Susan G. Goldberg

The Social Construction of BiPolar Disorder: The Interrelationship Between Societal and Individual Meanings

by Susan G. Goldberg
Fielding Graduate University, School of Psychology, Clinical Psychology Program
November 21, 2007

Viewed through the perspectives of individuals diagnosed with bipolar disorder, this qualitative study investigated how American society has constructed the diagnosis of bipolar disorder and what the implication may be for individuals labeled with this diagnosis. The study involved narrative interviews of five women and one man who were diagnosed with bipolar disorder. Participants were in their thirties to fifties and identified as European Americans. Hermeneutic, social constructionist, and Lacanian approaches influenced the analysis.
There were two main sets of findings. First, a mutual interaction between individual experience and societal labels was evident. Language, culture, and society limited the choice of labels for self and other. The participants’ self-labels, such as how they moved from being “depressed” to “bipolar,” reflected changing societal conceptions of mental disorder.

The second set of findings revealed the challenges to self and identity that the participants faced. It was difficult for participants to develop a cohesive sense of self in light of the particular way the psychiatric community defines bipolar disorder and society understands it. The participants also found it challenging to experience “selfsameness,” an ongoing and continuous sense of self, especially because they experienced some affective states as foreign and “not-me.” Further, the biochemical imbalance explanation for bipolar disorder undermined participants’ sense of identity and personal control because this explanation suggests that their feelings and behavior are controlled by an external entity (biochemicals) rather than their conscious will.
There are four areas in which the findings may link to larger societal issues. The first involves a blurred and fluctuating boundary in American society between “normal” exuberance and “crazy” mania and how this societal confusion affected participants’ meaning-making. The second addresses the process by which society inducts people into the role of patient. The third implicates Western society’s difficulty in recognizing the limitations of volitional control. A related issue is the Western challenge in bridging mind-body dualism. Participants faced this issue when making sense of experiences that are labeled a mental illness, but which have somatic, affective, and cognitive components. The findings also suggest that negative societal projections about bipolar disorder may be shifting.

Key words: Bipolar disorder, depression, mania, hypomania, manic depression, social construction, Lacan, narrative research, projective identification, labeling theory, identity.