In defence of meds (and neurochemistry): Notes from a bipolar socialist

by Ani White

This article will appear in Fightback’s upcoming September issue on Accessibility. To support our work, consider subscribing to our e-publication ($NZ20 annually) or print magazine ($NZ60 annually). You can subscribe with PayPal or credit card here.

Content warning: This article discusses a range of mental health conditions, including bipolar and suicidality.

Bipolar (definition): A mental condition characterised by depression and mania.

Mania (definition): An abnormally elevated mood state characterized by such symptoms as inappropriate elation, increased irritability, severe insomnia, grandiose notions, increased speed and/or volume of speech, disconnected and racing thoughts, increased sexual desire, markedly increased energy and activity level, poor judgment, and inappropriate social behavior.¹

“…depression isn’t about brain chemistry at all, it’s about social context.” This turn of phrase, coming from a friend over dinner, set off immediate alarm bells. At all? Isn’t that simplistic? Surely brain chemistry and social context interact? My friend was recommending some fellow published in The Guardian, so while arguing back I agreed to look into it.

In the article², author Johann Hari does actually acknowledge briefly that brain chemistry is a factor, and that medication can help, but strongly emphasises that improving peoples’ social conditions is necessary to alleviate depression and anxiety. I agree with all of this. High rates of mental distress in our society result from a brutally exploitative system that alienates us from ourselves, and a kinder (socialist!) society would result in better mental health outcomes. My point here isn’t about Hari, the ethics of his behaviour³, or the details of his work (I should admit upfront to not having reading his book, only the article). It’s about the popularity of his work, and the dangers associated with a simplified interpretation of it. I should also acknowledge that friends of mine with bipolar and borderline personality disorder find Hari’s work useful, so this is not intended to speak for all bipolar people.

However, I personally believe that what Hari says is most accurate and pertinent for people suffering from situational depression and anxiety. We should be careful about extending Hari’s arguments too far. They should not be blindly mapped onto all mental conditions. And I don’t accept that all mental illness is socially determined – Hari does not argue this, but it’s a common leftist outlook that Hari might appear superficially to confirm.

I’m bipolar (see byline for definition). One of my uncles experienced schizophrenia and committed suicide, another uncle experiences bipolar, my sister has experienced hypomania and depression. The evidence seems clear that bipolar is heritable,⁴ and given my family history it seems pretty likely my bipolar is inherited. This doesn’t mean social context is irrelevant: changes in my life have helped trigger my manic episodes for example. However, the phrase “depression isn’t about brain chemistry at all” isn’t useful for my situation, including my depressed periods. My brain does chemically have a greater tendency towards ‘imbalances’ than other brains, and my treatment has to acknowledge that. It’s common that bipolar is initially misdiagnosed as simply depression/anxiety, leading to treatment that can make the situation worse: for example, antidepressants can set off mania, as they did in my case. Our brains are simply not like other brains (this is not distinct to bipolar people – patterns in brain chemistry vary widely).

My bipolar diagnosis made a big difference to recovery, enabling a more appropriate treatment plan (including appropriate meds, talk therapy, and broader changes in my life). After 28 years with undiagnosed bipolar, the 2 years since my diagnosis have been marked by significant recovery. Over that time, I’ve also found that while many people are aware of how depression works, mania (again, see byline) is not widely understood.

Mental health advocates around the world have launched a number of prominent depression awareness campaigns. Depression is a common issue: about 15% of Australians will suffer from depression, compared to about 1.8% experiencing bipolar. With overstretched and underfunded mental health systems, there are inestimable challenges facing mental health advocates, and raising awareness of the most common mental health disorders does make sense as a priority. However, people with rarer mental health conditions exist, and our conditions remain widely misunderstood.

Reactions to Kanye West are a case in point (hear me out). The recent announcement of his bipolar diagnosis did not surprise me at all. What’s notable, unusual about Kanye’s manic episodes is that they’re broadcast across the world. Every manic person embarrasses themselves, most do not do it on the evening news. Kanye’s episodes are otherwise quite typical of mania: delusions of grandeur, ranting, a general disconnection from the social body. I do not mean to excuse everything Kanye has said, particularly his endorsement of the alt right. Kanye has millions of dollars, not something most bipolar people can claim, so this probably factors into some of the disconnected ideas he expresses. Bipolar people must take responsibility; I myself have fucked up, behaving inappropriately while manic. Manic people may lack filters, but the ideas we express do come from our brains.

However, it seems to me that many who would not mock a celebrity’s depression will mock a celebrity’s manic behaviour. In a mental health support group online, I saw a comment dismissing Kanye as on the ‘delusion train.’ It struck me as unlikely that anyone in that space would dismiss someone on the ‘depression train’ (even a multi-millionaire such as Robin Williams).

In my experience, even those who do not mock manic delusions understandably find them confusing. This is not just because the ideas manic people express are confusing, though they often are; it’s also that there is no script for dealing with these episodes the way there is for depression.

During a video posted on Facebook, Johann Hari repeatedly emphasised that “you’re not crazy.” This is affirming for many. However, I prefer to acknowledge that manic episodes are crazy. They involve delusions, incoherence, reckless behaviour. For some of us, it may be more useful to acknowledge that insanity is part of the spectrum of human behaviour than to imply that nobody is crazy. Perhaps talk of ‘insanity’ is stigmatising, and I don’t insist everyone use it; my point is more that we need to be frank about the realities of mania.

Brains will always be diverse. This may manifest as mood imbalances. Moods and perceptions would not all be stable and identical under socialism. It may be that periods of lower energy and mood – what we call depression – would be accepted, not punished as ‘unproductive’, a punitive approach that only exacerbates depressive spirals. In other words, yes, mental distress would be alleviated, likely leading to lower rates of depression and anxiety. But this would not mean the eradication of complex, varied, sometimes ‘imbalanced’ brains – and meds would likely continue to help.

Perhaps a defence of neurochemistry and medication is unnecessary; meds continue to be the mental health system’s first port of call. However, my concern is that those who rightly call attention to social context do not throw the baby out with the bathwater.