A Fearful Gift

Hindustan Times, 11 January 1992.

"Hi. It's me," Nima's voice, rather too cheery came over the phone. "I felt like a chat."

"It's five in the morning Nima," Kshamil responded cautiously. "Is everything okay?"
knowing that things were not in fact all right.

Nima had been feeling weller and weller with each passing day. She had energy and
ideas more than she could sustain. Her weight had dropped. Her friends had stopped
seeing her. She was irritable and impatient they said.

Kshamil knew from his own experience that this morning's cheer was yet another
indication of a high.

"It's alright if you don't want to talk. I thought you'd understand’, and the line was
quickly disconnected.

Later in the day Nima called again to say she needed to see the psychiatrist and would
Kshamil go along. In the evening when Kshamil went by her house it was locked. Nima
had had herself admitted to hospital.

Haliperedol would contain the ecstasy. The Lithium Bicarbonate Nima had been on for
five years would probably be continued in an increased dosage. Pacetane would contain
the side effects both known and unknown. This was Nimas tenth episode. She had never,
she said, felt the sense of hopelessness, self doubt, tearfulness and anguish that
characterise depression.

Depression and elation are probably the oldest recorded emotional disorders and have
been described by Homer and Hypocrites. Over the centuries come accounts inexplicable
moods ranging from periods of prolonged joy to utter despair.

In 1854 Jean Falret, a French psychiatrist, published a description of a cyclical

phenomenon "la folie ciculaire". In 1896 the German psychiatrist Emil Kraepehn
proposed the name "manic depression illness" to characterise recurrent episodes of
depression and elation. Today increasingly this phenomenon is being known as unipolar
and bipolar mood swings in patterns of recurrent depression or recurrent elation and
recurrent depression alternating with bouts of elation.

Kshamil's history had been charted as bipolar — long periods of depressive hopelessness
followed by destructive ecstasy. He had broken out of the cycle and with it broken with
all that had been his past security, plunging into a reality of the unknown present.

This was when Kshamil had had no option but to confront the 35 years of what had
seemed to be cheerful adjustment. Without warning this changed to an emotional

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disorder — an illness — a horrifying damnation conjuring up images of violent
unpredictability — sheer madness.

Sufferers and their families recoil when told the diagnosis. Coming to terms with it is a
long and painful process. Doctors mentioned that it by just be physical — the production
of lithogenic acid impaired.

In the 1940s while experimenting on the effects of the urine of manic patients on animals
John Cade administered lithium to the guinea pigs to reduce the toxic effects of the urea.
He noticed that the animals were quietened and making an inductive leap tried lithium as
a sedative in excited patients.

This chemical element is closely related to potassium and sodium which are the most
common metals occurring in the body's cells and fluids as components of dissolved salts.
Carefully regulated within narrow limits because of toxicity, lithium quietened manic
patients in one to three weeks. The effect was different from that of hitherto used
sedation. It reduced excitement, slowed overactive thinking and decreased impulsiveness
without causing drowsiness.

Further experiments indicated that its continued use prevents recurrence of manic
psychotic episodes. In the course of these studies it was found that in-patients with
bipolar disorders lithium acted as a mood stabiliser in both directions — preventing low
as well as high swings.

Emotions result from a complex interaction between memories, current events and their
personal significance. We cannot pretend to understand the nature of the mind,
consciousness and those much-vaunted human attributes of will power, perception and
judgement. What is abundantly clear is that they are easily overrun and made worthless
by uncontrolled mood swings.

Explanations of the cause of these mood swings vary from the effects of the lunar cycle
to the theory that seasonal mood changes are a carryover from the animal kingdom with
depression being a form of hibernation. Twin studies indicate that genetic inheritance
may account for up to 70 per cent of mood disorders.

A number of investigations into the effect of loss and stress in depression show that those
with depression report three times as many stressful life events before their mood change
as others of the same socio-economic background. There is evidence to support the idea
that the loss of a parent during childhood is associated with depression in later life.

During the '80s Lithium was the preferred allopathic therapy for controlling mood
disorders and preventing their recurrence, but despite its increasing use in psychiatry it
had side effects: Toxicity, diarrhoea, vomiting, dehydration, weight gain, under activity of
the thyroid gland and kidney malfunction.

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Yet psychiatrists have begun insisting less and less on blood tests to scrutinise lithium
levels and prescribing the drug more and more liberally despite the fact that it was
commonly found that lithium may in fact have only marginal positive effects while
producing toxicity in addition to one or more other side effects.

Less harmful than lithium in the bicarbonated form in which allopaths prescribe it is
lithium in its trace element available abroad as a gluconate. Similar to homeopathic and
biochemic formulations in its functioning, lithium traces are administered for periods of
two to three months at a time and when the swing in one or other direction appears
combined with homeopathy. This has been known to be beneficial and without side
effects.

During the '90 and continuing today is the use of Sodium Volporarate and
Carbamazepine.

What is crucially important is the accurate and timely identification of the swing.

While one bout of elation or depression casts a temporary gloom, for those dragged from
pillar to post by recurrent swings of mood life becomes a walking nightmare. Bout after
bout shatters their self-confidence and deprives them of family and friends.

"Why does she go on like this. I feel down too but have to keep going. If only she had
will power. I don't understand her…"

Disorders are never a part of an individual's dreams. When it interludes into our lives our
responses vary from rage to despair, conflicting as it dies with other aspirations,
destroying all that we held dear, a mental battle follows. Each victim has to come to
terms with the reality that this illness more than any other is a metaphor.

To have your mind and life within control once more becomes the object of living.
Meditation and yoga, prayer and temperance, medicine and philosophy all find a place in
this quest for the restoration of equilibrium and equanimity. But the single more
important factor is support.

Even one relationship that remains undestroyed and unchanged represents the confidence
that there is belief that things will be well again. A right balance of medication and
therapy are crucially important but the support of friends, acceptance of a genuine kind
are indispensable in rebuilding and living life once more.

Most people who have experienced the prison of manic ecstasy will testify to the fact that
the active support of those they love, meeting with others who have suffered similarly,
honest factual information and a doctor who is capable of accepting your judgement are
all vital in gaining a true acceptance.

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Mood swings are disorders of emotion and consequently emotional bonds alter. Those
who have not suffered similarly find it had to relate to the reality of the suffering. At first
those around will encourage you to seek help, take an interest and be willing to invest
their time and energy in doing what they can. Often these are frantic attempts born of
guilt. As time passes they may lose heart in the face of prolonged or frequent swings. As
your own understanding and sense of familiarity with your emotional states grows,
liasing among family, friends and medical support become easier.

Understanding is the crux of the matter in the acceptance of this fearful gift that brings
upon you realisation that your life is both your boundless and ecstatic energy and the
prison of your meaninglessness and despair. Somewhere between lies the balanced
moderation that constitutes normal functioning. Like the actor on the stage you return to
it enriched by the realisation that in fact it is neither.