Bipolar disorder: The two-faced monster that almost killed me

Two boys, barely 10 years old, snored peacefully in their hotel bed as their mother emptied the contents of a packet she had concealed all night, into a water bottle on the bedside table.

She watched the powder settle at the bottom, then shook it just to make sure every last bit dissolved.

Satisfied, she fastened the bottle and placed it back on the nightstand beside the tossing and turning of her sons in the wee hours of the morning.

This is how Jackie Ruguru Kagu, 34, wanted to end it all. Just a few hours before, in the dead of the night, she had sent the same message to her friends.

“I am nobody. I am tired of life.”

No one had read these 1am texts. And by the time anyone woke up, there would be three lifeless bodies in the hotel room in Karatina Town in Nyeri County.

At 5am, the poisoned water stood still in wait. At 7am, after two hours of watching her sons, Jackie left the room briefly. The boys would wake up thirsty as was their custom and their journey to the afterlife would begin.

However, there was a twist in the tale. Her firstborn woke up to the vibration of his mother’s phone, and picked the call.

 The caller pleaded with him to tell her where they were. Barely awake, the boy mumbled that he didn’t know the name of the hotel, but he recalled seeing a church nearby.

Jackie walked in just then, grabbed her phone, slapped her son and demanded to know why he was answering her phone. The boy recoiled and broke into tears.

The caller, Jackie’s colleague Irene Kipkolum, was listening in. Jackie cut her off, woke her other son up, and told the boys about heaven, where they’d be going in a short while.

A panicky Irene called the police. Luckily, they had an inkling of where the hotel close to a church might be, and rushed to the scene.

Barely an hour later, they broke into Jackie’s hotel room, just on time to turn around a dark and twisted moment. That was last year.

                        ***

Jackie had always been a normal, happy kid. Then she went to college in Nairobi, where she suffered fleeting bouts of depression and anxiety. With time she realised that it was not a matter of if she would have these episodes, but when they would return.

She wed in 2007, but the once blissful marriage hit the rocks once the first child came along. Violence led to a miscarriage and an acrimonious ending in 2015 after their second born came into the picture.

Unknown to her, the stress awakened the sleeping monster that remained faceless and nameless up until this point.

“I was consumed by racing thoughts and I couldn’t focus. I had trouble interacting with people … It felt like I didn’t know who I was,” she recalls.

Her sons lived with her in-laws and with no support system, Jackie turned to ‘retail therapy’ or what she later learnt was something other than.

Jackie walked into a bank, took a Sh800,000 loan and went on a spending spree. She bought several TVs, furniture ... anything she fancied, with one swipe of her debit card. Essentials like rent were not a priority, though, and this saw her kicked out of her house for accumulating rent arrears.

It took her a month to spend all 800,000 of the loan, then she turned to bhang, which left her grappling with extremely low spirits, insomnia and anxiety when the high wore off.

Homeless, she moved in with friend after friend, moving on to the next one once she overstayed her welcome. She took soft loans which she used to drink and make merry with her lenders.

 At the office of the registrar academics at Karatina University, where she had worked for six years, she was lashing out at colleagues and everyone else for no reason.

“I felt like I was losing my mind. My job, family and relationships were slipping through my fingers so fast, I couldn’t keep up,” she recalls.

Tired of life, she called a friend who had a hotel in Karatina Town, and asked for a room where she could put up with her sons for a few days, under the guise of homelessness. But Jackie had other plans.

When her plans to end her life and that of her children went awry, her employer took her to MediVa Wellness Centre, a rehabilitation and retreat centre for people with mental illness and alcohol and drug abuse problems, in Thika, Kiambu County.

Given her symptoms and recent behaviour, Jackie needed to be admitted for treatment, but she adamantly insisted on outpatient treatment. Some of her friends, family and fellow patients told her not to tell anyone that she was mentally ill. Understandably so, because stigma, myths and misconceptions often follow a mental illness diagnosis. In retrospect, this stigma from within and without only aggravated the illness, but Jackie did not get the help she needed.

