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Newspaper Articles part two
Is the label worse than the illness? |
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Just the diagnosis of manic depression can be a
shattering event, one sufferer tells Cassandra Jardine
Over Christmas 1998, a change came over 44-year-old
Dr Allan Levi, a high-flying heart disease researcher. For the
previous few months, he had been depressed and lethargic, sitting on
the sofa, staring into space.
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'If employers know, they can make allowances; if they don't
know, they can sack you'
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But when he returned to work at Bristol University
Medical School in the new year, he was frighteningly energetic:
bubbling with ideas, firing off memos non-stop, and, without
consulting his colleagues, inviting all and sundry to the opening of a
new laboratory for his cardiovascular research. Before long,
relationships were so bad that Allan had to leave.
Meanwhile at home, his wife, Jackie, a GP, was
finding him difficult. "He scarcely slept and would do strange things
like try to take the children out late at night. When I objected, he
could be quite unpleasant. The children started calling him 'mad
dad'."
Allan had suffered from depression several times
before, but never from this manically elevated mood. His psychiatrist
diagnosed manic depression - also known as bipolar disorder - because
of the extremes displayed. At the time, he didn't quibble: indeed, he
joined the Manic Depression Fellowship, a charity for those affected,
which afflicts one person in 100 - some 600,000 people in Britain - at
some point.
Allan was at home, trying to come to terms with the
end of his hopes of a professorship, when - through the MDF - he was
approached by Jonathan Goodman Levitt, a young American director and
research psychologist, who had come to Britain on a scholarship.
Levitt wanted to make a film about living with the disorder, and
Allan, with his medical background, sounded ideal. He was also happy
to take part: "I thought it would be exciting."
The result is Sunny Intervals and Showers, which has
been screened at film festivals around the world and has provoked
prolonged debate about the diagnosis of manic depression. The intimate
documentary, to be broadcast on BBC Four tonight, starts by showing an
engaging, high-spirited man and his loyal wife struggling with his
suddenly jobless state and diagnosis.
Without giving away too much, the film illustrates
how fragile even the most apparently sturdy relationships can be when
someone is diagnosed with a mental illness. With the rate of diagnosis
increasing, this raises important issues.
"Nobody really questions whether diagnosis is a good
thing," says Levitt. "Often the consequences of labelling are more
damaging than the mental illness itself, because there is such a
stigma attached to it."
Certainly, Allan found his diagnosis changed his life
in ways he hadn't anticipated. "You begin to look at yourself
closely," he says. "You wonder if what you regarded as normal
reactions - telling a joke or playing around with word associations -
are part of the illness.
"My wife also began to look at me in a different way
- as someone with a potentially serious disorder that could affect
those around me, especially our children. She works in clinical
medicine, where there is a view that people with bipolar disorder are
seriously ill."
Six years on, he wonders whether he should have been
given that diagnosis. "I have met people who had it far more severely;
they had delusions and hallucinations.
"But I don't think I was ever truly manic depressive.
I had hypomania - mild mania. I was more active than I should have
been, I was working at great speed, but I did not lose contact with
reality - and, since 1999, I haven't had further episodes. I believe
the hypomania was brought on by the anti-depressants. Certain drugs
elevate your mood to a normal level, but if you continue taking them,
they can elevate it higher still."
Professor Chris Thompson, healthcare director of the
Priory Group, which provides mental health services, says: "There is a
debate about whether anti-depressants can bring on mania in the two
thirds of cases where depression precedes it. But it appears that just
as many switched to mania before they were prescribed
anti-depressants. A third of sufferers do only have one manic episode
- that doesn't mean they don't have manic depression."
Jackie also challenges Allan's perspective, believing
her husband was much more ill than he admits. "He wouldn't go in to
hospital, which would have given everyone a breather, because he was
not able to appreciate the effect of his behaviour on others," she
says. "He didn't want others controlling him. But if you shove these
things under the carpet, you create more problems."
She believes diagnosis is important. "If employers
know, they can make allowances - sufferers are covered by the
Disability Discrimination Act; if they don't know, they can sack you.
It also makes it easier for carers to know how to give support."
Brenda Fontain, administrator of the MDF, is also
familiar with sufferers who deny their diagnosis: "Because there is so
much stigma attached to mental health, some members who are still
coming to terms with it find it easiest to say they never had it. But
diagnosis is good."
