All in the brain?

I was left with very mixed (almost bipolar!) emotions after watching Stephen Fry's portrait of his life with manic depression or bipolarity (BBC2).

On the one hand, I was uplifted by his very personal courage in exposing his private torment (reaching the verge of suicide at its worst) to a mass audience and also by the programme's laudable aim of using his celebrity status to promote a wider understanding of mental illness and presumably reduce the stigma associated with it. On the other hand, I felt my own mood sinking in response to the very impersonal way in which Fry's account constantly took us back to an unquestioned assumption that manic depression (and by implication all mental illnesses) have a primarily biological basis. I was hoping for something a little more bio-psycho-social – a little less brain and a bit more mind.
Stephen Fry talked us through critical moments in his life and interviewed people connected with him (for example, an old schoolmaster, friends and fellow celebrities). But rather than shed light on the possible meaning of his problems, these enquiries turned out just to be a historical and quasi-factual search for the first manifestations of 'it', the dreaded condition. Fellow sufferers (including celebrities like Robbie Williams and Carrie Fisher) were also interviewed to compare symptoms and we were shown an American family where 'bipolar disorder' had been thankfully diagnosed early in two very young, troubled boys (whose father did not seem to feature at all!).
No explicit mention of the impact of child development, life experience or relationships on mental health was made. The opportunity to explore links between Stephen's attachments, boarding school life, adolescence and his adult problems was wasted. An evident connection between his absconding from school and his absconding in adulthood (after receiving critical reviews for a West End production) was ignored. No direct links were made to his wit, humour, sexuality, hunger for fame and his craving for the buzz of performance and audience acclaim. And yet, in episode two Stephen tells us how he hears a voice – his own internal second-person critical thoughts rather than a full-blown psychotic third-person externalised voice. Sad though this was to see, no curiosity was expressed about the possibility that this denigratory self-talk (in conjunction with its polar opposite of self-admiration) might reflect an internal conflict rooted in actual life experiences. Of course, this would be too personal for TV which is really a performer's medium after all.

After biological treatments (including a promotion for ECT) had been exhausted, CBT put in a brief appearance at the end of episode two. Jan Scott (Institute of Psychiatry) was shown movingly reaching the emotional pain of a woman who needed to feel 'shiny' (which included 'being a writer') and who could not bear the thought of being dull or ordinary. There was a glimpse here of the potential value of one psychological approach to challenge an underlying schema and actually treat this problem, but this got lost in the final message that talking cannot go beyond helping people cope with their chronic brain disorders. In a way, though, the personal did ultimately triumph, because Stephen concluded that despite all he had been through he would never push a magic button to remove his bipolarity. If this were cancer this would be a crazy choice, but his choosing not to push the button shows us that his extreme mood swings are an aspect of him as a complex person and not simply a disease after all.
    Martin Seager

The media watches us too
THE validity of the stance adopted by the Society in response to the consultation by the Home Office on the possession of extreme violent pornographic material has been debated in the letters pages of The Psychologist in the May, June and July issues. But regardless of the particular stance, it is interesting to see the way in which the Society itself has been reported in the media.

First, it is positive that the Society is recognised by the media as having something to add to such debates and ultimately government policy. It is also positive that the stance adopted by the Society is recognised as being drawn from research evidence that people predisposed to sexual violence are more likely to engage in it once exposed to such material, and not a particular ideological stance (The Independent).

What is less positive is that disagreement among Society members about the validity of the stance adopted, evidenced in the letters pages of The Psychologist, is also acknowledged in the media (The Guardian). Disagreement among researchers in any discipline is to be expected yet it may be less tolerated by the public if, despite no clear agreement, the discipline is seen to be informing government policy.
Marc Jones