Carrie Fisher, who died on Tuesday, has been rightly celebrated for her artistic career. She’s also been recognized as a mental health advocate, and she often intertwined the two. Afflicted with bipolar disorder, she educated the public about the condition as if she were on a mission. Her books, notably the 1987 semiautobiographical Postcards From the Edge, interviews, and her 2009 one-woman show, Wishful Drinking, painted a realistic portrait of a woman who struggled mightily but endured.
Brutally funny and honest in equal measure, Ms. Fisher did not play the victim. “Well, I am hoping to get the centerfold in Psychology Today,” she once told WebMD. “I define [bipolar illness], rather than it defining me.”
As a psychiatrist, I can’t think of a healthier attitude. Fisher spoke publicly and truthfully about her condition and in doing so, offered many lessons from which we can all learn.
First, she promoted the best treatments that psychiatry has to offer. “The only lesson for me, or anybody, is that you have to get help,” she told People magazine in 2013. Too many Hollywood stars embrace fringe therapies as the sole approach to mental illness. Not Fisher.
“I have a chemical imbalance that, in its most extreme state, will lead me to a mental hospital,” she said to People. “I am mentally ill. I can say that. I am not ashamed of that. I survived that, I’m still surviving it, but bring it on.” Indeed, when her condition was at its most intense, Fisher turned to electroconvulsive therapy, or ECT. ECT is still overshadowed by its One Flew Over the Cuckoo’s Nest reputation as a damaging procedure. Yet it is one of the most effective treatments, perhaps the most effective, for severe mania or depression (both are symptoms of bipolar illness) that has not responded, or responded quickly enough, to medication. Fisher’s openness is one step toward demythologizing ECT and, as such, it was a major contribution to public awareness.
Second, Fisher’s openness about her family and personal history demonstrated the complexity of mental illness. She suspected her father had undiagnosed bipolar illness, stating that his wild overspending was at least one indication. Fisher had a tumultuous childhood. Her father abandoned the family when she was 2 years old; her famous mother, Debbie Reynolds, who reportedly gave her a vibrator for Christmas when she was 15, was absent much of the time. Fisher began using LSD in her teens, sometimes with her father. “I find that I don’t have what could be considered a conventional sense of reality,” she wrote.
To be sure, a chaotic childhood is not a risk factor for bipolar illness. (There is a genetic factor, of course, and other biological vulnerabilities.) But it may well have predisposed her to the insecurities and anxieties Fisher would go on to write about. And those in turn would play a role in her use of vast quantities of hallucinogens, alcohol, sedatives, and cocaine. These drugs complicated her life for years as she attempted to sort through which problems resulted from drug use, which resulted from her illness, and which came from some combination of the two.
Her willingness to speak candidly about how each of these situations influenced her life and her ability to accept her diagnosis and work with her doctors set an example for people struggling through similar situations.
Finally, Fisher had the real thing. Bipolar illness is devastating. The symptoms can be terrifying: paranoid hallucinations, delusions (she had those), a black abyss of demobilizing depression. The suicide rate is estimated to be as high as 15 percent, with one-quarter to half of all bipolar individuals attempting it at some point in their lives.
In recent years, I’ve been dismayed to see bipolar disorder become a throwaway diagnosis, often self-determined. Today, many people quip about being bipolar when they talk of “mood swings” or state that “one minute I am happy, and the next I’m sad.” It’s certainly true that many people who feel these things may benefit from psychological help. They may have mild mood instability, they may be impulsive, they may have difficult lives that would demoralize anyone, and they may use drugs (which can sometimes mimic the symptoms of mania). Some of them may even have bipolar disorder, and if they do, they should seek the help they need to get a correct diagnosis, and subsequent treatment, which can be quite effective at managing symptoms.
But when people label unwanted mood states as bipolar, they trivialize severe conditions and undermine efforts to reduce the burden of shame that many patients and their families still feel.
Embracing the seriousness of bipolar disorder and helping sufferers obtain quality care is the best way to fight the stigma. Fisher’s fearlessness in talking about her own battle—“the battle that is me,” as she called it— is a good reminder of why.