World Bipolar Day (30th March)

Prof N Heramani, Dr Seram Chaoba Devi, Dr Meesha Haorongbam *

Often called a "mad genius" and a "tortured artist", Vincent van Gogh, one of the most famous painters of 19th century is perhaps more well known for having cut off one of his own ears during a stressful event.

Plagued by psychiatric illnesses throughout his life, van Gogh committed suicide in 1890. He was posthumously diagnosed with Bipolar Disorder and his birthday i.e., 30th March is observed as World Bipolar Day every year since 2014.

World Bipolar Day was initiated to bring world awareness to bipolar disorders and to eliminate social stigma. Through international collaboration, the goal of World Bipolar Day is to bring the world population information about bipolar disorders that will educate and improve sensitivity towards the illness. As with many mental disorders, people with bipolar disorder are often impacted by misconceptions and stigma surrounding their conditions.

Common stigmas include anything from being shunned by friends or loved ones to being called hurtful names like "crazy" or "psycho". Many people also casually throw the word "bipolar" around in everyday conversations, which further contributes to the lack of sensitivity for the people with this condition. The first and most important step in breaking the barriers of stigma is education and awareness about the disorder.

WHAT IS BIPOLAR DISORDER?

BPAD or Bipolar Disorder or Bipolar Affective Disorder or Manic-Depressive illness is a mood disorder that affects 46 million people around the world and has a lifetime prevalence rate of 2.4%. India has a prevalence rate of 6.9% based on data collected in 2020. While there is no official statistics for Manipur, BPAD accounts for a majority of psychiatric hospital admissions in Manipur.

BPAD is a chronic mental disorder characterised by alternating episodes of depression (low mood) and mania (high mood).

Some common symptoms of depression include: persistent low mood, lack of energy, inability to enjoy things/activities you previously enjoyed, inability to concentrate, forgetfulness, irritability, not wanting to be around people, feeling hopeless or worthless, sleeping too much or too little, eating too much or too little, having suicidal thoughts etc.

Fortunately, in Manipur, compared to other mental illnesses, there has been increased awareness about depression in the past decade or so thereby leading to increased treatment seeking behaviour.

However, mania-the other "pole" of Bipolar Disorder-continues to be a mystery to a large population of the general public. In stark contrast to depression, mania is characterised by elevated or euphoric mood.

You feel you can get by without sleep, you become unusually talkative and you become over-familiar with almost everyone you interact with. You feel you are bursting with energy and you develop an exaggerated sense of well-being and self-confidence. You become easily distractible and you make poor decisions e.g. going on spending sprees, getting involved in risky sexual activities or making foolish investments.

Depression or mania can also be accompanied with psychotic symptoms such as hallucinations (hearing/seeing/feeling things that are not there) and/or delusions (e.g. thinking your neighbours/colleagues are conspiring to harm you, thinking your spouse is being unfaithful etc). At times a person might have milder symptoms of mania known as hypomania.

It is important to impress upon the fact that BPAD is more than just an up-swing or down-swing of mood. It affects every aspect of the person's life and also disrupts their family members' lives.

Some effects of BPAD are:

1) Problems with alcohol and/or drug abuse-More than 30% of people with BPAD misuse alcohol and/or drugs.
2) Suicide and self-harm-Risk of suicide is 5-6% higher than the general population especially if there are associated psychotic symptoms. There is also 30-40% more likelihood of self-harm.
3) Financial-During mania or hypomania, one may spend money recklessly and struggle to manage their finances.
4) Physical health-The likelihood of developing physical illnesses such as Diabetes or heart diseases increases among people with BPAD.
5) Damaged relationships-The disorder causes strain among relationships leading to frequent interpersonal discord
6) Effect on school/work-School or work life are severely affected.

WHAT IS THE COURSE OF BIPOLAR DISORDER?

Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, while as many as one-third of people have some residual symptoms. The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder.

Some people experience multiple episodes within a single week, or even within a single day, known as rapid cycling. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.

The vast majority of people with bipolar disorder can lead healthy and productive lives when the illness is effectively treated. Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent (rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared.

WHAT ARE THE CAUSES OF BIPOLAR DISORDER?

There is no single, satisfactory answer yet. But like most mental illnesses it occurs due to an interplay of genetic and environmental factors. If any of your family members have bipolar disorder, you've more chance of developing it too.

But scientists say no single gene can be linked to bipolar disorder. If someone in your immediate family has BPAD, like a parent, brother, or sister then there's a 13 in 100 chance you will develop it too. The risk is higher if both of your parents or your twin lives with the condition.

For some people symptoms of bipolar disorder can be triggered by stressful events in their lives such as: relationship problems, physical, sexual or emotional abuse, the death of a loved one, physical illness, losing your job or other work issues, problems with sleep, financial stressors, substance abuse (e.g. cannabis, opioids, alcohol, etc).

WHAT CAN BE DONE IF YOU OR A LOVED ONE HAS SIGNS OF BIPOLAR DISORDER?

As stated earlier, BPAD can impact a person's relationships. So being the loved one of someone with this disorder requires a lot of patience and understanding. Despite the disruptions that often occur as a result of BPAD, individuals with this disorder often don't recognise their emotional instability and how it's impacting their lives and their loved ones.

As a result, they might not seek or receive the mental health treatment they need. What's more, some people with BPAD even enjoy the manic episodes- the high mood, the increased energy, the feeling of invincibility.

However, these episodes are often followed by a crash and constantly dealing with these fluctuations in mood without professional help can further strain the person's mental health and their relationship with others. If you notice any of the symptoms of BPAD in yourself or a loved one, get help right away.

WHAT IS THE TREATMENT FOR BIPOLAR DISODER?

While there is no cure for BPAD as such, the illness can be effectively managed with medications and psychotherapy. In fact, numerous well-known personalities such as Stephen Fry, Winston Churchill, Mariah Carey, Yo Yo Honey Singh, etc who had been diagnosed with BPAD and had sought help have gone on to achieve great things in their chosen fields.

In conclusion, Bipolar disorder is common yet often misunderstood illness. It can affect anyone across all demographic variables but it doesn't have to be a death sentence. Even with a diagnosis of BPAD, one can lead a successful, fulfilling live provided they get help from a trained mental health professional.

As the late Carrie Fisher once said, "Bipolar disorder can be a great teacher. It's a challenge, but it can set you up to be able to do almost anything else in your life."