Face the facts, mental illness is scary (to the general public). Empire has been making attempts at showing the true nature of a certain type of mental illness. However, when a show is this popular and has over 14 Million viewers (according to Nielsen), we owe a bit more authenticity to mental health. Empire has been specifically tackling Bipolar Disorder, but in a dysfunctional way that confuses the truth about the condition with the drama of performance art.
As a Psychologist In Training and an Artist, I have been able to watch the show without letting the facts get muddled. However, it was a conversation with a close friend as well as an article written for the www.TheRoot.com by a person with BP that helped illuminate the various misunderstandings about what Bipolar Disorder is and how it can manifest that gave me the idea to try to clear the confusion.
Here we are going to address the issues of mental health as well as the specifics of Bipolar. Certainly, I am still only a Psychologist in Training, but I have enough understanding of the disorder from my on-going studies, that I am able to fill in the gaps with solid research. Let's do it!
What is Bipolar Disorder?
According to the National Institute of Mental Health (NIMH), Bipolar Disorder is
“a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.” (NIMH, 2014). These shifts can have varying results. So in the most recent version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-V), there are 4 classifications of BP.
This is really important when considering the way that a person with BP might behave due to his/her condition. This can cause confusion when trying to quickly explain the markers of this disorder. Furthermore, there is a severe form of BP I or BP II that is known as Rapid Cycling. All of these details get muddle quickly and it is easy to see why there is such a lack of understanding. First, let's take a servings to understand the 4 Types.
How does Bipolar Disorder manifest?
Just as it is important to have an understanding of what BP is, we must also consider what it looks like. BP manifests itself in various ways depending on the contributing factors associated with each individual person. Going back to Empire, let’s consider some of the factors that may contribute to the presentation of Andre’s condition.
On the mania side of things, Empire and Trai Byers have been doing a phenomenal job. Andre in his manic episodes is so happy and high emotionally that he could easily be classified as euphoric. Mania is marked by rash decision making and a euphoric mood without a cause for it. The best examples of this are Andre’s buying of the lamborghini in last week’s episode and the shopping spree in this week’s episode. Andre’s mania causes him shop for lavish gifts without regard to the negative consequences. There is not even a true attachment to that which he has purchased.
A person with Bipolar Disorder may seem like the perfect person to go out with during his manic episodes, but their untethered excitement and energy level quickly presents itself as problematic.
As it relates to depressive episodes, there are two major factors that come up on Empire. First, Andre is a male and that has bearing on his behavior. An important thing to remember in the behavior of a person that may be Bipolar (as well as someone with depression) is the sex of the person. In Western societies, men often manifest their depression through externalizing behavior. This includes anger (yelling and non-physical aggression), irritation and substance abuse. Men essentially manifest their depression in a highly visible way that seeks outlets for their depression. Women often internalize their depression and this results in withdrawnness. Since bipolar has both mania and depression, it is conceivable and likely for Andre to show anger in his depressive states, rather than being withdrawn. Empire gets this piece of Bipolar Disorder correct, but the public may not realize that BP can manifest this way.
Second, Andre is a ripped guy and while this is likely of the actor’s own personal choice, but if we are going to have a real discussion about the various factors that may be contributing to this portrayal on Empire, we must consider his strength and possible workout regimen. Assuming that Andre works out regularly in order to maintain his physique, we must consider how exercise influences one’s mood; after all BP is at its core manifests as a mood disorder. Much research has been done on the effects of exercise on depression. The results show that those who regularly exercise have lower depression levels and a lower level of substance abuse (Volavka, 2013). If Andre works out as often as his physique might suggest and he is on his meds, he would likely be calmer and more balanced than his portrayal on Empire. That is not to say that exercise is the only answer, but it is a contributing factor to mental wellness.
Finally, Empire portrays an Andre who switches from Mania to Depression in the matter of hours or minutes. This is confusing for the public watching and disturbing to mental health professionals. In Bipolar Disorder, one can have what is known as “Rapid Cycling”. This refers to a person who has had a certain number of manic and depressive episodes in a year. The word “rapid” is relative to the time periods laid out in the DSM, but episodes occur over weeks typically. Some people rapid cycle over a few days. Rarely, a person may cycle over hours. There is no evidence to support Empire’s portrayal of Andre cycling in minutes. It just doesn’t happen that way. Empire is likely attempting to add drama by cycling so quickly, but it misleading at best and irresponsible at worst. The issue is much more complicated than Empire shows and provides viewers with a false sense of knowledge.