Yannis Malliaris, a psychologist working on bipolar
disorder at the Institute of Psychiatry in London, says: "There can be
a delay in the diagnosis of bipolar disorder because early episodes
are often not recognised. Diagnosis can create problems, but for many
people it puts their life back in line because they get specialist
help."
Allan has received help and now works as a doctor in
occupational health. However, such is the stigma that he hasn't told
his employers. "Anyone like a solicitor or an accountant who is given
such a diagnosis would not wish to reveal it. I know a successful
architect for whom it caused big problems, because he was thought
incapable of acting responsibly. I imagine my employers would be
concerned if they knew."
Because of the film, Allan's secret will soon be out,
so he has reason to wish that he had never let Levitt's cameras into
his life. "Six years later," he says, "I would probably have made a
different decision."
All he can do is point to his current stable mental
state. Should he ever again show worrying signs, he will know to seek
help before it escalates. In the meantime, he avoids over-working and
lack of sleep, which would put him at risk. "As a research scientist,
I was under huge pressure to obtain funding and write papers - I was
working all hours. It would be unwise to work that hard again."
On that, he and Jackie agree. She emphasises to
patients the importance of a balanced and healthy life: "The factors
that affect physical health also affect mental health." And, while
being diagnosed with a mental illness can have life-wrecking
consequences, prevention has none.
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Michael Grinter has suffered from manic depression, or bipolar
disorder, for 17 years. In his manic periods he has spent more than
£40,000 on luxuries he couldn't afford, such as cars, watches and stereos.
During his lows, he's tried to kill himself.
Despite years of treatment with anti-depressants, it was only when he
was put on a drug called Seroquel that he began to reclaim his life.
Now, in the biggest trial of its kind, Seroquel has been found to be
the first drug to control both manic and depressive episodes - offering
hope to thousands of Britons affected by the condition, including
celebrities such as Caroline Aherne.
Bipolar disorder is a serious mental illness. Patients swing from
extreme depression, often involving thoughts of suicide, to a state of
high excitement or mania.
Although the condition can be genetic, it is thought it could also be
triggered by extreme stress.
During a manic period, the patient can become euphoric and full of
energy. They sleep less, have endless new ideas and start to feel very
important. Some lose control of everyday matters and run up debts buying
things they cannot afford.
But very few will seek medical help - because they do not consider
themselves ill.
The mania is punctuated by prolonged periods of deep depression, with
feelings of hopelessness and a lack of energy.
One of the major problems is that because patients often seek help only
when they become depressed, doctors treat them with drugs designed to lift
their mood. But this can bring on the mania again. In Michael's case,
doctors tried a range of drugs, but none succeeded in keeping his mania
and depression at bay for long.
He took Prozac, which treated his depression but made him manic, and
lithium, which kept his moods stable, but had to be taken alongside
anti-depressants.
"During my manic periods, I felt important and powerful," says Michael,
42, whose depression started in 1986 when he was training to be an
accountant.
"On one occasion I bought a new BMW car, a Rolex watch and an expensive
hi-fi system even though I had no job and no money to pay for them.
"I went on holiday to Norway and ended up being deported because of my
bizarre behaviour.
"I've lost all the friends I made at university, and my best friend of
ten years decided to end the relationship during one of my manic episodes.
"I even lost my job. One day I just decided not to go back to work. I
wanted to end everything because I couldn't function in the job with
depression. A couple of days later I attempted to take my own life."
Seroquel
Then four years ago, Michael, from London, was put on a trial for
Seroquel. The drug is an antipsychotic medicine already used to treat both
schizophrenia and the mania experienced by sufferers of bipolar disorder.
Researchers recently decided to investigate Seroquel further after
anecdotal reports from patients such as Michael who found that while it
controlled their mania, they also noticed an improvement in their
depression. The active ingredient is a compound called quetiapine, which
works on two particular neurotransmitters in the brain. These two
chemicals - serotonin and dopamine - are stored in nerve cells and have
the job of transmitting messages between cells.
Both are known to be involved in controlling mood and behaviour. For
example, schizophrenia is associated with brain cells mopping up too much
dopamine.
Seroquel works by blocking receptors on the surface of those cells,
effectively stopping dopamine from "docking" with them.
The drug works in a similar way in bipolar patients to dampen the
excitement they feel during manic episodes.
