Close this search box.

Bipolar Disorder and Chronic Illness Narratives

by Sam Swank

Note: This article discusses psychiatric illness and suicide.

Conventional movie narratives have a three-act, linear structure, with a climax somewhere in the second act and a resolution in the third act. How do you fit a lifetime, multi-episodic condition like bipolar disorder into three acts? 

Some, like Silver Linings Playbook, tell the story of bipolar disorder through how it profoundly affects another, more three-act-friendly plot. Others use the diagnosis to foster more tension or justify irrational actions by characters, such as the TV show Homeland.

Bipolar disorder type I affects about 1 percent of the global population during their lifetime. Bipolar disorder type II and cyclothymia affect an additional 4 percent, characterized by less severe—but just as disruptive—mood cycles. People with these disorders experience, on average, nine manic episodes dispersed through their lifetime, though some “rapid cycle” (have four or more manic episodes per year). And don’t forget about mixed episodes—a combination of mania’s agitation with depression’s low mood.

Movies tend to overrepresent manic episodes while underrepresenting depressive episodes. Some experience benefits from treatment, some benefit but relapse, and only a select few maintain a steady career. What type of message does this send about the quality of life people with bipolar disorder can attain?

What is the climax of the story of bipolar disorder itself? A suicide attempt? While bipolar disorder does carry one of the highest suicide risks of any psychiatric condition, at least one-half to two-thirds of those with it will never make an attempt. Plus, what type of message does that send—is rock bottom only the brink of death?

And what’s the resolution for a lifetime illness? It can’t be death—we don’t promote suicide as a solution. There’s no cure. Treatment is an effective but continuous, nuanced series of trials, errors, failures, successes, relapses, and remissions. Chronic conditions ebb and flow, with ongoing aftermath that doesn’t fit into the last fifteen minutes of a movie. 

Why do these narratives even matter? Evidence suggests that narratives might better persuade people to favorably regard those with mental illnesses than non-narrative messages.

Further, the average delay between the onset of bipolar symptoms and the diagnosis of bipolar disorder can range from 5 to 10 years. Because part of the disorder mimics more common unipolar depressions, people with it frequently receive a misdiagnosis of major depression, postponing appropriate care.

And while some treatments overlap between disorders, such as SSRIs and SNRIs, other first-line medications like lithium would never be considered for someone diagnosed with unipolar depression. Could our overemphasis on depicting bipolar disorder as a primarily manic illness contribute to misdiagnosis, leaving patients unaware that their depression could be something else?

Identifying poor filmmaking patterns is excellent, but what can we do to fix them?

  • Consider less traditional storytelling methods, including nonlinear narratives that can transport us through time and demonstrate how the character’s condition has changed throughout their lives.

  • While illness can provide a source of conflict, ensure that you don’t sensationalize, glorify, or otherwise make it excessively dramatic. The experience of conditions like bipolar disorder is, on its own, enough for a compelling plot with relationships and events the audience cares about.

  • Be careful when displaying certain characteristics like violence (especially for men) or innocent nonchalance (especially for women—i.e., part of the “Manic Pixie Dream Girl” trope), which are frequent stereotypes. At minimum, consider how often we complain about seeing the same stories over and over—why not change things up a bit while also contributing to a more balanced perception of a stigmatized illness?

  • Take caution with suicide as a narrative device. It’s not inherently wrong to tell stories that involve suicide, but we may inadvertently perpetuate misconceptions. Is suicide in the narrative because it makes sense for your character and you’ll be able to make a crucial point with it (e.g., even after multiple attempts, there’s hope for a good life), or is it simply for sensationalist shock value?

  • The story doesn’t need to be overly optimistic—people actually reject positivity bias where they can in favor of authentic, personal narratives of mental illness. But they also don’t need to be utterly hopeless, either. For chronic conditions, we have to reconsider what a good resolution looks like—it probably isn’t a permanent remission or “happy ever after” with the illness, but a routine where the individual lives a quality life, holds agency over their illness, and can take setbacks in stride.

  • Clearly distinguish treatments from cures and their roles in healing. Fun, friendships, love, and connection can be vital elements of a character’s journey, but they are by no means cures or standalone treatments.

As storytellers, it’s our job to capture human nuance and transport others into the experience of another. To do that with chronic illnesses—including psychiatric conditions like bipolar disorder—requires some additional awareness.

You may also like