Battling the ‘hidden’ highs and lows of bipolar disorder
One in 100 Singaporeans suffer from bipolar disorder. The New Paper speaks to sufferers on how they cope and what can be done to tackle the condition
Ms Ruth Komathi was only 15 when she felt something was wrong with her.
She had a tightness around her head that never seemed to disappear, her mind was constantly buzzing with disorganised thoughts, and she felt bouts of despair.
In school, her essays became incoherent word salads.
After rounds of medication and therapy , her doctor finally gave her condition a name when she was about 18 years old: bipolar disorder.
Ms Komathi is not alone.
A study conducted in 2010 by the Institute of Mental Health (IMH) discovered one in 100 Singaporeans suffer from the mental disorder in their lifetime.
Also known as manic-depressive disorder, bipolar disorder is characterised by extreme shifts in a person's mood, thoughts, behaviour and activity levels.
This can be marked by soaring manic highs or crushing depressive lows.
Dr Mok Yee Ming, senior consultant and chief of the department of mood and anxiety disorders at IMH, told The New Paper the disorder tends to run in the family and usually manifests itself during a person's youth.
He added that stressful life events and certain personality traits could contribute to the development of bipolar disorder too.
He said: "Alcohol and illegal drug use also have a profound impact on mood state, and use of these substances is likely to trigger a relapse or act against the medications for bipolar disorder."
While many people have the misconception the disorder is simply bad mood swings, Dr Mok said they can be disruptive and dangerous.
He said: "The mood episodes are severe and cause disruptions and chaos not just to the sufferer, but to the people around them.
"Even though everyone wants to feel happy, manic episodes can often result in severe consequences. For example, they may take dangerous risks believing they will not be harmed, or they may spend excessively till all their savings are used up."
Ms Komathi, now 28 and a counsellor at the Singapore Association for Mental Health (SAMH), recalls several depressive episodes as a teenager.
She would not leave home for months and spent days cooped up in her room, not even showering and eating only minimally.
She attempted suicide several times. She told TNP: "I did not feel worthwhile and did not know what was going on with my life. I guess it was my way of telling others I was suffering."
Other episodes remain a blur to her. For example, she remembers watching television in the living room once with a chopper in hand.
"Besides that, I can remember hearing my mother's screams in the background. Nothing else," she said.
Her doctor initially diagnosed her with depression and prescribed her antidepressants. Although they made the depressive episodes more manageable, her manic episodes worsened.
"During my lows, I wanted to kill myself. During my highs, I thought I could fly like Superman," she said.
She once stood in the middle of the road against oncoming traffic.
She said: "I thought I was invincible. My neighbours had to pull me back to safety."
The same research by IMH in 2010 found that it took people an average of nine years to seek help for bipolar disorder.
Assistant director of SAMH's outreach services, Ms Helen Yong, told TNP this time lapse could pose a potential problem.
She said: "During that time, they may be suffering from the disorder's symptoms yet not understand what is happening. Their loved ones might not understand too. As a result, some relationships become strained because of this lack of understanding."
Local novelist Mahita Vas, 55, discovered she had bipolar disorder only about 30 years after her symptoms surfaced.
She often experienced random and explosive bursts of rage, which might have strained her relationship with her twin daughters, who are now 26, when they were younger.
She said: "They would be doing whatever young children do, like decorating their rooms with toilet paper, and I would explode at them.
"I said some terrible and wicked things to them. All these episodes made them afraid of me."
It was only after a particularly intense manic rage episode at work did she realise something was wrong. She went completely ballistic on a colleague, screaming nasty and obscene things at her.
She said: "I was mortified by my behaviour. It was completely out of character for me. But it was too late. There was no way of taking back what was already said."
That incident prompted her to seek help from mental health professionals, who diagnosed her with bipolar disorder. She was 42.
Although Ms Vas' condition is currently under control with the help of medication, she regrets not getting help earlier.
She said: "That was 30 years of wasted time - of doing and saying things I regretted afterwards.
