‘There’s a lot of suffering’: Bipolar disorder disrupts life but recovery is possible, says a survivor
A Singaporean in his 40s who has bipolar disorder learnt to manage his condition over the years with support from the Singapore Association for Mental Health.
SINGAPORE — It is World Bipolar Day on March 30. For one man in his 40s, who is working as a consultant in a tech company here, it is a reminder of the importance of seeking professional help when a person’s mental health has tipped off the balance and is not quite right.
The Singaporean does not want to be identified, and will be referred to as Mr Tan.
He also wanted to raise awareness for those who have loved ones or friends who suffer from bipolar disorder, a commonly misunderstood psychiatric disorder.
Mr Tan knows what it is like because for years, he has experienced erratic mood swings — a burst of manic energy one moment, then utter hopelessness and depression the next.
These, coupled with his inability to control them, had disrupted friendships, relationships and affected his work.
In his lowest moods, he thought of taking his own life. He also thought he may have some kind of growth in his brain.
In 2011, he was finally diagnosed with having bipolar disorder.
When he started experiencing extreme mood changes in 2010, Mr Tan’s initial response was to ask his doctor for a brain scan.
“I thought that it could be due to something like a brain tumour. Back then, I didn’t know much about mental health conditions. I could not understand why I had such severe mood swings and emotions. Sometimes, the high and low moods would happen all in a day,” he said.
Now he wants to let sufferers know that there is hope for recovery.
“I went through (bipolar disorder) and survived it. I know how painful, how much of a mental anguish it is,” he said.
“If you have a mental health condition, what do you do to get over it and get a fulfilling life? There’s a lot of suffering, but I hope to let people know that there’s help available. With courage and determination, they can get their lives back on track.”
A Singapore Mental Health Study done by the Institute of Mental Health (IMH) in 2016 found that about 1.6 per cent of the adult population, or one in every 63 people, has experienced bipolar disorder in their lifetime.
In the last three years from 2017 to 2019, IMH saw in each year, an average of 1,500 diagnosed patients who were aged 18 and above.
Dr Mok Yee Ming, senior consultant and chief of IMH’s department of mood and anxiety, said that like most psychiatric disorders, bipolar disorder is believed to be a result of various factors including genetics, environment, personality and biochemical imbalances in the brain.
It affects both genders, and usually first surfaces in young adulthood.
Young adults aged 18 to 34 made up a quarter of the total adult patients with bipolar disorder seen at IMH in the last three years.
EUPHORIA OR DEPRESSION?
To onlookers, people with bipolar disorder can seem like they have extreme moods. The mental health disorder is characterised by severe mood changes, and individuals experience repeated episodes of depression and mania.
Dr Mok said that the condition can be classified into two types, the difference being the severity of the manic episodes.
While people with bipolar Type 1 suffer full manic episodes, those with Type 2 — which Mr Tan has — experience a minor form of mania (called hypomania).
Both types experience depressive episodes.
Between episodes, however, a person with bipolar disorder can function as normal, Dr Mok said.
Explaining why people with bipolar disorder may be easily misunderstood, Ms Valentina Any, deputy head of the Singapore Association for Mental Health (SAMH) Mobile Support Team, said that the symptoms can be confusing not only to sufferers but even more so to the people around them, particularly their family members and friends.
Ms Any is also Mr Tan’s case manager. The SAMH Mobile Support Team is a community-based team that provides psychosocial therapeutic interventions for people with mental health needs and support for their caregivers.
When they are experiencing mania, the patients may appear full of energy and active, sometimes going without sleep for long durations, even months, Ms Any said.
Dr Mok said that those in manic phase may sometimes develop grandiose ideas that have little basis in reality, such as feeling invincible. This may lead to reckless behaviour, such as putting a downpayment on a house or car they cannot afford.
But when the low mood hits, these traits disappear.
Ms Any said: “When they are in the depressive state, they may become withdrawn, losing interest or having no energy to be engaged in their usual activities, engaging in helpless, hopeless or even suicidal thoughts, causing others to view them as lazy, unmotivated, anti-sociable, not trying, negative, etc.”
