They live (or lived) with a severe mental illness which most of us have heard of yet is still largely misunderstood, and often goes undiagnosed – bipolar disorder.
Dispelling the ignorance and some of the misconceptions around the condition is the purpose of World Bipolar Day, held on 30 March every year.
The date was chosen because it was the birthday of painter Vincent van Gogh, who was diagnosed with the illness after his death.
Liz Kendrick-Lodge, co-executive director of the charity Focus on Mental Illness, said: ‘It’s about raising awareness, removing the stigma, and helping people accept that it exists.’
Bipolar disorder used to be called manic depression, and sometimes still is. But those affected by it prefer the more self-explanatory name.
Unlike other forms of depression, people with the condition suffer sharp mood swings from one extreme to the other.
It is not just a question of having up and down days. There are periods of chronic depression, which can last for weeks or longer. There may then be a more stable period, followed by a phase of euphoria – described as mania or in its slightly less extreme form as hypomania.
So those with it will endure all the feelings of worthlessness and despondency that come with being depressed, and later go through periods of great self-confidence, a loss of inhibitions, often the spending of money they don’t have, and sometimes a burst of energy and creativity.
One patient says of the high phase: ‘I felt like I could do anything. I kept starting businesses, though they never went anywhere.’
The ‘cycling times’ – the lengths of the phases and of the gap between them – will vary from person to person. And Mrs Kendrick-Lodge points out that this makes it difficult to diagnose. When there is a long gap between the phases, it is not always clear that a patient has anything other than normal depression.
‘It can take up to six years to receive the correct diagnosis,’ she said. ‘This is because a person needs to have episodes of both depression and mania.
‘Many people are unrecognised or misdiagnosed, so don’t receive the right treatment or any treatment.’
And yet bipolar disorder is one of the most common long-term conditions. Around one in 50 people are living with it, making it more than twice as common as dementia, epilepsy and autism – each of which affect around 0.8% of the population.
It affects equal numbers of men and women, and Mrs Kendrick-Lodge added: ‘It doesn’t discriminate between races or social classes. The rich and famous get it.’
It does, however, discriminate between ages.
‘Adolescence is the most common time of any mental illness being detected.
‘With bipolar disorder it’s usually between 15 and 30. It rarely starts after 50 – although people can be diagnosed after 50,’ said Mrs Kendrick-Lodge.
There are thought to be different causes of the disorder, which Mrs Kendrick-Lodge summarises as biological, psychological and social.
So the genes, the chemistry of the brain, an especially stressful or traumatic experience or an individual’s upbringing could all trigger it.
Treatments range from medicines such as mood stabilisers to psychiatric therapies.
She added: ‘Family relationships can break down because of family illness. People with bipolar disorder who are in close contact with their families can receive family therapy. That’s something we provide as a charity.
‘If the individual receives the right treatment and has good family support, there’s a reduction in relapse rates.’
She adds: ‘There’s an assumption that people with serious mental-health problems can’t be good parents, but there are people with bipolar disorder who are really good parents.
‘There are services in Jersey which support parents and they need to have an understanding of mental illness.’
Is that understanding of mental illness growing? The whole topic has been receiving more attention over recent years and in the past 12 months it has become clear that the pandemic has taken a psychological toll as well as physical one.
There may still be some who are dismissive of the emphasis on mental health, and advise those with problems to ‘get a grip’ or ‘pull yourself together’.
But Mrs Kendrick-Lodge replies: ‘That is a lack of awareness. You wouldn’t say to someone who has just had a breast cancer diagnosis “pull yourself together,” or “maybe you should eat a few more greens”.’
And the treatments for bipolar disorder often show their success.
She stresses: ‘It’s not absolutely written in stone that people with bipolar disorder are going to have a poor quality of life. Recovery is possible.
‘It doesn’t necessarily mean being symptom-free. But people with bipolar disorder can still have good mental health.
‘That needs to be at the heart of the message.’