The National Mental Health Survey of 2016 found that close to 14% of India’s population required active mental health interventions / Illustration from Freepik
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Coming Out as Bipolar: Why a Correct Diagnosis is so Crucial
Despite large strides in de-stigmatising mental illness in India, securing a correct diagnosis can be a traumatising, painful journey: a personal account.
Ashwita P.
I turned 29 this year. The last of my twenties. I have not finished the one book that I picked up last year. I also have not fully learned to play the ukulele I bought on a whim the year before that. My ‘artisanal soap making’ small business and a 'personal clothing line’ are the failed undertakings of my late 20s.
I also tinkered with watercolour painting, cat grooming, hair colouring, and making wine and fusion dishes. At 25, following a lengthy period of job hopping and soul searching, I found my calling in research and development work.
Three years later, I decided to quit my independence and comfortable job to pursue a career in communication and media. I also travelled a lot; a good part of it involved running away from things.
Presumably, my 20s were quite indistinguishable from those of my peers. It was a standard affair of fears, failures and fool-hardiness in equal measure, but for one common and recurrent thread- an undiagnosed mental illness.
The time period before my bipolar diagnosis in 2019 was a blur, most of which is now only vaguely perceivable. The afternoon I received my diagnosis, though, is a memory that stands out.
I can recall, with exactness, the sound of the doctor’s pen scratching into her pad and the slightly irksome thump of her fist on the table to get my attention when she finished. My fingers and toes curled in tension to control the restless trembling of my hands and legs. I was hyperaware, and every misplaced sound, gesture, and movement made me more enraged and anxious.
There I was, unaware of my predicament, smack-bang in the middle of a manic episode.
The world average age of early onset for bipolar disorder or BD is 22.5, so you see, at 25, I was right on time.
BD is a mood disorder- a patient will intermittently experience extreme and, in some cases, debilitating mood swings. In mental illness lingo, these patterned experiences of euphoric highs are called mania and intense lows of depression are called mood episodes.
Based on the duration and intensity of the episodes, the illness is classified as Bipolar Type I, Bipolar Type II, Rapid Cycling Bipolar, and Unspecified Bipolar. BD is a lifelong illness.
For two years before my BD diagnosis, I had been treated for unipolar depression with an arbitrary cocktail of anti-depressants, anxiety and sleep medications. I say arbitrary for a good reason; my psychiatrist adjusted, mixed and matched drugs on the slightest mention of mood changes. There would be no explanations.
On the best days, I felt little more than a scientific experiment. On the worst, certain drug combinations would botch my nervous system response, making me fall out of bed at night, unable to move my limbs, terrified and alone in the dark.
They also made me drowsy and forgetful. If I cared enough to mention being abnormally heightened, energetic and experiencing racing thoughts and speech, the doctor would excitably put them down to the medication working.
'Sleep Monsters'
Sketch by Ashwita P.
“Are you upset that you are feeling well? You should be happy,” he would admonish when the episodes eventually ended with a depressive crash. I would leave most appointments feeling guilty and ashamed about my fixations and anxieties.
By fortunate chance, I moved to a different city for my job and changed doctors. The new city and a slightly sympathetic psychiatrist made life bearable briefly, making me truly convinced that I was now fully treated.
I made the crucial mistake of voluntarily stopping my medication a month before I experienced a very personal loss.
My mania, or manic episode that would warrant my psychiatric detention and the subsequent bipolar diagnosis was triggered.
Dr Vivek U, a consulting psychiatrist at a private hospital in Kochi, explains the trigger, "BD is commonly misdiagnosed as unipolar depression. The usual treatment is anti-depressants, which is dangerous for a person with BD- it has been found to trigger mania and long-lasting rapid-cycling BD.”
In the 8-10 days that followed, I dropped around 13 kgs- from constantly exercising. I stripped myself to the bare minimum, giving away expensive and sentimental belongings to friends and strangers online. I barely ate, rested, or slept- I was constantly paranoid and jumpy. One particular evening, out for a run, I experienced dissociative amnesia, losing hours and coming back to friends worried about my disappearance.
I felt at the top of the world, and I was terrified.
In hindsight, the petrifying chaos could be described quite aptly in the words of Edgar Allan Poe:
“Sleep, those little slices of death- how I loathe them!”
One night, this break-neck mixed episode culminated in a psychotic break- involving auditory hallucinations, paranoid spiral, self-harm and substance abuse. That night, trembling with shock and locked in a room, held down by nurses and feeling myself slowly slip into a dark dream, I fervently hoped not to come back.
'The Afternoon of my Diagnosis'
Sketch by Ashwita P.
I was under observation for a day; the next day, in May 2019, my psychiatrist diagnosed the case as early onset Bipolar Type I with Generalised Anxiety Disorder after my first “documented” manic episode.
She only mumbled the diagnosis while hurriedly scribbling some notes in my medical file, almost as if telling me a shameful secret. My head exploded with questions, but I left the hospital with only a brand-new prescription and some generic advice to sleep and eat better.
Over the past years, I have realised that a correct diagnosis is only a battle half-won.
Vijay Nallawala, the founder of 'Bipolar India' (a Telegram app-based peer support group), explains, ”BD is largely misunderstood. In all our peer-support therapy sessions, we have people with BD, their caregivers and friends share very personal and painful experiences. My hope is that with every conversation, we can shed a little shame, guilt and stigma that is associated with the illness.”
Since my diagnosis, I have tried to write and talk more about my condition. Healing is hardly linear, but I will never go back to not knowing what ailed me. And that, to me, is a little victory.
This article was published on 26 April, 2023.
Ashwita P. is an architect-journalist, who is trying to negotiate between the here, there and everywhere of life through her stories and drawings. She is not opposed to human contact, so reach out! @ashwita_panicker
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