Friday, April 4, 2014, 09:50
Leading double lives
By Hazel Knowles / Focus HK

Leading double lives

The Society for the Advancement of Bipolar Affective Disorder celebrating the first “World Bipolar Day” with the launch of a Chinese language manual aimed at helping build awareness of bipolar disorder.

Legal consultant Joshua Lee remembers as a child reading Dr Jekyll and Mr Hyde — Robert Louis Stevenson’s tale of a doctor who experiments with the dark side of human nature and develops a split personality.

Lee was 10 years old and rather than feeling horrified, felt a sense of connectedness to the story. “It really resonated with me. I didn’t know why at the time,” said Joshua.

Twenty years on, Joshua understands why he felt that way. He has bipolar disorder, a mental disorder that causes extreme moods and levels of energy which see him swinging from depression to elation.

Like the character from the Stevenson novel, he often feels he is two very different people. On some days, Joshua says he is so down he is unable to move, eat or work. On other days, he feels on top of the world, creative, invincible and capable of almost anything.

“It is very challenging for my family and friends. There are days they are not sure who they are dealing with,” said Joshua, whose name has been changed to protect his privacy.

Around 5.5 per cent — or one in 20 people — in Hong Kong suffer from bipolar disorder, according to research by the Department of Psychiatry at the University of Hong Kong’s Li Ka Shing Faculty of Medicine.

The World Health Organization ranks it as the 6th leading cause of disability with the global incidence rate being around 5 percent.

Myth factor

Awareness of the condition, previously known as manic depressive disorder, is still relatively low among the public and the lack of understanding leads to sufferers facing social stigma.

Earlier this week, the Hong Kong Society for Advancement of Bipolar Affective Disorder (SABAD) joined forces with the International Bipolar Foundation and the Asian Network of Bipolar Disorder to launch the first ever World Bipolar Day.

Joshua was diagnosed with bipolar disorder about six months ago after a series of incidents in which he behaved strangely.

“Looking back, I was always a bit of an oddball but then last year things seemed to come to a head and I did some uncharacteristic things,” he said.

“For instance, after a New Year’s Eve party when I had been drinking, I just jumped in the car and went for a drive.

“It wasn’t as though I was trying to get home. I had already got home. I had no reason to do it. I was just over excited and I ended up getting into trouble.”

Unnatural high

This reckless behavior is typical of the manic stage of bipolar disorder, says Michael Wong Ming-cheuk, a specialist in psychiatry and the chairman of SABAD.

Wong said although happiness itself was not a problem, those with bipolar disorder suffer an extreme form of happiness in which they lose their sense of judgment. The manic stage is also accompanied by other symptoms capable of causing problems.

“For example the patient may overestimate his or her ability or have inflated self-esteem. He may think he is particularly clever,” said Wong.

“I see many patients who, when they are in this extreme state, get involved in meaningless investments and lose all their money. It can have quite serious consequences.”

Wong recalled one patient who invested all his money importing something from Africa and set up a shop to sell it.

“When I went to the shop and looked at the display, I had no idea what it was. Of course, he lost all his money and because the landlord of the shop wouldn’t let him get out of the contract, he had to carry on paying rent for 20 months,” said Wong.

There are other symptoms which can have negative consequences too, says Wong, such as an increased libido which, when combined with recklessness, leads some sufferers to indulge in casual sex which they later regret.

“Their judgment is impaired by their elevated mood,” said Wong. “Apart from feeling high, they may also be irritable and more critical of other people because they believe themselves to be more capable than others,” said Wong.

This makes relationships within families strained, and can lead to conflict and even domestic violence.

At the other extreme is the depressive mood which leaves sufferers unable to lead a normal life, and leaves them feeling withdrawn, hopeless, guilty and unhappy.

Mind matters

In the past, bipolar disorder was often mistaken for schizophrenia, said Wong. However, in recent decades, a deeper understanding of mental disorders has led scientists to conclude the two are different conditions.

Usually symptoms of bipolar disorder begin to appear during adolescence and reach a peak in adulthood.

The condition affects the brain’s limbic system, which supports functions such as emotions, memory and motivation, plus the neurotransmitters and the endocrine system which regulates hormones.

