Bipolar disorder: Idioms of susceptibility and disease and the role of ‘genes’ in illness explanations

This qualitative study explores (1) how members of the Dutch Association for People with Bipolar Disorder explain the affliction of bipolar disorder; (2) the relationship between genetic, environmental and personal factors in these explanations and (3) the relationship between illness explanations, self-management and identity. A total of 40 participants took part in seven different focus group discussions. The results demonstrate that there are two different explanatory idioms, each one centred around an opposing concept, that is, susceptibility and disease. Individuals who construct explanations around the concept of ‘disease’ attach more importance to ‘genes and chemicals’ than to environmental components in the onset of the disorder, whereas individuals adhering to the central concept of ‘susceptibility’ tend to do this much less. Compared with individuals using the ‘susceptibility’ idiom, those who use a ‘disease’ idiom tend to observe fewer possibilities for self-management and are less inclined to construct normalcy through a quest for personal growth. Stories of suffering seem more integral to the ‘disease’ idiom than to the ‘susceptibility’ idiom. The ‘disease’ idiom seems less integrated in a contemporary surveillance psychiatric discourse than the ‘susceptibility’ idiom; however, both vocabularies can offer normative constraints.