"If I had sought help and gotten medicated sooner, I would not have said or done so many hurtful things, especially to my children. Even though we are close now, I might have been a better mother."
Like Ms Komathi, educator Karen Lin, 27, was initially misdiagnosed as depressed while studying as a sophomore student at the University of Chicago in 2012.
She would struggle to get out of bed in the morning and everything seemed bleak to her.
Ms Lin said: "There was a veil lifted over my eyes that helped me see reality as I thought it was - terrifying and excruciating. It felt unbearable and the only way of getting out of it was by dying."
But after every depressive episode, she would be able to churn out essays and had as little as two to three hours' sleep.
It was only in 2013 that a psychologist brought up the possibility of bipolar disorder.
Even then, it took her a while to accept the diagnosis and receive help.
She said: "It was not like depression, which everyone talked about. Bipolar disorder seemed too bizarre, like it could never happen to me."
Ms Nicole Kay, 36, founder of the mental health support group Tapestry Project SG, said besides a lack of awareness, a lack of understanding about the disorder and its treatments, and financial constraints could lead to a late diagnosis.
She said: "Mental health is a complex condition that needs a variety of tools, such as psychotherapy, lifestyle adjustments and a support network, to manage.
"Not everyone understands or perhaps accepts that such professional intervention is needed. And the costs incurred from professional consultations, medications and therapy sessions can all add up quickly."
She added that the stigma attached to the disorder might prevent people from seeking help, especially since it may affect job prospects.
"There is the societal expectation for men to just 'suck it up', which is such a harsh and unforgiving attitude," she said.
"We need to understand it is okay not to be okay, and there is no shame in getting help or answers.
"With accurate information, proper treatment and empathy comes recovery."
Symptoms of bipolar disorder vary on type of episode
Dr Mok Yee Ming, senior consultant and chief of the department of mood and anxiety disorders at the Institute of Mental Health, said symptoms of bipolar disorder depend on the type of episode a patient is experiencing. These include manic or hypomanic episodes, depressive episodes, or a mixed episode.
Common symptoms of mania or hypomania include heightened energy and activity levels, euphoria and irritability.
They may lose their social inhibitions and display inflated self-esteem.
Manic episodes can also range from carefree joviality to almost uncontrollable excitement, such as talking excessively, racing and disorganised thoughts, an inability to concentrate, and expressing unrealistic and grandiose beliefs.
Some may even experience delusions and hallucinations with their mood symptoms.
Hypomania, on the other hand, is characterised by less severe mania symptoms and does not feature delusions or hallucinations.
Signs of a depressive episode include feelings of fatigue and moroseness, changes in appetite, an inability to concentrate, and sleep problems.
They may also lose interest in things they used to enjoy, feel guilty and worthless, and have ideas of self-harm or suicide.
Occasionally, people with bipolar disorder may experience a mix of both mania and depression during a single episode, said Dr Mok.
Their symptoms would then alternate rapidly from day to day, or even hour to hour.
- RY-ANNE LIM
Celebrities with bipolar disorder
The actress has been outspoken about her battle with bipolar disorder since 2011 when she sought treatment at a mental health clinic after her actor husband, Michael Douglas, was diagnosed with stage 4 throat cancer. She is still outspoken about with the disorder and advocates for its de-stigmatisation.
Since her diagnosis with bipolar disorder in 2011, the singer has been actively advocating for mental health awareness. In an interview with People magazine, she said: "If you know someone or if you are dealing with it yourself, just know that it is possible to live well. I am living proof of that."
The pop diva was diagnosed with bipolar disorder in 2001. She opened up about her struggle with it in April. She told People magazine: "I am hopeful we can get to a place where the stigma is lifted from people going through anything alone. It can be incredibly isolating. It does not have to define you, and I refuse to allow it to define me or control me."
Institute of Mental Health's Mental Health Helpline : 6389-2222
Samaritans of Singapore (24-hour hotline): 1800-221-4444
Singapore Association for Mental Health: 1800-283-7019
Silver Ribbon: 6386-1928
Care Corner Counselling Centre (in Mandarin): 1800-3535-800