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Scientists comment on Bipolar Disorder following news about Kanye West.
Dr Tamara Russell, a chartered member of the British Psychological Society, said:
What is bipolar?
Bipolar is a chronic debilitating illness affecting 2-3% of the adult population, characterised by recurrent depressive and/or manic episodes (Goes, 2023).
Sub-types of bipolar (including BD-I and BD-II) have been delineated and reflect the degree of intensity of symptoms experienced.
For example, ‘sub threshold’ symptoms of hypomania (referred to as bipolar spectrum disorder) are possible, and there may be further subtypes (Akiskal & Pinto, 1999).
Across all subtypes are difficulties in managing mood, cognition, and volition.
Symptom heterogeneity presents huge challenges for the treatment of bipolar.
What is the difference between Type 1 and 2?
Typically, Bipolar 1 involves manic episodes (which may include grandiosity, delusions, psychosis and extreme behaviours) while Type 2 involves manic and depressive episodes.
The nomenclature and classification are changing as our understanding evolves (e.g. there is now a type related to older adult onset, ‘mixed affective’ types and discussion about sub threshold diagnosis). The rate of cycling may also vary hugely.
Can you inherit it?
The illness is highly heritable (Gordovez et al., 2020), pointing to genetic factors, yet psychosocial stressors are common triggers for relapse (Johnson, 2005).
What kind of treatments are available, and can it be cured? Or successfully managed?
The route to diagnosis is often lengthy, averaging 9-14 years (Drancourt et al., 2013). Medication (anti-depressants, mood stabilizers, or antipsychotics) is essential to manage depressive and manic symptoms (Goodwin et al., 2016), augmented by psychological therapies, and social support (NICE, 2014).
Poor adherence to medication is a pervasive challenge (McVoy & Levin, 2023) with 20-60% of patients considered poor or nonadherent irrespective of the phase of illness (Levin et al., 2016), and many patients (73%) relapsing within 5 years (Gitlin et al., 1995). Serious medical side effects are one oft-cited key reason for stopping or wanting to reduce medication. The majority of patients with bipolar are under-treated.
More specific:
In general, is it the case that people with this condition may, as West describes, ‘lose touch with reality, become self-destructive, have poor judgement and engage in reckless behaviour,’?
In a manic phase, this is absolutely what would occur. It is incredibly hard to catch the exact moment when the behaviour tips over into something problematic (and also often illegal), even though the warning signs are often there. Lack of insight is a key issue as is the desire to stay with the ‘high’ and ride it as long as possible. This is especially the case for those who are coming out of depressed mode.
West has said he developed bipolar after a car crash after which he claimed doctors failed to diagnose a frontal lobe injury – how likely is this condition to be linked to a head injury? Is there evidence of that in other patients?
Frontal lobe injury (depending on the exact area) can certainly cause problems with inhibition. This might present as being a big odd, saying things that are offensive or harmful to others (the things our brain might usually edit), all the way to a total personality change (c.f. the case of Phineas Gage). Problems with executive functioning and inhibitory control are also a feature of bipolar. Possibly a cumulative effect could be at work. We actually understand so little about the brain.
There is a reported case study
Altuwairqi Y. (2023). Bipolar Disorder Due to Traumatic Brain Injury: A Case Report. Cureus, 15(12), e51292. https://doi.org/10.7759/cureus.51292
West is clearly attributing antisemitic behaviour to prolonged psychotic periods – is this usual? How long would such manic/psychotic behaviour last?
Highly variable. I have worked with clients who in a psychotic episode had beliefs and thoughts that were totally abhorrent to them when they were well. It is often about taboos. I have in fact had a client with similar beliefs. He never said them out loud, or acted upon them, but was extremely distressed to have them and in the end became obsessive about monitoring those thoughts to ensure they were never expressed. It was heart breaking to see.
Creative people also try to ‘surf’ the mania in ways that normal people who have to go to a regular job don’t. The creative edge is extremely compelling and if it’s your job, then you are more likely to do this.
Is much of what West refers to familiar for bi-polar or do the symptoms he describes sound atypical for this disorder? Or does it present differently in different individuals?
