Stories and podcasts WBW Stories Shake off the Stigma: Managing and Treating Bipolar Disorder Mental disorders are a neglected health concern in Kenya. There are numerous types of mental disorders. To list a few: Clinical Depression, Anxiety Disorder, Dementia, Hyperactivity Disorder, Schizophrenia, Autism, Post-Traumatic Stress Disorder and Bipolar Disorder. I will focus on Bipolar Disorder due to the numerous cases I have witnessed in my close circles. The American Psychiatric Association terms Bipolar Disorder as mental illness that can lead to a shift in an individual’s mood, energy and ability to function. Bipolar Disorder manifests in several different ways, and can be categorised into the following: Bipolar I, Bipolar II and Cyclothymic Disorder. The shift in moods brought on by Bipolar known as mood episodes can see people fluctuate between being manic, hypomanic or depressive. A manic episode can be characterised by high spirits, high energy levels and extreme irritability. During a manic episode, one will talk more than often, quickly and loudly, lack sleep, undertake many activities at once and engage in risky behaviour like reckless sex, driving or spending money. Though mania can sometimes seem ‘fun’ from the outside, it can be the source of irrational decisions or dangerous behaviours. Some patients report of taking loans and going on a spending spree. Others destroy property or become extremely violent. A Hypomanic episode is similar to a manic episode but less severe. During this episode one will talk more than usual, have a decreased need for sleep, have racing thoughts, be easily irritable and distracted or display increased productivity. In this headspace, the individual may still be able to function reasonably and may not require hospitalisation. Depressive episodes are where an individual feels low, desperate, fatigued, hopeless and worthless with thoughts of suicide. Bipolar I is characterised by extreme manic and depressive episodes. BipolarII manifests with less- intense elevated moods known as hypomanic episodes or hypomania and more episodes of depression. Depressions can occur after hypomania subsides, or a bit later. Some people experience back and forth episodes of hypomania and depression while others have long periods of normal mood between episodes. Cyclothymic disorder is a milder form of bipolar disorder with less severe mood shifts. In Cyclothymic disorder, moods vary between short episodes of depression and hypomania but not extremely severe. Although there are different types of Bipolar disorder with various forms and symptoms, they are all equally valid mental health conditions that require education, management and care to ensure that people living with Bipolar can live a happy and comfortable life. Persons living with Bipolar Disorder in Kenya face severe stigma and discrimination. Some report difficulties in maintaining romantic relationships, as potential suitors fear the burden of caring for a Bipolar partner. People speak ill of people living with Bipolar frequently, often dismissing them as crazy, bewitched or possessed by demons. Stigma and discrimination prevent people living with Bipolar from disclosing their condition and seeking treatment. “Mental illness is an equal opportunity illness. Every one of us is misplaced by mental illness. One in five adults is dealing with mental illness, and many are not seeking help because the stigma prevents that,” says Margaret Larson, an American broadcast journalist. Bipolar can be a natural manifestation due to internal brain chemistry, or it can be triggered by stress, traumatic experiences like the loss of a loved one, abuse, genetics and drug abuse. It is not as a result of witchcraft, as some people may believe. Avoiding highly stressful situations and proactively seeking mental health care are both important in managing bipolar disorder. These should be accompanied by healthy eating, good sleeping habits and engagement with supportive people like close family, friends and support groups. Although Bipolar Disorder comes with a lot of challenges, with the right medication and coping mechanisms, people can manage their condition, maintain healthy relationships and enjoy fulfilling careers. Bipolar Disorder is a treatable medical condition. Treatment can entail psychotherapy (talk therapy), prescribed medication, Electroconvulsive Therapy (ECT), or some combination of the three. ECT is the application of electric current to a patient’s scalp when they are under anaesthesia, and, though effective for some patients, is not without its risks – it is largely considered a ‘last resort’ practice, with the previous two treatment options strongly recommended as superior for maintaining good mental health. Continuous preventive treatment of Bipolar is recommended as it is a recurrent medical condition, and patients are advised to take their medication to completion and as directed by a psychiatrist. If medication is not working or someone living with Bipolar looks to be having an episode of mania or depression, family members and friends are encouraged to look out for early warning signs and support with accessing mental health care as needed. Because the treatment and management of bipolar disorder (as well as other mental illnesses) in a dignified healthcare centre is expensive in Kenya, medical insurance that covers mental illness is strongly encouraged. There are mental health gaps in Kenya as the sector has limited budgetary allocation, insufficient policies to oversee swift delivery of mental health services and limited mental healthcare specialists. Statistics show that Kenya has 54 psychiatrists and 418 trained psychiatric nurses. This is a drop in the ocean compared to the population of over 40 million Kenyans who may from time to time have mental health challenges. There is a need for governments and development partners to increase budgetary allocations towards the treatment and management of mental disorders. Resources should be channelled into the proper training of psychiatrists and nurses working in the mental health sector. Awareness on mental health challenges and the need to eliminate stigma and discrimination for mental health patients is critical. Such measures will ensure that mental health patients seek dignified treatment and support thereby living fulfilling lives. To quote former U.S. President, Bill Clinton: “Mental illness is nothing to be ashamed of, but stigma and bias shame us all.” About the Author.