In the first half of her life, Carrie Fisher became famous for her role in three very famous science fiction movies, but in the later half of her life, she continued to garner fame for another completely different reason – as an advocate for bipolar disorder and mental health services. She was very open about her ongoing struggle with mental illness and drug abuse and her experiences with the mental health industry. However, as I read about her life and watched her interviews, I was left questioning if her problem was really bipolar or just the drugs all along.

What exactly is bipolar disorder?

There is a fair amount of misinformation about bipolar, or as it was formerly called, manic depression. Before I get into Fisher’s life, I think an overview of bipolar disorder would be helpful for lay people, so I will provide one that contains both textbook criteria and clinical observations.

When symptomatic, the classic bipolar disorder patient is either on top of the world or at the bottom of a well, meaning they experience the heights of hypomania or mania and the depths of severe depression. During hypomania, a person experiences high energy levels and either optimism and euphoria or irritability and aggression. Other symptoms include but are not limited to a puffed-up attitude, pressured speech (talking pretty much like an auctioneer), excess talkativeness, decreased need for sleep (3 or 4 hours per night will do), increased libido, ADHD-like distractability, and an increase in goal-oriented behavior (often involving risky ventures). During a manic episode, the symptoms become severe enough to disrupt the person’s day-to-day functioning, and the person may even become temporarily psychotic.

Here’s a fact to counter a common myth about bipolar: most manic depressives never experience an actual manic episode. A lot of people use the term mania to describe what is actually hypomania. Mania is such an extreme state of madness that the person’s brain can become physically unable to register/record what was happening, and when it is over, the person might not remember what happened.

I want to impress that the hypomanic, manic, and depressive episodes of bipolar are not mood swings. They are mood shifts. The distinction lies in that a typical mood swing that any person experiences normally lasts a few hours or less, whereas the minimum duration of a hypomanic episode required for a textbook diagnosis of bipolar is 4 days. Hypomania lasts 4 months on average, and the depressive phase 6 months. The classic bipolar mood shifts aren’t always present and periods of normalcy can be maintained as long as nothing happens to trigger symptoms.

Bipolar patients are typically not medication-seeking. Often, they will end up medicated due to court order or family pressure.

Over time, they get cognitive deficits. This condition is stressful for the brain, and cognitive deficits, particularly memory problems, will set in over time.

Hypomanic patients are rarely seen in clinic because hypomania is often enjoyable, and the patient has no desire to seek help. However, they may seek help when they have crashed into depression. Manic patients do show up to the clinic often under duress, after police have subdued them and dragged them ranting and raving to the hospital.

And now we come to a criterion that most lay people are unfamiliar with and many psych providers seem to ignore completely: a diagnosis of bipolar cannot be given if the symptoms are caused by recreational drugs, medication, or a medical condition. Furthermore, per DSM criteria, a period of elevated mood that looks like hypomania or mania cannot be attributed to bipolar disorder if the person was merely high on meth or cocaine or some other stimulant. The idea is that true bipolar disorder is an organically occurring and sometimes inherited condition – not created.

So what exactly causes bipolar? Short answer: the mental health industry has no idea. Serious Christians do, but not everyone is willing to accept what they have to say.

Did Carrie Fisher match the criteria for bipolar disorder?

Now that you should have a pretty good picture of what bipolar disorder is supposed to look like, let’s take a look at Carrie Fisher’s life.

Ms. Fisher indeed matched many of the criteria above. The two issues I have with her bipolar diagnosis is her extensive drug history and the lack of sobriety before her diagnosis. In fact, even Fisher herself initially had these concerns –

I was diagnosed at 24, but I had been seeing a therapist since I was about 15. I didn’t like the diagnosis. I couldn’t believe the psychiatrist told me that. I just thought it was because he was lazy and didn’t want to treat me. I was on drugs, too, at the time, and I don’t think you can accurately diagnose bipolar disorder when someone is actively drug addicted or alcoholic.

