Being bipolar: what you need to know

Mood disorders may be hard to identify, especially when it comes to bipolarism

Although much attention has been given to their great masterpieces, few people know that some of the most successful personalities of the past century suffered from bipolar disorders throughout their lives. You may have heard of renowned female novelists Virginia Woolf and Sylvia Plath and even read their work, but did you know that the latter took anti-depressants for the greater half of her adult years? Also amongst the list of patients is legendary Dutch artist Vincent Van Gogh who became known not just for his exquisite paintings but vagrant moods as well. While bipolarism did not stop these creative geniuses from excelling in their fields, it affected their lives in ways only those who suffer from the disorder can comprehend.

Medically speaking, bipolar disorders can be described as dramatic changes in one’s mood and energy. From elated highs to the lowest forms of depression, the illness covers it all and affects people of all genders, ages and ethnicities. Typically, the initial symptoms begin to materialise in the late teenage years or one’s early 20s. For 40-year-old Warda Azad, the onset came early — around the time of her 18th birthday. “I had a nervous breakdown at 22, during a visit to the United States (US), and was diagnosed with bipolarism. Before this, I was misdiagnosed at 18 for I was unable to handle the stress of my O-Level examinations,” shares Warda. Now middle-aged, the social worker leads a happy personal and professional life, having conquered her illness successfully. “Ironically, the disorder became my greatest strength because I accepted it as a challenge — not a weakness,” says Warda. “I know how to harness it now. I learned to work faster and more effectively than others would do.”

Warda’s experience lends credence to something psychologists across the globe have been trying to argue for years. They believe bipolarism — or any mental illness for that matter — does not always have to be a hindrance in life. With prompt medical assistance, regular maintenance and self-management, about 50% to 60% of patients can lead perfectly functional lives. The only way ahead is by accepting the disorder as part of one’s life and learning to work around it.

According to Dr Uzma Ambreen, psychiatrist and medical director at The Recovery House in Karachi, early detection is best in these cases as timely treatment is imperative. “Bipolar disorders can remain disguised as minor depression for years,” she explains. “Even in advanced countries such as the US, it takes a long time for people to come to terms with their condition.”

What causes bipolar disorder?

Although the exact reasoning behind bipolarism is yet to be determined, research indicates it is most common amongst those with close family members suffering from it as well. Extensive work has been done on genetic vulnerability in bipolar disorders but Dr Uzma disagrees. “A person may have the disorder since childhood and only manifest the symptoms in adolescence. It isn’t necessary that it transfers through generations,” she says.

Nonetheless, individuals who are genetically pre-disposed to the illness may experience mood swings due to significant life events, changes in health, hormonal imbalances, insomnia and substance abuse. The link is evident in many a patient, such as 38-year-old Salman Wasi, whose grandparent suffered from the same problems.

What are the symptoms?

Overall, bipolar disorders comprise of two main poles: intense depression or intense mania. A patient may suffer from either or, as in some rare cases, both. Warda, for instance, has always shown an inclination towards mania and at times, resents the effect it has on those around her. “One time, I was experiencing an usual surge of energy. In that high state, I moved out the furniture in my room to the lounge — all by myself!” recalls Warda of one of her episodes. Dr Naim Siddiqi, associate professor and head of psychiatry at Sindh Institute of Urology and Transplantation in Karachi, elaborates on mania further, explaining that it perpetrates subnormal spikes in adrenaline. “This rush of energy motivates patients to undertake actions that could leave a negative impact on those they come in contact with,” says Dr Naim. “For example, they might begin talking much faster and a lot more than normal, as ideas come rapidly.” The brain is tricked into over-excitation, making one feel fresh and energetic, even with minimal rest or sleep. While this may not necessarily be detrimental, hyperactivity has a flipside in that the patient might overestimate their worth and potential and make a hasty decision. Overspending, impulsively resigning from a stable job, unnecessary arguing and accepting risky investments are just some of the ways in which bipolar mania manifests itself in the life of the patient. Violence and aggression are also common indicators.

