Personal and Societal Construction of Illness Among Individuals With Rapid-Cycling Bipolar Disorder: A Life-Trajectory Perspective

From the Department of Psychiatry and of Biostatistics and Epidemiology, Case Western Reserve University School of Medicine, Cleveland, OH (MS); the Departments of Anthropology and Psychiatry, University of California San Diego, La Jolla, CA (JHJ); the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH (RS, JAW, KAC, WJM, JRC); and NorthEast Ohio Health Services, Cleveland, OH (RS).

Address correspondence and reprint requests to: Martha Sajatovic, M.D., E-mail: Martha.sajatovic{at}uhhs.com.

	Abstract

Objective: Bipolar disorder is a chronic mental illness associated with substantial impairment in quality of life and function. Although there has been tremendous growth in understanding bipolar disorder with respect to treatments, very little study has focused on the viewpoint of affected individuals. The purpose of this study was to examine the subjective experience of illness among 19 men and women with rapid cycling bipolar disorder receiving treatment at an academic psychiatry clinic. Methods: Personal constructs of illness with respect to life-trajectory and societal reaction to the individual, specifically the issue of stigma, were evaluated using a semistructured, open-ended anthropological interview. Results: Participants perceived bipolar disorder as a disease with biologic underpinnings. Stigma was a major issue for all individuals. In common with individuals without serious mental illness, individuals with bipolar disorder work at mastering developmental tasks appropriate for their life stage. At times, younger individuals appeared to have difficulty separating their own identity from the effects of illness. For older individuals with bipolar disorder, life was perceived to be disrupted by bipolar disorder, with early plans and dreams often "derailed". Conclusion: Although bipolar disorder may severely alter an individual's planned life trajectory, accomplishment of life goals can at least partially offset the sense of loss that is often seen in bipolar illness.

Key Words: Bipolar disorder, stigma, rapid cycling, life course, aging, subjective experience