In that, she possibly displayed better clinical judgment than her psychiatrist. However, she also wrote this in an advice column for the Guardian:

I was told that I was bipolar when I was 24 but was unable to accept that diagnosis until I was 28 when I overdosed and finally got sober. Only then was I able to see nothing else could explain away my behavior.

Her logic made no sense. Do all people who fall into addiction do so because they must have bipolar disorder? Of course not! People do drugs for all kinds of reasons. Some do it solely for the pleasure, some to get relief from misery, some to perform better at work, and some due to social pressure.

At any rate, here’s a rough overview of Carrie Fisher’s early drug history, as best as I could glean from her interviews and articles about her. I doubt it is complete. She also abused at least one pharmaceutical, the opioid pain medication Percodan (oxycodone), but I do not have a time period for that.

• Age 13: Started doing marijuana when her mother supplied her with a bag. She purportedly continued to do marijuana until age 19, when a particularly potent variety gave her a scary experience.
• Age 21: Started using LSD (acid). Used it at least into her thirties.
• ~Ages 23-24: Used cocaine heavily when filming The Empire Strikes Back. During the filming of Under the Rainbow, she was abusing drugs so severely her weight fell to 95 pounds. She even experienced a seizure. In her own words, she “was not sleeping” and “completely crazy.”
• ~33: Possibly started using heroin at this time.
• ~Age 34: Did ayahuasca in the Amazon.

As we can see, she got into hard drug use in her early twenties, just before her diagnosis of bipolar. Is it a coincidence that she received the diagnosis after binging on the stimulant cocaine?

This quote from an addiction treatment center highlights the conundrum this situation creates for an accurate diagnosis:

[S]omeone who’s using cocaine can display almost identical symptoms to someone going through a manic episode. Likewise, someone going through withdrawal experiences many of the same mental symptoms as someone in a depressive phase.

One could counter that she started having mood problems at age fifteen, when she began attending therapy. But remember, she started doing marijuana two years earlier. While it is true that the marijuana of today is far stronger than it was back then, even 8.5-14 times stronger, the risk of mood disruption and psychosis has always existed. For example, hundreds of years ago, Egyptians knew that insanity was a potential risk with using marijuana.

Ms. Fisher did mention that she used drugs to tone down her moods. It is curious, then, why she abused cocaine, a stimulant. Bipolars often use alcohol (a depressant) during hypomania and mania to calm themselves down, but Fisher reportedly did not like alcohol.

Moving on to the genetic heritage factor… Carrie’s father, Eddie Fisher, was described as an “undiagnosed manic-depressive.” But Mr. Fisher was also known to have used methamphetamine and cocaine, so there’s that.

All this said, the possibility remains that she had something going on besides the drugs. However, let’s keep in mind that there are no medical tests for what constitutes bipolar disorder. From a purely empirical perspective, the only thing to determine that Carrie Fisher had a problem was her behavior, which included taking a lot of drugs. Since psychiatry aspires to the empiricism practiced by medicine, it is curious why she wasn’t simply diagnosed with something more solid than “bipolar,” like “substance-induced mood disorder.”

In her interview with Diane Sawyer, Carrie Fisher stated matter-of-factly, “I have a chemical imbalance that in it’s most extreme state will lead me to a mental hospital.” If she had thought of asking her psychiatric providers for proof of this chemical imbalance, she could have ultimately discovered that they had lied to her.

As it was, she submitted herself into their hands, attending AA meetings and (at one point) taking almost 24 pills of psych drugs a day. She also underwent ECT (electroconvulsive therapy), which she credited with helping her depression – at the cost of 4 months worth of memories. Despite up to 3 decades of psychiatric care and a current prescription for 3 different psych drugs, her post-mortem revealed she had used heroin, cocaine, methadone (which can be used either to treat pain or heroin dependence) and ecstasy.

In conclusion, there is no way we can know for sure if Carrie Fisher really had bipolar disorder or not, seeing as she has passed on. What I can say is that she put her trust in the mental health industry, and it ultimately failed her, as it does millions of other patients.

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