Bipolar Disorder as Presented in Silver Linings Playbook
Bipolar Disorder is a serious mental illness that affects approximately 5.7 million adult Americans. It is so serious in fact, that on average, it results in a 9.2-year reduction in expected life span, and as many as one in five patients with bipolar disorder completes suicide (DBSA, 2009). Bipolar Disorder is complex, and patients often suffer from a broad spectrum of symptoms. Treatment for bipolar disorder often requires medication, therapy and even inpatient psychiatric hospitalization. To fully understand and treat bipolar disorder, we must consider the neurochemistry behind the illness. Psychiatric disorders have long since been a topic in movies, one example in particular is Silver Linings Playbook which portrays a man (Bradley Cooper) who was recently diagnosed with Bipolar Disorder and his struggle to get his life back on track.
The main character in Silver Linings Playbook is Pat Jr., a young man who has just been released from an inpatient psychiatric hospital where he was diagnosed with Bipolar Disorder. “Bipolar disorder is a mood disorder characterized by the presence of at least one manic episode. A manic episode is defined as a distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least one week that includes symptoms such as inflated self-esteem, impulsive behavior, increased rate of speech, and decreased need for sleep” (Lebeau, 2013). In the beginning of the movie, Pat Jr. has a very severe manic episode in which he violently attacks his wife’s lover when he finds the pair together in the shower. This leads to his being hospitalized in a psychiatric unit for eight months. Pat is released from the hospital into the care of his parents. Not long after he is discharged, he meets Tiffany, a complicated girl with her own issues who offers to help him get back in his estranged wife’s good graces. The two develop a unique bond that ultimately ends in a romantic relationship. Pat decides not to take the medication prescribed to him that is meant to manage his bipolar symptoms. “People experiencing bipolar disorder may believe they have special powers, go without sleep, talk incessantly, act recklessly and experience racing thoughts and irritability” (Haslam, 2020). Throughout the movie, we see several examples of these behaviors in Pat. One classic scene from the movie where his bipolar tendencies are clearly noted is when rather than sleeping, he stays up to finish Ernest Hemmingway’s A Farewell to Arms. When he gets upset that there isn’t a happy ending, he throws the book through the window and storms into his parents’ bedroom where he wakes them up ranting about the ending of the novel.
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“There are four types of mood episodes in bipolar disorder: mania, hypomania, depression, and mixed episodes” (Smith, 2020). In a manic episode people tend to experience heightened energy, creativity and euphoria. We see this throughout most of the movie with Pat Jr. His energy level is palatable. His speech is pressured, he paces constantly, he seems like he is driven by a motor. He is obsessed with trying to win his estranged wife back and fails to understand that his goal is unrealistic, as she has taken out a restraining order against him. “Hypomania is a less severe form of mania. In a hypomanic state, you’ll likely feel euphoric, energetic, and productive, but will still be able to carry on with your day-to-day life without losing touch with reality. To others, it may seem as if you’re merely in an unusually good mood” (Smith, 2020). We see this when Pat goes to the school he used to work at in order to get his old job back. He is overly cheerful and optimistic about getting his life back on track. He doesn’t seem to realize how unrealistic his expectations are given the circumstances. Pat Jr. cycles between mania and hypomania throughout most of the movie. Pat’s obsession with “silver linings,” reuniting with his estranged wife, and his tumultuous relationship with Tiffany are all examples of his hypomanic states. The movie does not show Pat in Depressive episodes quite as much. A depressive episode is not the same as regular depression. Although a depressive episode and regular depression share some similarities, certain symptoms are more prevalent in bipolar depression. For example, a bipolar depressive episode is more likely to involve irritability, guilt, mood swings and restlessness. Some symptoms are moving and speaking slowly, excessive sleeping and weight gain. People with Bipolar are also more likely to experience major problems with work and social functioning. They are also more prone to psychotic depression, a condition where you lose contact with reality (Smith, 2020). “A mixed episode of bipolar disorder features symptoms of both mania or hypomania and depression. Common signs of a mixed episode include depression combined with agitation, irritability, anxiety, insomnia, distractibility, and racing thoughts. This combination of high energy and low mood makes for a particularly high risk of suicide” (Smith, 2020). We see Pat exhibit signs of agitation, anxiety and racing thoughts. In another scene where Pat wakes his parents up in the middle of the night, he is frantically looking for his wedding video. He accuses his mother of hiding the video in order to protect him. Pat is yelling, swearing and tearing the house apart to find the video, and is clearly distraught. In fact, he is so escalated that he accidently hits his mother and must be restrained by his father; ultimately the police respond.
