“I have been and am battling a depression. It is as if my life were magically run by two electric currents: joyous positive and despairing negative – which ever is running at the moment dominates my life, floods it. I am now flooded with despair, almost hysteria, as if I were smothering.” (Plath, 1982, p.239)
These are the words of the American poet, Sylvia Plath, who was treated for major depressive illness in her twenties and committed suicide when she was thirty. More commonly known as manic depressive illness, bipolar mood disorder commonly affects 1% of the population. The usual onset is late adolescence and early adulthood. Many claim to know what it is like to be depressed, because they have gone through a divorce, lost a job or a loved one. However, manic depression is entirely different from these experiences. The disorder is characterised by two alternating episodes: depression and mania. People differ in terms of the frequency and duration of these episodes. Left untreated a manic episode or a hypomanic episode (which is not quite as severe as a manic episode), can last a few months, while the depression usually lasts for more than six months.
Symptoms, which may signify a manic episode, include feeling unusually “high”, euphoric or irritable. At least four of the following symptoms need to be experienced or observed in order to be diagnosed with the illness: needing little sleep yet having enormous amounts of energy, talking so fast that others have difficulty keeping up with you, having racing thoughts, being easily distracted, having inflated sense of your own importance, behaving recklessly with little regards for the consequences, especially regarding money, sex, drugs or alcohol, extreme irritability. In addition, there may be hallucinations and delusions.
Another particularly debilitating symptom of bipolar disorder is the belief that nothing will help. However, with a combination of therapies (medication and psychotherapy), nearly all sufferers of depression can be helped to manage their illness. Counseling is an important adjunct in the treatment of bipolar disorder. Not only can it help to ensure that patients stay on their medication, but it can also help the patients to deal with the psychosocial stressors that may trigger or exacerbate episodes.
Someone suffering from depression should not be thought of as “crazy”. Rather, bipolar disorder is an illness, just as “flu and heart disease are illnesses. Possible causes or precipitating factors of bipolar disorder include: a chemical imbalance in the brain; heredity/genes; changes in biological rhythms (including sleep, seasonal and hormonal changes) and psychological stressors.
When Bipolar disorder manifests in adolescence, the feelings of isolation and loneliness become unbearable as the teenager may feel like there is no one else like them and they may have thoughts of suicide. Ross Szabo, spokesperson for the U.S. National Mental Health Awareness (NMHAC) Campaign, acknowledges surviving depression and a suicide attempt as a teenager. He describes how outwardly, he was a typical high school kid, with many friends and involved in a number of activities. However the bouts of depression kept worsening and the mask of happiness was getting harder to fake. When his feelings of loneliness and desperation reached a crescendo, he decided that he would take his own life. Luckily, his parents were there and noticing something was wrong with him, they intervened. Szabo began speaking about his experience, when he realised that people didn’t understand what mental illness is all about. He has found that by telling his story about living with bipolar disorder, he has been able to reach thousands of young people and encourage them to open up about their own experiences with mental illness and suicide.
Ross Szabo was lucky that his parents recognized a problem, however many parents believe that adolescence is a time of angst, rebellion and moodiness, therefore they may consider depression symptoms to be just a passing phase, and the teenager may not want to admit either, that they have a real problem. However many teenagers reach breaking point and consider suicide to be the only alternative. According to the NMHAC, approximately 20 percent of high school children have seriously considered or attempted suicide and it is the third-leading cause of death for people aged 15-24.
The South African Depression and Anxiety Support Group, Africa's largest non-profit, patient advocacy support group, has been educating the public about suicide and fighting the stigma attached to mental illness for the past six years. The group offers counselling, referrals to mental health professionals, and has over 160 support groups in Southern Africa. The group has also been targeting schools with the "Suicide Shouldn't be a Secret" campaign. Talks are given to classes or standards by trained counsellors. Younger counsellors give the talks as they are easier for the pupils to relate to and the talk is given in the format of an informal discussion rather than a lecture - to encourage the students to open up and express their fears and concerns.
The discussion covers depression - what it is, what it feels like, what causes it, how to recognise it and what to do about it; and suicide - discussing what can drive someone to that decision, the myths surrounding suicide, the bad consequences of failed suicide attempts, risk factors for suicide, signs to look out for in friends, what to do if someone tells you they are thinking about committing suicide and where to go for help.
What can you do if you think you or a loved one may be suffering from Bipolar Disorder? The first thing to do is to contact a mental health professional. Your physician, or a psychiatrist, community mental health centre or self-help and support groups can also be helpful. It is essential that you consult someone who is knowledgeable about bipolar disorder and that you, your family and significant others learn as much as possible about the disorder, through reading books, attending lectures and talking to specialists. The more you know, the more control you have over the illness.