Faces of Bipolar Disorder

April 10, 2013 in inQueery


“Mania’s kind of social engagement has a specific quality: it is a one-way outpouring of energy (perceived as masculine in style) rather than a two-way exchange (perceived as feminine in style).” (Martin).

Throughout the evolution of the conceptualization of bipolar (manic-depressive) disorder, there have been markedly gendered qualities to its diagnosis. Prior to the 1800s, the experience of mania was often seen “as both frightening and masculine” (Martin). Throughout the early twentieth century, a transformation occurred in the diagnosis with respect to categorical gender associations, namely gender became “encoded in the very category itself…the most salient characteristics…were those associated in other contexts with an unbounded, out-of-control femininity” (Martin). At this point in time, men who received a diagnosis of mania were characteristically seen as feminine in nature due to the assumptions surrounding the “excitable, distractible, and talkative” behavior of women (Martin).

Although research into gendered experiences of bipolar disorder have shown no evidence of differences (Kawa), the intersection of gender with the diagnosis is stunningly perverse. The inception of a male manic has occurred in the current paradigm of psychiatric treatment, yet it is seen as potent, “powerful and effective despite or, more exactly, because of his instability” (Martin). For the same reasons of energetic intensity, those who are perceived to be women by social norms have a difficult time reconciling their female identity with a diagnosis of bipolar disorder.

This intersection of gender and bipolar categories are seen in the experiences of inner-city Latina women with severe mental illnesses (Collins). First hand accounts of 24 Latinas demonstrated that “having a mental illness, being a member of an ethnic minority group, being an immigrant, being poor, and being a woman who does not live up to gendered expectations” (Hankivsky) compelled behavior that ultimately resulted in a greater risk for HIV. These individuals, all of whom were considered to be bipolar, also expressed feeling a need to identify “with faith and religion (‘church ladies’) and uphold more traditional gender norms (‘good girls’) that are often undermined by the realities of life with a severe mental illness and the stigma attached to it” (Collins). As noted previously in the discussion surrounding bipolitics and social discourses, individuals with bipolar disorder often pursue acceptance of their peers through attempting to engage with normative behavior (Martin). In this instance, these women often attempted to be ‘church ladies’ and ‘good girls’ so as to satisfy what may be their cultural norm. Through pursuing behavior that conforms to an individual’s gendered norms, the women often simultaneous pursued non-normative behavior, including hypersexuality that exposed them to higher risk of HIV. (Collins).

The experiences of the 24 Latinas and research by contemporary medical anthropologists have demonstrated a continued exacerbation of the symptoms of bipolar disorder through gendered norms. Through failing to recognize nature and culture as not mutually exclusive, but rather that body, sex, and gender are fluid (Tuana), bipolar disorder has interacted with gendered norms in a destructive manner. The “interweaving of genetic and environmental factors” (Tuana) that contributes to bipolar disorder implores the recognition that social determinants, such as gender identity among other factors, alters the experience of the disorder. Subsequently, addressing the manifestation of the condition requires purer objectivity as well as thoughtful and non-assuming social support. Yet, the true neuroanatomical and physiological nature of the disorder is, currently, not well characterized and so its treatment rests upon socially shaped, clinical observations (DSM-IV-TR (2000) 4th ed., text rev.; Savitz).

Gender constructs are also reinforced through the comorbidity of bipolar disorder with other “socially deviant” behavior. Through the same normative perspective that sees the over-pouring of energy as exclusively masculine, men are also reported to have “higher rates of comorbid alcohol abuse, cannabis abuse, pathological gambling, and conduct disorder” (Kawa). Meanwhile, women were often observed to have “comorbid eating disorders and weight change” (Kawa). Literature looking into biological factors to these different comorbid experiences could not be found, yet it’s strong correlation between sex and behavior may have reinforced pre-existing gender differences. Furthermore, it has been concluded that the burden of anxiety disorders is “more disabling in women than in men” (McLean). Previous research into the intersection of gender identity, immigration status, and mental health condition complicates these gendered findings. Perhaps these gendered differences in the experience of bipolar disorder are not of a biological origin, but rather a consequence of extensive gender normative socialization.

Jonathan Baio is a guest contributor at InQueery and studies Chemical Biology at UC Berkeley.
You can follow Jon’s personal and business ramblings on Google+


    References

    • American Psychiatric Association. (2000). Bipolar Disorder. In Diagnostic and statistical manual of mental disorders (4th ed., text rev.).
    • Collins, P.Y., von Unger, H. & Armbrister, A. (2008) Church ladies, good girls, and locas: Stigma and the intersection of gender, ethnicity, mental illness, and sexuality in relation to HIV risk. Soc. Sci. & Med. 67: 389-97.
    • Hankivsky, O. (2012) Women’s Health, men’s health, and gender and health: Implications of intersectionality. Soc. Sci. & Med. 74: 1712-20.
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    • Tuana, N. (2009) Viscous Porosity: Witnessing Katrina. In S. Alaimo and S. Hekman (Eds.), Material Feminisms (188-213). Bloomington: Indiana University Press.