‘The Button Question’: A Mixed-Methods Study of Whether Patients Want to Keep or Remove Bipolar Disorder and the Reasons for their Decision

Background: Many people with a diagnosis of bipolar disorder associate positive qualities with their condition, which may place a ceiling on the effectiveness of treatment and the likelihood of recovery. However, the extent to which patients would, or would not, want to be free of their bipolar disorder has not been directly assessed.
Method: An international online survey of 103 people (80 female, 23 male) with bipolar disorder assessed whether they would want to permanently remove their bipolar disorder with a ‘button press’, as well as whether they would do the same if the effect was reversible. We also coded and analysed free-text reasons for their decisions.
Results: A total of 75 individuals (73%) would permanently remove their bipolar disorder and most of these did not report that bipolar disorder was part of their identity. A smaller number, 49 (48%) of the sample, would ‘switch off’ their bipolar disorder if the effect was reversible and most of these individuals reported enhanced qualities and the ‘fun’ of mania. Distinct positive and negative qualities of bipolar disorder were identified.
Conclusions: This mixed-method analysis has revealed wide variation and contrasts in attitudes. There is a sizeable minority of individuals who would not wish to remove their bipolar disorder for specific reasons, and knowledge of these reasons can inform approaches to interventions that are tailored to the individual.