LIVING WITH BIPOLAR DISORDER
Mr Tan said that while his friends knew he was “suffering”, many did not understand the mental disorder.
Neither could his mother. They did not have a good relationship and Mr Tan believes it could have been one of the stressors for his mood symptoms.
His father, who he said was an abusive man, left emotional and physical scars on him. Mr Tan’s father left them for another family when he was around 10 years old, he said.
Recalling a particularly horrible fight that he had with his mother while he was struggling with symptoms, Mr Tan said: “She blurted out, ‘Why don’t you jump off a building so I can claim your insurance?’
“I was working fulltime and studying part-time at the time, all of which contributed to the stress. The thoughts of suicide were very real at the time.”
Recognising that he was facing a serious mental health issue, Mr Tan sought professional help and was put on medication — the first line of treatment to stabilise moods in bipolar patients.
He also sought help from SAMH and did some research on the disease to learn to better manage the stressors in his life.
Mr Tan moved out of his family home to put some distance between himself and his mother. These measures helped with his recovery.
“I find the process of talking about my experience helped me process my mental health issues and helped me find solutions to cope,” he said.
“Lately, I’ve been experiencing some stress in my life again and that has caused my moods to be less stable. Talking through my stress with friends and (my case manager at SAMH) helps me process my stress.”
No longer on medication, Mr Tan said that he now takes hour-long walks every morning and meditates regularly to help him cope with stress.
His relationship with his mother has also improved tremendously. They have taken many overseas trips together in recent years.
“The situation with my mum has changed a lot. As a son, I’ve come to the revelation that these are the things I have to do to make things right with my mother,” he said.
Ms Any said that from what they have seen at SAMH, the common issues people with bipolar disorder face include relationship challenges, difficulty sustaining employment and disruptions to their day-to-day lives.
“Some may also experience stress arising from problems created during their mania phase, for example, having to settle debts incurred when they were in that phase,” she said.
Having said that, Ms Any said it is a misconception that people with mental health issues, including bipolar disorder, are ticking timebombs incapable of being responsible for themselves, and cannot hold down a job or live an independent life.
Debunking these misconceptions, Dr Mok said: “There is no reason why people living with bipolar disorder are not able to complete school, find a job, advance in their careers and find love.
“People suffering from bipolar disorder have and are able to live rich and fulfilling lives as long as they are able to manage their condition and not let it hamper them.”
HIGHLY TREATABLE CONDITION
Dr Mok said that while there is no cure for bipolar disorder, it is a highly treatable condition that can be well-controlled.
A combination of medication and therapy, as well as learning to minimise triggers can significantly reduce chances of a relapse.
He added that medications, mainly mood stabilisers, are the main treatment option for bipolar disorder.
Anti-depressants, anti-psychotics and sedatives can also be used in different combinations, depending on the individual, to treat acute episodes and prevent relapses.
Besides these, there are other forms of therapy that can help patients recognise the early symptoms of an episode and seek treatment, reduce expressions of negative emotions in relationships and implement lifestyle changes to avoid triggers, he said.
Ms Any also said that recovery is possible. Factors such as having supportive relationships, insights into their symptoms and condition, and acquiring self-help skills can help patients cope better.
Being compliant with treatment, investing in a healthy lifestyle and developing social skills are helpful as well.
Dr Mok said that support and understanding from family members and friends are important in the treatment of bipolar disorder.
At workplaces, employers can do their part to better support their employees with mental health issues including bipolar disorder.
Ms Any suggested the following ways to approach this:
Scheduling dialogue sessions to check in with them on work, personal and other health or mental health concerns.
Promoting self-care and mental wellness by allowing staff members to ask questions about mental health and inviting people in recovery to share their experiences. This helps break down stigma and eliminate assumptions and fears.
Facilitating resource links for workers who may need support for themselves and their loved ones, such as displaying flyers where they can access counselling or therapy services, mental health-related workshops, etc.
Supporting employment opportunities for individuals diagnosed with mental health issues. Flexibility can be considered to support traineeship placements or work trials, depending on the workplace and individuals.
