In an interview with People, Mariah Carey revealed that she has been struggling with bipolar disorder for years.
Though Carey says that she was first diagnosed with the mood disorder in 2001, she didn't seek treatment until last year, after going through a few particularly difficult years.
"Until recently I lived in denial and isolation and in constant fear someone would expose me," she told People. "It was too heavy a burden to carry and I simply couldn’t do that anymore. I sought and received treatment, I put positive people around me and I got back to doing what I love — writing songs and making music."
It's unsurprising that Carey says she was in denial about her mental health diagnosis. Although we've made progress in decreasing stigma around more common mental health problems like depression and anxiety, we still don't talk about illnesses like bipolar disorder as often, which makes it more difficult to ask for help.
And, the fact that there's more than one type of bipolar disorder makes it more complicated to talk about. But, beyond the stigma, Matt Lundquist, LCSW, a psychotherapist based in New York City, says that bipolar, especially the bipolar II disorder that Carey says she suffers from, is a particularly under-diagnosed disorder, because it can be difficult to pin down.
Of the two main subsets of bipolar disorder, bipolar II may be more subtle and more difficult to diagnose. While bipolar I is characterised by more obvious episodes, symptoms of bipolar II might be easier to miss or dismiss. For example, someone who has bipolar II may have symptoms like mood swings, increased energy, and decreased need for sleep (Carey herself said that she initially thought she had a sleep disorder); symptoms that are easier to dismiss than manic episodes, which Lundquist says are usually severe enough to put someone in the hospital.
"Bipolar I includes very clear manic episodes that are hard to miss, whereas bipolar II doesn’t necessarily have that," says Sally Winston, PsyD, a clinical psychologist and member of the Anxiety and Depression Association of America. "It takes longer to be diagnosed with bipolar II because the lack of the signature extreme mania makes it difficult."
Bipolar II is where there’s an experience of ups and downs, but there’s a greater amount of the lows.
Matt Lundquist, LCSW
Not only that, Lundquist says that bipolar II is commonly misdiagnosed as depression because those who have it might experience more of the downsides of mood swings.
"With bipolar I, there is an inconsistency in terms of mood that is typically comprised of especially high highs and especially low lows," he says. "Bipolar II is where there’s an experience of ups and downs, but there’s a greater amount of the lows."
And, Dr. Winston says that bipolar is usually diagnosed by looking at patterns in a person's life, and their mental health history, rather than by looking at any first impression symptoms — which might be another reason it takes longer to be diagnosed and treated.
"You have to look longitudinally at their history, so you can see the [symptoms] over time," she says. "Some people might just seem like chronically productive people-persons, and just always doing wonderful stuff, and then they have their first depressive episode in their 40s and suddenly their history becomes more clear."
Once it's diagnosed, however, Dr. Winston says that there are effective treatments no matter when you get diagnosed. Usually, treatment will include mood stabiliser medication as well adhering to a routine.
"With bipolar of both types, regularity is important," Lundquist says. "Everyone, even if you don’t have bipolar, can understand the importance of routine in your life. If you travel, have a chaotic weekend, or miss a meal, it has implications. For folks with bipolar, there’s increased sensitivity to those routines being disrupted."
Carey, for her part, once she decided to get help, was able to get therapy and medication, and told People that she's "in a really good place right now." Her frank discussion of what she went through is a huge step toward taking away the shame that comes with discussing mental illness and will hopefully inspire others to seek help if they need it.
As she told People, "I’m hopeful we can get to a place where the stigma is lifted from people going through anything alone. It can be incredibly isolating. It does not have to define you and I refuse to allow it to define me or control me.”
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