New School...lol

I'm wondering what is going through the mind of this fox...  “Why bother chasing them in this 21st century when I can just shoot them down...after all, it is still hunting”.

Inside The Mind of a Patient with Mania

You might think that from a manic patient’s viewpoint, mania is an exhilarating experience-a feeling of being invincible, all powerful, and all-wise. In milder forms of the disorder, that is precisely how the manic patient feels. 

The problem, however, is that mania often escalates to such feverish heights that the patient is totally and frighteningly out of control.

Here is how one woman described the terrible transition from relatively mild mania (called hypomania) to much severe symptoms:

[Hypomania] At first when I’m high it’s tremendous…ideas are fast…like shooting stars you follow’ till brighter ones appear…all shyness disappears, the right words and gestures are suddenly all there…uninteresting people, things become intensely interesting. Sensuality is pervasive; the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria…

[Mania] The fast ideas become too fast and there are far too many…overwhelming confusion replaces clarity…you stop keeping up with it-memory goes. Infectious humor ceases to amuse-your friends become frightened…everything is now against the grain…you are irritable, angry, frightened, and uncontrollable. You feel trapped in the blackest caves of the mind-caves you never knew were there. It will never end.

(Goldstein, Baker, & Jamison, 1980)

BIPOLAR AFFECTIVE DISORDER …that extreme excitement could be a tell- tale sign of an imminent mental breakdown

As a fresh resident psychiatrist, Bipolar Affective Disorder was the first mental illness to intrigue me. The story I will share here was the first of what would later become many of my encounters with people who are burdened with this illness. 

This experience, which actually happened to a close friend, led me to writing and blogging about mental illness.

John really felt good with himself because he thought he had finally overcome his shy nature. He could now walk up to any lady and chat with them because he felt he was irresistibly charming. He was full of energy and had earlier disclosed to me that he had discovered that “great men don’t have need for much sleep”. He was so excited about all the great ideas rushing through his mind and he went on and on talking… like forever. None of this new behavior stared up any need for concern from his family members until he did something…something really embarrassing and he had to be admitted into a psychiatric ward.

John (not real name) has a condition called Bipolar Affective Disorder, which refers to a disturbance in the mood of an individual. Though we don’t have the exact figure here in Nigeria the lifetime prevalence (will occur at some point in a person’s life) is between 0.3 and 1.5% of most general population.

What is Bipolar Affective Disorder?

Like the name implies “Bi” meaning two… there are 2 poles or sides to the illness, the individual with bipolar affective disorder is either sometimes “manic” or at other times “depressed” hence it’s commonly called a Manic-Depressive disorder.

There are two major variants of bipolar affective disorder; Bipolar I and Bipolar II.

In bipolar I the individual experiences one or more manic episodes with or without obvious depressive episodes in between while in the bipolar II variant the individual experiences repeated episodes of major depression interspersed with hypomanic episodes. Bipolar disorder generally shares the same incidence (rate of new cases) between both sexes however the bipolar II variant is more common in women.

How to recognize it?

Though there are two poles to this condition, in this edition I’ll be focusing on recognizing the manic pole. Mania is characterized by elated (happy) mood which would have lasted for at least one week with three or more of the following

   Self-esteem: highly inflated, grandiose; believing their ideas and works are exceptional

       Sleep: decreased need for sleep, rested after a few hours

  Speech: They are usually talkative; talking loudly, rapidly and endlessly making it impossible to interrupt them.

     Thoughts: racing thoughts moving very fast from one topic to another.

  Attention: easily distracted. They start many activities but would usually leave them unfinished as new ones catch their fancy.

    Spend extravagantly

    Display over familiarity even with strangers

   Sexual desires are increased and behavior may be uninhibited; may neglect precautions against pregnancy without the slightest awareness of the consequence of the behaviour.

Hypomania is a milder form of mania with all the above symptoms however the duration for the elated mood or irritability could just be as short as 4days. In milder forms of the illness the manic individual feels they are having an exhilarating experience; a feeling of being invincible, all powerful, and all-wise however the situation often worsens and then the condition becomes frighteningly out of control.