Interestingly, there have been cases of patients taking to the belief that they are genius scientists, gifted scholars, religious or political leaders. At times, the mania translates into paranoia, making one feel that others are jealous of or trying to harm them physically. “The suicide rate is therefore, quite high amongst patients with bipolarism,” suggests Dr Naim. “Usually, they begin to feel guilty about their behaviour once they come out of their reverie.”

At the other end of the spectrum are patients like Salman who suffered prolonged episodes of depression, as opposed to mania. “On days when I feel down, it becomes very difficult for me to move, let alone get out of bed,” shares Salman. “Suicidal thoughts and the desire to inflict pain on myself are common. I am transported to a hell of sorts, without any fear of death.” At the time of his diagnosis, Salman was engaged to his current wife who tracked his symptoms and sought medical help. “I cannot thank her enough for this — for her undying support through the hardest of times,” admits Salman whose condition has deteriorated to the extent of hallucinations and hearing random voices. “It felt like navigating a radio at different wave lengths. I would hear a lot of voices but none of them were clear, which created a lot of confusion. The voices were in my head, along with some unbearably profane images,” he says.

Treating bipolarism: psychotherapy and consistency

Salman highlights an important but often overlooked aspect of psychological disorders as well: they are harder to recognise due to our lack of knowledge and the social stigma attached to them. “I remember that when I first told my mother about the voices and images in my head, she took me to a spiritual healer instead of a doctor,” he says. The reluctance to accept fate only delays the process, granting the illness more time to germinate.

But there is a way around this. According to clinical psychologist Dr Naheed Khan, treating bipolar disorders involves both drugs and psychological counseling. “Also, the patient must remain consistent with both lest the treatment prove futile,” says Dr Naheed. She warns against the drawbacks of skipping of medication as this can lead to a relapse in the patient. “Sometimes, individuals grow discouraged by counseling as it takes longer to work than medicines. But the sessions are necessary as they inspire hope, courage and support.” Salman agrees with Dr Naheed, saying that letting go of medicines was the worse decision he ever made. “There were times when I also felt no real benefits from the medicines I was taking. But one must fight through those moments of disillusionment as in reality, the drugs really are helping.”

There is also considerable evidence which suggests that up to 25% of the symptoms of psychological illnesses can be remedied via regular exercise. Not only does this improve the quality of sleep enjoyed by an individual, it also keeps their physical health in check. “Nonetheless, the established and effective treatment remains medication, with or without psychotherapy,” confirms Dr Naim.

The concept of mental illnesses and marriage

It seems that the only instance wherein illness has led to the termination of marriage is when the spouse is not supportive towards the ailing person.Warda, for example, received no help from her husband, even though her in-laws were made aware of her bipolarism before the wedding. “We lived in the US. There, I fulfilled all the domestic chores and cooking to please him and his family but nothing was ever appreciated,” recalls Warda. “He did not accompany me to the psychiatrist even once. I used to drive to therapy all by myself.”

Once when Warda became severely ill, her husband sent her to a friend’s place in another state of the US. After she had recovered, he asked her to go back to Pakistan and proceeded to send in the divorce papers. “I live with my mother and sister now and am certainly much happier,” adds Warda.

In our part of the world — where psychological illnesses are barely understood, let alone accepted — it is often assumed that a mentally challenged individual will be unable to lead a sound married life. Of course, there is no scientific or social evidence to support this notion. Not to mention there are many people with severe psychological illnesses leading normal, happy lives. “Marriage is a contract between two people who are equally responsible for the success or failure of their relationship,” says Dr Naheed. “Bipolar disorders, in isolation, cannot account for marital discord.”

Ishrat Ansari works on the Karachi desk at The Express Tribune

Published in The Express Tribune, Ms T, October 11^th, 2015.