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BIPOLAR DISORDER: A SUICIDE RISK?

“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.

Are you or is someone you know depressed? Medical attention is advisable if you recognise the following symptoms for at least two weeks: feeling ‘down’ and a loss of interest in activities that you used to enjoy. In addition, the disorder is characterised by four or more of the following symptoms: change in sleep patterns, fatigue, feelings of worthlessness or guilt, inability to concentrate, persistent thoughts of suicide or death, overwhelming sadness or crying spells, feeling slowed down or too agitated to sit still, pessimism, indifference or social withdrawal, loss of interest in sexuality. In addition, there may be hallucinations (perceiving things that aren’t there) and delusions (believing things that aren’t true).

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, nearly all sufferers of depression can be helped to manage their illness. Unfortunately there is no definitive cure.

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.

Despite the clinical fact that bipolar disorder is an illness that can be managed with a combination of therapies, a stigma often attaches to sufferers of the illness. Kay Redfield Jamison, a psychiatrist who suffers from manic depression, gives a rich amount in her autobiography, The Unquiet Mind (published by Picador in 1995) of the precariousness of many of her work and personal relationships, engendered by her illness. Reactions ranged from shock and disappointment to disapproval and outright hostility, when she disclosed her illness to certain colleagues and friends. Although these caused her a great deal of pain, she acknowledges that having bipolar disorder can confer advantages on both the individual and society. In Jamison’s study of the illness, entitled Touched with Fire, she examines the apparent correlation between bipolar disorder and the creative temperament. It is widely supposed that madness is a requirement for creativity.

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 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.

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.