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”.
Wednesday, 16 May 2012
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.
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
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.
Sunday, 13 May 2012
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).
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.
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
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
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”.
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