Together at the Poles

Is Bipolar Disorder Real? Version One: Is Bipolar Disorder a Brain State?


I’ve increasingly lately met a number of people who doubt the very existence of bipolar disorder. As someone who thinks he has bipolar disorder, figuring out whether or not they are right is of no small importance. After all, if I don’t have bipolar disorder, then I’m really wasting a lot of my time (for one thing, I’d have to retitle my blog “The Tooth Fairy Today”).

What I’ve found quite interesting is that the question “Is Bipolar Disorder Real?” actually says as much about what people mean by “real” as by what they do by “bipolar disorder”. I’ve discussed this sort of phenomenon before in my discussion of what “causes” bipolar disorder. However, this question cuts even deeper. While everyone uses the term “cause” in multiple, compatible ways, the question of whether or not bipolar disorder is “real” shows significant disagreement of what the conditions are for something being called “real”.

So, I thought I’d answer the question in the different senses in which I think the question is asked. Each of these answers will be put in its own post. I’ll be writing these answers as a series, though I will be treating it more as an occasional feature rather than publishing them all consecutively.

Is Bipolar Disorder A Brain State?

One version of what people mean by asking if bipolar disorder is real is whether or not bipolar disorder is some identifiable state of the brain that can, for example, be recognized in a CT scan. So, for instance, if we can’t see that there is activity in a certain, unique area of the brain during episodes (and I imagine there would need to be different areas for different types of episodes), then bipolar disorder doesn’t exist.

Physical Descriptions and Mental Descriptions

However, this position rests on a mistake. To put it simply, even if the mind is the brain, that doesn’t mean that we can reduce descriptions of the mind to descriptions of the brain.

So, for instance, let’s say that the belief that swans are blue always occurs when certain brain neurons fire. That might be true. However, on what grounds do we call that firing “the belief that swans are blue”? Only a person who understands what “swans are blue” means will even understand what it means to say that a particular brain state is the belief that “swans are blue”. In other words, even if we completely describe the brain state, we have not described the mental state.

However, the problem is worse than this. It’s not unimaginable that the belief that “swans are blue” always corresponds to a certain type of brain state. It’s also not imaginable that the belief that “4+3=9” always corresponds to a certain type of brain state. However, this does not imply that there will be some physical sign that we can look for to find “false beliefs”. The falsehood of these beliefs is something that can only be understood in terms of their mental descriptions, not their physical descriptions.

Bipolar Disorder is Described in Mental Terms

Bipolar disorder is something going wrong with our emotional states, in some fairly consistent patterns. However, these problems with our emotional states are ultimately mental descriptions, not physical descriptions. The symptoms of bipolar disorder are ultimately be like “false beliefs”, that is, something that can be described only in mental terms that simply cannot be reduced to physical descriptions.

One the one hand, bipolar disorder may be the result in a physical defect in the system that produces certain neurotransmitters. In that case, there will be a corresponding physical description. On the other hand, this would just be a contingent empirical fact. It is at least theoretically possible that there would be no corresponding physical description, just like with falsehood.

Now, I think that the evidence is pointing more and more to there being some sort of physical cause for bipolar disorder that can be described in terms of brain states. There does seem to be some sort of problem with neurotransmitters, and the twin studies would seem to indicate that it is not the result of environmental factors such as trauma.

However, there are other mental illnesses, such as post-traumatic stress disorder, that do seem to be the result of trauma and other environmental factors. Even if bipolar disorder has a physical cause, it is no more a mental illness and no more real than mental illnesses whose causes can only be described in mental terms. Not only this, but it is real for exactly the same reason: it is a discernible pattern of mental states that can be described in mental terms.

I therefore would argue that this is irrelevant to the question of whether or not bipolar disorder is real. The description of bipolar disorder is ultimately a mental description, not a physical description. Like many mental states, whether or not there is a unique corresponding physical description is irrelevant to whether or not bipolar disorder is real.

2 Responses to Is Bipolar Disorder Real? Version One: Is Bipolar Disorder a Brain State?

  • 4/19/12 I have taken lithium since 1982 and have little side affects so it has been good for me. I started having problems after age 35 and after assault in my home by stranger. It was 11 years later that I got on lithium after many years on wrong medicines. I now take an anti depressant at night to help me sleep along with 300 mg of lithium. The low dosage has been enough to keep me from the high and lows of bi polar disorder. I am thankful for lithium.

    • Hi Loretta,

      That’s quite interesting that you’ve had success on such a small dose. There was a study last month that suggested that small doses of lithium can be very helpful, when combined with other medications (in that case, atypical antipsychotics, but the principle could apply elsewhere). For those who’ve had trouble with lithium side effects, it may be worth talking to a psychiatrist of using a smaller dose along with another medication.

      Best,
      Daniel

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Psychotherapy from Daniel

Daniel Bader, Ph.D., RP (Qualifying), CCC

Daniel Bader, Ph.D., is a Registered Psychotherapist (Qualifying) and Canadian Certified Counsellor specializing in bipolar disorder, offering in-person psychotherapy in Kitchener, Ontario, and online and telephone psychotherapy within Canada.

To book an appointment with Daniel, please visit his Psychology Today profile.