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By Marion Scher

Like many mental illnesses, bipolar is often misunderstood and, if left untreated, can have serious consequences.

Because what we don't know or don't understand scares us, we usually ignore it. This is why so often this debilitating illness goes undiagnosed and the bipolar sufferer is left in a world that doesn't understand them or their sickness.

When Charlotte da Silva (23) of the Vaal Triangle goes to her bedroom, opens her cupboard and takes out the green stockings and orange mini dress with huge circles all over it, she knows she's in trouble. She feels reckless and free – in fact she feels great, but at the same time she knows that she's heading for a manic period, which could last anywhere from a few hours to a week. "When I'm manic I have no inhibitions and I'm likely to give away half my possessions – sometimes to virtual strangers."

Da Silva was only diagnosed as having bipolar disorder at the age of 19 and up to then, apart from a couple of bouts of depression, had led a normal teenage life. "When I look back now there were some warning signs. I battled to concentrate or finish my work properly at school and every report would say I want' reaching my full potential. My parents put my behaviour down to being a normal teenager and the stress of matric, but inside I knew it was more than that."

Their local GP immediately recognised that this was more than just normal teen behaviour and sent da Silva to a psychologist who, only seeing her depression, immediately put her on anti-depressants. This is a disaster to someone suffering from bipolar disorder, as this immediately sets off a manic period.

What is bipolar disorder?

Also known as manic-depressive illness, it's a brain disorder causing the sufferer to experience extreme changes in mood, energy and behaviour. It's classified as a mood disorder and is very different from the normal ups and downs that everyone goes through. The symptoms of bipolar disorder are severe. One day the sufferer will be in a deep depression and the next, feel on top of the world. In fact, they have so much energy and confidence they think they can tackle anything. Untreated it can lead to suicide, but with the right medication and treatment, people with this illness can lead normal lives.

The problem for most bipolar sufferers is simply being correctly diagnosed. According to psychiatrist Dr. Lee Janet, one of the country's leading experts in this illness, "someone with bipolar will often only be seen by doctors or psychologists while they are in the depressed stage of their illness and will then be prescribed anti-depressants, which will usually bring on a manic phase.

"Bipolar is very tricky to diagnose and often people with an extreme form of the illness can look as though they have schizophrenia, although this is a totally different illness. A person can be genetically predisposed to bipolar, which means it can be triggered by something like substance abuse or trauma. Very often it's a family gene and once we take a family history and see bipolar this is a sure confirmation of the illness."

This was the case for Lee Loggerenberg (34), a Johannesburg-based freelance journalist. "There was a history of depression and bipolar in our family, but it wasn't until 10 years ago that I was correctly diagnosed. Looking back I have always had this condition. As a child I was moody and often angry, although my parents didn't seem to think it was a problem.

"School wasn't easy and after matric I started doing drugs and drinking way more than normal for a girl my age. That went along with my lack of inhibitions. I couldn't control my emotions and I had mood swings. Even when I was diagnosed I didn't take it seriously and brushed it off until after I got married and fell pregnant. That was when the real problems started," says Loggerenberg.

Even a normal pregnancy will see a woman's behaviour change as the hormones kick in, but for a person with bipolar this is seven times more severe and their moods are severely affected. "I literally had to be held back one day as I wanted to attack my sister and do serious damage to her," she explains.

"This was when I was taken to a psychiatrist who diagnosed this as hypermania. I would get very excited and talk very fast one minute and sink into a deep depression the next. Before I saw the psychiatrist the medication I was on, as well as the alcohol I was drinking, had triggered this behaviour. My poor husband, who is a quiet guy, was incredibly patient and a wonderful stabilising influence for me. One day I even picked up a kitchen knife and came at him – I'd later ask myself 'where did that come from'?"

Loggerenberg's problems intensified once her twin boys were born. They moved in with her parents just as post-natal depression (the normal condition after a bipolar pregnancy) set in. "One night I was so frantic I held a pillow over my child's face and said 'if you don't help me I am going to kill my children'." It was at this point that her parents took the children and her medication was changed. Within days her mood had stabilised and she now knows if a manic period is about to start. "Today I look for the signals and simply adjust my medication." Prevention is, of course, better than cure.

Recognising the signs is often the key to controlling this illness. Zane Wilson, founder of the South African Depression and Anxiety Group (SADAG), receives daily calls from sufferers or family members who suspect bipolar disorder. "If we don't catch them as soon as possible, the problem gets so bad we have to get them admitted to hospital to stabilise then to get their lives back on track. What would help is if people around bipolar sufferers start to see signs of mania coming on, check if they're taking the medication and keep a close eye on them."

SADAG advises those close to sufferers to identify what kinds of things are likely to trigger manic episodes and then try to avoid these, as well as making sure they stick to their medication. "When a family member calls us to report someone behaving in a way that sounds like bipolar disorder we immediately advise them to seek psychiatric help. Very often the on set is in quite young people and it's hard for their families to face this," adds Wilson.

This was the case for Charlene Stoker (33) of Pretoria, who feels she has had bipolar disorder from a very young age. "Apart from growing up feeling totally apart and different from other people, the signs were all there. As a teenager I went from a quiet, withdrawn child to a "joller" overnight and then back to a young girl sitting crying in a corner."

But how could this type of behaviour have gone unnoticed? "I think my single mum was too busy worrying about how she was going to put food on the table for me and my two brothers to worry about me, so the illness just got worse. Then, when I got married, my ex-police officer husband also found my illness a total puzzle. "For many people that sums up bipolar disorder – a total puzzle.

The causes

"No-one really knows the cause," explains Janet. "It's a combination of biochemical, genetic and psychological factors, causing a chemical imbalance in the brain."

Even with these symptoms it often takes time before a person seeks help. It was only after Stoker's baby son David fell seriously ill and was hospitalised that she began having anxiety attacks and suffering from deep depression. "Then would come the 'highs' when I'd hit the shops until I ran out of money. I kept saying 'something is wrong with me – I need to see a psychiatrist'. I was always crying out for help. Those around me just felt I was just seeking attention."

In the end, after a major anxiety attack, her son's paediatrician recommended a psychiatrist who immediately hospitalised her for four days. "Although the original diagnosis was post-traumatic stress disorder, I'd read enough by then to know I was bipolar. I'd been on the Internet and read enough books to recognise my symptoms."

Today, all these women are living fulfilled lives, are on medication and see a future in front of them.

How to treat it

"We look at each case individually, as some people will have one episode a year, whereas you can have one when you're 20 and the next when you're 70," explains Janet. If you have three or more episodes then you would have to stay on mood stabilisers. For around 15 percent of people, this is all they need, but with others it's often a cocktail of medications. It sometimes takes a little juggling to find the right combinations."

A further problem for sufferers of this and other such conditions is the stigma hat comes with the tag "mental illness". "I've kept it quiet at work," explains Stoker. "My boss knows – I told him this is what's wrong with me and some days I will have ups and downs. I've been fine for the last three months and am working through things myself I write poetry, which is a wonderful release for me.

Copyright 2006, Used with permission from Marion Scher.