VIEW: Bipolar Anonymous —Ishrat Saleem

Due to lack of awareness, superstitious culture and inadequate mental health infrastructure, people prefer to go to traditional charmers and quacks rather than seeking proper psychiatric and psychological help to treat symptoms of mental illnesses

A number of bipolar disorder patients and their families meet regularly in Lahore in separate groups called Bipolar Anonymous (BA) and Bi-Anon respectively, named after Narcotics Anonymous (NA) and Nar-Anon meant for narcotics addicts and their friends and families respectively. The programmes of these two sets of meetings are almost similar because it has been observed that the challenges of bipolar patients and their friends and families in terms of social relations closely resemble those faced by alcoholics or narcotics addicts and their families. In NA, the addicts undergo a process of recovery from their addiction through regular sharing and listening to other recovering addicts and following the 12-step programme under the active guidance of a sponsor selected from among the senior and experienced members of the group. The friends and families of addicts and alcoholics follow a similar process in their own groups. Bipolar groups follow a similar pattern.

Bipolar disorder is characterised by cyclic alternation of manic and depressive episodes. However, the degree and duration of each episode may vary from person to person. Mania includes some or all of the following symptoms: high energy level, excessive spending and socialisation, promiscuity, irritability when criticised, drug abuse, and even violence. Depressive symptoms may include lasting sadness, loss of interest in life, guilt, excessive sleep and even suicidal tendencies. Based on the degree and duration, it has been classified into various sub-categories. In many cases, bipolar disorder remains undiagnosed for several years because patients and families do not recognise symptoms and seek medical help. Sometimes, even when it is diagnosed, patients resist treatment because of the stigma associated with being mentally ill. However, being bipolar does not necessarily mean a life-long disability. There are healthy chances of bipolars leading a perfectly normal and productive life with proper management of their mood alterations and counselling. History’s many great figures suffering from this phenomenon suggests that perhaps it is nature’s way of mining most creativity out of an individual’s mind during the manic episodes. Victims suffer because society generally does not accept anything out of the ordinary and stigmatises it, which is detrimental to the health of the patients and aggravates the symptoms.

Like addicts’ friends and families, people associated with bipolar disorder patients become co-dependent, i.e. psychologically as disturbed as the patients themselves, and cannot contribute towards their patient’s well being. More often, it is due to lack of awareness and training rather than lack of good intentions and love towards the patient. Therefore, both the patients and their associates need help. More than medicines, it is society’s acceptance and willingness to give the patient due respect and sympathetic understanding that contains the symptoms and prevents families from becoming dysfunctional.

There are incredible stories of how sometimes attending a single meeting of BA or Bi-Anon diametrically changed the perspective of members and provided solidarity and support. Razzaq, a driver by profession and son of a 72-year-old bipolar patient, attended a Bi-Anon meeting and participated in the discussion. At the next meeting, he narrated that he had applied small tips and understanding gained from the meeting in dealing with his father. Within a day or two, his father has stopped cursing and abusing, getting angry and remaining isolated from the rest of the family (as was his habit). He now talks and plays with his grandchildren and happily run errands for his daughters-in-law, and even for little children. This change was achieved without any medical intervention.

Amina, a bipolar patient, used to resist taking medicines. She said that she had felt strangly relieved and happy after a group meeting because she met other people like her and discovered that she was not the only one in the world who suffered from extreme fear and obsessive/manic behaviour. Her husband Ali, who attends Bi-Anon group meetings, revealed that now Amina herself takes care of her medication because she understands it is essential for her well being. Arifa, a doctor by profession and member of BA, says she gets solidarity and support from the group. After attending the first group, she felt the need for meeting more frequently as she had started taking better care of herself in such small things such as combing her hair, wearing good clothes, etc, which was otherwise ignored in hectic professional and family life. Mobeen, a young university student, always says, “When I first heard of these meetings, I felt like jumping up and down with glee because I expected to have a group of friends who would understand me, with whom I could share whatever I feel.”

Two sisters attended a meeting at a time when their family was undergoing extreme pain and suffering due to their brother’s manic behaviour, antagonism and isolation from the family, and refusal to accept medical treatment. In his extreme irritability, he had beaten up his sister, broken home appliances, and destroyed other things. The state of fear of his violent moods was so extreme that on seeing him, the rest of the family would lock themselves in a room until he left home or went back to his room. Small tips based on sympathy, love and respect for the patient learnt at Bi-Anon meetings drastically changed his behaviour. He has shown willingness for treatment and started interacting with the family.

Bipolar disorder is more prevalent than we would like to believe. According to estimates, three in every 100 Americans suffer from one or the other form of bipolar disorder. There are no figures available in Pakistan, but chances are that the prevalence is more or less near this figure. Due to lack of awareness, superstitious culture and inadequate mental health infrastructure, people prefer to go to traditional charmers and quacks rather than seeking proper psychiatric and psychological help to treat symptoms of mental illnesses. It is not uncommon to find news of people, particularly women, losing their lives or suffering injuries at the hands of babas, who beat them up in order to exorcise jinns in what are most likely manic episodes of bipolar disorder.

Even when someone reaches a mental institution, little attention is paid to the psychological and social side of the problem, which constitutes about 70 percent of the mess that is created by it. Our mental health infrastructure has to go a long way before it could address medical, psychological as well as social aspects of mental health and addiction problems through groups like these, which cost nothing at all except some thoughtfulness.

Note: All names have been changed to preserve the anonymity of the group members.

The writer is an Assistant Editor of Daily Times and can be reached at ishrat.saleem1@gmail.com