The Cause

Genetic and family studies show it runs in families however it could be triggered by environmental stressors and there is also evidence that depriving oneself of sleep could trigger it especially in those who are already vulnerable to this illness.

The Course (how it progresses)

For bipolar patients, the mean age the illness shows up for the first time is about 18years this is usually mild and may go unnoticed, the individual may get better without treatment. The mean age for first treatment is about 22years, and the mean age for the first hospitalization is about 25years. 25-50% of people with this illness also usually attempt suicide at least once especially during one of their depressive episodes.

In between episodes of the illness these individual are perfectly okay and can carry out their usual duties effectively. It has affected many creative people in the past and present hence it is nicknamed ‘creative madness’, though those who battle with this illness would rather live a ‘normal life’ and be free from the unpredictable mood swings.

Self Help Tips

These few tips could help reduce the chance of frequent reoccurrences in those already diagnosed with the illness and generally improve their quality of life

  Setting and maintaining a standard bedtime and wake time this is to prevent sleep deprivation which may trigger the illness

    Practicing relaxation or meditation exercises regularly

    Reducing work and family stress as much as is practical

   Eating a healthy diet at regular times each day as excessive fasting tends to trigger it too

Regular participation in communities including religious communities;   community participation helps prevent depression

   Taking medication at the same time everyday

   Regular attendance at clinical appointments and regular self-monitoring

    Avoidance of mood-altering drugs, including alcohol

Coping with those with the Illness

Like every chronic illness there is a lot of emotional and financial strain placed on family and friends. The spontaneity of the reckless behaviour of these individual in terms of excessive spending, suicidal attempts, promiscuity and general odd behaviour may cause a form of embarrassment and anxiety.
To cope with the ones with the illness and also better assist them one should

    Get information about the nature of the illness so they can help monitor the individual’s mood thereby being able to detect early onset of the illness and possibly initiate intervention when necessary.

  Encourage these individuals to comply with medication since most of them have a tendency to stop their drugs complaining that they don’t like the way the drugs make them feel.

  Develop an ongoing relationship with a family therapist who can provide advice and crisis management services.

Limit the patient’s access to large money possibly by introducing co-signatory modalities.

Long acting birth control methods can be used to reduce the risk of unwanted pregnancy.

  Regular testing for sexually transmitted disease for patient and spouse when sexual promiscuity is involved.

       Find a support group (could be a religious group) that could always give the needed support when you feel like giving up.

Please bear in mind that these individuals did not bring the illness upon themselves so be gentle on them and if you suffer from this illness I encourage you to comply with your medication and maximize your quality of life.

Please check out this link http://www.youtube.com/watch?feature=player_detailpage&v=rqoj7Mse7iQ

A Therapy called " Forgiveness"

Timi was only 26 years old when he married Preye who was a little over 18years old back then. Exactly one year after their wedding, she slept with someone else and this infuriated him to no end but after much counsel, he decided to give the marriage a second chance.

 They went on to have 4 children but exactly 10 years later, she cheated again and this time he sent her packing .Now without trying to justify his wife’s actions I must inform you that Timi also had his share of infidelity while they were married but you know, like the saying goes, it’s okay for the man but wrong for the woman (for the record, yours truly sincerely does not share this opinion!).

I met Timi 15years after the separation; he was now in his fifties. He had come in with complaints of being unable to sleep without taking medication for more than 13 years, he was also unable to concentrate at work and had actually resigned from an enviable position in a successful bank and was now teaching economics in a private secondary school. He had been to several hospitals, done several tests, taken so many medications over these 13years yet the problem was still there. He was unable to trust women after the separation and was now in various relationships strictly for the sex.

Timi had come to the hospital for help but one desire was glaring, he was obsessed with proving to his ex-wife that he would rise again.
As I spoke with him it became obvious to me that he had a “Somatoform disorder” (a term used for a group of disorders characterized by physical symptoms with no proof of organ malfunction and discovered to have a psychological origin).

Alas! Timi’s problem no doubt, stemmed from all the bitterness he had bottled up against his ex-wife! And so my focus will be on dealing with the issue that led to the deterioration…Unforgiveness!

