BIPOLAR DISORDER

ANALYSIS OF BIPOLAR DISORDER WITHIN CONTEMPORARY SOCIETY: SILVER

LININGS PLAYBOOK

OVERVIEW OF BIPOLAR DISORDER

The mental disorder which the film “Silver Linings Playbook” (2012) provides

exposition towards is known as bipolar disorder. Throughout the film, we observe Pat

coping with bipolar disorder, in addition to viewing the effects on his daily interactions

with his family, friends, and (eventual) romantic partner, Tiffany. Bipolar disorder, also

known as manic-depressive illness, is a mental disorder that affects the brain, is largely

tied to biological variances in hormonal balance within the brain itself, and results in

sporadic episodes of abnormal mood, energy, and ability to carry out daily tasks. The

biological etiology of this disorder involves the altered levels of key hormones such as

serotonin, dopamine, and catecholamine; however, according to Hilty (2006), there is no

inclusive hypothesis that unifies “genetic, biochemical, pharmacological, anatomical,

and sleep data” (Hilty et al. 2006) on the definite cause of bipolar disorder. Bipolar

episodes, subsequently, result in abnormal shifts in mood which can impair function and

increase the presence of aggressive tendencies. Abrupt and abnormal intensities of

emotions, insomnia, and lack of apathy can eventually curtail the desire to live, resulting

in suicidal thought. There are four basic types of bipolar disorder: bipolar I disorder,

bipolar II disorder, cyclothymia, and unspecified bipolar and related disorders, all of

which share the presence of manic episodes but may not present symptoms of

depression. For bipolar disorder to be accurately assessed and diagnosed, psychiatrists

must carefully analyze a wide range of factors through comprehensive mental

evaluations and physical/mental examination of patients’ symptoms. The most common

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treatments for bipolar are targeted psychiatric therapy and pharmacological treatment

directed at managing symptoms. Treatment tends to be chronic and often pairs therapy

alongside medication. The DSM-5 (2013) details the variety of symptoms and conditions

that must be present for the legitimate diagnosis of bipolar disorder including, but not

limited to: decreased need for sleep, excessive grandiosity, and “distinct periods of

abnormally… elevated, expansive, or irritable mood” (DSM-5 2013). Current

epidemiological distribution studies show no definite association between race, gender,

or ethnicity towards bipolar prevalence. According to Rowland and Marwaha (2018),

differences in patterns of bipolar disorder presence could be linked to “cultural factors,

migration and higher rates of misdiagnosis of black ethnic groups” (Rowland and

Marwaha 2018). Regarding gender, Rowland and Marwaha reported higher prevalence

of bipolar type I in males and higher rates of bipolar type II in females (2018: 253).

There is no indisputable evidence that deviates from a study (Bauer and Pfennig 2005)

claiming that bipolar disorder appears to have “a roughly equal distribution across sex

and ethnicity”.

Overview of Bipolar Disorder from an Epidemiological Perspective

In accordance to modern research, bipolar disorder is an entirely biological

mental health affliction. Numerous studies have been and are currently being conducted

on the impact of individual neurotransmitters (catecholamines, serotonin, GABA,

glutamate), hormones (serotonin, dopamine, and others), and steroids as well as

multiple chemical variables in synchrony. Studies have shown that mania is due to an

excess of catecholamines whereas depression is due to shortage of catecholamines.

Dopamine has been associated with the development of hypomania because the L-
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dopa, the primary dopamine precursor, produces in bipolar patients. Defining the illness

has been presented with a variety of issues, primarily regarding the clarity in symptoms

and diagnosis. Bipolar disorder is often confused with schizophrenia, schizoaffective

disorder, and depression because most mood and psychotic disorders share a similar

presentation of symptoms: mania, depressive episodes, and hypomania. The definition

of bipolar disorder isn’t the concern as much as the importance Expanding the definition

of bipolar II disorders revealed that “half of the patients currently diagnosed with a

unipolar depressive episode could suffer from unrecognized bipolar II disorder” (Bauer

and Pfennig 2005), and relatively equal number of mild depressive patients could have

minor bipolar disorder. The reason for epidemiological studies on bipolar disorder and

the “bipolar spectrum” is primarily formulate effective sampling for research efforts and

greater detection of patients with genetic precursors for bipolar development. This

spectrum approach to measurement is necessary since bipolar disorder presents itself

over time and remains fluid in its effect on the human psyche. Bipolar disorder is a

personality based on nonbiological factors as its effects are clearly denoted as socially

deviant from “normal”. An important thing to note in relation to mental illness being

viewed differently across cultures: it’s crucial that mental health practitioners and

researchers understand the role of culture, the variety of opinions concerning bipolar,

and incorporate this knowledge into the biopsychosocial understanding and treatment

process. Mental illness is most often associated with insanity and the degree to which

one is afflicted is often ignored. Shamans and certain religious leaders throughout the

world have been known to possess mental disorder but gain shelter from public shame

due to their religious position in their communities. When deviant behavior is shown in a
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community, especially because of bipolar disorder, more than often majority of

individuals never view someone with mental illness in the same light. In an early study