Her salvation came last March. Her mother sent her to buy blood pressure medication, but the pharmacy she had been sent to had run out of the drugs. Jackie used the money to buy a snack. Stranded, she called her mother and asked her to send more money, but her mother would hear none of it. She scolded her daughter for being irresponsible, and inadvertently charged an already emotionally-unstable Jackie.

“When I got home I was enraged beyond belief. I caught sight of a metal sickle used to shear grass and thought how I would use it to slit my mother’s neck. I cringe when I think about it now, but that was me then,” she recalls.

Luckily, the presence of her father and sons kept her from following through with her murderous thoughts. Instead, Jackie ran into the rainy night, hopped onto a motorbike and fled to MediVa Wellness Centre. She doesn’t remember much of the ride, but she remembers banging on the centre’s gate wailing.

'LOW AND LOST'

“The watchman was hesitant, but one of the staff saw me and let me in. I ran to the back and I cried like I have never done before. I felt so low and so lost.”

Dr Njeri Muigai (deceased), the founder of the centre, met her the next morning and after talking to her, diagnosed her with bipolar disorder. The two words sounded very foreign, but the symptoms were very familiar.

 “She told me it is a psychiatric condition marked by out-of-control mood swings — from debilitating depression to elevated moods. I had alternating periods of intense depression and good or irritable moods. I was bitter and angry. I cried for days.”

While at the facility, she tried to harm herself, hoping that by doing so, they would let her go. She argued that she was “not crazy like the other patients”.

During her four weeks at MediVa, she went through counselling, while her doctor tried to work out which combination of medication would help stabilise her mood. She could not leave, but her friends and family were allowed to visit.

“Slowly, I began to piece everything together. I had a disorder that I would live with for life, but it could be managed. When this dawned on me, my life started anew. And now that I think about it, I may have had it for a while, but it was misinterpreted as me being rebellious and spoilt.”

Jackie misses her children who are in the custody of her parents.

“I used to feel guilty for what I wanted to do to them, but I am healing. I know that healing begins once you accept that you are sick and seek help.

“I am glad that I can tell my employer when I suspect I may be getting low moods and almost all Karatina University staff know where I live.”

Now that she had accepted her condition, Jackie no longer wanted to hide. She took to her Facebook page and shared that she had been diagnosed with bipolar disorder. With that, she began an uncomfortable discussion about mental illness.

One in four Kenyans (11.5 million people) suffer from one or a combination of mental disorders. These include mood disorders, thinking disorders and behaviour disorders such as bipolar disorder, depression, anxiety, schizophrenia and substance-induced psychosis. Research has also shown that between 20 to 40 per cent of Kenyans seeking outpatient treatment have one or more mental disorders.

Mood disorders are often caused by genetic predisposition, though not everyone with a family history of mental illness will become ill. According to Dr Catherine Syengo, a psychiatrist, mood disorders are often precipitated by financial, work-related or relationship stress.

With proper diagnosis after psychiatric review, a condition like bipolar disorder can be treated and managed.

And while there are less than 100 psychiatrists in Kenya, general doctors can help diagnose and refer the patient to a specialist.

Bipolar disorder, in particular, is diagnosed after psychological evaluation of the patient’s thoughts, feelings and behaviour patterns. One of the key symptoms is racing thoughts (too many ideas at the same time that are difficult to articulate).

Jackie has been on medication for a year. She takes five pills every evening and gets a monthly injection to help her sleep, moderate her mood and keep the depressive and manic episodes fewer and far between.

Unfortunately, this does not come cheap. Her treatment costs Sh20,000 a month, an expense that is covered by her medical insurance, as was her one-month hospitalisation that came to Sh200,000, with Sh1,600 a day for the bed footed by the National Hospital Insurance Fund (NHIF).

“I’m lucky to have a medical cover courtesy of my employer, but what about the unemployed? Treatment is very expensive and it is something we need to talk about,” she says.

Drugs are also not easily accessible. She has to travel all the way to Thika to buy medication, as it is not available in Karatina where she works and lives.