DSM-5 Criteria and Presentation
Bipolar Disorder is a mood disorder characterized by extreme highs and lows. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Bipolar disorder “is a category that includes three different conditions - bipolar I, bipolar II, and cyclothymic disorder:
- Bipolar I disorder is a manic-depressive disorder that can exist both with and without psychotic episodes
- Bipolar II disorder consists of depressive and manic episodes which alternate and are typically less severe and do not inhibit function
- Cyclothymic disorder is a cyclic disorder that causes brief episodes of hypomania and depression” (Truschel & Montero, 2019)
Pat Jr. fits the criteria for a diagnosis of Bipolar I with psychotic episodes. When Pat caught his wife with her lover, their wedding song “My Cherie Amour,” happened to be playing. Every time Pat hears this song thereafter it triggers a psychotic episode and he even becomes aggressive at times. There is a scene where Pat hears this song playing in the waiting room of his therapist’s office and it triggers him to have an emotional outburst. In another scene, he is in front of a theater and is having an argument with Tiffany. After becoming emotionally triggered he begins to hear this song playing, although it appears that he is having a psychotic break and that it is not in fact actually playing. In the very beginning of the movie, Pat explains to his therapist that not long before he assaulted his wife’s lover, he had called the police to report that his wife and the lover had been embezzling money from the local high school where she worked. Pat admits that this too was a delusion.
Brain Based Explanation of Bipolar Disorder
The exact cause of Bipolar Disorder is still not completely understood. However, doctors and scientists have discovered a lot about the disorder over the last few years by studying the brain. “The neurotransmitters that are suspected to be involved in bipolar disorder include dopamine, norepinephrine, serotonin, GABA (gamma-aminobutyrate), glutamate, and acetylcholine” (Nemade, 1995). These chemicals appear to be unbalanced in people with bipolar disorder. Studies have shown that GABA is lower in the blood and spinal fluid, whereas oxytocin is higher in those with a bipolar diagnosis. “However, the role of these findings to overall brain functioning is not yet understood. Whether the presence, absence, or change in these chemicals is a cause or outcome of bipolar disorder remains to be determined. The importance of neurochemicals in creating bipolar disease cannot be denied” (Nemade, 1995). It would make sense that dopamine levels are lower, since dopamine is responsible for regulating pleasure and emotional reward. Serotonin levels being low would contribute to disturbances in “sleep, wakefulness, eating, sexual activity, impulsivity, learning, and memory” (Bhandari, 2019) that is oftentimes associated with bipolar disorder. It is also believed that “As a biological disorder, it may lie dormant and be activated on its own, or it may be triggered by external factors such as psychological stress and social circumstances” (Bressert, 2020).
Recent studies using Computerized Axial Tomography (CAT) and Magnetic Resonance Imaging (MRI) scans showed “enlarged ventricle spaces (spaces which carry cerebrospinal fluid through and around the brain) in those with a bipolar diagnosis. Larger ventricles indicate less brain tissue is present as a whole within the brain and suggests that either deterioration has occurred, or that bipolar brains develop differently than normal brain controls” (American Addiction Centers, 2015). Researchers also noted that in the brain of people with bipolar disorder there was an abnormal amount of “small, white areas in the brain known as 'white matter hyperintensities'. White matter is partly responsible for transmitting messages to other areas of the brain. It was noted that people with these “hyperintensities” are three times more likely to have bipolar disorder. These brain scans also showed that there was a reduction of glial cells in patients with bipolar. These cells are what insulate neurons, allowing them to communicate more efficiently (American Addiction Centers, 2015). Because of the hyperintensities and reduction of glial cells and the effects this has on communication within the brain, it is possible that it contributes to the symptoms of bipolar disorder.
