Recently, I’ve been coming across a lot of voices in the bipolar community saying that bipolar disorder isn’t a chemical imbalance.
The first time I really started thinking about this was after coming across Michelle Baughman Reittinger and her work with The Upside of Bipolar. I came across her on Instagram, and something she said made me stop and think about something I had always believed about bipolar disorder. It made me start rethinking something I had never really questioned before.
When I was younger, being told that bipolar disorder was a “chemical imbalance” actually helped me. I thought of the brain as an organ, just like the heart or kidneys. If something was wrong with my brain, that meant I had an illness. It didn’t mean there was something wrong with me as a person.
That distinction mattered to me. It helped me separate who I was from what bipolar disorder could cause me to experience during an episode. I felt less to blame and less ashamed.
But I’m beginning to understand why the term “chemical imbalance” is no longer considered an accurate way to explain bipolar disorder.
The DSM-5-TR, the current version of the Diagnostic and Statistical Manual of Mental Disorders, doesn’t diagnose bipolar disorder by identifying a chemical imbalance. Instead, it describes the disorder through patterns of symptoms and mood episodes. In other words, the diagnosis tells us what bipolar disorder looks like clinically, but it does not point to one specific biological cause.
The National Institute of Mental Health says the exact cause of bipolar disorder is unknown. Research suggests that multiple factors are involved, including genetics and differences in brain structure and function, rather than one simple chemical problem.
There’s also research suggesting that the way we explain mental illness can affect how people view those who have it. Biological explanations can reduce blame, which can be helpful, but some studies have also found that they can contribute to ideas that someone’s brain is defective, that their condition is hopeless, or that they may be more dangerous or difficult to be around.
The University of Michigan has discussed this same concern, explaining that the problem with the “chemical imbalance” metaphor may be that it can make people think something in the brain is simply broken or defective.
I can understand that.
But my experience was almost the opposite.
For me, the biological explanation helped remove the idea that bipolar disorder was a character flaw. It helped me understand that I had an illness involving my brain—not that I was a bad, weak, crazy, or difficult person.
So maybe the problem wasn’t that we tried to explain bipolar disorder biologically. Maybe “chemical imbalance” was simply too simple to explain something as complicated as bipolar disorder.
The terminology needs to change because our understanding has changed.
I can change my mind about the words we use without changing my belief that bipolar disorder is real. It is an illness, the brain is involved, and having an illness is nothing to be ashamed of.
For me, that part will never change.