Slouching around the internet recently I happened upon an article with a title that intrigued me – and one that I have shamelessly stolen for this blog. Where once the mentally troubled went to enormous lengths to avoid a diagnosis of mental illness, today some of us are actively seeking it, or seeking one diagnosis in particular: bipolar disorder. Part of the occasional BBC Online series ‘Scrubbing up’, the article, by psychiatrist Diana Chan, describes how the ‘celebrity effect’, it might more properly be called the ‘Stephen Fry effect’, has led to people directly requesting the diagnosis. According to Chan, the willingness of celebrities openly to discuss their experiences of mental illness has withered some of its stigma. In the case of bipolar disorder it may even have become – the word is mine, not Dr Chan’s – fashionable. “A new diagnosis of bipolar disorder” she writes, “might also reflect a person’s aspiration for higher social status and a feeling that by having the condition they too are creative.”
Few will argue against reducing the stigma attached to mental illness. Felled by depression in my twenties (the verb nicely borrows flavour from the adjective: ‘fell’ – cruel, fierce, terrible) I struggled almost as much under the weight of diagnosis as with the condition itself. And this despite my mother being a psychiatric nurse, and having been exposed to the occasional symbiosis between mental illness and creative genius during an arts degree. But it is clearly one thing to view mental illness through the gorgeous prism of a fine art monograph – as I did with van Gogh – and quite another to be struck down by it while unemployed, without obvious talent and living in a down-at-heel student flat. I was appalled when told I was mentally ill, and even now I prefer the label ‘depression’ to its proximate cousin ‘anxiety’ as to me it lacks the latter’s suggestion of effeteness, despite never having set much store by my masculinity. It is still easier to admit to being melancholy than to being afraid.
But while we must welcome any reduction in stigma, we might need to be wary of a consequent flight into diagnosis. For a diagnosis can be more than a neutral description of some deviation from normal, whatsoever we might take that to mean, functioning. A diagnosis can also be a fate, or even a figleaf. As Chan writes, “It is important for psychiatrists to make the diagnosis when valid. Conversely, it is equally essential to help people that desire the diagnosis to understand that having ‘mood swings’ or chaotic and disorderly behaviour does not necessarily mean that they are suffering from bipolar disorder.” Looking between Chan’s lines my young self hoves into view. To say that I was responsible for the depression that overtook me is as absurd as saying I had nothing to do with it. Trying to think about these things is not easy. It is a little like trying to walk in two directions at once, with fairly predictable results. Certainly it has taken me many years to come to a kind of truce with my depression, or however it might be best to label it. I have been lucky. Medicine helped and it has been many years since I have been laid low. No doubt depression is also some nasty trick of my underlying biology. But living with it, knowing its destructive potential, I recognise that I also have to make choices, that with or without it my life is also mine to steer. We owe a great debt to the courage of people like Stephen Fry. But diagnosis is not destiny and medicine is not a reading of our fate. There will almost always be some room for choice.