Professor Seggane Musisi (Consultant Psychiatrist) and Jimmy Odoki Acellam (Heartsounds Uganda Coordinator) were hosted on NTV by Josephine Karungi
JK: A very good evening and warm welcome to the programme tonight. Thank you for joining us. We are talking this evening about bipolar disorder and it’s not a condition we hear about in our day to day conversation. This may be because we do not generally pay much attention to mental and emotional health. We dismiss this situation as someone is a weak character, witchcraft or we find something to label it as. So on our show, we try to raise awareness about important issues that can easily fall off the radar in our society today.
My guest this evening, I am privileged to have a Professor and a Doctor, Musisi Ssegane who is a professor of psychiatry at Makerere University, College of Health Sciences, Mulago. He is also a consultant psychiatrist at Entebbe Lakeside Hospital at Abaita Ababiri. Thank you very much Dr Musisi for joining us on the show, it is a pleasure to have you.
Dr. Segane will be giving us a medical perspective to bipolar disorder while Jimmy Odoki will be sharing his own personal experience.
Jimmy, welcome to the show. Thank you for allowing to share your experience, I really appreciate it.
Jimmy: Thank you for having me, Josephine, it is a pleasure to be on your show.
JK: I am going to start with Dr. Ssegane to set the stage for us. Explain to us what we mean by bipolar disorder.
Prof: First of all I have to say that mental illnesses are very common. They are part of our everyday life and of very many different types and bipolar disorder is one of those. It is one of the serious mental conditions. It is really an illness of emotions. Extreme emotions. It is called bipolar; bi for two and polar for pole (like North Pole, South Pole) so it has two poles. A very elated pole. A high pole where one is excited, overactive, over-talkative, energetic, argumentative with what we call expansive feelings.
Then it may have a depressed pole. Where the emotions are very low and one is sad, unhappy, no energy, no appetite, feeling fed up and sometimes wanting to die or committing suicide. Both of these poles cycle throughout one’s life. They may last anywhere between a week, a month, a year. They may be mild or even extreme.
In extreme cases, the high pole which is called the manic pole, one may even become violent and sometimes people tie them up. The extreme of depression, on the other hand, one may become suicidal and want to kill themselves. Or just drift away from life to a point of helplessness to the point of getting bedridden especially the old people. The extremes are dangerous but also even if it is not the extreme, it interferes with your daily life and disrupts those around you hence necessitating treatment.
JK: Thank you for that elaborative explanation, so I want to bring in Jimmy now maybe just to bring it home in terms of someone who is dealing with this to share their experience. I know that many conditions like these carry stigma in society and it takes a lot of courage for someone to come out and speak openly about their experience. Jimmy, this is a service to society for those who are suffering silently. Those who have suffering loved ones but do not know what to do. I thank you for coming to the show and speaking openly about this. I met you so many times on the streets of Facebook, it is good to meet you in person finally.
Tell me about your experience, when did you first realise you had the condition?
Jimmy: Thank you. It’s been a period of time. I did not know I had bipolar. But having seen a doctor and explained to me. I realised it started when I went to do my undergraduate studies in the UK. That is when I experienced all those conditions the doctor has talked about; manic, depression and sometimes violence. At one point, I threatened violence at the university and they were not happy. I would make something small (situation) to look so big. It was a record of things. If they had known that my condition was out of bipolar disorder, probably, it would have been different. They would have known that it needed treatment and needed help because elsewhere some students with diagnosis of Bipolar disorder have been helped.
Prof: What Jimmy is trying to explain is that him as a layperson, a student at university had changes in him that he could not understand and he was reacting to them in what he felt was normal. However, it was in the extreme. In other words, you lose temper very quickly. You become argumentative unnecessarily. You become argumentative and it disrupts your normal activity. It disrupted his schooling he could not sit in class.
Now the other symptoms which go with it for example lack of sleep. Tending to want to enjoy too much, over partying, feeling that you are great and wonderful. He could have felt that maybe he was more intelligent than his professors. People feel that they have extreme powers for example they are getting special messages from God and are getting connected to angels and therefore cannot top them. These are extremes. But what I think Jimmy was insinuating there is that it disrupts your normal activity. It disrupted his schooling.
He could not sit in class. In bipolar disorder, you feel you know more. You can even feel like fighting your lecturers. Now, stress can induce a bipolar reaction/ disorder. They can trigger depression. Maybe his feelings of stress at that time were because he came from a war situation. But remember that bipolar disorder is there in peaceful times as well as bad times. It was there in ancient times as it is today. It is a very common condition occurring in about 1% of the population. Everyone in a hundred people, it is likely they have a bipolar disorder or ma have a lifetime bipolar disorder situation.
JK: I wanted to understand the relation or how dangerous it is when depression comes into the picture for someone who has bipolar.
Prof: Two kinds. One it may come as a natural cycling; from bipolar to depression. Often, one has had a manic episode, it calms down and they realise how ridiculous they were. The kind of abuses they churned out to people. The money they spent, the schooling they missed. The friendships lost. And sometimes there are things they have done that they are embarrassed of. For example. In bipolar extremes, they have a high libido and they can go out and have relationships that they may later regret. There is a tendency to regret what one have done and they become depressed.
JK: Jimmy, how do you explain to your family? I can see you are surrounded with family photos, to some who do not have that support they can end up in alcohol and drug abuse, how did you manage that?
