For Ray Richmond (not his real name) life has been an endless wheel of psychiatric wards, antidepressants and sedatives.
Eleven years of living with bipolar disorder has given him enough time, lying on psychiatric beds, to relive all of the words and actions he had no control over; to think about the broken relationships; the pain and the hurt of keeping this part of his life a secret. For Richmond, a man in his early thirties, the future seems dim yet he holds on to hope that one day life would be normal again.
“It does hurts that most people are progressing at a pace that I can’t reach because of my limitations. This has affected all aspects of my life—any relationships, any studies and any work. I am not like most people who could study all night because if I don’t get sleep it could trigger an episode and I could get sick again,” he said.
Bipolar disorder, also known as a manic-depressive illness, is a brain condition. This mental illness is characterized by periods of high spirits and periods of depression.
There is no cure.
“What hurts the most is that I don’t have control over my emotions during an episode and that’s something I live with every day. It’s different when you can control what you say,” Richmond said, recalling his first episode and being told by doctor that he had bipolar disorder.
“At first I was in denial. One day I was good and the other day I was being rushed to a hospital in an ambulance. It wasn’t easy accepting this. It actually took years to accept that I have an illness,” he stated.
“This is going to be my eleventh year,” he said, adding that there is always a fear that he might say or do something wrong.
Clinical Psychologist Dr Michaela Mc Rae, in an interview with Stabroek News, said that bipolar relapses leave a cyclic line of shame and embarrassment for a lifetime.
“That’s not an easy way to live… There is this apprehension of having to watch themselves at all times just not to slip up,” Dr Mc Rae said. “They are in constant fear that they might say or do the wrong thing that will give away… [that they are mentally ill].” She added that these people are usually very sensitive to other people’s opinions.
Every few months they are on a rollercoaster of manic or depressive behaviour or sometimes both, causing most of them to be hesitant to expose themselves to people.
She explained that people living with this illness experience unusually intense emotional states that occur in periods called episodes. An overly joyful or overexcited state is called a manic episode while an extremely sad or hopeless state is called a depressive episode. Extreme states include inability to sleep, high energy and creativity. They may even be bombarded with thoughts of suicide.
“In manic behaviour they become very happy, noisy; their thoughts are always speeding, they are in love with everybody, and they can be very violent and unpredictable. They can be aggressive to the point of committing crimes, committing murders,” she said, noting that the aggression is a “danger curve.
“But after this fabulous height there is a dismal drop into the deepest possible depression for no apparent reason…where everything becomes horrible and they hate themselves; they hate the world, they wish to kill themselves,” she stated.
However, unlike schizophrenic psychosis in which the patient is disconnected from reality, bipolar patients are not. Mc Rae explained that deep inside of their minds there is some part that is conscious and fights desperately to control the episode. “….the harder they try to control it and fail the angrier they get with themselves and the world. With their memories intact they will remember everything that they did and said during that last episode,” she said sadly.
“That is the shame and pain. If they didn’t remember what they use to do, it wouldn’t be so tragic. This is one of the reasons why they become depressed afterwards because they are flooded with the proof of their misdeeds… Their embarrassment is so acute they cannot face it or forgive themselves,” she stated.“Having to bear the burden of this knowledge of all the bad things you did, of all the crazy things you said, of all the embarrassment you have put yourselves and others through causes some of them to toy with the concept of suicide, and that in itself is dangerous because people with such impulsive behaviour, toying with a concept and jumping to implement it is not such a big gap,” she said, indicating that there was a history of successful suicides among bipolar disorder patients.
She stated that even though bipolar disorder is not a curable condition it is controllable with medication. She said patients who use their medication and receive counselling can integrate themselves into society quiet normally but they should not use alcohol or drugs.
Mc Rae indicated that mood stabilizers are usually the first choice treatment for bipolar disorder but in cases where medications and psychotherapy do not work electroconvulsive therapy (ECT) is used.
Electroconvulsive therapy
This type of treatment was reintroduced at the National Psychiatric Hospital (NPH) in Fort Canje, Berbice last October. So far, over 45 patients at the hospital and referrals have been treated.