Reality vs. Portrayal in the Movie
In my opinion, Silver Linings Playbook is a mostly accurate portrayal of what it is like to live with Bipolar Disorder. Although it may seem that certain aspects are exaggerated for a cinematic effect, I feel as though that is because people living with bipolar disorder are prone to such extreme behavior. Of course, it is still a major motion picture, and thus needs to captivate the audience. I believe it is for this reason that no depressive episodes were portrayed. Mania and psychotic episodes are far more captivating to watch than someone in the throes of a depressive episode. I found that all of the characters in the movie all feel very real and relatable and were well-developed. I also like that the movie shows the struggle with adhering to treatment as well as patients’ reluctance to take medication. Not all real-life cases have such an optimistic outcome, however Silver Linings Playbook shows that treatment for bipolar disorder can be effective.
As one movie critic who himself suffers from Bipolar Disorder said, “There are job losses, broken relationships, unlimited optimism, anger, and a feeling that no one understands you. But he doesn't even understand himself. He thinks he is the only sane person around. He is in complete denial yet goes along with treatment just to get along with others. The obsession with his estranged wife drives him. Everything he does is to make himself look desirable to her. Then there is the hair trigger and the propensity toward violence which ultimately put him into the hospital. He has the belief that he sees with much more clarity than anyone else. There is also the hatred of medications and the belief that he doesn't need them. Yet, there is hope” (IMBD, 2012).
Treatment Options
Luckily, there are very effective methods of treating Bipolar Disorder. Medication is often necessary in mitigating the symptoms of the disorder. Most often prescribed are mood stabilizers, antipsychotics, antidepressants and anxiety medications. Psychotherapy is also vital in successfully dealing with bipolar disorder. Some helpful types of therapy include Interpersonal and social rhythm therapy (IPSRT), Cognitive Behavioral Therapy (CBT), Psychoeducation, and family focused therapy (Mayoclinic, 2018). Another less common treatment method is electroconvulsive therapy (ECT). “Electrical currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can reverse symptoms of certain mental illnesses. ECT may be an option for bipolar treatment if you don't get better with medications, can't take antidepressants for health reasons such as pregnancy or are at high risk of suicide” (Mayoclinic, 2018).
Bipolar Disorder is a complex mood disorder that if left untreated can cause significant challenges in a person’s life. The extreme shifts in mood can make everyday life incredibly challenging. Because of studies done on physiological causes of Bipolar Disorder, doctors are now able to better treat the symptoms with a variety of medication as well as other treatment options. Bipolar Disorder is a fairly common diagnosis, in fact 1 out of every 100 people will be diagnosed with it at some point in their life (DBSA, 2009) therefore it is important that we have an accurate understanding of the disorder.
References
- American Addiction Centers. (2015). Brain Imaging and Bipolar Disorder. Retrieved from https://www.mentalhelp.net/bipolar/brain-imaging/
- Bhandari, S. (2019, March 18). Bipolar Disorder Causes & Risk Factors. Retrieved from https://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-causes#1
- Bressert, S. (2020, January 14). Causes of Bipolar Disorder. Retrieved from https://psychcentral.com/bipolar/bipolar-disorder-causes/
- Haslam, N. (2020, March 2). Romcom's silver lining is its portrayal of mental illness. Retrieved from http://theconversation.com/romcoms-silver-lining-is-its-portrayal-of-mental-illness-11715
- LeBeau, R. (2013, January 26). 'Silver Linings Playbook' Makes a Hit Film Out of a Risky Concept: A Romantic Comedy about the Mentally Ill. Retrieved from https://www.psychologyinaction.org/psychology-in-action-1/2013/01/26/silver-linings-playbook-makes-a-hit-film-out-of-a-risky-concept-a-romantic-comedy-about-the-mentally-ill
- Mayoclinic. (2018, January 31). Bipolar disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/diagnosis-treatment/drc-20355961
- Nemade, R. (1995). Neurochemistry and Endocrinology in Bipolar Disorder. Retrieved from https://www.gracepointwellness.org/4-bipolar-disorder/article/11204-neurochemistry-and-endocrinology-in-bipolar-disorder
- Silver Linings Playbook. (2012, December 29). Retrieved from https://www.imdb.com/title/tt1045658/reviews
- Smith, M. (2020, February 17). Bipolar Disorder Signs and Symptoms. Retrieved from https://www.helpguide.org/articles/bipolar-disorder/bipolar-disorder-signs-and-symptoms.htm
- Truschel, J., & Montero, H. A. (2019, November 29). Bipolar Definition and DSM-5 Diagnostic Criteria. Retrieved from https://www.psycom.net/bipolar-definition-dsm-5/
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