(Sanches and Jorge 2004), a comparison was done between Caucasian, African-

Caribbean and African bipolar disorder patients. The goal was to determine to what

extent culture presents implications that can either promote or decrease susceptibility to

developing bipolar disorder. Subjects were randomly sampled but organized according

to the manner of bipolar disorder they possessed based upon the clinical symptoms

they each expressed. The research found that among patients diagnosed with bipolar 1

disorder, African patients cumulatively had higher proportions of manic symptoms than

Caucasians. Afro-Caribbean patients presented more “mood-incongruent psychotic

symptoms when compared to manic patients of the other ethnicities”. This data indeed

indicates that there are cultural influences in the clinical presentation of BD. This may

have implications for the diagnosis of bipolar disorder across varying populations and

subpopulations.

Bipolar disorder in silver linings playbook.

Pat displays symptoms of bipolar disorder across the film. The film displays Pat’s

definitive outburst with a ferocity that clearly indicated what act left little, if any, doubt, as

to whether he was mentally ill or not. Stigmatization against him escalated from that

point on in his life with the entire neighborhood resenting him except for a few

sympathetic individuals. The film vividly depicts symptoms a bipolar individual would be

most likely to possess through the character of Pat. Numerous scenarios are plastered

with undoubtable and aggressive shifts in his emotion. A primary example of such a

mood swing is when Pat proceeds to attack the magazine stand outside his psychiatrist,
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Dr. Patel’s office room when the receptionist clearly explains that she cannot alter the

music. The song which played was a trigger for Pat’s bipolar disorder as it was present

earlier when Pat found his wife in the shower with another man. Another example

includes when he returns home and sees his father after release from the mental

institution. He was intensely ecstatic when he returned to his parents’ house. Finally,

Pat spent lots of screen time running around the neighborhood, a display of

hyperactivity (and a health-conscious mind). Required visits to a therapist and

prescribed medications were nice additions to the films. Accuracy towards the depiction

of Pat’s mental illness included his ignorance of social dysfunction. The paradox of

normalcy is important to note as Pat clearly believed he was not acting irrationally while

his behaviors were clearly the opposite of his pre-diagnosed identity. An interesting

aspect of the film to note in relation to a sociological context is that he refused to take

his medications because he viewed himself as being sane. Symptoms of bipolar

disorder displayed through the movie include: racing thoughts or flight of ideas,

increased activity (hyperactivity), insomnia (scene of Pat not being able to sleep late at

night), and an inflated self-esteem. Since bipolar disorder is highly variable as it comes

to symptoms, the movie cannot be said to have NOT shown certain symptoms.

According to the DSM-5, three or more of the conditions for symptoms must be

observed in a patient during mood disturbances (as well as other key requirements

being met) for an individual to be diagnosed as having bipolar disorder. Silver Linings

Playbook was a fantastic representation of the concept of “sporadic mood swings” and

“intense episodes of emotion”. The Hollywood-esque ending was a feature to the film
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that slightly made the film corny but this was a film that greatly broadened my ihorizons

on mental disorder awareness.

REFERENCES

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental

disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Bauer, Michael and Andrea Pfennig. 2005. “Epidemiology of Bipolar Disorders.”

Epilepsia 46:8–13.

Hilty, Donald M., Martin H. Leamon, Russell F. Lim, and Rosemary H. Kelly. 2006. “A

Review of Bipolar Disorder in Adults.” Psychiatry (Edgmont) 3(9):43–55.

Retrieved December 9, 2018

(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963467/).

Rowland, Tobias A. and Steven Marwaha. 2018. “Epidemiology and Risk Factors for

Bipolar Disorder.” Ther Adv Psychopharmacol 51–269.

Sanches, Marsal, & Jorge, Miguel Roberto. (2004). Transcultural aspects of bipolar

disorder. Brazilian Journal of Psychiatry, 26(3), 54-56.