused, and able to make intuitive mathematical leaps that had up to that point entirely eluded me. At that time, however, not only did everything make perfect sense, but it all began to fit into a marvellous kind of cosmic relatedness."
In a way, it can be so intoxicating that there are some patients who want this manic phase. They miss the pleasurable excitement, the preternatural elation and the apparent creativity of mania, and they resent the levelling effect of medication. But this tumultuous brainstorm and frenetic overdrive of mania are not sustainable.
The mania is ultimately exhausting and alienates others. Mania gets those who experience it into messes which they regret when they come out of it, and wrecks their life and work. Van Gogh had lamented that "if I could have worked without this accursed disease, what things I might have done".
And there is the other polarity; that same person who experiences such exultation of mood can plunge into a state of depression that brings in its wake abject misery, apathy, dejection and hopelessness that can make suicide seem the only way out.
Ten years ago, the British actor and comedian Stephen Fry, who has bipolar disorder, starred in a BBC television documentary called The Secret Life Of The Manic Depressive. In it, he spoke about his life with the disorder and went on to interview other celebrities, including British pop singer Robbie Williams and Hollywood actress Carrie Fisher, as well as other people with bipolar disorder.
A few years after the airing of this programme, psychiatrists Diana Chan and Lester Sireling reported in a 2010 publication of the British College of Psychiatrists, The Psychiatrist, on the phenomenon of a rising tide of people actively seeking out psychiatrists - either of their own accord or at the instigation of family members - and wanting to be diagnosed with bipolar disorder.
The two doctors speculated that the increased media coverage and the line-up of famous people of high social status talking about their own personal experiences have not only made bipolar disorder less stigmatising but possibly even desirable. They posited that beneath the quest for a diagnosis of bipolar disorder is the person's aspiration for a higher status which is vicariously attained through association.
Therein lies the potential treachery of such well-meaning efforts to enlighten and raise awareness of mental illness. In banishing those disparaging stereotypes and replacing them with positive ones, there lies the risk of romanticising and glamorising the condition.
The onus lies with the psychiatrist to ensure that the right diagnosis is made. There are obvious dangers in misdiagnosing bipolar disorder: a person could end up being shunned by others, discriminated against by employers and insurance companies, and being prescribed medication with potential side effects. But it is just as harmful, if not more so, to miss a true bipolar diagnosis. All things considered, it is better for people who think they have this disorder to err on the side of safety and seek help.
In the 2010 Singapore Mental Health Study, which was conducted among the general population, my colleagues and I found that of those with bipolar disorder, seven out of 10 had never sought help. Equally alarming was the inordinately long time taken by those who eventually sought help - on average, they waited nine years before doing so. Our problem is therefore not a situation where we have droves of people beating a path to the psychiatrist's door and clamouring for a diagnosis of bipolar disorder; it is quite the opposite.
In all likelihood, bipolar disorder - like all mental disorders - remains shrouded in ignorance, fear and embarrassment. And people with this disorder - as with those with other mental health issues - are likely to be avoided, mocked, misunderstood and discriminated against. That needs to change, and the call for change needs to be made again and again as long as this situation remains unchanged.
- The writer is vice-chairman of the medical board (research) at the Institute of Mental Health.