However, researchers have now found that, unlike other medication,
Seroquel doesn't push patients back into depression. Instead, it appears
to keep them stable.
The study by scientists at the National Institute of Mental Health in
the US looked at 542 patients with bipolar disorder who were treated
either with Seroquel or a dummy pill for two months.
Using a special scale, researchers measured improvements in depression
among the volunteers.
The results, published in the American Journal of Psychiatry, showed
that within a week of taking Seroquel, patients' depression was easing.
Severity of symptoms halved
After eight weeks, almost 60 per cent of those on the drug said the
severity of their symptoms had at least halved.
"There was a dramatic response within eight days of beginning
treatment," said Dr Joseph Calabrese, who led the research project. "About
50 per cent of patients responded quickly to treatment with Seroquel
versus placebo."
Michael noticed improvements within a couple of months. For the first
time in years his moods were completely under control.
He has improved so much he has been able to return to work for the
first time since 1990. Two years ago, he took a job with support charity
the Manic Depression Fellowship.
"It's given me the chance to have a normal life for the first time in
many years," says Michael.
"There's a great deal to make up for. I've lost so much in terms of
work and money - running up debts of £40,000 - but now I'm rebuilding my
life."
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Here Sophie Corlett, policy director for the mental health charity
Mind, answers your questions about depression.
1. How can I help my partner accept he is depressed?
My partner has manic depression and has been diagnosed for about ten years
now. He knows he has this illness and comes to manic depression fellowship
meetings with me, but I feel that he makes no effort to acknowledge or
fight this illness. He lets it happen to him. When he is unwell, he is
abusive, drunk and is horrible to live with.
He won't admit that he is unwell and stops taking his medication which
makes things worse. He will refuse to see his nurse or go to the doctors
and won't be hospitalised. He is just not 'mad enough' to be sectioned.
When he is well, he refuses to talk about the illness. I know that this
illness can be managed, but feel that unless he accepts this illness and
talks about it more, that the same thing will happen year after year. Is
there some kind of counselling available that might help him to accept his
condition and make plans for the future?
Sophie Corlett says:
You are right in that it can take a while for people to accept that they
have a problem such as bi-polar disorder - more commonly known as
manic-depression. Many people - with the help of talking treatments, self
help, support of family and friends and medication - can live creative and
fulfilling lives, and indeed many famous figures have been thought to have
been bi-polar, including Winston Churchill and Florence Nightingale.
Does your partner possibly suffer unwanted side-effects from his
medication? If so - perhaps you could suggest that he discusses these with
his GP - as there are alternative mood stabilisers that may be easier to
tolerate.
One type of counselling that could be helpful is Cognitive Behavioural
Therapy, which might help him both acknowledge the consequences of his
problem, and how he can look how to recognise 'early warning signs' which
many people experience prior to a 'high.'
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Everyday I would Ask "Are you going
to Kill Yourself
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A new scheme helping people with mental
illnesses set up their own businesses is being piloted in the
North East. Here, one man who has battled with his demons, talks
to Mitya Underwood
Lionel Joyce remembers suffering his first
bouts of depression when he was just teenager, a period when he
should've been without a care in the world.
For years he endured mood swings, but it
wasn't until the former Newcastle City Health Trust boss was in
his 50s that he was finally diagnosed with Bipolar Disorder II.
As one of the most influential men in mental
health support in the North East, Lionel's story is extraordinary.
"When I was diagnosed I had been the chief
executive for 15 years. I was responsible for 3,000 staff and had
a budget of £1m, but that didn't cause me to have the condition.
I had already been a patient in psychiatric
hospitals for nine months in 1971," he says, very
matter-of-factly.
"My childhood was relatively happy. I was one
of four brothers and sisters and had a normal family life. There
was nothing exceptional about it."
Lionel, 59, lives in Newcastle city centre
and is now a contented dad-of-three.
He is married to a local artist and runs an
increasingly successful consultancy business, working with health
organisations to provide better care for mental health patients.
And he's a shining example of how people with
mental health problems can set up a successful firm.
But his current situation is a world away
from how he felt 40 years ago. Desperately unhappy, he didn't see
his life getting any better.
When he left school at 18 he travelled more
than 3,000 miles to South Africa with the Voluntary Services
Overseas organisation.
"I was drinking very heavily. I didn't
consider myself depressed although I clearly was," he says.