The presentation is highly variable but the biggest thing we work with when we are working with bipolar clients it the shame of the behaviours they have done while in a manic or psychotic episode. This is the number 1 area of work once the symptoms have been stabilised. Patients are often horrified about what they have done. It often involves nudity, public spaces and acting in ways they would never do while well.
Prof David Curtis, Honorary Professor, UCL Genetics Institute, University College London (UCL), said:
What is bipolar?
“Bipolar disorder is a severe mental illness characterised by episodes lasting weeks of months of low mood (depression) or high mood (excitation and/or elation). Symptoms can include very severe mood disturbance and for some people also psychotic symptoms, consisting of delusions and hallucinations. Between episodes people typically have normal mental health and there are suggestions that it can even be associated with enhanced creativity.
What is the difference between Type 1 and 2?
“Type 2 bipolar disorder consists of relatively mild disturbances of mood and indeed some people with a bipolar 2 diagnosis may have mood fluctuations which are not obviously distinguishable from normal human experience.
“Type 1 bipolar disorder is by definition more severe and to receive this diagnosis somebody should have had at least one clearcut manic episode.
“That said, it is very important to realise that there is a broad spectrum of severity and that for some people with bipolar 1 disorder symptoms may still be relatively mild. Conversely, some people can have symptoms which are very, very severe. They can do truly awful things, including acts of violence up to committing homicide or suicide. They can become completely delusional and incoherent. They can do and say things which they would never normally do. It is important to realise that people with the most severe bipolar disorder can do the most extreme things for which they could not be said to be responsible. It is very difficult to fully appreciate this if you have never come across somebody with severe bipolar disorder and if all your conceptions are actually derived from people with less severe forms of the disorder.
Can you inherit it?
“Yes, there are strong genetic effects on risk of bipolar disorder and efforts are underway to identify the specific genes responsible. Evidence for a genetic basis means that we should very much consider this to be a “disease of the brain” and not something the patient themselves can be responsible for. A good analogy would be epilepsy.
What kind of treatments are available, and can it be cured? Or successfully managed?
“Treatments can somewhat ameliorate manic and depressive episodes and some treatments, such a lithium, can be taken long term and for some people will reduce the chance of episodes occurring.
“It is important to realise that people undergoing an episode may not realise they are unwell and may only be treated under compulsion. This means that mental health legislation may be very relevant and that somebody living in a jurisdiction where compulsory treatment may be difficult to enforce may consequently be more at risk of being left untreated. This perhaps applies especially to those who are rich and powerful who may be left to commit career suicide in the public domain without anybody being able to effectively intervene.
More specific:
In general, is it the case that people with this condition may, as West describes, ‘lose touch with reality, become self-destructive, have poor judgement and engage in reckless behaviour?
“Yes, this is absolutely the case. In fact, it’s even something of an understatement.
West has said he developed bipolar after a car crash after which he claimed doctors failed to diagnose a frontal lobe injury – how likely is this condition to be linked to a head injury? Is there evidence of that in other patients?
“There is some suggestion of increased risk of bipolar disorder after head injury but it may well be the case that this is simply a coincidence. With our present state of knowledge there are no specific implications for treatment.
West is clearly attributing antisemitic behaviour to prolonged psychotic periods – is this usual? How long would such manic/psychotic behaviour last ?
“Is much of what West refers to familiar for bi-polar or do the symptoms he describes sound atypical for this disorder? Or does it present differently in different individuals?
“This is indeed fairly typical of the kind of thing which can happen with severe manic episodes. It would typically last weeks or months, especially if left untreated, before spontaneously resolving. I think his description is fairly familiar and persuasive. There are a variety of presentations but what he describes would perfectly well fit with a diagnosis of bipolar disorder alone and need not be any reflection of any other negative traits such as personality disorder or latent antisemitism. People with bipolar disorder can indeed act in a way which is completely out of character during a manic episode.”
Dr Sameer Jauhar, Clinical Associate Professor in Affective Disorders and Psychosis, Imperial College London, said:
“Bipolar is a severe mental illness, that generally presents in adolescence, though can present later in life.
“It is characterised by recurrent mood episode, lasting months, that can consist of elevated mood (mania), depression, or both (mixed).
“It is classified on the basis of mania (requiring hospital or crisis care whilst experiencing elevated mood), this being referred to as bipolar 1. Bipolar 2 is when people’s episodes of elevated mood are not as severe.
“In both bipolar 1 and 2 people can spend a lot of time in depression (up to 50%).
“More than half of people with bipolar will experience psychosis (mores in mania) when they are unwell. Psychotic symptoms include delusions and hallucinations.
“When someone develops mania, it is a medical emergency, due to the risks to the individual (suicide rates are upwards of 15% in some studies).
“In most people, symptoms of bipolar respond well to medication and holistic care (adjunctive psycho-education and talking therapies), and a lot of people are able to manage their illness well, over the longer-term.
“In terms of causes, like most psychiatric illnesses there is a genetic component, with environmental influences. Around 60-80% of causality can be attributed to genetic factors, though there are over 100 genes of small effect involved.
“Major challenges in the UK include delay to diagnosis (up to 9.5 years, in a report by Bipolar UK), and ensuring people receive evidence-based treatments in primary and secondary care.”
A statement from Bipolar UK published in January [posted 29th January]:
“This week, Ye, formerly known as Kanye West, ran an ad in The Wall Street Journal apologising for antisemitic and racist statements he made in the past while also discussing his struggles with bipolar disorder.
“As a charity that supports those living with bipolar and their loved ones, we wanted to use this opportunity to clarify what bipolar is, and isn’t, in a bid to address harmful narratives around the condition that reinforce stigma regularly experienced by our community.
“Bipolar disorder is a severe mental illness (SMI) that causes extreme mood swings and changes in energy levels. It affects over one million people in the UK alone.
“Bipolar mood swings are more extreme than most people’s everyday experiences of feeling a bit down or happy.
“Someone with bipolar can have long or short periods of stability but can then go ‘low’ (into depression) or ‘high’ (experiencing hypomania and/or mania and psychosis).
“It still takes on average 9.5 years to receive a bipolar diagnosis and has the highest suicide rate of any mental health condition.
“In his statement, Ye attributes his bipolar disorder to damage he sustained to his brain’s frontal lobe during a 2002 car accident.
“Although a serious head injury can increase the relative risk of developing a mental health condition, there is no evidence that it directly causes bipolar disorder. Most people who experience a brain injury will not develop bipolar, and many people with bipolar have no history of head trauma. At present, research linking head injuries to bipolar disorder is extremely limited, so any suggested connection should be treated with caution.
“Ye’s statement claims his antisemitic comments were made during a bipolar episode and are because of his condition.
Some people living with bipolar:
“Finally, Ye reports that his wife encouraged him to seek help towards the end of 2025 leading him to undertake an effective regime of “medication, therapy, exercise and clean living.”
“Along with getting plenty of sleep, research proves that all of these things combined can support people with bipolar to experience long periods of stability and live well with their condition.
“Family and loved ones understanding bipolar and noticing the warning signs that someone is heading towards an episode is also something we strive for at Bipolar UK.
“We want to empower people with the knowledge about what bipolar is and how it can be managed so they can help those closest to them stay well or seek help when they need it. Our in-person and online bipolar peer support groups are an amazing resource for anyone impacted by bipolar.
“Our latest campaign, ‘Maybe it’s bipolar?’ aims to raise awareness and help people to recognise symptoms, such as periods of high energy, restlessness, difficulty sleeping, increased risk-taking and/or impulsive behaviour, followed by periods of low mood, which may be signs of bipolar.”
Declared interests
Dr Sameer Jauhar:
“Received honoraria for non-promotional educational talks given for Boehringer-Ingelheim, Lundbeck, Recordati, Sunovian and Jannsen- predominantly on antipsychotics.
I have consulted for LA Pharmaceuticals on Amisulpride, an antipsychotic.
Advisory Board for Boehringer-Ingelheim and Accord.
I have sat on a Wellcome Funding Panel and been an expert advisor for NICE on drugs for tardive dyskinesia and schizophrenia.
Ex Council Member, British Association for Psychopharmacology.”
Prof David Curtis: No conflicts of interest to declare.
Dr Tamara Russell: I work in private practice, occasionally with clients with bipolar from the creative industries. I specialise in ‘minimum medication models’ of working.