CRITICAL APPROACH
Image Source: Weiner
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The critical approach looks at the culture of biomedicine and pharmaceuticals and how it has manifested itself throughout history. It quite literally views biomedicine, biotechnology, and pharmaceuticals with a critical lens.
There are two integral concepts to know and understand when using the critical approach: medicalization and biomedicalization. Medicalization is "the control over bodies and behaviors through medical interventions" (Karim, Lecture 5.1). An example of this would be that of menstruation and how it was reconceptualized as an illness after the advent of birth control. The image to the left is also an example of medicalization. Biomedicalization, on the other hand, is "the enhancement of bodies and behaviors through medical interventions" (Karim, Lecture 5.1). An example of this would be Viagra, a drug that is often used to enhance one's sex drive, although its intended purpose is to treat erectile dysfunction. This page will look at the cultural history of bipolar disorder in order to gain insight into the political, social, and economic factors that influence its current status. |
MENTAL ILLNESS AND STIGMA
Before discussing the history of bipolar disorder, I want to give you a brief introduction to the history of mental illness. Way, way back when, in the ancient civilizations, it was understood that mental illnesses were the cause of the supernatural, which is exemplified by the treatments that were offered to those who were mentally ill – trephining, for example, is where a hole was created in the skull potentially to expel whatever spirits were there (Foerschner, 2010). Sometime between the 5th and 3rd centuries BCE, Hippocrates rejected the supernatural causes of mental illnesses, instead ascribing it to natural, biological causes; this is where the four essential fluids concept came in. It was believed that mental illnesses occurred when these four essential fluids were out of balance (Foerschner, 2010).
Those with mental illnesses who were in the custody of their family were likely abused and treated inhumanely, particularly those in Christian Europe (Foerschner, 2010). Having a mental illness was considered a deviant act so those with mental illnesses were hidden and ostracized from society. In Europe, during the Middle Ages, there would be beatings for those had a mental illness for their deviant behaviors as well as to send a message to others with similar behaviors. It was around the sixteenth century that asylums and other mental institutions became prevalent. These institutions were known for their inhumane treatment and living conditions. They were not effective and only exacerbated the conditions faced by those who had a mental illness. Bedlam, the infamous asylum located in England, even held sideshows for their more "violent" patients (Foerschner, 2010).
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It wasn't until the mid-to-late 1800s that reforms began to take place, improving the conditions of both the patients and the institutions. However, these strides towards better care hit many roadblocks with the advent of immigration (racism probably won't improve anybody's condition) and pharmaceuticals (drugs will cure all!). Then came electroconvulsive therapy, which was largely used to abuse the patients into submissiveness. When that didn't work, there were psychosurgeries like lobotomies that had 25% mortality rate and undesirable side effects (Foerschner, 2010). And finally, the drugs that we are familiar with today.
The image to the right depicts an ad campaign against the stigma of mental illness. I wanted to introduce you to the history of mental illness and stigma (albeit quite diluted) because it is important to understand how those with mental illnesses were viewed and treated. Although the treatment options have considerably improved, there is still a lot of stigma associated with mental illnesses that need to be rectified.
The image to the right depicts an ad campaign against the stigma of mental illness. I wanted to introduce you to the history of mental illness and stigma (albeit quite diluted) because it is important to understand how those with mental illnesses were viewed and treated. Although the treatment options have considerably improved, there is still a lot of stigma associated with mental illnesses that need to be rectified.
THE HISTORY OF BIPOLAR DISORDER
Both depression and mania have been documented aplenty but there relationship was first noticed by the Ancient Greeks. Aretaeus of Cappadocia, a physician and philosopher during the first century AD, described patients that would "laugh, play, dance night and day, and sometimes go openly to the market crowned, as if victors in some contest of skill only to be torpid, dull, and sorrowful at other times" (Burton). A more comprehensible understanding of bipolar disorder could be credited to early Chinese authors, specifically Gao Lin. Additionally, Avicenna, a Persian physician, also established bipolar disorder as having both mania and depression. However, what we understand of bipolar disorder today is the result of its conceptualization since the 1850s.
At the Académie de Médicines in 1854, Jules Baillarger and Jean-Pierre Falret presented their concepts of bipolar disorder separately – Baillarger called it foile à double forme (dual form insanity) and Falret called it folie circulaire (circular insanity). Half a century later, Emil Kraepelin, a German psychiatrist, studied individuals who had this disorder (although it hadn't yet been recognized as such) and was able to distinguish it from schizophrenia (Burton). It is Kraepelin who named it manic depressive psychosis. However, the distinction that Kraepelin made did not include those with both manic and depressive symptoms and those with only depressive episodes and psychotic symptoms. This particular distinction came about in the 1960s and is primarily responsible for the emphasis on mood elevation, which plays a huge part in how we view bipolar disorder today.