There are various ways that BP can manifest and I am not even scratching the service of the subject. However, what we should keep in mind is that BP does not look the same from person to person. We must consider the BP works in conjunction or in contrast with the person and the environment.
How can I support someone with BP?
Being a part of any support system for another person is important, but must be handled carefully. The first and most important step is to ask the person with Bipolar Disorder how they would like you to support them. Consider the fact that your mind and behavior is being hijacked by a mental condition and how helpless you might feel. By asking the person what they want from you, you are giving back power to the person. Furthermore, this subtly encourages the person to take ownership and control over his/her condition.
Treatment for BP is imperative, but is not the focus of this article. On last night’s episode of Empire, music therapy was used for Andre. I strongly believe in the use of the Arts to work through mental illness. However, where Empire went astray was the invitation to prayer by the therapist. This is problematic on a number of levels.
First, Andre’s protestation to prayer was quickly ignored. Second, this situation perpetuates the belief in much of the Black community that God will fix everything and the need for a mental health professional is unnecessary. Certainly, this was in the setting of a mental health hospital. However, by including this scene Empire is making a suggestion to forgo treatment and pray that God will take the bad things away. I firmly believe in God and I pray, but this scene is counterproductive.
______________
The concern over a fair and responsible representations of mental illness is larger than the popularity of a tv show. It is about the creation of a Collective Consciousness in America that fears and is repulsed by those with mental illness, rather than creating a culture of support and understanding. What Hollywood does not understand about the the misrepresentation of people with mental illness is that their mass appeal is having a negative impact on the mental health community. When Empire portrays Andre as violent and out of control during one of his episodes, it sends the message to viewers that people with Bipolar Disorder (and/or mental illness in general) are violent, dangerous and fear-inducing. Such a characterization of this community consciously and unconsciously creates a negative impact that goes beyond that of tv. It tells the public that one must be careful of the mentally ill because of their penchant for violence. In fact, people with mental illness are not violent in large numbers. Specifically looking at BP, those who are violent, their violence is due to comorbidity with another issue such as substance abuse (Volavka, 2013).
The major issue with this misrepresentation is that it creates a culture of blaming catastrophes on those with mental illness without infusing the same fervency into the implementation of affordable mental health services for the community. This dichotomy is the fundamental problem of how mental illness is addressed in this country.
This phenomenon becomes more evident when watching the news cycle. In a desire to find explanations for shootings and bombings, many White perpetrators are labeled as mentally ill to explain away their culpability in a criminal act. While we could, I won’t go into the racial disparities in the treatment of the mentally ill and the criminal justice system. When the media labels criminal actors as “mentally ill”, they reinforce the narrative of the violent crazy person. This does two things: 1) Brands all people with mental illness as violent and 2) Removes culpability for the criminal act. Both of these things are wrong.
America must take mental illness seriously and combat improper or misleading information about mental illness. Bipolar Disorder is one of a multitude of mental health issues. As we can see, even within this one condition, there are various classifications and factors that make each case unique. The field of mental health is vast and requires a commitment to understanding. When people lack understanding, they allow themselves to be ruled by misinformation, speculation and outright lies. In short, people fear that which they do not understand. Let’s foster understanding of mental health in America and create strong support and treatment for the members of the mental illness community.
Bipolar Disorder. (2014, November 7). Retrieved March 12, 2015, from http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
Volavka, J. (2013, January 1). VIOLENCE IN SCHIZOPHRENIA AND BIPOLAR DISORDER. Retrieved March 14, 2015, from http://www.hdbp.org/psychiatria_danubina/pdf/dnb_vol25_no1/dnb_vol25_no1_24.pdf
As a Psychologist In Training and an Artist, I have been able to watch the show without letting the facts get muddled. However, it was a conversation with a close friend as well as an article written for the www.TheRoot.com by a person with BP that helped illuminate the various misunderstandings about what Bipolar Disorder is and how it can manifest that gave me the idea to try to clear the confusion.
