“When I stopped hearing the voices in my head”

In today’s Guardian there is a lovely short article by ‘Anonymous’ about what it is like to hear voices.  Well worth a read for those struggling with the same issues, or those trying to understand the experience of voice hearing.

The author’s story is very familiar to me, the stress of going university seemingly bringing on a severe depression while later, with the added stress of exams, the voices appear.  I’ve been told this story many times, often by people who I interviewed for the Maudsley Bipolar Twin Study, and then more recently by my clients.  My recollection is that the majority of those who’ve related this particular sequence of events were women, but perhaps this was random or recall bias.

The author, via some combination of medication and therapy reports that she no longer hears voices, and that she has found a way to cultivate a supportive inner voice in their place.  No point in me saying more, read what she has to say!

(I assumed the author was a woman from the photo, but it’s just a stock image, so who knows).

 

“Up/Down” Bipolar Disorder Documentary

A film produced by Matt Stockalper and Kyle Gehring

The following is the first contribution to my attempts to provide a resource for those searching for mental health media for use in therapeutic settings (or indeed more generally).

“Up/Down” is a full length documentary (1h23m) about the diagnosis of bipolar disorder.  It is a well produced and well shot film, which involves interviews with the general public, psychiatric professionals, people with a diagnosis of bipolar disorder and family members.  For me, the strength of this film is very much the latter two sets of people.  The film begins by briefly surveying what bipolar disorder means to the general public and providing an introduction to bipolar disorder, before  progressing on to more detailed interviews.  For these later interviews, the producers have chosen a format whereby they ask each participant a number of set questions, and hence we get a variety of responses, reflecting the peoples’ diverse experiences of the bipolar spectrum.  The questions broadly cover each person’s experience of bipolar generally, as well as more specifically in the manic and depressive stages.

All the participants are US American, and this is perhaps reflected in the number of medications each participant is taking, the upsides and downsides of which are explored in a later section of the film.  One of the people interviewed also describes her experiences of ECT, with the pros (being shocked out of depression) and cons (very severe complications of memory loss).  Towards the end of the documentary, relatives of people with bipolar are interviewed and they discuss how it is to have a relative with bipolar disorder.

Overall I liked this documentary.  Although one never knows what has been lost or emphasised in the production and editing, the film appears to give space for each participant to express their own experience.   I feel that the film could be of interest/use to professionals, patients and relatives.

Some reservations.  I have some concerns  with regard to the introduction to bipolar disorder.  Primarily, it is perhaps too ‘factual’ in nature, when what is presented as fact is often actually rather controversial.

Diagnosis is always a difficult topic to deal with and in this film the validity and utility of  diagnosis are taken for granted; this is always going to be an issue for those, who like me, have concerns about the way in which diagnoses are used.  The film continues the tradition of treating disorders such as bipolar and schizophrenia as unitary and separable conditions, when the evidence for this is limited.   For example the brief history of bipolar disorder at the beginning of the film gives the impression (as many believe) that the distinction made by Kraepelin was a clear scientific progression (previously the disorders were ‘confused’).   It is an irony that although we know that there is little evidence for a clearcut distinction between these diagnoses, it is hard to talk about the experience of people who have these symptoms without using their diagnoses and we thus reinforcing the impression that we are discussing two independent, valid diagnoses.   On the other hand, the film clearly shows one of the benefits of diagnoses, by using the diagnosis of bipolar disorder, the filmmakers were not only able to easily select a group of people with similar (but not the same) symptoms and experiences, but also enabled me and others to easily find their film.

There is also a very controversial statement that ‘children as young as three have displayed signs of the [bipolar] disorder’, again perhaps reflecting that this is an US film, where very very early diagnosis and medication is not unheard of (very extreme examples include the treatment and subsequent treatment related death of a four year old).  The narrator also states that ‘Most psychologists and psychiatrists believe that it [bipolar disorder] is genetic’, which is far from the full story, and is to my mind, misleading.  Most of us may accept that the diagnosis bipolar disorder is highly heritable (and has a shared genetic component with schizophrenia among other diagnoses), but many of us are aware that the full story is much more complicated and that  heritability is a very misunderstood topic.

Documentary Timeline. For my own purposes, I’ve detailed some questions/points in the documentary along with the appropriate times (not at all complete)

Introductory Topics

  • History of bipolar disorder:  07.00
  • Childhood bipolar 8.30
  • Symptoms 09.00
  • Diagnoses, depression to mania ratios 10.00

Questions

  • ‘Could you give me a general explanation of how you felt before you were diagnosed?’  0h14
  • ‘And how long have you felt the symptoms of bipolar’  0h16.55
  • ‘What was this person like in a depressive episode and how did you react to it?’  1h06
  • ‘What was this person like in a  manic episode and how did you react to that?’  1h07.30
  • ‘How do you view bipolar disorder now after having been exposed to it personally?’  1h09
  • ‘Have you accepted the disorder as part of your life?’  1h12
  • ‘What are your thoughts and hopes for the future?’ 1h13
  • ‘What would you like the general public to know about bipolar disorder’  1h13.30
  • In your own words, try to sum up what it’s like to have bipolar disorder’  1h16.30

Other

  • A lovely description of bipolar disorder at 1h18.00.  Boat, anchor and kite metaphor.