This story may be considered to be an extreme example of the toll that unforgiveness could have on our health and general well being but the saying is true that when we do not forgive someone, we end up hurting ourselves even more.

Everett Worthington, Jr, a clinical psychologist and a professor at Virginia Commonwealth University, has completed studies that show that people who won’t forgive the wrongs done against them have more stress related disorders, lower functioning immune systems, and more cases of heart disease than people who forgive. Unforgiving people also tend to have higher divorce rates.

There are three types of forgiveness: first is judicial forgiveness, this type of forgiveness can only be given by God. It is the pardoning of sin, the gift of undeserved kindness. Second is psychological forgiveness. It is the victim’s job. It is letting go of the desire for personal revenge and negative feelings towards the offender while extending undeserved kindness towards him or her. And lastly, reconciliatory forgiveness; It is the offender’s job. It is at this point that the relationship is restored or at least restoration is sought. In order for this to happen the offender must be repentant.

Now looking at these three types of forgiveness, the first and the third are beyond our control but the second is well within reach; our responsibility and fundamentally necessary for our total well-being. Forgiveness is a process that takes time and effort but it is well worth it!

“Forgiving doesn’t necessarily mean forgetting the offence rather it means “to let go of the resentment and the thoughts of revenge; the bitter ties that bind us to the one who hurt us”

 
Forgiving someone is not an easy task; you can’t just skip to the part where you feel better but you can commence the journey to feeling better with these liberating steps listed below.

Step One: Don’t deny the pain

You cannot heal what you do not feel. Rather than brush it aside, avoiding the pain, you should allow yourself the time and place to feel these emotions. You have a right to feel hurt. Deciding to just let go of the hurt or trying to forget it will lead to failure of effectively dealing with the hurt. Those are quick fixes and only mask the anger. It usually resurfaces. You may have to find a trusted family member or friend who will just listen, like a sounding board, without making too many comments and wouldn’t share your delicate issue with others.

Step Two: Don’t pass it round

When hurt, there is usually the tendency to become easily irritable and the tendency to snap at others is high, the hurt generally colors our judgment and it affects our decisions and those around us. Sometimes we look for who or what to blame and at moments like that, we must accept and own the hurt without transferring it to someone else.

Step Three: Visualize separating the offender from the offence

This is pretty difficult because as far as we are concerned there wouldn’t have been any offence in the first place without the offender however by doing this you are giving up your control, your right to go over and over again in your mind what they did to you. It is like making an excuse for the offender; it may sound foolish but it is a step in the right direction of achieving peace of mind

Step Four: Release the offender and the pain

Every thought, every emotion, hold nothing back. You could write down the offense and all the emotions you feel; anger, guilt, depression, disappointment and so on, then burn it afterwards. You could write a letter to the person who hurt you expressing your hurt and then just simply throw the letter away. This may look like a ritual but it also has a therapeutic effect. You should also ask God constantly to give you the strength to let go of the hurt because it would occasionally return like waves especially when you find yourself in a situation that reminds you of the offense, for example, being in the presence of the offender.

Step Five: Express love to the offender

This should be approached like a baby attempting to walk…one step at a time. After the offense is committed there will surely be setting up of boundaries directly related to the nature and severity of offense and I wouldn’t expect you to let down your guard and allow them back into your life with all the privileges they once had. It may begin with a smile when you meet, regardless of if he or she has asked for forgiveness. You should also continue showing love despite the boundaries like sending a get well message when you find out they are not feeling fine. This last step makes you look vulnerable but remember this whole forgiveness therapy is for your well being not for the offender though your attitude and actions of love may eventually help them. I cannot tell you what boundaries to keep after an offense especially if the offense was severe like in sexual, physical and/or mental abuse and the exact measure of love to show but I would say a counselor (whether religious or a clinical therapist) would be of great help here.

Like I said forgiving is a process that could take a while but it is worth it because in freeing the pain and the offender you literally set yourself free. Accommodating feelings of anger and hurt in your system can actually make you ill over time, and lead to unhealthy addictions. Like they say; don’t get bitter, get better! And yes, it often takes God’s help to go through it, after all;” to err is human but to forgive is divine”.