Bipolar Disorder

 

Is a lifetime medical condition.

It affects moods, energy, thinking and behaviour.

It causes major mood swings from one emotion to the other.

Going from emotional highs, Mania or hypomania, to low depression.

 

How Bipolar affects people

These changes can affect:

Sleep

Focusing

School

 

During high moods, a person may experience:

Feeling very happy or excited (euphoria)

During high moods, a person may experience:

Feeling very happy or excited (euphoria)

Lots of energy

Needing very little sleep

Racing thoughts

Talking very fast

Feeling irritable or angry

Impulsive behaviours (spending lots of money, risky choices)

Poor judgement

In severe cases, some people may experience psychosis (losing touch with reality).

Lots of energy

Needing very little sleep

Racing thoughts

Talking very fast

Feeling irritable or angry

Impulsive behaviours (spending lots of money, risky choices)

Poor judgement

In severe cases, some people may experience psychosis (losing touch with reality).

 

⬇️ Low Moods: Depression

During low moods, a person may experience:

Deep sadness or hopelessness

Very low energy

Loss of interest in things they usually enjoy

Trouble concentrating

Changes in sleep or appetite

Feeling worthless or guilty

Thoughts about death or suicide

 

🔄 Episodic Nature of Bipolar Disorder

Bipolar disorder is episodic.

This means:

Mood changes happen over days, weeks, or months

Some people have periods of stable or normal mood in between episodes

Everyone’s pattern is different.

 

⚠️ Causes and Risk Factors

Bipolar disorder usually develops due to a combination of factors, including:

Genetics (family history)

Brain structure and brain chemistry

Stressful life events or trauma

It is not caused by personal weakness.

Bipolar disorder can be managed with the right support.

 

🩺 Treatment and Management

💊 Medication

Mood stabilizers

Antipsychotic medication

Sometimes antidepressants (carefully monitored)

 

Talking Therapies

 

Psychotherapy can help people:

Understand their moods

Develop coping skills

Improve relationships

Recognise early warning signs

 

 

 

 

 

 

 

 

Work

How we get along with people. 

 

 

 

 

 

 

 

 

 

 

 

 

Key points from the WHO bipolar disorder fact sheet

Bipolar disorder affects mood.

 Energy, activity and thinking.

 The moods go from episodes of mania or hypomania.

 

 

 

 

Episodes of depression.

Research says there were 37 million people worldwide who were living with bipolar disorder in 2021, which made up approximately 0.5% of the global population.

It can have a huge effect on work, education, relationships and everyday life.

  It is important to know that it is a disability and social issue as well as a medical one.

Employment isn't necessarily negative. WHO specifically says that employment can sometimes be protective.

With good working conditions and reasonable workplace adjustments, employment can improve functioning, symptoms, quality of life and self-esteem.

Treatment can include a combination of medication, psychological interventions and psychosocial support.

 WHO also identifies supported employment, supported housing and peer support as useful recovery-oriented approaches.

 

 

 

Access is a major problem.

 WHO says treatment coverage is low, and many people are misdiagnosed or do not have access to recommended services.

Stigma and discrimination can also restrict people's opportunities for education, employment and housing.

This connects really well with what we were discussing

 

The employment section is particularly relevant to your earlier point about disabled people who can work and those who cannot.

 

Bipolar disorder doesn't automatically mean that somebody cannot work. Someone might be able to work full-time, part-time, with reasonable adjustments, intermittently, or not at all depending on their circumstances and symptoms.

 

And that is why I think this sentence from the WHO is particularly useful for your course:

 

Employment can be protective when working conditions are supportive.

 

That challenges the idea that disability support and employment are opposites. Good support can sometimes help someone remain in employment rather than forcing them out of it.

 

It also fits your argument about affordable mental-health services. If someone receives appropriate treatment and support early enough, they may have a better chance of maintaining their relationships, education, employment and independence. WHO describes recovery as possible and says people with bipolar disorder can live meaningful and productive lives with appropriate care.

Bipolar disorder is a life-time mental health condition.

It affects mood, energy, thinking, and behaviour.

It causes major mood swings, ranging from emotional highs (mania or hypomania) to lows (depression).

 

 

 

 

 

 

🧠 What Happens in Bipolar Disorder?

                      People with bipolar disorder face episodes, which can last days, weeks, or longer:

 

                      🔺 Manic / Hypomanic Episodes (High Mood)

                      Feeling unusually happy, excited, or “on top of the world”

                      Very high energy and activity levels

                      Reduced need for sleep

                      Talking quickly or racing thoughts

                      Impulsive or risky behaviour (e.g., spending, decisions)

Irritability or agitation (not always “happy” mania)

👉 Hypomania is a milder form (less severe, no hospitalisation typically needed)

 

🔻 Depressive Episodes (Low Mood)

Persistent sadness or emptiness

Loss of interest in activities

Fatigue or low energy

Sleep problems (too much or too little)

Difficulty concentrating

Feelings of hopelessness or worthlessness

🔍 Main Types of Bipolar Disorder

Type  Key Features

Bipolar I At least one full manic episode (may include depression)

Bipolar II   Depression + hypomania (no full mania)

Cyclothymic Disorder: Ongoing mood swings that are less severe but long-term

⚠️ Causes and Risk Factors

The exact cause isn’t fully understood, but it usually involves a mix of:

 

Genetics (runs in families)

Brain chemistry (neurotransmitter imbalance)

Stressful life events

Substance use (alcohol/drugs)

🌍 Impact on Daily Life

Without support, bipolar disorder can affect:

 

Relationships (conflict, misunderstandings)

Work or education (inconsistent performance)

Finances (impulsive spending during mania)

Physical health (sleep disruption, stress)

👉 It can sometimes be mistaken for conditions like Depression or Anxiety disorder, especially early on.

 

🩺 Treatment and Management

Bipolar disorder is manageable, but usually requires long-term support:

 

💊 Medication

Mood stabilisers (e.g., lithium)

Antipsychotic medications

Sometimes antidepressants (carefully monitored)

🧠 Therapy

Cognitive Behavioural Therapy (CBT)

Psychoeducation (understanding the condition)

Family or group therapy

🧘 Lifestyle Support

Regular sleep routine

Stress management

Avoiding alcohol and drugs

Monitoring mood changes

🚨 When to Seek Urgent Help

Immediate support is needed if someone:

 

Is at risk of harming themselves or others

Experiences severe mania (loss of control, psychosis)

Has suicidal thoughts during depression

In the U.S., you can call or text 988 for mental health crisis support.

 

🔗 Learning Links (for your modules)

Mood disorders → Depression

Anxiety overlap → Anxiety disorder

Substance use links → Alcohol Use Disorder

❓ Study & Reflection Questions

What is the difference between mania and hypomania?

Why might bipolar disorder be misdiagnosed at first?

How does sleep affect mood stability?

What risks can occur during manic episodes?

💡 Key Takeaway

Bipolar disorder involves real biological changes in mood and energy—it’s not just “moodiness.” With the right treatment and understanding, many people live stable, fulfilling lives.

 

IQ

 1961: A change in classification

 

The American Association on Mental Deficiency (AAMD) published its Manual on Terminology and Classification in Mental Retardation in 1961. The manual moved away from the older historical categories such as idiot, imbecile, and moron and toward a more standardized classification based substantially on intellectual functioning and adaptive behavior.

 

The 1961 system included:

 

Classification  Historical IQ range*

Borderline 68–83

Mild    52–67

Moderate 36–51

Severe      20–35

Profound   Below 20

 

*The precise ranges varied depending on the intelligence test being used. The classification was based heavily on IQ and was expressed in terms of standard deviations from the test mean.

 

Why this was an important change

 

The change shows how professional terminology was becoming more standardized and systematic.

 

Instead of describing someone with highly stigmatizing historical labels such as:

 

"idiot" → "imbecile" → "moron"

 

the classification moved toward terms describing levels of functioning.

 

However, it's important to remember that the terminology still differed greatly from today's language. The term mental retardation remained the professional term for many decades.

 

Another important development was the increasing recognition of adaptive behaviours in everyday life—rather than relying entirely on an IQ score. The 1961 AAMD manual incorporated adaptive behaviour into its terminology and classification.

 

The terminology continued to change

 

The process didn't stop in 1961.

 

1961:

Mental retardation + IQ-based categories + growing emphasis on adaptive behaviour

 

⬇️

 

1973:

The AAMD changed the definition to require significantly subaverage intellectual functioning and deficits in adaptive behavior and eliminated the borderline category.

 

⬇️

 

Later decades:

The field increasingly moved away from defining people primarily by IQ level and toward considering adaptive functioning, support needs, and the person's actual functioning in their environment.

 

⬇️

 

Today:

Intellectual disability is the preferred terminology. In the United States, federal law formally replaced mental retardation with intellectual disability through Rosa's Law (2010).

 

The bigger lesson for your module

 

This fits extremely well with your earlier section on the danger of labelling.

 

The history shows that changing terminology is not merely about finding a nicer word. It reflects changing ideas about:

 

What disability means

How people should be assessed

How much importance should be placed on IQ

The role of adaptive functioning

The person's support needs

How society views people with intellectual disabilities

 

And importantly, changing the label alone does not eliminate stigma. A new term can eventually acquire negative meanings if society continues to use it to stereotype or devalue people.

 

That is why modern disability practice places increasing emphasis on the individual, strengths, abilities, support needs, participation, and right-not simply a diagnostic label or IQ score.

Life for disabled people from 1900 to 1945.

 This develops the 1900–1945 section much further. It is especially useful because it shows that disability history involved both severe oppression and the beginnings of organised resistance and rehabilitation.

One thing I would change in your notes is the wording “two World War homecomings.” World War I had a particularly important impact on rehabilitation and attitudes toward disabled veterans; World War II continued and expanded those developments.

🏥 Disability, 1900–1945: Segregation and Eugenics

During the first half of the 20th century, many disabled people experienced institutionalisation, segregation, paternalism, and discrimination.

Mass institutionalization

People with intellectual, psychiatric, physical, and sensory disabilities could be placed in institutions rather than supported to live in their communities.

Conditions could include:

• Overcrowding
• Lack of privacy
• Separation from family
• Restricted freedom
• Physical restraints
• Poor living conditions
• Forced or unpaid work in some institutions

The important issue is that institutionalisation was not experienced the same way by everyone, and conditions varied considerably between institutions and countries. But the broader system often gave disabled people very little control over their own lives.

🧬 Eugenics

Eugenics was one of the most damaging ideas of this period.

It promoted the false belief that society could be improved by encouraging reproduction among people considered "desirable" and preventing reproduction among people considered "undesirable."

People with disabilities were among those targeted.

This resulted in practices including:

• Forced sterilization
• Restrictions on marriage
• Institutional segregation
• Discrimination against people considered "feebleminded"
• In Nazi Germany, ultimately systematic murder of disabled people

The Nazi Aktion T4 program is an especially horrific example of what can happen when disability is viewed as making a person's life less valuable.

🎒 Children and education

Disabled children were also frequently separated from their non-disabled peers.

Assumptions about what disabled children could achieve could limit education. Some children were prepared mainly for basic or manual occupations, rather than being given the same educational opportunities available to other children.

This is an important example of how low expectations can themselves become a barrier.

⚔️ The impact of the World Wars

The World Wars created a major contradiction.

Large numbers of soldiers returned with:

• Physical injuries
• Amputations
• Spinal injuries
• Brain injuries
• Psychological trauma
• Other long-term disabilities

Society could not simply ignore disability when thousands of people who had served their countries returned disabled.

This helped drive development in:

• Rehabilitation
• Prosthetics
• Reconstructive surgery
• Vocational rehabilitation
• Employment programs
• Specialist housing
• Disability advocacy

In Britain, Historic England describes how the return of disabled First World War servicemen challenged existing ideas about disability and contributed to developments in rehabilitation and employment.

🔄 The important transition

So this period contains a major contradiction:

Segregation and eugenics
⬇️
War creates large numbers of disabled veterans
⬇️
Greater public visibility of disability
⬇️
Rehabilitation and employment programs develop
⬇️
Disabled people begin demanding greater control and equality
⬇️
Later disability rights and independent-living movements

And this leads directly into the social model of disability.

The question gradually changed from:

"How do we treat or manage this disabled person?"

to:

"How do we remove the barriers that prevent this person from participating in society?"

That change in thinking is one of the most important developments in modern disability history.

Historical Disability Labels

 

 

Before modern disability terminology developed, words such as “idiot,” “imbecile,” and “feeble-minded” were used in medical, legal, educational, and social contexts to classify people who were considered to have intellectual or developmental impairments.

 

These words may look shocking today because they eventually became insults, but their original historical use was different. Over time, however, they became strongly associated with stigma, institutionalisation, discrimination, and negative assumptions about people's abilities.

 

Idiot — historically used in some classification systems for people considered to have the most significant intellectual impairments.

Imbecile — historically used for a less severe level of impairment than “idiot.”

Feeble-minded — a broad and often poorly defined term used for people considered to have intellectual or developmental limitations.

Moron — introduced in the early 20th century, particularly through the work of psychologist Henry H. Goddard, for people classified at what was then considered a higher level of intellectual ability.

⚠️ The problem with these classifications

 

Historical classifications were often based on much more than what we would consider appropriate assessment today. People could be judged according to:

 

School performance

Communication abilities

Self-care skills

Behaviour and social conformity

Physical or motor characteristics

Whether they met expectations for their age and culture

 

This meant that social prejudice could become mixed with medical or psychological judgment.

 

Someone poor, behaved differently, had difficulty communicating, or failed to meet social expectations could be treated as though they were inherently less capable.

 

🧠 From labels to modern terminology

 

Over the 20th century, terminology changed considerably. “Mental retardation” eventually replaced some of the older terminology in professional settings, but that term itself became increasingly unacceptable because it was used as an insult and carried substantial stigma.

 

Today, “intellectual disability” is the accepted term in most professional and legal contexts.

 

The historical lesson is important:

 

A diagnostic or classification label can change over time, but the way society uses that label can have lasting consequences for people's dignity, opportunities, and rights.

 

This connects directly with your earlier point about the danger of labelling. A label that was originally intended as a professional classification can eventually become a word used to insult, bully, stereotype, or dehumanise people.

 

📚 Disability in the 20th Century

 

History can be understood in three broad stages:

 

1. Early 20th century — Segregation and control

 

People with disabilities were frequently viewed through a medical, institutional, or eugenic lens.

 

Many people were placed in institutions away from their communities.

Eugenic ideas portrayed some disabilities as undesirable traits that should be prevented from being passed on.

Forced sterilisation occurred in the United States and elsewhere.

Some communities even used laws to restrict visibly disabled people from appearing in public.

People were often given very little choice about where they lived, worked, or received services.

 

This period demonstrates how attitudes and social policies can create enormous barriers, even when those policies are presented as being for someone's "care."

 

2. Mid-20th century — Rehabilitation and emerging advocacy

 

The World Wars changed public awareness of physical disability because many injured veterans returned home needing rehabilitation, employment, housing, and accessibility.

 

This helped increase attention to:

 

Rehabilitation

Employment

Prosthetics and assistive technology

Community support

Disability organizations

Economic assistance

 

However, rehabilitation was not the same as disability rights. The focus was often still on changing or "fixing" the individual rather than changing society.

 

3. Late 20th century — Disability rights and independent living

 

This is where there was a major shift.

 

Disabled activists increasingly argued:

 

People with disabilities should have control over their own lives and should not have to be "fixed" before they can participate in society.

 

The Independent Living Movement emphasised choice, autonomy, community living, personal assistance, and equal participation.

 

The Rehabilitation Act of 1973, particularly Section 504, was an important U.S. milestone because it prohibited disability discrimination in programs receiving federal financial assistance.

 

Then came the Americans with Disabilities Act (ADA) of 1990, which established broad federal protections against disability discrimination in areas including employment, state and local government services, public accommodations, transportation, and telecommunications.

 

🔄 The change in thinking

 

You can summarise the overall historical change like this:

 

Institutionalization

↓

Rehabilitation

↓

Advocacy

↓

Independent Living

↓

Civil Rights

↓

Accessibility and Inclusion

 

And this connects directly with the models of disability you've been studying.

 

Earlier approach    Rights-based approach

"What is wrong with the person?" "What barriers exist?"

Institutional care  Community living

Dependence    Independence and choice

Professionals make decisions  Person participates in decisions

Rehabilitation Accessibility

Segregation    Inclusion

Pity/charity    Equality and rights

 

One particularly important lesson is that legal change doesn't automatically eliminate prejudice. Laws can remove discriminatory barriers, but attitudes, stereotypes, inaccessible environments, and social exclusion can continue.

 

That's why modern disability practice combines rights + accessibility + Universal Design + person-centred support + respect for lived experience. Key points from the source

 

1. Eugenics and segregation

 

Early 20th-century society included strong eugenic beliefs. Some influential people believed disability and other differences were threats to the "health of the nation." This contributed to the segregation of disabled people and the belief that society should prevent or eliminate perceived "defects."

