Bipolar affective disorder, or manic-depressive illness, is classified in the ICD-10 as a common, severe and persistent mental illness. It is a condition with a serious lifelong struggle and challenge. Bipolar disorder is characterised by periods of deep, prolonged and profound depression that alternate with periods of an excessively elevated or irritable mood, known as mania.1
Actor and broadcaster Stephen Fry has written and spoken eloquently about living with bipolar disorder: “Eleven years ago in the early hours of the morning I came down from my flat in central London,” he says, recalling the period immediately after he walked out on the play Cell Mates. “I went into my garage, sealed the door with a duvet I’d brought and got into my car. I sat there for at least, I think, two hours in the car, my hands on the ignition key. It was, you know, a suicide attempt, not a cry for help.”2
Despite the misery of depression and the danger to his own life, Fry has publicly stated that he is reluctant to take lithium to dampen the mood swings because the highs are so good, the lows are worth the risk.
I once asked a psychiatrist colleague: “Is what I have a disease? – Do I have a problem?” “Not if you’re not suffering,” came the reply. “What if my wife is suffering?” “Then she has a problem!”
Clearly the physician’s primary duty is to the patient, an imperative sometimes forgotten in Irish medicine where there is often more time spent speaking to patients’ relatives than to the patients themselves. But there is no doubt that the families and friends of those with bipolar disorder do suffer hugely and their exasperation can often turn to anger and frustration with consequent marital breakdown, loss of lifelong friendships, financial ruin and much more.
So what should the carers of manic depressives do? Just that – care. Recognise the disease as an illness like pneumonia or a broken leg, offer practical help and advice rather than recrimination, keep your head down and your eyes open and wait and hope until the dust settles. Ask for help but respect the fact that the patient, even though they’re driving everyone mad, retains the right to consent to or refuse treatment until they are deemed to lack mental capacity to manage their own affairs.
- Bowden C, Singh V. Long term management of bipolar disorder. http://www.medscape.com/viewprogram/2686
- Fry S. My long battle with manic depression. The Guardian 2006 (July 21)