Jimmy: my father came to university once talk to me. My parents are teachers. They are very keen on discipline and all. They thought I was misbehaving. Maybe I had become an alcoholic. They thought I had gotten into bad company. When I got expelled, I went to live with some relatives and friends far away in London but they thought that I was so undisciplined. People never welcomed me. I just decide to come back home. It was only my uncle who was doing a masters at medical school who took me to Dr Musisi that saved me. From there, he put me on treatment. I had episodes when I started seeing him but not as many as before.
There are times I can’t sleep for like three nights. Then there is a problem. Dr Musisi told me when I see such, I should know there is a problem and I have to address it. If it is depression, then waking up is a problem. Usually, I am awake by 7 but in such circumstances even by 10 am I feel so lazy to jump out of bed. Sometimes you do not have restraint over the things you say to people.
JK: Doctor, you earlier talked about the prevalence rate and I wanted to know in Uganda, have we done any studies? How many people in our population are likely to have bipolar? Do we know?
Prof: Yes we have done a lot of studies on mental illness in this country especially in the last 25 years. There are lots of publications but of course in medical journals. But we also try to reach out to have a common understanding of mental illness. The prevalence or the frequency of bipolar disorder in the population is about 1%. 1 person in every 100 has this disorder. When you look back to your class in your school days, there were always those people. In our country, maybe 450,000 people have bipolar disorder. This does not mean that they are all getting treatment. It is only a very small fraction of them getting treatment. In fact only a privileged few of them. Most go to faith healers, traditional healers and many just drift off wandering on the streets never treated and they die prematurely through suicide or accidents.
JK: In relation to that, you said many people never get treated and you said people die prematurely, what’s the worst that can happen if you do not get treatment? But before that, is one born with bipolar?
Prof: With an untreated condition, you got through a life of ups and downs. In the extreme ups, chances are that something is going to happen to you. You could be killed, have an accident. It is very important to help with bipolar disorder to get treatment. The condition they go through, they do not choose to. They get too excited. The prevalence happens to both men and women.
You may see a lot of breakdowns in the covid-19 pandemic from people who have not been affected or those who recovered from it. The stress which they go through breaks them down. This has not been documented yet, we are just recognising it as practitioners. Our minds are already on those lines.
JK: You’ve mentioned a number of causes, for some reason I am going to pick on HIV for example, how is that related?
Prof: Yes. Two ways.
1) It is a very stressful condition. It is fatal and much stigmatised.
2) As soon as one gets HIV, the virus runs to the brain and hides there. And I have seen some studies that indicate that the covid-19 virus also goes to the brain. But we have not had Coronavirus long enough to know its long term effects but we shall study it.
JK: Jimmy mentioned that bipolar condition is a lifetime condition, is there a cure or at least a way you can manage it in such a way that you can meet your day to day obligations? I see Jimmy is doing quite well for himself, what’s it like for other people?
Prof: With treatment, one does very well. And he’s doing very well. Jimmy was able to go to university to finish his Bachelor’s degree. I encouraged him to go for a master’s degree, he got it. He can now even consider doing a PhD. With treatment, there is no limit to what a bipolar patient can achieve. The success rate is very high. It is also important to follow up the treatment with psychotherapy or counselling because it deals with many issues which are regrettable. The biggest mistake a bipolar patient will ever do is to feel so well and stop treatment.
JK: When you speak about treatment, I am wondering at the cost of it. Jimmy tell us how expensive or affordable it is for anybody who needs it.
Jimmy: For medication, usually you discuss with the doctor. There are meds that are very affordable and the generic ones. For bipolar, the medicines are not uniform.
Prof: There are three kinds of drugs. When you are high, there are drugs to put you low. When you have low depression there are drugs to lift up your mood. But there is also a drug to maintain you called stabilisers. Stabilisers are the ones that are very important to take. It is very important to check your lifestyle. Avoid drugs and alcohol. The third one is the therapy, the psych therapy and talk therapy or group support therapy.
JK: Jimmy, when you had episodes, are you aware of how people are treating you?
Jimmy: People are different. Some people do not know. Some people look at what I post on Facebook and call me mad. I use social media to write about the things I may not be able to talk about with people at that moment.
JK: People are worried about everything, what can you tell people out there? PROF, do you see any increased cases? What would you advise the audience?
Prof: Stressful times bring on emotional turmoil in individuals. Like we said bipolar disorder is triggered by emotions. It can be triggered by stress. Stressful times have made people breakdown. We are not yet at the end of the road. We have to brace ourselves to have to be our best to survive. Avoid misinformation.
JK: Would I know that I have bipolar? Jimmy, how are you dealing with these times of stress?
Jimmy: Talking to friends. Send messages to people. Sometimes you let people do things at their pace. There are friends you can reach out to only at specific times. We have our group, Heartsound Uganda. It is a peer support group with doctors we can get the help.
Talking to people is helpful.
Prof: Sleep is a biological prerequisite for normal functioning. Psychologically, physically, chemically and biologically. Not getting enough sleep will cause sleep. On average it should be 8 hours of uninterrupted sleep. Online interactions that keep you awake through the night disorganise the natural rhythm. I encourage people to get adequate sleep. And do not take chemicals that disrupt sleep. Lack of sleep is a symptom of depression and anxiety.
If you feel angry, over energised and breakdowns, it is important to seek help.
JK: Thank you for the time you have shared with us.