The National - Port Moresby,Papua New Guinea
... Your choirmaster is suffering from a mental illness known as Bipolar Disorder. Bipolar Disorder is a type of mental illness. ... Bipolar Disorder is an illness. ...
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Article:

Problems in a person’s mood

Dear Doctor,
I AM a pastor in the Momase region of Papua New Guinea. We have a very active congregation and have been very blessed by God.

Our church choir is popular with the youth as well as older members of the church. However, I have noticed something unusual about the choirmaster and some of the congregation has also talked to me about him.

You see, his character seems to change from time to time and we cannot understand it. I call it his happy character and his sad character. During the time of his happy character, this choirmaster is really energetic, enthusiastic and motivates the choir so well. He even composes fantastic songs, setting biblical words to PNG music.
He can compose for hours, even staying overnight in church for two or three days continuously with no sleep. He is fun to be with, tells jokes, talks non-stop, laughs a lot and makes others laugh too.

Doctor you have never seen anyone so happy without a reason.

He also becomes very generous, e.g. promising to pay school fees for all the youth choir members, even though he cannot afford this.

When he talks non-stop he sometimes shifts from one topic to another and sometimes says God has given him special gifts so he is the most important person in the whole church (which is not true). One Sunday he even wanted to conduct the entire service himself, single-handedly preaching the sermon, leading the prayers, taking the collection, reading the Bible lessons, etc . . . all in addition to leading the choir. He feels he is a very important and powerful person at such times. What I have also noticed is that even though he has all these great plans in his head, he cannot stay focused for long so the plans do not succeed.

For example, he was talking about bringing the choir to Port Moresby to perform for the Governor-General at Christmas but then he saw a poster about Makoma and decided there and then that he would take the choir to Africa instead to pay a return visit to Makoma. You see how unrealistic his plans can be?

He usually has this happy character for some weeks and then without warning his character changes to the sad one. During the sad period he loses interest in the things he was so excited about. He no longer cares about composing music or leading the choir. He says it is all pointless, since everybody will die one day. He avoids the same people he used to laugh and joke with, he can stay in his house for three or four days without coming out, he loses his appetite and complains of having no energy even though he does nothing. When we ask him why he is no longer composing songs, he says he cannot concentrate or think clearly and wants to be left alone. He does not like talking much during this time, but when he does he just talks about sad things. For example when he hears of a person who has died, he says the dead person is so lucky to be dead and he wishes it was him.

This is such a contrast from his happy character when he keeps saying how wonderful life is and how lucky he is to be alive. This sad period can last for maybe two months, then he seems to be normal, i.e. like the rest of us, not too happy and not too sad.
Then after some more weeks, he gets into his happy character again, with excess energy and ambition, unrealistic plans, over-activity and overspending money. He is very entertaining during this period and we really enjoy his company, but we know by now that it does not last long and sure enough after a couple of weeks or so the sad character comes back. I don’t know which character is worse. The happy character is fun, but irresponsible and unrealistic and worries me because he gets into a lot of debts during this time and puts up the choir’s hopes for nothing. One the other hand, the sad character is so unproductive and worries me because I am afraid he might commit suicide.

Doctor, what is wrong with my choirmaster? Which is the real character? How can someone change back and forth like this? Is he sick or just strange? He wasn’t always like this.

Worried Pastor,

Dear Worried Pastor,
Your choirmaster is suffering from a mental illness known as Bipolar Disorder.

What is bipolar disorder?

Bipolar Disorder is a type of mental illness. The main problem is found in the person’s moods. The moods are unstable and can change from one extreme to another without any provocation.

I still don’t understand.

Everybody experiences moods. Most people feel sad from time to time, especially when something bad happens. That is normal. Most people also feel very happy or excited from time to time, especially when good things happen or they hear good news. That is also normal. For most people, there is a limit to these emotions and there is also a reason for these emotions. That is normal.

However, in people suffering from Bipolar Disorder these changes in mood are more intense than in other people, they may last for a longer time and they may occur spontaneously, i.e. without any obvious cause.

Can you give examples of normal mood changes?

If something happens to make us very happy, such as winning a free ute in a competition, we may feel very excited at first and run around telling everyone our good luck and making all sorts of plans. We may even find it difficult to sleep the first night or skip work for a day or two while celebrating.

However, after a couple of days the intensity of our feelings would go down and we would return to our usual mood. We would still feel pleased about the win, but the initial excitement and over-activity would be reduced. Furthermore, we would know what had caused our excitement and over-activity.

On the other hand, if a friend dies or we lose our job or experience some other problems, we may feel sad and depressed for a while. How sad we feel and how long we feel sad would depend on the cause, e.g. the death of a friend would cause us greater sadness and for a longer time than having our bilum snatched by a rascal. These are normal mood changes and not signs of mental illness.

How are the moods in people with bipolar disorder?

Bipolar Disorder is an illness. The people with Bipolar Disorder have moods which swing from one extreme to another, from very high to very low. When they are high, doctors call this stage the manic stage and when they are low, doctors call this stage the depressive stage.

The manic and depressive stages are just different stages of the same illness.
What you call your choirmaster’s happy character is actually the manic stage of his illness and what you call his sad character is actually the depressive stage of his illness. The old name for this illness was Manic-Depressive Psychosis because at times the patients are in the manic stage and at times they are in the depressive stage.
Nowadays doctors call it Bipolar Disorder but it is still the same illness and the patients still have unstable mood swings. Both extremes are abnormal so neither the ‘sad character’ nor the ‘happy character’ is your choirmaster’s true character. Both extremes are stages of the illness.

