KOCHI: Mental health has become a much-discussed topic in recent times. With more people sharing their personal struggles, it isn’t hushed up anymore. There’s a growing openness.
One highly misunderstood condition that’s being widely discussed these days is bipolar disorder. Many people are still unaware of what the symptoms entail and how to interact supportively with those affected by the condition.
Recently, bipolar disorder has gained more visibility as several celebrities have been sharing their personal battles with the condition. Yo Yo Honey Singh, Kanye West, Selena Gomez, and Mariah Carey are some of them.
Now a book, ‘Finding Order in Disorder: A Bipolar Memoir’, by Ishaa Vinod Chopra, daughter of ace director Vidhu Vinod Chopra, has yet brought forth discussions on the condition. [See interview]
Dr Arun B Nair, professor of psychiatry at Thiruvananthapuram Medical College, explains the basics: “It is a mood disorder characterised by episodes of overactivity, increased energy, and reduced need for sleep. When there is either excessive anger or happiness, that phase is called mania.
“There are two types – bipolar 1 is characterised by episodes of mania alternating with episodes of depression, while bipolar 2 is when the patient experiences episodes of hypomania, alternating with episodes of depression. Hypomania is a state in which there is an increased sense of well-being and increased energy, but it is not as disruptive as mania.”
Dr Muralidharan Kesavan, professor of psychiatry at National Institute of Mental Health and Neuro Sciences (NIMHANS), notes that the National Mental Health Survey points out that the prevalence of bipolar disorder is estimated at around 0.5 per cent of the population.
“That’s quite significant, really. In fact, it’s a large number—about 6.5 to 7 million Indians, if you go by that statistic,” he says.
“Interestingly, the prevalence is slightly higher in men compared to women in India, although globally, it’s equally prevalent across genders. In fact, a WHO survey estimated the global prevalence at around 2.4 per cent, which makes it a significant public health issue.”
Dr Arun hints at ‘social disconnection’ happening among youngsters to be one of the reasons behind the increasing prevalence of the disorder. “Many adolescents and youngsters are getting isolated from their family and friends,” he says.
“They don’t have anyone to ask for support during stressful events, and brood over it in solitude. This can evolve into mood episodes. They lead a solitary life sometimes with gadget addiction or substance use like cannabis and stimulants, all of which can induce mood disturbances.”
Bipolar disorder often becomes noticeable when the person is suffering from mania – where there is a visible change in the baseline behaviour, like over-talkativeness, intrusiveness, high energy levels, sleep-deprivation, etc.
As mania intensifies, it can lead to more severe behaviours such as aggression, hypersexuality, excessive religiosity, and grandiose delusions.
“For example, someone might believe they have extraordinary powers or will soon become wealthy. During these episodes, they may engage in reckless spending. This kind of behaviour can result in financial and legal problems,” Dr Arun highlights.
He cites the case study of an 18-year-old boy who was initially shy but later showed heightened talkativeness and energy. His family viewed this change positively at first. However, his sleep soon became disturbed, and there was a dramatic shift in behaviour.
“He woke up one day displaying violent tendencies. Claiming to be God, he began blessing others. He also asserted that he was wealthy enough to buy an aeroplane and made sexually explicit gestures in public,” Dr Arun recalls. “The situation escalated and he had to be admitted to a hospital.”
Bipolar disorder usually manifests between the ages of 15 and 25. Popular columnist Aparna Piramal Raje, author of ‘Chemical Khichdi: How I Hacked My Mental Health’, experienced bipolarity when she was 24. “It was in mid-2000. I was about to begin an MBA at Harvard Business School. This excitement, combined with some emotional turbulence in my personal life, created the ‘perfect storm’ that triggered hypomania,” she says.
“I lost sleep, experienced delusions of grandeur, and had a constant rush of ideas. My sister and mother had to accompany me to Boston because I was unable to travel on my own. They were perplexed by my behaviour, particularly the changes in my facial expressions and eyes. When they left Boston, I sank into depression for several months. After consultations, I understood it was bipolar.”
Misconceptions & treatment
The disorder isn’t hard to identify, as in most cases there will be a clear change from baseline behaviour. “However, people often don’t understand that this is a medical issue — a mental health condition,” says Dr Muralidharan.
“There’s also a tendency to blame the individual, especially in the case of depression, suggesting they’re not trying hard enough to feel better or that they are lazy.”
Experts stress that early intervention significantly improves outcomes for those with bipolar disorder. With proper treatment, individuals can lead normal, successful lives.
Along with medications, psychological therapy is vital. “This includes cognitive behaviour therapy, acceptance and commitment therapy, interpersonal therapy, etc. These would help the person identify the negative thought process, so that it won’t affect the emotional state of mind,” Dr Arun explains.
“If left untreated, however, bipolar disorder can lead to cognitive dysfunction. In rare cases, electroconvulsive therapy may have to be given. There is a dangerous condition called catatonia, where the patient does not speak, move, or have food and water. So after giving anaesthetic medications, a mild electric current has to be administered.”
Freelance journalist and writer Shreevatsa Nevatia, who has gone through the trauma of the disorder, says bipolarity is manageable through therapy and medication. But he cautions that even with all the precautions, one might still experience mania.
“That’s the nature of the illness. It could happen once a year, or once in two years, or, if you’re lucky, after longer breaks.
“The emotions one feels during these episodes are always extreme,” he says.
What often gets overlooked is that bipolar disorder is primarily caused by chemical imbalances in the brain, he adds. “It is often misunderstood, and people don’t always realise that it wasn’t ‘you’ talking—it was the illness,” says Shreevasta.
“But when your support system understands that it’s a cycle and that you will come out the other side as yourself again, it makes all the difference. They stand by you, love you, and support you — and that’s vital. Without a support system, I wouldn’t have been able to live my life the way I do.”