blog #2: how to travel light

reviewing bipolarity

Hello Reader! I hope you’ve been well since the last time I greeted you. Welcome to
my second blog. I want to start by thanking you for liking my first post. It’s what
motivated me to work on a new one.

Back In 2017, when I had graduated to reading novels and bigger

books, I bought a box of 13 novels from this exhibit. Among these books
was a blue-coloured one, that I had bought merely because the cover &
title caught my eye. I did not know what the book was about; and I had
absolutely no idea of what bipolar meant. Years went by and I had
forgotten about this book. I was now an aspiring psychologist who had
just finished her exams, and was picking up reading once again. That’s
when I picked this one, feeling both excited and curious of what world
this book would bring to me. I’m talking about How to Travel Light by
Shreevatsa Nevatia, a memoir by the journalist on his experience with
the manic-depressive phases of bipolar disorder.

What is bipolar disorder, in a gist?

In simple words, bipolar disorder is a mood disorder. The person experiences severe
mood swings from mania to depression, phases of which can last for months or
years. For some, the pattern is even predictable. Diagnosis of bipolar disorder is
categorised into bipolar I and bipolar II, the former given to people who experience
both: mania and depression while the latter given to those who only experience
hypomania (more about that in a minute) and depression. Like many other
psychological disorders, there are a multitude of factors that interact with each other
and lead to this condition. For instance, traumatic experiences (especially in one’s
childhood), genetics, changes in one’s brain chemistry, differences in brain function
(elevated or diminished activity in certain areas of the brain), stress, social &
cognitive factors (life experiences & their appraisal), sleep dysregulation, drug abuse
and so on. When in manic phases, the person experiences excessive energy in
them. They feel excited, confident and euphoric; that they can accomplish anything.
Mania even causes delusions (unshakeable false beliefs) & agitation. The person
cannot sleep. Depression on the other hand, brings with it a lack of motivation &
pleasure and an absence of any will to go on. For people with bipolar, it also brings
regret & self-hatred due to their behaviour in the manic phase. Right before mania,
the individual starts experiencing “hypomania”. The elevated mood, energy & activity
of this less-intense mania causes the individual to feel more productive than usual.
People tend to like the hypomanic experience due to its shorter duration & the
happiness & productivity it brings. But the problem is that hypomania can still evolve
into mania, which can cause problems.
Is there memory loss after an episode of mania or depression?​
Research has found a link between cognitive deficits like memory loss & problems
with attention in those with the disorder. Many even experience “brain-fog” that is
fuzzy/imprecise recollections. These could be because of rumination, delusions, lack
of blood flow and other problems in areas related to memory (e.g. hippocampus),
drug use, etc. However, this is not the case for everyone.

Are there any positives to bipolar disorder?

Research says that due to the oscillating moods & experiences of bipolar, people tend to
become more empathetic and resilient. Not just that, hypomania can bring out one’s creative
side. In an interview with the APA, Ms. Terri Cheney, a writer & mental health advocate
stated: “When I’m hypomanic, I see connections between things… It’s like the fabric of the
universe just seems to be connected and it makes sense to me…” You feel happy, energetic,
productive and creative. What is so wrong with that, you may think? But a disorder brings
with it dysfunction. Once your hypomania evolves into mania, there are delusions & possible
hallucinations that you may experience. You tend to get irritated very quickly and it does not
prove to be good for your relationships. Not to mention, the anxiety that depression is soon
to follow and the actual hitting of the depressive phase can further harm one’s well being.

Is there treatment available?

Although pharmacotherapy is prescribed, non-adherence to medications in bipolar
disorder is a huge issue on its own. A US-based study showed how half the patients
with BD became non-adherent to mood-maintaining medications within a year. One
of the reasons could be the high that mania brings or the side-effects of drugs taken.
But such behaviour increases the risk of relapse, increases expenditure on mental
health, intensifies the manic experience and risks one’s wellbeing & life. However,
another reported that nostalgia of the manic episode has caused people to retrieve
their treatment. Clinicians thus even make it a point to keep checking for compliance
to treatment. Lithium is usually used for mania, as a mood-stabiliser, however many
even resort to cannabis since they work as a ‘quick-fix’ to the high-and-low emotions
of BD. This can also cause addiction, along with other physiological symptoms.

Does psychological therapy exist for bipolar disorder?

Yes. Along with medication, people can get Cognitive-behavioural therapy (CBT),
Dialectical-behavioural Therapy (DBT), Family-focused therapy (FFT), and
Interpersonal therapy (IPT). Since people exist in a context, group-based
interventions also help greatly. Setting a fixed routine also helps regulate mood &
sleep and reduce the risk of an episode.

