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LIVING A LIFE OF EXTREMES
It's Bipolar Awareness Day today. Lindsay Ord asks two local sufferers how they manage with the disorder, which is thought to affect more than a million South Africans and is characterised by manic highs and deep depression MENTION the word bipolar and people think they understand it - they've seen a celebrity admitting to having it or they know someone with mood swings and casually label him bipolar. But the reality of the disorder is far removed from the glamour of the red carpet and it is more than mere moodiness. Electronics engineer Wesley* describes it as "the worst kind of hell". The 54-year-old says it has cost him his career, a marriage and his social life. "It's an illness characterised by recurring bouts of hypomania, which is like a feeling of invincibility followed by bouts of depression, where your world comes crashing down," he says. In the manic phase, sufferers can impulsively engage in high-risk behaviour, including spending sprees, drug and alcohol abuse, and sexual promiscuity Wesley ran a successful IT company and would work obsessively in a manic state, with extraordinary levels of energy which would always be followed by black depression. When hypomanic, there was no stopping him. He once bought 11 houses in a month. "I plunged my family into financial chaos," he says. He was forced to sell them at a loss. Photojournalist, Eve, 41, also tells of an upward spiral during manic episodes. "On the upside, I would be very creative and have fantastic ideas, but I would hardly sleep for weeks," she says. "I was impatient with people who were moving too slowly for me and I thought nothing of taking huge risks in every sphere of my life." According to the South African Anxiety and Depression Group (Sadag), people with bipolar disorder experience unusually intense emotional states that occur in distinct time frames. They swing from the overjoyed highs of a manic episode to the crushing lows of depression. Extreme changes in energy activity the need for sleep and food, and behaviour are part of these mood changes. Bipolar is a chronic mental illness that affects about 2 percent of the population and it is thought that there are more than a million people in South Africa with it. It is misunderstood, stigmatised and hurtful stereotypes abound, and, according to Sadag, individuals are sometimes labelled "psycho" or "crazy", or are told they should not have children and that they cannot live normal lives. Severe symptoms recur unpredictably and often make it impossible for the sufferer to function at work, socially or at home. As a result, many people with bipolar disorder battle to keep their jobs. For Wesley depression, often triggered by workplace stress and what he describes as "corporate bullying", forced him to close his business. "I have been ill for long periods of time and I have been in and out of rehab over the years. Although my bipolar disorder is well controlled with medication now, lam taking a break from work and monitoring my situation. I hope to return to work at some point." Wesley's bipolar disorder has also been hard on his loved ones. "Bipolar depression is always accompanied by acute anxiety incredible fear, feelings of worthlessness and hopelessness and often thoughts of suicide. That is not easy to live with. I would not be alive today without the support of my second wife. Family support is crucial." Eve, who has a diploma in journalism, has also had a chequered working life, symptomatic of her condition, working as an estate agent, make-up artist, missionary store manager and, finally photojournalist. She has been hospitalised several times and endured tumultuous relationships. The birth of her daughter, now 5, has given her the most stability she has ever had. "I attempted suicide many times in the past, but she is what stops me from doing it now As a single mom, I am wholly responsible for her, though I have a fantastic support system in my mother and friends. Interestingly, while pregnant, I was the most 'normal' I have ever been and was off most of my medication." Wesley and Eve were misdiagnosed with depression and it was many years before they were correctly diagnosed. Some research suggests that 50 percent of people with bipolar were first incorrectly diagnosed with depression or Attention Deficit Hyperactivity Disorder (ADHD). "It can be difficult to make a diagnosis of bipolar disorder" says Sadag founder and director, Zane Wilson. "And possibly bipolar isn't the first diagnosis you received from a mental health provider" People are more likely to go to a doctor when they are in depressive distress: they rarely seek treatment when they feel elated or hypomanic. Wilson advises people to consider all their moods (not just the depressive ones), including signs of excess energy hypersexuality or racing thoughts. "It's vital that mental health professionals have all the information - not just part of it." Psychiatrist Dr Frans Korb says: "Many people, including health professionals, have no idea what bipolar is or what a diagnosis means - they have stereotyped misconceptions and there is a general lack of awareness about the disorder and its symptoms." Getting the correct treatment, too, can be difficult. "It is often hit-and-miss until you get the right medication and you can manage the condition well with the right medication," says Wesley "It is important to keep taking it, no matter how well you feel. I learnt that the hard way" Eve also learnt not to stop her medication. "When you are high, you do not want anything to take the edge off. When you are depressed, you can't see the point. Also, what works for you now might not work in two years' time and it is important to stay in contact with your doctor and monitor the effects of the medication." Going off medication is a serious problem because patients mistakenly feel they no longer need it. However, even a stable mood can, without treatment, spiral into mania or crash into depression without warning. "Many patients require the use of medication, and often a combination of medications, to be well," says psychiatrist Dr Leigh Janet. "Helping patients understand their diagnosis is key Patients need guidance and support in understanding what their diagnosis means and what their treatment entails, what medication they are taking and why Research has shown that patient compliance occurs as a result of patients' motivation, ability and willingness to take and sustain treatment. The more difficult that treatment is, the more challenging it is to stick to and the more support the patient needs." Lori Barausse, of the Solos survivors of suicide group, says bipolar disorder is utterly debilitating and, if not treated, can lead to suicide. "It must be taken seriously and we need to learn to be empathetic," she says. "Sufferers need treatment." Wesley and Eve have both had electroconvulsive therapy (ECT) which, they say is not for the faint-hearted, but which worked well for them. And so, for people with bipolar, like Wesley and Eve, it is a matter of managing a lifelong condition through vigilance and medication compliance. "I take it a day at a time, sometimes and hour at a time - and even, occasionally a minute at a time," says Eve. *Not his real name Chris Brown is just one of many celebrities who has been diagnosed with bipolar disorder. Others are Britney Spears, Catherine Zeta-Jones, Demi Levato, Amy Winehouse, Carrie Fisher, Mel Gibson and Stephen Fry. FAST FACTS Bipolar disorder affects about 2 percent of people in South Africa. It is the sixth leading cause of disability in the world. It is not restricted to any social or educational class. It was previously known as manicdepressive illness. It is a physical illness marked by extreme changes in mood, energy thinking and behaviour. It is typically seen as episodes of deep depression and manic highs. It often disrupts work, school, family and social life. Men and women are equally affected; however men tend to have more manic episodes while women experience more depressive episodes. Famous people in the past, like Winston Churchill, Isaac Newton, Abraham Lincoln, Vincent van Gogh, pictured, were all bipolar sufferers. It is believed to be a combination of bio-chemical, genetic and psychological factors. Bipolar disorder typically begins in adolescence or LIVING A LIFE OF EXTREMES WHO TO CALL Sadag, the South African Anxiety and Depression Group, has a toll-free line sponsored by Adcock Ingram. The Bipolar Helpline, 0800 70 80 90, has a linked SMS service (31393) to enable callers, even from rural and isolated areas, to call Sadag for expert advice, information and counselling. The line is open every day from 8am and 8pm. For more information, visit the website www.sadag.org irCOGNISE YOURSELF? On its website, Sadag has a bipolar self-rating questionnaire, the answers to which you should discuss with a mental health expert. It is a screening tool, not a diagnostic one. 1. Has there ever been a period of time when you were not your usual self and... You felt so good or so hyper that other people thought you were not your normal self or you were so hyper that you got into trouble? You were so irritable that you shouted at people or started fights or arguments? You felt much more self-confident than usual? You got much less sleep than usual and found you didn't really miss it? You were much more talkative or spoke much faster than usual? Thoughts raced through your head or you couldn't slow your mind down? You were so easily distracted by things around you that you had trouble concentrating or staying on track? You had much more energy than usual? You were much more active or did many more things than usual? You were much more social or outgoing than usual, for example, you telephoned friends in the middle of the night? You were much more interested in sex than usual? You did things that were unusual for you or that other people might have thought were excessive, foolish, or risky? Spending money got you or your family into trouble? If you checked YES to more than one of the above, have several of these ever happened during the same period of time? How much of a problem did any of these cause you - like being unable to work; having family, money or legal troubles; getting into arguments or fights? Please circle one response only. No Problem Minor Problem Moderate Problem Serious Problem Have any of your blood relatives (such as children, siblings, parents, grandparents, aunts, uncles) had manicdepressive illness or bipolar disorder? Has a health professional ever told you that you have manic-depressive illness or bipolar disorder?