Deciphering Manic Depressive Disorder

In a recent response to me, one of my Indian friends (a senior bureaucrat) said "we both had a brush with abnormal psychology in 1980s as we had opted for psychology as one of the two optionals for Indian Civil Services Examination. On going through your case I tried to think of the possible reasons and implications but soon decided to accept the authors view".

Another friend wrote to me about his close relative, a senior executve of a large multinational who committed suicide due to his bipolar illness and but for the grit of his wife who single handedly brought up children after taking up teaching job his family would have been destroyed. A third friend wrote about his own brush with being detected with bipolar disorder in mid 1990s. Most damning was receiving the news of sad state of affairs of a close friend (and a senior Indian bureaucrat) who is not able to come out of the illness and he could not get the type of support with his marriage breaking down...... such are the traumas of this just one illness and there are many compounding and comorbid mental disorders which often come in bundles

It forces me say a few words of my own and some borrowed from one of the most trusted scientists in the field. Let us accept prima facie that doctors and researchers are still trying to figure out what exactly causes Manic Depressive Disorder and that in some way explains why there is no certain cure of the disorder ( but patients can be well managed) more than 110 years after Krapelin labelled it as Manic Depressive Insaniy by separating it from what he called other form of insanity- dementia paracox (since designated Schizoprhenia by Bleurer).

Manic Depressive Disorder itself in 1980s (DSM III onwards) was given a more exotic covering of Bipolar Disorder though the change of nomenclature has no way impacted on the lethal and pernicious nature of the disease where in the case of untreated cases, 15-20% of the sufferers complete suicide and at least double of that make one or more attempt to make suicide. In India among those who donot die due to self inflicted unjury a large majority remain incarerated in asylums, jails, homes or streets. Most go untreated and in case ofthose who manage to reach vanishing tribe of psychiatrists (last count 3000 left in India for 1.2 billion population)nearly three fourth are misdiagnosed either as cases of clinical depression or schizoprenia.

Sadly, in India those who fail in their suicide attempt have to face the ignominy of harrasement at the hands of state (instead of rehabilitation and help)- the country has a glorious tradition of having Assisted Suicide Clinics in the name of religion (like Mukti Dhams in Kashi and Swargashrams in Rishikesh) but mental health sucide cases instead of being regarded as serious public health problem are treated as right cases of harrassement by state in the garb of 19th century Criminal Procedure Code for managing 21st Century

India- which makes suicide punishable by imprisionment.

It would be instructive to note that in a country like India, those who suffer from mental illnesses (and one out four Indians will suffer at least once in their life time), have no where to go and are not supposed to have a even decent lunatic life even in an asylum or a jail. Street is more often the natural abode.

Sorry for digression.. but what else can I write about a country which till very recently was governed by Indian Lunacy Act, 1912 and what ever statute changes have happened recenly they still are some where rooted in the basic premise of the old Lunacy Act. Sadly the subject continues to be dehumanised as the Indian Constitution itself is yet to come out of the mould of Constituent Assembly Debate of 1948 and the phrase which desribe mentally ill in the constitution even today is "mentally unsound", a remnant of old latin phrase meaning insanity.

While causes and consequences of Manic Depressive Disorder will be dealt with, I am tempted to quote two paragraphs from hundred of thousand pages read by me on the subject. They are extracted from " Prologue" of "An Unquiet Mind: A memoir of moods and madness" by Kay Redfield Jamison, an eminent authority on the subject, a professor at John Hopkins School of Medicine and a sufferer of the Bipolar Disorder herself:

".....Manic-depression disorts mood and thoughts, incites dreadful behaviours, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet the one feels psychological in its experience of it an illness that is unique in conferring advanage and pleasure and yet one that brings in its wake almos unendurable sufferings, and not infrequently, suicide.

.....The major problem in treating manic-depressive illness is not that there are not effective medications-there are-but the patients so foten refuse to take them. Worse yet,because of lack of informaion, poor medical advice, stigma or fear of personal and professional reprisals they do not seek treatment at all"


Dr. Jamison wrote he above in her autobiography in 1995 and the same was written in the American context. Think and mull over how bad the case in India is amidst familial, societal and governmental apathy, rather antipathy towards the mentally ill.