Can BD be cured?
More like, it can be managed. When it comes to psychological disorders, you are
going to be vulnerable to them even after treatment. But treatment will equip you with
ways to manage the symptoms and your lifestyle in such a way that your well being
is not harmed. For instance, taking time off work and stress management, healthy
communication with those around you, sleep regulation and so on.

People who experience the disorder often say that it has its own highs and lows.
They feel good, but then there are a number of risks that follow, too. Many times, due
to its cyclic nature, people can even forget their own self and think of themselves as
a product of their condition, only. Thus, it is best not to ignore counsel or other kinds
of psychological treatment and comply with it.

How do I support someone with bipolar disorder?

IBPF released an article on the same, which is linked here. Some of the points are to
give them space but reassuring them of love, not assuming that every emotion is the
start of an episode, contacting their psychologist/psychiatrist and keeping a check on
their finances and so on. ​

About How to Travel Light by Shreevatsa Nevatia

When I learned about Bipolar disorder as part of my curriculum, it was from the
perspective of a student/clinician. We looked at it just as a disorder that had a
checklist of symptoms, a list of causes and treatments. Moreover, the description of
mania was allotted a much smaller section. I think, although not always accurate,
people know alot about depression and what it entails, but we can’t say the same
about mania. Reading this memoir gave me a very detailed view into the life of a
person who is living with the condition. Although confusing at times, the writer
explores multiple themes in his life with every chapter. For example, his feelings and
experiences during institutionalisation, the people he met there and their life-stories,
the feelings of greatness and enlightenment (and believing that he is Kalki or Shiva)
that came with mania, how his work and relationships fared when he met an
episode, and such. He expresses this need to entertain an audience with his
‘performances’ every time he experiences mania, by being funny or strong or
righteous and even discusses childhood histories that might have led to his present.
The writer talks of how he makes sense of his symptoms & experiences with the help
of the world of fiction: by comparing relationships to movies, and himself to its
protagonists. His experiences with stigma, and with the different practitioners he
encounters are described in detail. Some instances, in the chapters about his
encounters with the Indian mental health sector, are even disturbing for me at times.
But then, how supported and loved he is by those around him warm my heart. He
expresses both gratitude for this social & financial support he has received from his
loved ones, and the regret that he experiences when he hurts them during the highs.

He also shares about his addiction and the after-effects of lithium and cannabis. Although
extremely personalised, the memoir helped me understand the inner-world of someone like
him. I feel like the book was a boon to both: people who want to be understood, and those
who want to understand. I am very grateful for (and also, in awe of) the honesty and
vulnerability that was shown in the book, because it’s not easy at all to showcase something
so personal for the world to read. But I still wish there were more memoirs and personal
accounts of such conditions (by Indians especially), so that people could make sense of their
own experiences and empathise with those of others as well.

That’s all I have to say for now. I hope that the book interests you as well, and that you pick it
up sometime to read it; I would love to hear your opinions and takes on it. If there are any
book recommendations or topics that you’d like to suggest, then do reply/comment here.
Once again, this is my first go at writing blogs and if there are any tips or suggestions that
you’d like to make, I’ll appreciate those, too. Thank you for your time. I hope this post helped
you know a little more about this lesser-known condition.

Take Care, Until Next Time. :)

References:

American Psychological Association. (2023, January). How to live with bipolar

disorder, with David Miklowitz, PhD, and Terri Cheney (episode 224).

[Link]

Bulteau, S., Grall-Bronnec, M., Bars, P. H., Laforgue, E., Etcheverrigaray, F., Loirat,

J. B., Victorri-Vigneau, C., Vanelle, J., & Sauvaget, A. (2018). Bipolar disorder

and adherence: implications of manic subjective experience on treatment

disruption. Patient Preference and Adherence.

[Link]

Jawad, I., Watson, S., Haddad, P. M., Talbot, P. C., & McAllister-Williams, R. (2018).

Medication nonadherence in bipolar disorder: a narrative review. Therapeutic

Advances in Psychopharmacology.

[Link]

Sagar, K. A., Dahlgren, M. K., Racine, M. T., Dreman, M. W., Olson, D. L., & Gruber,

S. A. (2016). Joint Effects: A Pilot Investigation of the Impact of Bipolar

Disorder and Marijuana Use on Cognitive Function and Mood. PLOS ONE.

[Link]