Bipolar disorder, formerly known as manic depression, is a mental illness characterized by extreme mood swings. People with bipolar disorder alternate between episodes of mania (elevated moods, high energy, and sometimes reckless behavior) and depression (low moods, low energy, and sadness). This alternating pattern can wreak havoc on a person’s life, damaging relationships and careers. But are bipolar individuals responsible for their actions, especially during manic episodes when their judgment is impaired?
The Nature of Bipolar Disorder
Bipolar disorder is widely considered to be a biological illness, rooted in genetics and brain chemistry. Research suggests that abnormalities in certain neurotransmitters (chemical messengers in the brain) and hormonal imbalances contribute significantly to bipolar mood episodes. Genetics also play a strong role, as bipolar disorder runs in families.
In this sense, those with bipolar disorder did not choose to have these biological vulnerabilities and irregularities any more than someone chooses to have diabetes or heart disease. Their brains are simply wired differently, making them prone to unstable moods over which they have limited control, especially when ill.
Manic Episodes Impair Judgment
During manic episodes, elevated moods, racing thoughts, impulsivity, and other symptoms often cause severely impaired judgment. Mania affects parts of the brain controlling inhibition, self-control, and rational thinking. This altered state prevents reasonable decision-making and appropriate social behavior.
For example, a person in a manic state may:
- Make impulsive, risky financial decisions like spending sprees or bad investments
- Engage in reckless behaviors like drug use or unsafe promiscuity
- Lash out in anger or get into fights
- Make impractical, grandiose plans that are unrealistic
In a normal state of mind, the individual would likely not make such choices. But in mania, they are acting on poor judgment caused by a malfunctioning brain, rather than conscious intent.
Full Awareness is Often Lacking
Many people in a manic state have limited insight that their behavior is abnormal or inappropriate. The Euphoric high feels so right to them that they believe it, despite the consequences. This lack of awareness further compromises their ability to make reasonable choices.
After an episode ends, however, most feel deep remorse and regret over their uncontrolled actions. They may attempt to make amends where possible, recognizing that the mania drove them to behave in ways that do not reflect their true character.
Impaired Functioning and Disability
The extreme mood swings of bipolar disorder significantly disrupt normal functioning. Rates of unemployment, disability, substance abuse, divorce, and suicide are much higher in those with bipolar compared to the general population.
According to one study, bipolar patients had the following elevated rates:
- Unemployment: 60% vs. 25% in control group
- On disability: 50% vs. 15% in control group
- Drug or alcohol abuse: 60% vs. 10% in control group
- Divorce: More than 70% had been divorced at least once
- Suicide attempts: 25 to 50% vs. 2-9% in general population
This indicates that bipolar disorder severely interferes with normal, healthy functioning in numerous aspects of life.
Stigma Surrounding Bipolar Disorder
There is significant stigma related to bipolar disorder and other mental health conditions. Some people view it as a character flaw or personal weakness rather than a legitimate medical illness. But research clearly contradicts this misconception.
When symptoms spiral out of control during an episode, relationships often suffer. Family and friends may take things personally rather than recognizing it as the disorder. This can damage relationships and leave patients feeling judged or abandoned.
Medication is Often Necessary
Due to its biological nature, medication is often needed to help regulate moods and brain chemistry in bipolar disorder. This may include mood stabilizers, antipsychotic medications, and antidepressants. However, some struggle with adherence due to side effects, lack of insight, forgetfulness during manic states, and other factors.
Consistent medication compliance can help diminish the severity of episodes. With proper treatment, many start to gain better control over their moods and impulses, allowing more normal functioning.
Psychotherapy Helps Provide Coping Tools
In conjunction with medication, psychotherapy often helps those with bipolar disorder:
- Gain insight into their condition
- Identify triggers and early warning signs of episodes
- Develop coping strategies to mitigate symptoms
- Make necessary lifestyle adjustments
- Monitor their moods and thoughts
With therapy, many begin to take accountability for their health by developing skills to more responsibly manage their illness.
Self-Management Strategies Are Key
Along with professional treatment, individuals can take responsibility through self-management strategies like:
- Keeping a regular sleep, diet, exercise, and routine
- Reducing stress and avoiding triggers
- Practicing mindfulness and stabilization
- Maintaining open communication with doctors
- Recognizing early warning signs
- Following a treatment plan consistently
Using such strategies helps them take control of their illness rather than allowing it to control them.
Personal Accountability Varies
Accountability ultimately depends on the individual case and where the person is in treatment and self-management of their bipolar disorder. During severe manic episodes, personal accountability is often quite limited. But between episodes, many are able to take responsibility through proper treatment and lifestyle choices.
Some general guidelines for assessing personal accountability include:
- Severe mania: Little to no accountability due to break from reality.
- Mild-moderate mania: Impaired judgment reduces accountability.
- Depressive episodes: Severe depression may limit but not eliminate responsibility.
- Between episodes: Responsible for pursuing proper treatment and self-care.
- Adherence to treatment: Accountable for following treatment plans as prescribed.
- Self-awareness: Responsible for monitoring moods, thoughts, and behaviors.
- Lifestyle factors: Accountable for diet, sleep, substance use, stress management.
- Support system: Should enlist help from others when needed.
Legal Implications
Legal responsibility ultimately depends on each specific case and situation. General principles include:
- Severe mania may meet “insanity” standards in criminal courts due to lack of awareness or control.
- Impaired judgment during mild/moderate episodes may warrant professional testimony about mitigating circumstances.
- Competency may be questioned during severe episodes when mental capacity is very compromised.
- Civil lawsuits consider if the person exhibited reasonable care and judgment given their condition.
- Judges and juries should educate themselves about bipolar disorder to make fair informed decisions.
- A longitudinal history of adherence vs. non-adherence to treatment should be considered.
Those with bipolar disorder should not face blanket punishment without regard for extenuating circumstances. But legal responsibility ultimately depends on each unique situation.
Conclusion
In summary, personal accountability for those with bipolar disorder varies substantially based on the individual’s phase of illness and whether they are experiencing an acute episode. Severe manic episodes may lead to extremely poor judgment in which the person is acting on their brain’s impaired impulses rather than rational choice. But during stable periods, most are capable of taking responsibility through proper treatment, lifestyle choices, self-awareness, and self-management strategies. Those with bipolar disorder should not face stigma or blanket judgment, but be assessed based on their own specific circumstances. With compassion and understanding, accountability can coexist with recognizing the legitimate medical affliction these individuals face.