 

2. World War I changed some attitudes

 

The return of almost two million newly disabled British ex-service personnel challenged the idea that disabled people were simply a "burden." These men had been injured while serving their country and were often regarded as heroes. This contributed to advances in prosthetics, plastic surgery, rehabilitation, employment initiatives, and specialist housing.

 

However, there was an important inequality: disabled civilians did not necessarily receive the same recognition or opportunities as disabled veterans.

 

3. Institutional "colonies"

 

People with learning disabilities were still placed in isolated rural institutions, described at the time as "colonies." These were largely self-contained communities with housing, farms, laundry, bakeries, recreation facilities, and other services. People could be strictly segregated according to sex, age, and perceived ability.

 

This is a powerful example of the difference between being provided with services and actually having choice, independence, and inclusion.

 

4. Disabled children

 

Historic England explains that between 1900 and 1945, as many as half a million children had physical or sensory disabilities, with poverty and disease being significant factors. Children could attend specialist schools, but some educational approaches were harsh, and many were trained for low-skilled work because society assumed they would not be able to obtain ordinary employment.

 

5. World War II created another change

 

When World War II began, many workers left employment to join the armed forces. The resulting Labour shortage led the Ministry of Labour to recruit people who had previously been considered unfit for work. This again challenged assumptions about what disabled people could contribute.

 

🔄 The really important lesson

 

This source shows that disability history isn't simply a story of "people were discriminated against, and then everything got better."

 

There were contradictions:

 

People could be considered heroes when they became disabled through military service, while disabled civilians were still segregated and viewed as dependent or defective.

 

That distinction is important when studying the social model of disability. It shows how much disability is influenced by society's attitudes, expectations, policies, employment practices, education, and physical environments, rather than being determined solely by an individual's impairment.

 

It also connects directly to your earlier section on labeling: the historical terminology used for disabled people wasn't neutral. Words such as "mentally deficient" and "crippled" reflected the attitudes and classifications of the period, and some later became stigmatizing insults.

1.🧠 Disability Models

 

The key models to understand are:

• Medical model — focuses on the person's impairment or condition and often views disability as something that needs to be treated or managed.
• Social model — focuses on the barriers created by society and the environment, rather than seeing the person as the problem.
• Biopsychosocial model — combines biological, psychological, and social factors to give a broader picture of disability and functioning.

Simple example:
A wheelchair user cannot enter a building because there are stairs.

• Medical model → focuses on the person's physical impairment.
• Social model → focuses on the stairs and inaccessible building.
• Biopsychosocial model → considers the person's health/functioning and the environmental and social factors affecting them.

2. ⚖️ Human Rights and Equality

Disability is not only about healthcare or support services. It is also about rights, equality, dignity, participation, and freedom from discrimination.

Important areas include:

• Access to education
• Employment
• Healthcare
• Housing
• Transportation
• Communication and information
• Relationships and community participation
• Equal treatment under the law
• Reasonable accommodations/adjustments

A major principle is that people with disabilities should be able to participate in society on an equal basis with others.

3. ♿ Universal Design and Accessibility

Universal Design means designing things so they can be used by as many people as possible without needing special adaptation.

For example:

• A building with step-free entrances
• Clear signs and good contrast
• Websites that work with screen readers
• Captions on videos
• Easy-to-understand information
• Controls that can be operated in different ways

This is different from designing something for an "average" person and then trying to modify it afterwards.

4. 🔎 Accessibility Audits and Removing Barriers

An accessibility audit asks:

"What could prevent someone from using or participating in this?"

You can examine:

Area	Things to check
Physical	Steps, doors, toilets, lighting, noise, signage
Digital	Keyboard access, captions, screen readers, contrast
Communication	Plain language, Easy Read, alternative formats
Policies	Rules that unintentionally exclude people
Attitudes	Stereotypes, assumptions, stigma
Financial	Cost of transportation, equipment, services, or participation

The important step is not just finding a barrier, but asking how it can be removed or reduced.

🌍 The bigger picture

One of the most important ideas running through this module is:

Disability is influenced by more than a person's impairment.

Culture, attitudes, poverty, education, employment, healthcare, physical environments, technology, laws, and social support can all affect a person's experience.

So inclusion isn't simply:

"How do we help this person?"

It can also be:

"What is preventing this person from participating, and what can we change?"

That connects particularly well with the social model of disability and Universal Design.

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