The first treatments for bipolar disorder were offered in the 1950s by Dr. John Cade, an Australian psychiatrist. Cade was studying veteran patients who had what was then referred to as manic depressive psychosis and found that using lithium carbonate had positive results. Interestingly, during this time-period, there was fear that table salt substitutes purportedly led to death ergo what Cade had discovered didn't start gaining traction until a little bit later (Mitchell and Hadzi-Pavlovic, 2000). Soon enough, lithium was approved by the U.S. Food and Drug Administration (FDA) in 1970.
The term that we see today (bipolar) was first introduced in 1980, in the third revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) (Krans). The preference for bipolar disorder over manic-depressive illness is because bipolar disorder is seen as less stigmatizing than the other.
At the Académie de Médicines in 1854, Jules Baillarger and Jean-Pierre Falret presented their concepts of bipolar disorder separately – Baillarger called it foile à double forme (dual form insanity) and Falret called it folie circulaire (circular insanity). Half a century later, Emil Kraepelin, a German psychiatrist, studied individuals who had this disorder (although it hadn't yet been recognized as such) and was able to distinguish it from schizophrenia (Burton). It is Kraepelin who named it manic depressive psychosis. However, the distinction that Kraepelin made did not include those with both manic and depressive symptoms and those with only depressive episodes and psychotic symptoms. This particular distinction came about in the 1960s and is primarily responsible for the emphasis on mood elevation, which plays a huge part in how we view bipolar disorder today.
The first treatments for bipolar disorder were offered in the 1950s by Dr. John Cade, an Australian psychiatrist. Cade was studying veteran patients who had what was then referred to as manic depressive psychosis and found that using lithium carbonate had positive results. Interestingly, during this time-period, there was fear that table salt substitutes purportedly led to death ergo what Cade had discovered didn't start gaining traction until a little bit later (Mitchell and Hadzi-Pavlovic, 2000). Soon enough, lithium was approved by the U.S. Food and Drug Administration (FDA) in 1970.
The term that we see today (bipolar) was first introduced in 1980, in the third revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) (Krans). The preference for bipolar disorder over manic-depressive illness is because bipolar disorder is seen as less stigmatizing than the other.
THE MEDICALIZATION AND BIOMEDICALIZATION OF BIPOLAR DISORDER
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As the popularity of drugs increased, the definition of bipolar disorder changed. The medicalization of bipolar disorder "shows how a serious psychiatric condition was mutated into something so vague and inclusive that the label can be attached to a whole myriad of common personal difficulties, which thereby become legitimate targets for drug treatment" (Moncrieff, 2014). This coupled with the rise of the informed patients who go into the doctor's office more to confirm what they have rather than ask what they have, bipolar disorder is being diagnosed more than ever – "the number of clinical diagnosis of bipolar disorder in young people has increased by 40 times over the last 10 years" (Maturo, 2010). Additionally, by 2003 around 24% of the general population showed "some form of disturbance on the 'bipolar spectrum'" (Moncrieff, 2014). It would be interesting to see what the percentage would be now, in 2014. The increase in numbers of those having bipolar or bipolar symptom is indicative of the changing and loosening definition of bipolar disorder.
In the 1990s came the concept of mood stabilizers – although it is unclear what this exactly means. The basic assumption is that it would assist and fix emotional regulations (Moncrieff, 2014). When you have this with its current loosened definition has enabled these mood stabilizers to be more widely marketed and distributed. There was an advertisement in 2002 by Eli Lilly that depicted a woman with bipolar disorder via videos of her being happy and doing activities and sporadic images of her being depressed. It suggested that those whose depressions' weren't being improved might have bipolar disorder (Moncrieff, 2014). Advertisements would also promote the idea that bipolar disorder is actually more common than one would think and is often unrecognized. These advertisements would also emphasize the links between bipolar disorder and creativity, which was amplified by their use of celebrities. |
It is clear that bipolar disorder has not been immune to the effects of medicalization and biomedicalization. By highlighting the ways in which the pharmaceutical companies have advertised their drugs as 'mood stabilizers' and assisted in the loosening of bipolar disorder's definition in order to create a market for them, I am in no way stating that bipolar disorder isn't real.