This causes fluctuations of mood as though the sufferer’s “mood thermostat” is malfunctioning.

Wong said there was a spectrum of bipolar disorder with some forms being more severe than others.

“We believe there is a genetic influence which makes some people more vulnerable and the chance of developing it is 10 times higher in people who have a family history of the condition,” he said.

Environmental factors such as stress and substance abuse are also believed to play a part in the development of bipolar disorder, said Wong.

Treatment usually involves a mixture of medication and psychological treatments, along with education in recognizing early symptoms so they know when to seek help.

“We also have to teach the patients long-term maintenance treatments such as how to cope with stress and solve problems. We show them how leading a normal lifestyle with regular sleep, avoidance of alcohol and substance abuse, and regular exercise is beneficial,” he said.

Social stigma

In many cases, however, treatment and support is often delayed because of the lack of awareness and the social stigma surrounding mental conditions which means sufferers are often reluctant to seek help.

Wong stressed the importance of seeking help early, not only to help lead a normal life, but also to avoid damaging the brain’s function.

Research by Eric Cheung Yat-wo, a fellow member of SABAD, showed repeated episodes affected memory and the brain’s executive function — the mental process which connects past experiences with present actions and allows us to plan, organize, pay attention to detail and manage time and space.

“Every time someone has a relapse, regardless of it being depression or mania, it is somehow toxic to the brain and does more damage which impairs brain function,” said Wong.

Joshua says his diagnosis has made him feel more able to cope with his moods. It has also helped him understand why he felt attached to the Jekyll and Hyde story.

He has now moved out of the city center to one of Hong Kong’s islands and works as consultant rather than a corporate lawyer — something he believes makes his life less stressful. Recently, he set up a support group with two fellow bipolar disorder sufferers.

“The similarities in our experiences are quite staggering,” said Joshua. “One of the things we talked about was how we felt we were adopted because we were so different from our siblings when we were growing up. One of the women even checked her birth certificate,” said Joshua.

Despite his confidence, Joshua says the stigma and lack of awareness in the community means he has kept his condition secret from anyone but his partner and close friends.

“When I first heard about World Bipolar Day, I knew I wanted to contribute to increase awareness,” he said.

“I admire those high profile people who admit they are bipolar. But I think it is easier when you are an actor or someone who doesn’t rely on someone else for your income.

“I feel a bit more courageous now but part of the reason I have not revealed my real name is because my partner asked me not to. I don’t have an issue but if I was working in a law firm I might be more worried about what my colleague or my bosses would think.

“Because of the stigma associated with it, you don’t want to walk around waving a placard saying you are bipolar. It is still misunderstood and people will judge you.”

Inside the master’s mind

Leading double lives

Lam Chun, the honorary secretary of SABAD, said it was important to educate the public so they understood bipolar disorder and to dispel myths which stigmatized sufferers.

The first World Bipolar Day was held on March 30, the birthday of the artist Vincent Van Gogh, who has been diagnosed posthumously as probably having bipolar disorder.

Medical experts believe the Dutch artist, known for bright beautiful sunflower paintings and his inspirational starry night scene, suffered from the disorder, explaining his periods of extreme productiveness and creativity and the deep depression which led to his suicide.

Michael Wong Ming-cheuk, the chairman of the Society for Advancement of Bipolar Affective Disorder (SABAD), said sufferers were often bright and creative people like Van Gogh.

However, there are myths and misconceptions surrounding the condition which not only impeded people seeking help but also exposed them to prejudice.

SABAD highlighted 10 of these myths in the run-up to the first World Bipolar Day. They include the misconceptions that bipolar disorder is a made-up disease, that it only affects people in Western countries, and that it is contagious.

Lam Chun, the honorary secretary of SABAD, said it was important to educate the public so people understand the condition and to increase the social support for those diagnosed.

“This way patients will be able to seek early help from doctors and receive proper treatment,” said Lam.

“The earlier they receive consultation from the doctors, the lower the adverse impact brought by bipolar disorder to patients.”

To tackle the challenge of public awareness, the society has published a Chinese version of a guide written by Spanish expert Eduard Vieta.

The guide, called “Psycho-education Manual for Bipolar Disorder”, is aimed at medical professionals, patients and their families and is available from SABAD (www.sabad.org.hk).