Can you explain a little more how moods can swing or be unstable?
Let us compare moods with the sea and let us compare a person with a boat on the sea. Most times the sea is quite calm and that is like our normal mood. From time to time the waves may rise and fall, but the waves are usually less than a metre high and the boat can ride up and down them quite safely.

These normal waves are like the ups and downs most people face in life.
At times we sink down for a while when something bad happens, and at other times we ride up when something good happens, but in spite of these waves the boat still keeps on track and remains stable.

Now imagine there is a big storm at sea with gigantic waves.
The waves may rise several metres high, carrying the boat up with it and then the boat comes crashing down into the depths before being tossed up again. The boat is obviously unstable and out of control. The highs are much higher than the normal small waves and the depths are also much deeper than the normal small waves.
For most people, feelings of happiness and feelings of sadness are like riding up and down small waves. For people suffering from Bipolar Disorder the mood changes are like the huge waves in a storm, being either extremely high (manic stage) or extremely low (depressive stage). The moods are unstable (i.e. keep changing) and the person has no control over them, just like the boat in a storm has no control over the huge waves.

What are the signs of the manic stage of Bipolar Disorder?

Doctors diagnose the manic stage of Bipolar Disorder when the person shows several of these signs:

* Restlessness and overactivity. The person is unable to keep still;
* Increased talkativeness and changing quickly from one topic to another;
* Excessive cheerfulness for no reason, but the person can also be very irritable if people disagree with him;
* The person feels he is much more important or powerful than he really is;
* Decreased need for sleep, e.g. the person feels rested after only 3 hours of sleep at night; and
* Excessive involvement in pleasurable activities that can lead to harmful consequences e.g. spending money recklessly without thinking.

If these symptoms are severe, they interfere with the person’s job or social life. You have noticed many of these signs in your choirmaster during the manic stage which you call his happy character.

But, aren’t some people naturally very talkative, energetic and cheerful?

There is a difference. People who are naturally talkative, energetic and cheerful are like that most of the time, i.e. it is their normal personality. Those who know them will say they have always been like that. It does not interfere with their job or social life and they are productive in what they do.

However, in people with Bipolar Disorder, the excessive talkativeness, excessive cheerfulness, excessive activity and feelings of importance are a CHANGE from their usual personality. Those who know them will say they are not normally like that, they have changed. Secondly, the intensity is abnormal, i.e. they are not just cheerful, they are over-cheerful; they are not just talkative, they are over-talkative; they do not just change topic when talking, they change from topic to topic so fast that the people listening to them have difficulty following what they are saying. They are not just active, they are over-active and have too many ideas going around in their heads at the same time which they are trying to accomplish at the same time. Thirdly, these signs appear in episodes then stop, so that for some days or weeks the person is manic and then he or she changes to a period of depression.

What are the signs of the depressive stage of bipolar illness?

Doctors diagnose the depressive stage of Bipolar Disorder when somebody who has experienced the manic stage in the past now has the following signs of depression:

n The mood is sad or depressed;
n The person loses interest and pleasure in most of his daily activities;
n The person may lose his appetite;
n The person may have no energy to do anything;
n The person may feel useless or worthless;
n The person may have difficulty thinking or concentrating or remembering things; and
n The person may think a lot about death – some even try to commit suicide.

You have noticed many of these signs in your choirmaster during the depressive stage which you call his sad character.

Does everybody who suffers from depression have Bipolar Disorder?

No. A diagnosis of Bipolar Disorder is only made for those people who have had a manic stage, as described above. Very many people suffer from depression without ever having a manic stage. Such people just have simple depression, which is very common.
Bipolar Disorder refers specifically to those whose moods swing from mania to depression. It is very important to remember that most people who get depressed do not have Bipolar Disorder. If a person has never had a manic episode he cannot be diagnosed as Bipolar Disorder.

What causes Bipolar Disorder?

In some cases, Bipolar Disorder is inherited, so there may be a parent or grandparent who had the same illness. In other cases the illness just starts by itself. People with Bipolar Disorder often have an imbalance in the brain chemicals that regulate moods, so their moods swing wildly out of control. Men and women are affected equally and the illness usually starts when the person is in his 20s or 30s.

What about sorcery or marijuana?

Sorcery does not cause Bipolar Disorder. Marijuana does not cause Bipolar Disorder, although marijuana can cause some other types of mental illness.

What are some of the risks associated with Bipolar Disorder?

During the manic stage, the person can waste a lot of money, commit fraud e.g. by writing cheques he has no money for, get involved in risky behaviour such as having unsafe sex with infected people and so on. He may also get into fights with people who mistake him for a conman etc. During the depressive stage he may see no purpose in living, may quit his job or even commit suicide. Therefore, Bipolar Disorder needs urgent treatment whether the person is in the manic stage or the depressive stage.

How can Bipolar Disorder be treated?

Bipolar Disorder needs medical treatment. It cannot be treated by counselling alone, or by herbal treatment. All patients with Bipolar Disorder need to be treated by a doctor. The doctors use medication called Mood Stabilizers.

What do mood stabilizers do?

As the name suggests, drugs called mood stabilizers work by making the person’s moods stable, i.e. the drugs stop the moods swinging from extreme highs to extreme lows. It is like changing the huge waves in a storm to small waves that the boat can cope with, so that the person can continue on his way stably.

But the boat will still be on the sea

Yes. The boat will still be on the sea, but it will be a calm sea with occasional small waves and not the uncontrollable huge waves of the storm. In other words, the person will still have Bipolar Disorder, but the illness will be under control so that he can get on with his day to day life in a normal way.