BIPOLAR DISORDER IN POPULAR CULTURE
There is still a lot of stigma associated not only with bipolar disorders but mental illnesses in general. Many believe that those with mental illnesses are weak, deserving of it, faking it, etc. Many also believe that some of the fatal effects of these mental illnesses such as suicide is a choice that those with mental illnesses willingly make. Although this ideology is quite pervasive, there have been measures taken to combat it. Additionally, these efforts allow for more awareness of these illnesses which, in turn, helps those who are suffering from it to understand what they're going through.
As stated in the previous section, bipolar disorder is often associated with the more creative occupations, like that of acting or painting or writing. Although this is a prevalent assumption, I do not think there has been any grounding for those claims. With the on-going process of de-stigmatizing mental illnesses, more celebrities have been coming out with their illnesses. For example, Demi Lovato, a famous singer and actress, discussed on People Magazine her dealings with bipolar disorder. Hopefully, there will be a time where mental illnesses are not stigmatized as they are now.
Using this approach allows for understanding how bipolar disorder was and is constructed in our society (and other societies) which, in turn, enables one to use that information to help with the de-stigmatization of bipolar disorder and other mental illnesses.
Next is the Applied Approach! To learn more about it, click here.
As stated in the previous section, bipolar disorder is often associated with the more creative occupations, like that of acting or painting or writing. Although this is a prevalent assumption, I do not think there has been any grounding for those claims. With the on-going process of de-stigmatizing mental illnesses, more celebrities have been coming out with their illnesses. For example, Demi Lovato, a famous singer and actress, discussed on People Magazine her dealings with bipolar disorder. Hopefully, there will be a time where mental illnesses are not stigmatized as they are now.
Using this approach allows for understanding how bipolar disorder was and is constructed in our society (and other societies) which, in turn, enables one to use that information to help with the de-stigmatization of bipolar disorder and other mental illnesses.
Next is the Applied Approach! To learn more about it, click here.
REFERENCE(S)
Burton, Neel. "A Short History of Bipolar Disorder." Psychology Today. Psychology Today, 21 June 2012. Web. Aug. 2014.
Foerschner, Allison M. "The History of Mental Illnesses: From "Skull Drills" to "Happy Pills"" Student Pulse: The International Student Journal 2.09 (2010): 1-4. Web. Aug. 2014.
Image 1. Digital image. Mental Health Stigma and the Misuse of Words. Healthy Place, 1 Aug. 2013. Web. Aug. 2014.
Image 2. Digital image. Cartoon Stock. Cartoon Stock, Web. Aug. 2014.
Karim, Tazin. "Lecture 5.1 Culture of Biomedicine." ANP 204. Lecture Notes. Aug. 2014.
Krans, Brian. "The History of Bipolar Disorder." Healthline. Healthline, 10 Jan. 2012. Web. Aug. 2014.
Moncrieff, Joanna. "The Medicalization of "ups and Downs": The Marketing of the New Bipolar Disorder." Transcultural Psychiatry 51.4 (2014): 581-98. SAGE Journals. Web. Aug. 2014.
Weiner, Zach. The Perception Problem. Digital image. Saturday Morning Breakfast Cereal. Zach Weiner, Web. Aug. 2014.
Burton, Neel. "A Short History of Bipolar Disorder." Psychology Today. Psychology Today, 21 June 2012. Web. Aug. 2014.
Foerschner, Allison M. "The History of Mental Illnesses: From "Skull Drills" to "Happy Pills"" Student Pulse: The International Student Journal 2.09 (2010): 1-4. Web. Aug. 2014.
Image 1. Digital image. Mental Health Stigma and the Misuse of Words. Healthy Place, 1 Aug. 2013. Web. Aug. 2014.
Image 2. Digital image. Cartoon Stock. Cartoon Stock, Web. Aug. 2014.
Karim, Tazin. "Lecture 5.1 Culture of Biomedicine." ANP 204. Lecture Notes. Aug. 2014.
Krans, Brian. "The History of Bipolar Disorder." Healthline. Healthline, 10 Jan. 2012. Web. Aug. 2014.
Moncrieff, Joanna. "The Medicalization of "ups and Downs": The Marketing of the New Bipolar Disorder." Transcultural Psychiatry 51.4 (2014): 581-98. SAGE Journals. Web. Aug. 2014.
Weiner, Zach. The Perception Problem. Digital image. Saturday Morning Breakfast Cereal. Zach Weiner, Web. Aug. 2014.