"Looking back I probably had periods of
depression from about the age of 14 onwards, but diagnosis of
depression and other illnesses in adolescents is very, very poor.
It's just assumed that bad behaviour and mood swings is part of
being young.
"I thought the solution was to experience
somewhere with different values. The unhappiness led me to think
that it was just my way of life and where I was living.
"What I discovered there was that I could
drink more for less money and things weren't better at all. I felt
I was only there doing the job I was doing because I was white and
it was quite a racist place at the time."
Lionel stayed in Botswana for two years
before returning to England. He was drinking up to 10 pints of
beer every day and becoming more and more depressed.
He was managing to hold down stable jobs
until his condition took an almost fatal hold on him.
"When I came back to England I realised the
geography made no difference. I thought I should just kill myself.
"When I was 25 I was very unhappy, not the
sort of unhappiness that other people feel. It was a joyless
unhappiness, you just have no feelings. I thought: `If this is the
quality of life I'm going to enjoy, I'm better off dead', which is
actually quite sensible."
His urge to commit suicide became stronger
and stronger until one day he took an overdose and ended up in
hospital. He was put in touch with the Samaritans before spending
the next nine months in two psychiatric hospitals.
Lionel explained: "I left and didn't think
anything was different in terms of why I should still be alive.
"I was also wondering who would employ a
person with a history of mental illness. When I left the hospitals
I decided to join the National Health Service.
"I concocted a CV which was broadly true but
which also contained a number lies. It got me a job in personnel
and I was promoted after eight months.
"But still every morning I would wake up and
say: `Are you going to try and kill yourself today?' and `Are you
going to succeed?' "
In 1974 he was caught drink driving which
prompted him to join Alcoholics Anonymous the following year.
He believes this helped him in two ways.
Firstly, he could use it as a form of therapy, and, secondly, it
provided him with the techniques to stop his destructive drinking
habit.
In 1976 he married Hilary Turner, also now
59. Like Lionel, she wasn't aware of his exact condition but
learned to cope with his mood swings.
By the early 1980s, the dad-of-three to Jo,
27, Rozzie, 26, and Luke, 24, was steadily climbing the career
ladder in the NHS. He was heavily involved in giving mental health
patients a better voice so they could get the services they need.
Despite his successful career with Newcastle
City Health Trust, Lionel still didn't have a diagnosis to explain
his feelings.
"My expectation was that I was bound to go
back into hospital one day. I was always aware that at some point
in a year I would be so down that I would be worried about
myself," he remembers solemnly. "In 1999 I crashed with a really
awful depression and was off work for six months.
"I just walked into the office at work and
said `I have to go'. My psychiatrist wanted me to go into hospital
but we agreed on balance to try to deal with it at home.
"I think I came very close to dying one day.
The sense of feelings were awful, but a friend of mine who is
actually a psychiatrist rang me up, realised what was happening
and stayed on the phone for three hours. I slowly recovered, but
was always arguing with her about the diagnosis.
"She eventually sent me to Newcastle
University's Department of Psychiatry who tested me for a full day
and eventually diagnosed me with Bipolar Disorder II."
Bipolar Affective Disorder is a serious
mental health problem involving extreme mood swings.
The exact causes are not known, but around 1%
of people develop a bipolar disorder in their lifetime.
Bipolar Disorder I is thought to be the less
severe of the two and is characterised by at least one manic
episode with or without major depression.
Symptoms of the depression experienced in
bipolar disorder are almost identical to those of major
depression, including fatigue, sleep problems, lack of
concentration, agitation and pessimism.
Unfortunately for Lionel, key to coping with
the condition is an early diagnosis by a mental health specialist.
"It was the best explanation I had heard in
my life, and it came as no surprise that I was an alcoholic
because it's a way of managing the mood swings.
"But, at the same time, who wants a condition
like that? People aren't queuing up saying `Please can I have that
disorder'," he laughs.
So, in the same year as he was diagnosed,
Lionel quit his high-profile job. He was already chairing various
organisations to help people with mental illnesses work with the
NHS and primary care trusts and decided that was his future.
He then set up Turner Sheringham Ltd
management consultancy which is often hired by health trusts to
help them understand the best way to provide their services.
"People seem to feel as ashamed about
depression as they do about schizophrenia even though it's all a
normal part of life," he said.
"I think I will be running the business for a
long time. I can't ever see myself stopping as I know how
important it is to give the patient a voice."
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