Beating bipolar

Mariah Carey is probably good at keeping secrets. For almost 20 years, the American superstar was trying to sweep under the carpet her struggle with mental illness. So when she opened up to People magazine last month that she has been treated for bipolar disorder since 2001, millions of her fans were stupefied.

Despite her global celebrity status, Carey -- like the majority of mental health patients -- still felt as if the diagnosis left a huge scar on her life.

"I didn't want to carry around the stigma of a lifelong disease that would define me and potentially end my career," Carey, 48, told People editor-in-chief Jess Cagle in an interview. "I was so terrified of losing everything, I convinced myself the only way to deal with this was to not deal with this.

"Until recently I lived in denial and isolation and in constant fear someone would expose me. It was too heavy a burden to carry and I simply couldn't do that anymore. I sought and received treatment, I put positive people around me and I got back to doing what I love -- writing songs and making music. As hard as this is, I also knew it was time to finally share my story."

Carey admitted she has been undergoing therapy and taking medication to keep at bay her psychological condition called bipolar II, a disease characterised as causing mood swings among other symptoms. And she is not alone among celebrities who have been battling bipolar. In 2011, Academy Award-winner Catherine Zeta-Jones went public with her bipolar II diagnosis while Star Wars icon, the late Carrie Fisher, was remarkably open about her suffering with bipolar. Oscar winner Patty Duke, who also died in 2016, was diagnosed as having bipolar in 1982.

But what is Carey's bipolar II and how is it different from bipolar as we know it?

Psychiatrist Dr Piyawat Dendumrongkul said that bipolar disorder can be broadly categorised into three different types: bipolar I, II and III. While the third type is an unofficial term for mood shifts induced by medicines or other chemicals, bipolar I and II are both associated with mood cycling between extremely high and low over time. But in a nutshell, bipolar II is a milder version of bipolar.

"To keep it short and simple, bipolar II doesn't affect how patients function at work," he explained. "Bipolar I has a significant impact on work. For example, patients might laugh all day because they feel extremely happy about something, but they cannot perform. And they might get fired because of that."

Like bipolar I, bipolar II also involves cycles of extreme ups and downs. But because the mood shifts are mild, the disease can often be misunderstood as merely someone's personality.

"Bipolar II presents itself in the form of mood instability," added the psychiatrist. "You are extremely happy now and might turn extremely sad the next moment. In the low episode, you feel depressed and want to be alone. In the high episode, you feel so grand that you become hard to please and subsequently feel easily irritable. All these can be seen as bad personalities but they are actually symptoms of bipolar II."

All the said characteristics of bipolar II are, however, the reason that explains why Thailand has no statistics with regard to the disorder. According to Dr Piyawat, most patients feel no need to visit a psychiatrist because their symptoms only slightly affect how they perform and function, especially at work.

Even though the mood shifts can be disturbing, in most cases patients are the only one affected by the consequences of their own emotions and behaviours, not others.

"And because visiting a psychiatrist is still somehow seen as a stigma in Thailand, that adds up to why patients with mental sickness like bipolar II are still kept hidden."

In the United States, the National Institute of Mental Health estimated that bipolar disorder affects approximately 5.7 million adult Americans, or about 2.6% of the US population aged above 18. Figures collected in Thailand over a decade ago revealed that bipolar I affects only 1-3% of the Thai population. Unfortunately, there is no recorded number of bipolar II patients in the country.

Before getting help from a psychiatrist, it is paramount for patients or relatives to differentiate between bipolar and normal emotional changes. According to Dr Piyawat, stimuli is a significant threshold to pinpoint if it's bipolar or just normal ups and downs everyone goes through.

"Bipolar is a brain disease. So the extremely high and low episodes occur on their own without patients being stimulated by incidents or anything. With events like being complimented or disparaged by your boss, winning the lottery or losing it, then you feel very happy or very depressed, that's emotions."

Genetics is a risk factor for bipolar. People with lineal family members diagnosed as suffering any psychological disease are more likely to develop bipolar than those with no such family history. Bipolar is mostly diagnosed in the teen years. Men and women are equally found to suffer from the disease.

A piece of good news about bipolar from Dr Piyawat, though: "We haven't seen many cases of bipolar patients committing suicide. The disorder is a mix of high and low episodes so it's only during the low when they feel worthless. That's why bipolar-related suicidal rate is much lower when compared to other more severe mental diseases like depression or schizophrenia [a mental disorder where patients may lose touch with reality, hear things and develop hallucinations]."

More good news is that bipolar symptoms can be curbed by means of medication and psychological therapy. The duration of medicinal treatments depends on the severity and on whether there is a relapse. But studies found that it is best for patients to keep taking the lowest dosage of medicine for the rest of their lives to keep their symptoms in check, just like many people do with their high cholesterol or high blood pressure.

Setting aside all these medical perspectives, the term bipolar has been widely used with negative connotations to refer to behaviours of someone who is emotionally unstable, and in such cases this is nothing to do with an actual diagnosis at all. As a psychiatrist, Dr Piyawat does not think such a verbal phenomenon would lead to more negative attitudes people would have towards the disorder. "Bipolar is a generic term, meaning two opposite poles [of emotions]. From a medical point of view, bipolar is a disorder associated with behaviours and I don't think the term scares people. But for others out there, it is crucial to understand that bipolar is a brain disease which needs to be treated, especially if it affects people's quality of life. Yet bipolar is not taboo."

While it is paramount for bipolar patients to accept that they themselves fall sick, which is a challenge in society these days due to social stigma that still exists in many organisations, key for others to deal with bipolar patients is just to treat them like normal people.

"Every human being has various episodes of ups and downs and we all have to adjust ourselves according to that. Bipolar patients can be more sensitive but should we then only say positive things to them? I don't think we need to go that far. Self-adjustment is important for both patients and people around them. And we must understand patients as they are. Forgive them and encourage them for treatment and adjustment," advised Dr Piyawat.

Encouragement. That's probably what Mariah Carey wants the most.

"I'm hopeful we can get to a place where the stigma is lifted from people going through anything alone," she said.