Here we are going to address the issues of mental health as well as the specifics of Bipolar. Certainly, I am still only a Psychologist in Training, but I have enough understanding of the disorder from my on-going studies, that I am able to fill in the gaps with solid research. Let's do it!
What is Bipolar Disorder?
According to the National Institute of Mental Health (NIMH), Bipolar Disorder is
“a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.” (NIMH, 2014). These shifts can have varying results. So in the most recent version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-V), there are 4 classifications of BP.
This is really important when considering the way that a person with BP might behave due to his/her condition. This can cause confusion when trying to quickly explain the markers of this disorder. Furthermore, there is a severe form of BP I or BP II that is known as Rapid Cycling. All of these details get muddle quickly and it is easy to see why there is such a lack of understanding. First, let's take a servings to understand the 4 Types.
- The 4 Types of Bipolar Disorder:
- Bipolar Disorder I - (Bipolar Disorder Manic) - Mania in mental health is marked by significantly higher levels of energy than normal (NIMH, 2014). Typically, mania is presents as a state of euphoria. A person with BP I must have manic episodes that last at least 7 days as well as depressive episodes that last 2 weeks. One Liner: BP I is characterized as having mania and depression in high levels.
- Bipolar Disorder II (BP Depressive) - This type is primarily depressive episodes with hypomanic episodes as well (NIMH, 2014). Hypomania refers to a lower level of mania, but still a higher than average level of energy.
- Bipolar Disorder Not Otherwise Specified - A person with this type has BP, but does not meet criteria for I or II (NIMH, 2014). This person is is acting outside of normal behavior, but does not meet everything needed for a diagnoses for a specific type at that time. Hospitalization is required as well.
- Cyclothymia - This is a mild form of Bipolar Disorder that has hypomania and mild depression and that last at least 2 years (NIMH, 2014). This is a long term form of the disorder when it does not meet the criteria for another type.
How does Bipolar Disorder manifest?
Just as it is important to have an understanding of what BP is, we must also consider what it looks like. BP manifests itself in various ways depending on the contributing factors associated with each individual person. Going back to Empire, let’s consider some of the factors that may contribute to the presentation of Andre’s condition.
On the mania side of things, Empire and Trai Byers have been doing a phenomenal job. Andre in his manic episodes is so happy and high emotionally that he could easily be classified as euphoric. Mania is marked by rash decision making and a euphoric mood without a cause for it. The best examples of this are Andre’s buying of the lamborghini in last week’s episode and the shopping spree in this week’s episode. Andre’s mania causes him shop for lavish gifts without regard to the negative consequences. There is not even a true attachment to that which he has purchased.
A person with Bipolar Disorder may seem like the perfect person to go out with during his manic episodes, but their untethered excitement and energy level quickly presents itself as problematic.
As it relates to depressive episodes, there are two major factors that come up on Empire. First, Andre is a male and that has bearing on his behavior. An important thing to remember in the behavior of a person that may be Bipolar (as well as someone with depression) is the sex of the person. In Western societies, men often manifest their depression through externalizing behavior. This includes anger (yelling and non-physical aggression), irritation and substance abuse. Men essentially manifest their depression in a highly visible way that seeks outlets for their depression. Women often internalize their depression and this results in withdrawnness. Since bipolar has both mania and depression, it is conceivable and likely for Andre to show anger in his depressive states, rather than being withdrawn. Empire gets this piece of Bipolar Disorder correct, but the public may not realize that BP can manifest this way.
Second, Andre is a ripped guy and while this is likely of the actor’s own personal choice, but if we are going to have a real discussion about the various factors that may be contributing to this portrayal on Empire, we must consider his strength and possible workout regimen. Assuming that Andre works out regularly in order to maintain his physique, we must consider how exercise influences one’s mood; after all BP is at its core manifests as a mood disorder. Much research has been done on the effects of exercise on depression. The results show that those who regularly exercise have lower depression levels and a lower level of substance abuse (Volavka, 2013). If Andre works out as often as his physique might suggest and he is on his meds, he would likely be calmer and more balanced than his portrayal on Empire. That is not to say that exercise is the only answer, but it is a contributing factor to mental wellness.
