In last week’s People magazine cover story, Mariah Carey disclosed that she has Bipolar II disorder.
Bipolar disorder is characterized by cycles of mania and depression. During a manic phase, people experience symptoms such as feelings of euphoria, increased energy and productivity, racing thoughts, irritability and difficulty sleeping. Manic phases are often followed by a depressive phase where a person has symptoms such as deep sadness, anhedonia, lack of energy, isolation, hopelessness and worthlessness.
{mosads}Carey, 48, says there were times when she couldn’t sleep, worked nonstop and felt irritable. Eventually she “hit a wall” and had low energy, felt sad and lonely.
Bipolar is commonly mischaracterized as moment to moment “mood swings.” In actuality episodes of mania and depression typically last for several days, if not weeks.
Approximately 5.7 million adults (4.4 percent) in the U.S. have bipolar disorder in their lifetime. Bipolar II, a version of the disorder where the symptoms of mania are milder, is more prevalent that bipolar I. Symptoms of bipolar typically first appear in the mid-20s. Young adults ages 18-29 have the highest rates of bipolar disorder.
People in creative fields, such as musicians, artists and actors are up to 25 percent more likely to carry genes associated with bipolar disorder. Actress Carrie Fisher, comedian Robin Williams and musician and activist Nina Simone are all known to have bipolar disorder. It is often during the manic phase of bipolar disorder that creatives are most inspired. They feel on top of the world, their minds are racing with new ideas and they have more energy to start new projects.
While the feelings of euphoria and creativity can be pleasurable for some, others leave behind a trail of ruptured relationships, bad decisions and neglected responsibilities.
Impulsive behavior like excessive drug and alcohol use, anger leading to fights, risky sexual behavior and spending sprees are also symptoms of mania. A person acting out during a manic phase may be arrested rather than identified as having mental illness. Encounters with law enforcement or the emergency room are key opportunities for people with bipolar disorder to be appropriately identified and connected to treatment.
Approximately 60 percent of persons with bipolar disorder also have an alcohol or drug use disorder. Creatives in particular may use drugs and alcohol to even further elevate their creative state. Alcohol and drugs can induce or exacerbate symptoms of mania.
It is during the depressive phase that people often seek mental health treatment. In my experience as a clinical psychologist who treats patients with bipolar disorder at Northwestern University, people with bipolar are notoriously difficult to engage and maintain in treatment and are often non-compliant.
Although the Affordable Care Act mandates depression and alcohol misuse screening as a preventative care service, individuals with bipolar disorder are often missed. While a person may come into treatment desperate for relief from the despair, once the dark cloud of depression lifts they often disengage.
When a person is feeling better and they are early in the trajectory of the illness, they may not yet see a need for long term treatment. They may risk long term mental health for euphoria and creativity in the moment. It may take several cycles of the illness before a person fully appreciates the benefits of remaining in treatment long term. The Affordable Care Act lifted yearly and lifetime caps on payouts, however, limited access to providers and expensive co-pays are key barriers to people with bipolar disorder remaining in treatment long term.
A combination of psychotherapy and medications to stabilize the mood are standard treatments for bipolar disorder. Treatment can help people feel less depressed and improve their functioning, however, some people experience side effects to the medications including feeling slowed down, weight gain, or decreased interest in sex. Some people also report feeling “flat” or “not myself” which can be particularly devastating for creatives who thrive on having periods in which they feel high.
Carey says that she was first diagnosed in 2001 but she “didn’t want to believe it.” Denial about having a mental health problem, the belief that it will get better on or that you can handle it on your own are key barriers that can prevent people from getting needed treatment.
When treatment is delayed, there is more time for symptoms to progress. Early intervention is especially important with bipolar disorder as the phases of mania and depression can become more frequent and last longer with each untreated cycle.
Mariah Carey says that she is currently in therapy and takes medication to treat her bipolar disorder.
In recent months, Black Panther star Letitia Wright, Prince Harry and rapper Logic have spoken out about their personal experiences with depression and suicide. These public disclosures are critically important in normalizing mental illness and eradicating mental illness stigma. We must follow these celebrities lead and create safe spaces for people to discuss their mental health and get the support and treatment that they need.
Inger E. Burnett-Zeigler, PhD, is an assistant professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine