Bipolar disorder, better known in layman’s terms as manic depression, is regarded as one of the most under-diagnosed psychiatric illnesses of all time. Bipolar disorder accounts for the highest rate of successful suicides amongst psychiatric diagnosis. The sad misconception amongst the population is that all persons having a psychiatric disorder have the unfortunate disposition of a lower IQ, disorganised, low profile jobs, struggling to make ends meet. No wonder bipolar disorder has been misdiagnosed! This profile fits the same way a left shoe fits a right foot. Bipolar patients are usually of above average intelligence, often highly intelligent individuals occupying high profile jobs. Doctors, accountants, ministers, lawyers, etc. When the illness is controlled on medication, they are highly functional individuals in various spheres of their lives. The flipside of the coin is unfortunately also true. If uncontrolled, the patients are dysfunctional, disorganised and extremely difficult to manage and to live with.
As the name indicates, bipolar means two poles. The bipolar mood fluctuates between two poles of severely elated mood and major depression. However, some patients only experience a manic episode. To further compromise the situation, these euphoric and depressive states of mind, do not present the same in all individuals. A manic episode for one patient may be that he acts irresponsible (maybe a shopping spree relates more to female counterparts!), another will go to the streets, while others become very aggressive. Marked raise in energy levels as well as sleep disturbances (need less sleep), rapid speech, high irritability and racing thoughts are usually present in the manic phase. The depressive phase follows the manic phase. The patient becomes severely depressed and all stimuli are interpret from this state of mind. This is usually the phase where the patient becomes a threat to himself regarding suicide. The patients usually experience a great amount of guilt.
It is essential to realize that both the mania and depression are irrational states of mind. In these phases, the patient has no control over his actions and emotions. Their actions are impulsive without any alternate motives. There is also no pre -meditated actions or planning. When reaching the depressive stage, the person experience overwhelming emotions of guilt and are truthfully sorry about their behaviour. Psychosis can be present where the patient experiences hallucinations and illusions. The patient interpretates reality from his current mindset and he perceives his own actions as appropriate, his arguments fair and his paranoia justified. At this stage the patient is not responsible for his actions and should be managed accordingly.
Since bipolar disorder is a psychiatric illness, chemical intervention is imperative. Deciding the type and dosage of medication, as well as following up of patients is the responsibility of the treating psychiatrist. Depending on the severity of the illness, medication usually includes a mood-stabilizer, anti-depressant and anti-psychotic drugs. The compliance of patients with bipolar disorder is poor and therefore it is strongly advised that someone close to the patient takes the responsibility to monitor and administer the medication.
Who is susceptible to bipolar disorder? Anybody. Bipolar disorder is more often diagnosed where there is a family history of bipolar disorder, major depression or schizophrenia. Onset of bipolar disorder is often triggered by a traumatic emotional event. The onset could often be subtle, making the diagnosis complicated. A patient could be stabilized for a period of time on medication; yet a stressful situation or traumatic event can be the stimulus for a new onset of symptoms. This will lead to reassessment of medication. It is therefore safe to say that the treatment of the bipolar patient is a dynamic interaction between the patient, the family and the psychiatrist.
The family of the bipolar patient also suffers from bipolar disorder. The spouse, partner, children or close family members have fallen victims to the incontrollable periodicity of the illness as well as the devastating consequences of the illness. They are constantly bombarded with either the onslaught of an acute attack, or trying to pick up the scattered pieces. Even if the patient is controlled on medication, they always anticipate the next fallback.
Family members are often ill informed regarding the complexity of the illness. This makes them even more vulnerable. However, the sad reality is that families are torn apart whether they are illiterate or specialists in the field. The sequalae of the illness has a rippling effect reaching all aspects of life. The family usually have to deal with the consequences of the manic episodes. Even if they understand the illness, the effects become personal. The person they once knew, loved, admired and cherished, has become a distant total stranger. Children become insecure, sad, frightened, misbehaved because their nurturing parent has been substituted by someone the neither know, nor understand. The family can be financially ruined. The possible effects are endless.
It is impossible to comprehend the impact of bipolar disorder in a family. Therefore, it is totally understandable why marriages result in divorce, partnerships break up, children’s lives fall apart. No blame can be directed towards the spouse (partner) of a person with bipolar disorder, who makes the painful decision to divorce the patient. Even if they are aware of the pathology of the illness, even if they are aware of the fact that the person’s life is in pieces. The fact is, they are also broken. Their lives are also lying in pieces. They are also only human.
With regards to my initial question whether it is worth going on in a relationship with a bipolar person, I have come to the conclusion that even in a secure, nurturing environment, the whole family ( including the patient, spouse and kids) are not excluded from episodes of erratic behaviour. The bipolar person is torn between his irrassional behaviour, over which he has no control and the realization of the devastating effects this has on his family. Is it worth it for the spouse (partner)? They are torn between the person they once knew and loved and this total stranger from whom they often have to protect themselves and their family. And then they are also just human.