Finally, Empire portrays an Andre who switches from Mania to Depression in the matter of hours or minutes. This is confusing for the public watching and disturbing to mental health professionals. In Bipolar Disorder, one can have what is known as “Rapid Cycling”. This refers to a person who has had a certain number of manic and depressive episodes in a year. The word “rapid” is relative to the time periods laid out in the DSM, but episodes occur over weeks typically. Some people rapid cycle over a few days. Rarely, a person may cycle over hours. There is no evidence to support Empire’s portrayal of Andre cycling in minutes. It just doesn’t happen that way. Empire is likely attempting to add drama by cycling so quickly, but it misleading at best and irresponsible at worst. The issue is much more complicated than Empire shows and provides viewers with a false sense of knowledge.
There are various ways that BP can manifest and I am not even scratching the service of the subject. However, what we should keep in mind is that BP does not look the same from person to person. We must consider the BP works in conjunction or in contrast with the person and the environment.
How can I support someone with BP?
Being a part of any support system for another person is important, but must be handled carefully. The first and most important step is to ask the person with Bipolar Disorder how they would like you to support them. Consider the fact that your mind and behavior is being hijacked by a mental condition and how helpless you might feel. By asking the person what they want from you, you are giving back power to the person. Furthermore, this subtly encourages the person to take ownership and control over his/her condition.
Treatment for BP is imperative, but is not the focus of this article. On last night’s episode of Empire, music therapy was used for Andre. I strongly believe in the use of the Arts to work through mental illness. However, where Empire went astray was the invitation to prayer by the therapist. This is problematic on a number of levels.
First, Andre’s protestation to prayer was quickly ignored. Second, this situation perpetuates the belief in much of the Black community that God will fix everything and the need for a mental health professional is unnecessary. Certainly, this was in the setting of a mental health hospital. However, by including this scene Empire is making a suggestion to forgo treatment and pray that God will take the bad things away. I firmly believe in God and I pray, but this scene is counterproductive.
______________
The concern over a fair and responsible representations of mental illness is larger than the popularity of a tv show. It is about the creation of a Collective Consciousness in America that fears and is repulsed by those with mental illness, rather than creating a culture of support and understanding. What Hollywood does not understand about the the misrepresentation of people with mental illness is that their mass appeal is having a negative impact on the mental health community. When Empire portrays Andre as violent and out of control during one of his episodes, it sends the message to viewers that people with Bipolar Disorder (and/or mental illness in general) are violent, dangerous and fear-inducing. Such a characterization of this community consciously and unconsciously creates a negative impact that goes beyond that of tv. It tells the public that one must be careful of the mentally ill because of their penchant for violence. In fact, people with mental illness are not violent in large numbers. Specifically looking at BP, those who are violent, their violence is due to comorbidity with another issue such as substance abuse (Volavka, 2013).
The major issue with this misrepresentation is that it creates a culture of blaming catastrophes on those with mental illness without infusing the same fervency into the implementation of affordable mental health services for the community. This dichotomy is the fundamental problem of how mental illness is addressed in this country.
This phenomenon becomes more evident when watching the news cycle. In a desire to find explanations for shootings and bombings, many White perpetrators are labeled as mentally ill to explain away their culpability in a criminal act. While we could, I won’t go into the racial disparities in the treatment of the mentally ill and the criminal justice system. When the media labels criminal actors as “mentally ill”, they reinforce the narrative of the violent crazy person. This does two things: 1) Brands all people with mental illness as violent and 2) Removes culpability for the criminal act. Both of these things are wrong.
America must take mental illness seriously and combat improper or misleading information about mental illness. Bipolar Disorder is one of a multitude of mental health issues. As we can see, even within this one condition, there are various classifications and factors that make each case unique. The field of mental health is vast and requires a commitment to understanding. When people lack understanding, they allow themselves to be ruled by misinformation, speculation and outright lies. In short, people fear that which they do not understand. Let’s foster understanding of mental health in America and create strong support and treatment for the members of the mental illness community.
Bipolar Disorder. (2014, November 7). Retrieved March 12, 2015, from http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
Volavka, J. (2013, January 1). VIOLENCE IN SCHIZOPHRENIA AND BIPOLAR DISORDER. Retrieved March 14, 2015, from http://www.hdbp.org/psychiatria_danubina/pdf/dnb_vol25_no1/dnb_vol25_no1_24.pdf