Bipolar mood disorder: Two sides of the coin

“Mania starts off fun —not sleeping for days, keeping company with your brain which has become a wonderful computer, showing24 TV channels all about you. That goes horribly wrong after awhile,” says Carrie Fisher, American actor and writer. Indeed, it’s a wonderful and different feeling for those who are in mania. More talking and increased socialisation, immense amount of energy .... you want to do multiple things.

Mr Shah had plans to do multiple businesses. In fact, he started renting places for various businesses like grocery shops, restaurants and an IT firm. He started interviewing people. He was spending money unnecessarily. He would talk big, and that he knows many politicians. He would claim that he had made some Members of Parliament into ministers as he has connections with the Prime Minister. He would feel that he could control political ups and downs, and could easily get finances from these politicians for his businesses. He would appear very happy and cheerful, and would talk a lot on any subject. He would not allow anyone to speak before he completed his long talks filled with ideas, upliftment of the poor, and improving the Indian economy. He would say he could do anything. He would sleep less and eat less. He would always tell his family that he had a lot to do. At times he would become irritable and aggressive. He would promise anything to neighbours and would distribute money to poor. Once he gave his iPhone to a cabdriver. He gave thousands of rupees to a beggar.

All this led to a lot of financial loss and his family wanted to consult a psychiatrist, but he would not agree. Eventually, he was brought to me. He appeared dressed colourfully. He was elated and talking a lot about different topics. Of course politics was one important area. In fact he suggested to me, “Doctor, why are you just MD? I will make you MP; that is, Member of Parliament.”

He was suffering from bipolar mood disorder. Bipolar mood disorder has two stages — Mania and Depression. Mr Shah was in the manic phase. These are the symptoms of mania.

Elated mood: Always feels happy. Gregarious, laughs a lot, cracks jokes and has increased self-esteem. Sometimes, it leads to irritability or anger outbursts.

Inflated self-esteem: Patient feels over-confident that he can do anything, is unusually talkative and dresses in a fashionable manner.

Racing thoughts: Patient has multiple thoughts and plans on various topics. He talks continuously on subjects tirelessly. Usually, there is a theme of either doing something for the poor or country or unlimited power of self.

Sleeping less and Eating less: In spite of this, they appear energetic and not tired at all.

Due to the above symptoms, they appear energetic and talkative. They do talk about ideas and business. They distribute money. As there are multiple ideas, they're not focused. Hence in a few months they cannot sustain their ideas. In fact I have seen many patients who had financial losses in the manic phase. As they are on top of world, they are not ready for any kind of treatment. They have to be brought forcefully to the hospital. Many bipolar disorder patients need hospitalisation due to their financial mismanagement or violent behaviour. It is also possible that these patients have arguments and disagreements with friends and family. They may appear arrogant and stubborn. They may lose ties with closed ones for the long run.

When these patients go into the other phase, that is depression, then they may develop insight and want to take treatment. In this phase, however, they are not heard as the family feels they are quiet and that’s what they wanted. But they are not happy — they need help. In depression, they are sad and quiet. Sometimes, they realise their mistakes and misdeeds done in the mania phase. They start blaming themselves and often have immense guilt. It can lead to suicidal ideation and even attempts. Some 25% to 60% of individuals with bipolar disorder attempt suicide at least once in their lifetime. Between 4% to 19% die of suicide which is a significant number. It needs to be treated properly.

I want to remind all those with bipolar disorder that Carrie Fisher, who herself suffered from bipolar disorder, said, “At times, having bipolar disorder can be an all-consuming challenge, requiring a lot of stamina and even more courage. So if you are living with this illness and functioning at all, it is something to be proud of, not ashamed of.” It is the illness that causes the irrational behaviour and not the individuals. The family of such individuals show high levels of expressed emotions like criticism or overprotection. Studies revealed that there is absence of family cohesion and adaptability. There are also significant inadequate interpersonal relationships. All these account for lower family and social support to the individuals having this illness. Apart from individual dysfunction, there is ample evidence of familial dysfunction bipolar mood disorder and it is associated with impaired psychosocial functioning. This can lead to increased number of episodes and poor functioning.

Hence, apart from biological treatment of the patient, it is important to intervene in the family functioning and psychosocial function. Psychosocial functioning interventions are beneficial in improving family conflict, enhancing cohesion and moderating family adaptability in bipolar disorder individuals. Studies show that support from family and friends may contribute to personal recovery and psychosocial functioning in the patients, and help individuals build resilience and cope with adverse environments effectively. Good social support helps in reducing clinical symptoms and poverty, and better social support indicate higher household income and lower caregiving burden.

Interestingly, suicidal ideations are less in the patients having good family support. Nowadays , we have ample ways to intervene in the family to increase the family functioning and social functioning.

So please, support an individual who has bipolar disorder, it can bring about a change in the patient as well as family. As famous singer Mariah Carey, who suffered from bipolar disorder for 17 years, said, “Until recently, I lived in denial and isolation and in constant fear someone would expose me. It was too heavy a burden to carry, and I simply couldn’t do that any more. I sought and received treatment, I put positive people around me, and I got back to doing what I love.”

Apart from biological treatment of a bipolar patient, it is important to intervene in the family functioning and psychosocial function

Dr Shailesh Umate is a consultant psychiatrist, sexologist and addiction specialist, whose mission is spreading awareness about mental health and well-being