Due to some of the challenges of accessing treatment, patients often turn to alcohol or bhang for relief and become dependent. This worsens their condition since drugs like alcohol act on the same brain region as many antidepressants, and often make depression symptoms worse.

 In addition, the mind-altering chemicals in bhang and alcohol do not help sustain mental stability.

 “People with bipolar disorder are more likely to have episodes if they drink, no matter how much (or little) alcohol they have. So it is best for people diagnosed with bipolar disorder to avoid alcohol at all costs,” warns Elvis Osimbi, the lead addiction counsellor at MediVa Wellness Centre.

***

MANIC TODAY, DEPRESSED TOMORROW

What is bipolar disorder?

Bipolar disorder involves those areas of the brain which control our moods. It is characterised by mood swings from high (manic) to low (depressed). It is often controlled with medication.

Periods of high or irritable mood are called manic episodes. They  can  be  brought  on  by  stressful  experiences  or  physical  illness.

Bipolar disorders are divided into two subtypes (bipolar I and bipolar II):

Bipolar I disorder is the classic form where a person has had at least one manic episode.

In bipolar II disorder, the person has never had a manic episode, but has had at least one hypomanic episode and at least one period of significant depression.

Most people who have manic episodes also experience periods of depression. The depression phase is more common than periods of mania. Bipolar depression can be much more distressing than mania and, because of the risk of suicide, is potentially more dangerous.

 

SYMPTOMS

During the manic phase, symptoms can include:

  High level of energy and activity

  Irritable mood

  Decreased need for sleep

  Exaggerated, puffed-up self-esteem (“grandiosity”)

  Rapid or “pressured” speech

  Rapid thoughts

  Tendency to be easily distracted

  Increased recklessness

  False beliefs (delusions) or false perceptions (hallucinations)

During elated mood, a person may have delusions of grandeur, while irritable moods are often accompanied by paranoid or suspicious feelings.

 

DURING A DEPRESSIVE PERIOD, SYMPTOMS MAY INCLUDE:

  Distinctly low or irritable mood

  Loss of interest or pleasure

  Eating more or less than normal

  Gaining or losing weight

  Sleeping more or less than normal

  Appearing slowed or agitated

  Fatigue and loss of energy

  Feeling worthless or guilty

  Poor concentration

  Indecisiveness

  Thoughts of death, suicide attempts or plans

 

TREATMENT

Bipolar disorder is treated with a combination of medication and talk therapy. Talk therapy (psychotherapy) is important because it provides education and support and helps a person come to terms with the illness. Often, more than one medication is needed to keep the symptoms in check.

 

TAMING THE MOOD SWINGS

1Learn  how  to  recognise  all  the  symptoms  of  mania,  and  diarise  them  as  they  appear.  This  will help you  seek  help  before  the symptoms  get  out  of  control  and  in  the  process prevent destructive episodes or hospital admissions.

2. Read as much as possible about the condition.  Be in charge.

3Learn  about  stress  and  how  to  manage  it  so  that  stresses  that  are  part  of  daily  life  do not overwhelm you and possibly precipitate a manic episode.

4 Improve personal relationships, especially with close confidantes by telling them of your condition and how it can adversely affect relationships. This will help them understand you and support you when you are under attack.

5 Occupy  yourself  (without  overworking  yourself)  with  activities  that  take  your  focus away from the illness.

6 Exercise regularly. Get involved in activities that are relaxing and non-destructive. 

7 Get  regular  check-ups  from   your  healthcare  provider  and  do  not  change  or  stop medication  without  consulting  your doctor.   

8Your  relatives  and  close  confidantes  need  to  be  educated on bipolar disorder  as  well  so  that  they  can recognise  early symptoms and help you seek professional help in time. They will also learn how to handle your manic and depressive phases and watch out for suicide risk.

9 Discuss  how  to  handle  your  finances and treatment in the event that you go into a manic or depressive episode with your relatives and doctor. Make plans on what should be done about your family and especially your children should you become manic or severely depressed.

 

Sources: International Bipolar Association, Africa Mental Health Foundation, Ministry of Health, World Health Organisation.