Most people look back on adolescence as the most carefree period in their lives, but Kreangkraimas Photjanasuntorn didn't enjoy his teenage years at all. A hypersensitive type, he remembers always being stressed about his academic performance or getting worked up about whether he was popular in class and said that this anxiety eventually drove him to hide himself away in his bedroom and cease interacting with the world outside.
"I would worry about not being able to finish my homework on time or about whether I annoying schoolfriends of mine. I was afraid of being disliked," recalled Kreangkraimas, who is also known as DJ Kendo.
Not long before his 30th birthday, he was diagnosed as suffering from anxiety disorder and depression. Then he started tracking his emotions and realised he had moderately extended stretches when he was in a good mood, more or less, during which periods he noticed he was unusually creative in his thinking but also had a tendency to be overconfident and to lose his temper in an explosive manner.
"Several ideas would pop into my head at the same time. My colleagues said I would talk a lot and speak very rapidly while I was doing a presentation on some project idea I'd had. I would scream at anyone who dared criticise my work and get into a real fury if anyone argued with me," he said.
Kreangkraimas would have periods of euphoria, followed by emotional troughs when he would feel sad and depressed. These alternating cycles of high and low moods continued for years until finally, six months ago, he was diagnosed by a psychiatrist as suffering from bipolar syndrome, a disorder formerly known as manic depression.
"A patient may have had an anxiety disorder prior to being diagnosed as bipolar," said Dr Apisamai Srirangsan, director of the Bangkok Mental Health Rehabilitation and Recovery Centre.
Apart from extreme mood changes, this mental illness is also marked by shifts in energy, thoughts and behaviour. During a manic episode, Dr Apisamai explained, sufferers may experience increased physical activity and a flood of thoughts. Some bipolar patients can exhibit aggressive and other risky behaviour during these periods and their judgement may also be impaired.
During a depressive phase, bipolar sufferers may be totally incapable of enjoying any activity in which they are engaged since they are overcome by an overpowering sense of gloom and hopelessness. Many of them experience a change in their eating patterns and have difficulty sleeping. Some develop extreme feelings of worthlessness and suicide attempts are not uncommon. Patients with severe cases may experience psychosis, losing contact with reality and starting to believe in things that are not real. This may be accompanied by hallucinations or delusions.
"The symptoms can vary greatly from person to person," Dr Apisamai noted.
In Kreangkraimas' case, the major concern was avoiding the devastating emotional lows to which he is particularly prone.
"The depressions are very painful for me to experience and also for members of my family to witness. I feel very down and often have a fleeting desire to kill myself," he said, showing scars on on his left arm which, he said, were the result of an abortive suicide attempt.
"The euphoric part can be so amazing. I am full of beans and feel on top of the world!
"I feel embarrassed now when I think of how offensive I might have been towards other people at certain times," added Kreangkraimas, who is now 33 and receiving ongoing treatment for his condition. His sister also suffers from bipolar syndrome, he said, but seem better able to manage her condition and has only had to be admitted to hospital once in the past 10 years or so.
Bipolar syndrome can be caused by genetic factors, Dr Apisamai affirmed, noting that anyone with lineal relatives who suffer from this disorder are at a higher risk of developing it themselves. Bipolar sufferers have an imbalance of chemicals in their brain, she said, explaining that the chemicals in question are neurotransmitters whose function is to carry information from the brain to other parts of the body.
Fortunately, however, bipolar syndrome is treatable and improvements can be noticed in the patient within three to four months of commencing treatment. Medication is generally used to help balance out the brain chemicals. Active participation in some sort of psycho-social rehabilitation programme is also an important part of any treatment plan.
"Patients who make a full recovery are able to enjoy a productive life. Their abilities and potentials will also be restored," the psychiatrist said.
"But recovery from bipolar syndrome does not happen overnight. Many patients are not able to stick to the treatment plan so their condition does not get treated effectively."
If left untreated, bipolar syndrome may cause several other problems. Patients with judgement impairment may make unwise financial decisions that can lead to loss and legal issues. Extreme mood shifts and the resulting bizarre behaviour may cause irreparable damage to the relationships the person has with friends and colleagues. Patients having depressive episodes may become aloof and frequently absent themselves from work. Those in a manic (high) phase may go on spending or gambling sprees, get involved in drugs or exhibit other risky behaviour.
Dr Apisamai pointed out that the social stigma associated with having a mental disorders often makes bipolar sufferers less willing to seek help when they most need it and this can worsen the overall situation.
"Many sufferers are reluctant to see a psychiatrist for fear of being labelled 'crazy'," she said, going on to note that of the estimated 3 million Thai people with bipolar syndrome, only about 20% are currently receiving any treatment.
"It's not easy to accept that we are unwell," reasoned Kreangkraimas, who seems to be making a good recovery at the moment. "And when we go public and talk about this openly, we have no control over how people will react. By definition, I am mentally ill. While living with manic depression can be both a blessing and a curse, the episodes brought on by this condition just cannot be ignored."
A problem shared
A peer support group called Bipolar Friend Club, set up by the Thai Family Link Association, has proved a helpful option for some bipolar sufferers.
Operating out of Srithanya Hospital in Nonthaburi province, the club has signed up 365 people since its inception in 2007. Its mission is to offer support and encouragement to members who may need suggestions on appropriate types and dosages of medication, advice on handling manic or depressive episodes, information on self-help techniques, the recovery process and the ways in which caregivers can help a patient. Another objective of the club is to promote understanding and raise public awareness of this condition.
In addition to discussion groups, members are also encouraged to take part in recreational activities in order to strengthen their social skills.
"We discuss how certain drugs can bring the chemicals [in the brain] back into balance. Many patients do not fully understand the role of medication in treatment. Some of our members say they are mentally ill, but wonder why they need to take medicine," said the club's leader, Peanchanan Leeudomwong.
Apart from bipolar sufferers, the club's activities are also open to caregivers, people with family members or friends who are bipolar and people who suspect they might have this condition.
"When bipolar disorder strikes, it not only affects the patient but also family members and friends. Patients need support when they are dealing with these high and low moods. And knowing people with a similar condition makes you feel you are not alone. That's why we're here _ to support one another," Peanchanan said.
At club meetings, she went on, members take turns sharing their experiences while the other participants show a willingness to listen and understand. Everybody is treated with respect and strict confidentiality is observed.
Meetings are usually held on the fourth Saturday of each month.
"All members are encouraged to speak their minds. But what we discuss should never leave the room.
"We believe in educating ourselves. Experiences shared can be helpful for everyone," explained Peanchanan.
People who volunteer to help out at the club have first to undergo a training programme provided by the Thai Family Link Association. Doctors, psychiatrists and other experts are invited to lecture the club' members from time to time.
"A peer group like this can also be very beneficial for people like myself," said Sununtee Amornpitpratya, 54, who looks after a family member who suffers from bipolar syndrome. "I've learned several coping skills. Now I feel I'm able to better help a relative of mine who gets what we call 'whim-wham' episodes. And the most important part is that I've learned how to take care of myself, which is essential for anyone who takes care of people with bipolar."