Richmond was one of those patients who sought treatment at NPH after having an episode. He stated that he had recently started a new job and was getting himself into the work when he relapsed. He was taken to a city hospital and was referred to the NPH for further treatment. It was there that his family was told that doctors there could perform ECT on him. According to the Minnesota-based Mayo Clinic, ECT is a practice where electric currents are passed through the brain, deliberately triggering a brief seizure and causing changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses.
However, this type of treatment has attracted a lot stigma because of how it was administered in the past. Developed in 1938, ECT was administered to patients under high doses of electricity without anaesthesia.
“Think about somebody putting two electrodes on your head and literally driving current through your brain. The mere thought by a normal person would be that this is an inhumane kind of treatment,” NPH Psychiatrist Dr Mayda Grajales said, stating that there have been international medical debates on whether it was right to administer this type of treatment.
“In a few countries it is controversial because people believe that you are taking away the basic human rights of a patient,” she said. The procedure, nevertheless, has improved significantly over the decades, with patients feeling no pain or discomfort during the therapy.
Dr Grajales stated that the therapy is only used if the patient’s illness has not improved after other forms of treatment. She said it was used to treat severe forms of depression and mental illnesses such as bipolar disorder and schizophrenia.
Before it is performed, she said, the patient or his/her family would sign a consent form. The patient would then be given general anaesthesia and supplied with a muscle relaxant to prevent movement during the procedure.
Grajales explained that five minutes after the treatment the patient awakens and is unaware of what happened to them. A few hours after, the patient would be able to resume their normal activities.
“It is not clear how the treatment actually works but it works,” she said, adding that the only problem a patient would have is a “little memory loss.” However, she said the memory loss is not severe and only lasts for a while.
She said that of the 45-odd patients who had received ECT, they had to stop the procedure on two of them because they were not responding to the treatment.
“Both of them were schizophrenic patients with diagnosis for more than 15 years and they have a lot of hallucinations,” she explained, adding that they had tried the procedure on several other schizophrenic patients and it had worked.
In fact, she said, when the procedure was first implemented by a group of Canadian psychiatrists in October, the first patient was schizophrenic. “We used him for the demonstration and he hasn’t had any relapses since,” she said.
This patient was very aggressive and delusional, she said. “He is improving. His dosages have been reduced. This patient was all the time admitted at the hospital because he was very aggressive and he was delusional— out of the 12 months in the year he had spent 10 months in the hospital. Now since he’s had the treatment he is at home with his mother,” she said.
“I don’t have any complaints about the ECT. In fact, we want to get another machine because it is saving us a lot of money. The medications for these patients are not cheap,” she said. Grajales recalled that there was one drug addict who was not responding well to medication and when they administered the treatment, his condition improved. “This is a man who attacked staff and get on bad,” she said.
“Some doctors agree, some doctors disagree. I agree because I’m seeing what it is doing here. Many of these patients don’t need to be in this hospital for so long,” she said.
Grajales noted that the hospital was now seeking to create awareness on ECT and its benefits. “We want to show them that this has worked for us… More time is saved and it is less costly. They take the treatment and within a few hours they go home and continue with their normal lives… They don’t need to be hospitalized,” she said.
Chief Executive Officer of the Berbice Regional Health Authority Dr Vishwa Mahadeo said the treatment is helping a lot of patients and it is also saving the government a lot of money. He said the procedure was something very positive for hospital, which was looking at buying another machine.
“A machine will have a lifespan and I don’t want now that we have started this process something goes wrong. A patient might be getting therapy and they have to get 12 session and only six have been completed and then it’s left halfway. I think we will need a backup for situations like that,” he said.
Richmond stated that since the therapy he has been able to study again. “I have been sleeping and eating better. I feel great and I haven’t had any side effects from it,” he said, adding that he felt it was necessary for his treatment. “I think people are afraid of shock therapy but it helps once you understand that it is a procedure that will help and not hurt you,” he said.
He urged other persons living with bipolar disorder to seek treatment and accept their illness instead of hiding and denying it.
