Among other things, he said the condition was 'overdiagnosed' by incompetent shrinks, and that it had become 'fashionable' to be bipolar. He said people with the condition were self-seeking, and that therapy was more useful to them than medication.

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Complaints of hate speech have been laid against him by, among others, Professor Deon Knobel, former forensic pathologist at the University of Cape Town.

Kombuis has been asked to retract his comments and the blog has been removed from LitNet.

What is bipolar disorder?
But could he be right? What is bipolar disorder, and is it more common today than it was in years gone by?

What has been known as melancholia has always been common. It was accepted that men, the dominant gender, had their bouts of raisin' hell and hitting the bottle harder than a mule's kick. Melancholia covered a host of sins. It may also have covered real mental disorders.

Who's to say what the real disorder was back then. But there's no reason to think it's any less prevalent today – probably in fact more common than we care to believe. Today periods of an almost manic high lasting weeks or days and followed by plunges into the depths of depression can be clinically diagnosed as bipolar mood disorder (BMD) (previously called manic depression).

It is a persistent illness. Without treatment, people with bipolar disorder face long periods of serious life disruption and distress.

"The problem is that once the condition has been 'switched on' it cannot be 'switched off," says Durban psychiatrist Dr Catherine Maud. "But with treatment, often a combination of medication and psychotherapy, people can live fulfilling and happy lives.

Bipolar is a life-threatening condition and the risk of suicide is very real. Although violence is rare, manic states can lead to rash decisions with dire consequences in business, finances and relationships. People with bipolar often have a history of failed marriages, bankruptcy, huge debts, not to mention substance abuse problems.

What causes BMD?
The illness can be triggered by highly stressful incidents or major hormonal changes. Post-natal depression in women can also be the trigger.

BMD is caused by interference with the chemical transmitters in the brain. Mood stabilisers such as lithium can correct chemical imbalances and restore normal function.

"The medication controls the brain’s neurological functions, and a natural tendency to fall out of kilter. Without medication the neurological problems recur. That's why it is so dangerous," says Maud.

Susan's story
Susan, a successful banker in Durban, says that a combination of medication and therapy has helped keep her stable and symptom-free for four years now. Initially the stress of getting a diagnosis took forever with many different medications, initially for depression.

"My husband was very supportive and as we tried to understand my spending sprees and working all night, we eventually understood that it was a real illness, with good treatment Before we got the diagnosis I felt huge guilt and shame. As a teenager I was an over-achiever, intelligent and talented, but there was another side of me that was angry and confused and had major problems. Luckily when I found the right medication I felt normal again very quickly and got the balance and control of my life back which I desperately wanted."

"Sometimes at 4 in the morning I would send out bizarre e-mails to family and friends. At one stage my husband had to unplug phones and internet to stop me sending them out and trying to talk to people at all hours of the night. Only my immediate boss knows of my illness and he has been very understanding."

Often misdiagnosed
Due to the similarities with major or chronic depression, BMD is frequently misdiagnosed. When symptoms first arise, patients normally seek the help of their GPs, as Susan did. Luckily she was eventually referred to a psychiatrist who was able to diagnosis bipolar.

An additional hurdle, says Maud, is the high cost of medication. "Pharmaceutical companies invest millions in the development of drugs and have to recoup their investment from sales. Drug companies have a 10-year window of protection during which no generic drugs can be made available.

"Once that is over, generics flood the market, forcing prices down. With BMD having only fairly recently been recognised, there are no generics and treatment costs are high," she adds.

Medical schemes
"Because bipolar patients must stay on treatment and treatment is expensive, this makes it imperative that they receive chronic medication support from medical schemes."

South Africans – and especially those suffering from mental illnesses – will have to continue to wait and see how individual medical schemes deal with new requirements. Lingering stigmatisation will undoubtedly become more entrenched if early signs vindicate the popular view that medical schemes are indeed unsympathetic towards sufferers.

Signs and symptoms
Signs and symptoms of bipolar disorder are:

1. Manic episode
Often begins with a pleasurable sense of heightened energy, creativity and social ease. It can quickly escalate out of control into a full-blown manic episode. People with mania typically lack insight, deny anything is wrong, and angrily blame anyone who points out a problem. Symptoms are present for at least one week, to the point where the person has trouble functioning in a normal way.

It could also manifest just in feeling unusually "high", euphoric or irritable (or appearing this way to those who know you well).

Also look out for (if four of the following are present, doctors are more likely to diagnose bipolar):

• Needing little sleep yet having great amounts of energy
• Talking so fast others can't follow your thinking (motor-mouth)
• Having racing thoughts
• Being so easily distracted your attention zips between many topics in just a few minutes
• Having an inflated feeling of power, greatness or importance
• Doing reckless things such as spending too much money, inappropriate sexual activity or making foolish business investments
• Drug or alcohol abuse

In severe cases, there may be symptoms such as hallucinations or delusions.

2. Hypomanic episode
Hypomania is a milder form with similar, but less severe symptoms and less impairment. You may have an elevated mood, feel better than usual, and be more productive. These episodes often feel good to the extent that people stop their medication to get a "high". However, there is a severe price to pay - either escalating to mania or crashing to depression.

3. Major depressive episode
Symptoms are present for at least two weeks and make it difficult to function:

Feeling sad, blue, down in the dumps or losing interest in things you normally enjoy.

Plus at least four of the following:

• Trouble sleeping or sleeping too much
• Loss of appetite or eating too much
• Problems concentrating or making decisions
• Feeling slowed down or too agitated to sit still
• Feeling worthless, guilty or having very low self-esteem
• Loss of energy or feeling tired all the time
• Thoughts of suicide or death

For more information on bipolar visit SADAG’s website at www.anxiety.org.za or contact them on 011 783-1474.

Read more:
Bipolar: To tell or not?
 

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