We have at least once in our lifetime, met a weird but fascinating character. They sometimes may be extremely annoying but brilliant. Sometimes, from an indispensable genius, they turn to totally useless. If you yourself, are thinking that you might be one of them or that someone close to you is, then it might be good to have a little introduction on what a mental disorder is. This may help you decide if you or your friend needs to see a doctor or if it’s just a quirkiness one could easily cope with.
Let’s all think of a hypothetical character named Tom. Tom is a brilliant, creative individual whose charisma and optimism inspire a lot of the people that he meets. However, those who are truly close to him know that his mind runs too fast, and sometimes gets overloaded. He tells his friends, at some point that he feels so happy, like he was flying or is on top of the world and then he crashes. Upon crashing, he feels as if dark clouds are hovering above him. Sometimes, this crash is triggered by a dreaded event, too much stress or sometimes, the dark clouds just come with no apparent reason. Hopeless, unfocused, lethargic, he stays in bed all day. Occasionally, his kindness gets shrouded by his irritable mood that manifests itself by his snide remarks or sometimes coldness. He would also bang his head on the wall, smash an expensive piece of equipment on the floor or walk along the streets hoping that a car would just hit him. Tears would not stop falling even if he is in a place full of strangers. He pushes people away. His work and relationships suffer. He entertains the idea of taking his own life.
Tom’s extreme moods characterized by elation and sadness are nothing but symptoms of what psychologists call Bipolar Disorder. On one pole there is the depressive condition, on the other pole, there is the manic state – a state of intense optimism, happiness and delusions of grandeur. Some of Tom’s concerned friends tell him he should seek professional help but some others tell him that it is all a matter of control and that takes practice. As one of his friends says, “arent’ we all a little crazy?”. What then distinguishes someone with a mental condition from a “normal” person? Are the boundaries between disorders that clear cut? Tom, in his readings finds that he could also be someone with Aspergers Syndrome or ADHD. What does he really have? Should he take pills? Should he see a shrink or should he just simply exercise, meditate and practice Deepak Chopra’s tenets? (No, he does not follow Deepak Chopra.)
In diagnosing individuals, psychiatrists have a guidebook called the Diagnostic and Statistical Manual of Mental Disorders (DSM -5) [1]. The book is the culmination of more than a decade’s work of revising the classification of mental disorders. Depression is not just some short feeling of sadness. The DSM V characterizes someone who is suffering from depression as someone who has experienced at least five signs of depression for more than two weeks. [2] Some of the symptoms are, moroseness, hopelessness, significant weight loss and gain, too much or too little sleep, feelings of worthlessness, fatigue, decreased interest in activities that s/he usually enjoys, difficulty concentrating or making decisions and recurrent thoughts of death and suicide. Someone with Bipolar Disorder however may flip back and forth between overexcited states of mania and depression within a single day, week, or month or year. With the manic state he can also be hyperactive, he also overestimates his abilities and his self.
While Tom did entertain the idea of visiting a psychiatrist, it took him seven long years before he went to one. His parents warned him that, consultation might be too expensive. He might also be too dependent on the drugs and he might suffer from unwanted side-effects. His intelligence made him very self-aware. He tracked his moods. He exercised, meditated, ate fish which has a lot of omega-3 fatty acids that are supposed to “heal” the brain and he wrote a lot of poems and reflections in his journal. They all helped his character. However, he has noticed that in times of extreme stress, pressure from school, work, financial and family problems still get the better of him despite all his efforts of preventing a fallout. The tipping point came, when he ran away and took a 24-hour trip by land and sea to the south of the country. Without clothes and not enough money to last him a week, he left. It almost destroyed him and his dreams. He finally decided to meet a doctor.
The doctor admired his self-awareness and noted that this is one of the most important abilities one should have. He should be able to recognize the feelings that are coming to him so that he can gain full control of his so-called demons. He must come up with a strategy or a game plan.
Fig. 1 Tom came to his doctor with a piece of paper describing the mood swings he was experiencing. He made a rough sketch of his ‘highs’ and ‘lows’ over time when he was off and on medication. With medication, Tom’s mood became more stable.
One of the strategies suggested to him was cognitive behavioral therapy[3]. Specifically, he was asked to write his thoughts and feelings whenever he feels like he is bound to do something that has dire, irreversible consequences. For example, reasons for suicide, things he might look forward to the next day, week or year, snapping at someone, quitting a job instantly, among many other things. Writing his thoughts and how he dealt with them, helped become even more self-aware and things that are needed to be done to are clearer to him. He was also asked to try certain drugs that will address the chemical imbalance in his brain. Exercise and eating food rich in omega-3 fatty acids, are no longer enough.
In the beginning, Tom’s medicine worked well with him until he experienced lethal side-effects. While others were afraid, Tom was willing to experiment to get the right balance and dose so that he could get the quality of life he wants. He had experienced rashes, extreme sleepiness for over 12 hours, and vomiting. He has also arrived at a point that he is confident enough to skip a couple of days without medication just so he could experience the “creative highs” of a typical bipolar. He just has to prepare for the “crash” that will ensue.
So to answer the question, “Do you need to see a shrink?”. If you think that you have been undergoing prolonged distress, your behavior has been negatively affecting your work and the people you love no matter how you try to control yourself, then it is best to seek professional help. Seeking professional help will not magically take away your troubles. The pills, the strategies, the changes in perspective are all part of a delicate balancing act in having a well-lived life. It will be a lifetime of management and the first step is to recognize that you do need people who can understand what is going on in your gifted but differently-wired brain. The next question is, how does your shrink know what kind of condition you have?
Preview for Part II: Standardized measures in psychiatry, Learned Helplessness and Comorbidity. Tom thinks he has Aspergers Syndrome and ADHD too. We will introduce another hypothetical character named Sylvia who “demands” understanding for her bad behavior just because she has a disorder.
Useful Links
[1] Diagnostic and Statistical Manual of Mental Disorders Fifth Edition :http://en.wikipedia.org/wiki/DSM-5
[2] Crash Course Psychology on Psychological Disorders: http://www.youtube.com/watch?v=ZwMlHkWKDwM
[3] Cognitive Behavioral Therapy:
http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy
