Monday 24 September, 2018

The many moods, swings and challenges of bipolar disorder

Haile Clacken

Haile Clacken

With the unfortunate death of 36-year-old former teacher, Haile Clacken, who suffered from bipolar disorder, in St Elizabeth on Friday evening, much public spotlight has since been directed at the mental disorder itself, which noticeably affects high academic achievers.

Clacken reportedly climbed on top of a Guardsman Armoured truck which was on rounds in the parish, and was later shot dead by one of the guards on the unit under circumstances which his family is contending amounted to an execution, based on his obvious mental state.

A police investigation is under way into the incident, which also involved an almost three-hour standoff between residents of Cheapside district and the security team, during which the guards had to take refuge in the armoured truck.

Interestingly, Clacken has been described by his former colleagues as a brilliant teacher with a phenomenal appetite for knowledge.

And only two weeks before he was shot dead, his contemplative mind led him to post on Facebook that, "to kill a human should be a matter of absolute necessity (last resort)".

In reflecting on his own life on Facebook, Clacken wrote: “My life is at a crossroads at 36... I have challenges in mental health, I’m in financial debt, 191 pounds, I'm unemployed, I'm separated from my wife and jumping on and off the … as I try to experience love...

“But I still think this life is a winnable fight... I may have gotten a lot on my plate as problems all at once, but it is also a test of my character and strength.”

In another Facebook post, he wrote:

“I go through this mid-life crisis. I reflect on my successes as a student, and my impact as a teacher... It gives me the confidence to make it through this test, as I dedicate my life to formulating a THC chewing gum to help with defects of the mind.

“The rise up of my life will be a story worth inspiring Ben (his son)... How I conquered depression and bipolarity, how I influenced the marijuana redemption campaign, how I got my body back to fighting fitness, how I wrote to inspire millions in the African tradition and, finally, the epic love story of restoring a broken marriage after nearly a decade (of) separation…

“My life is a human revolution. It is a story of a man who kept faith during unparalleled doubt, who kept optimism when the skies were gloomy, and who restored the breach of the fellowship of humanity in morality."

So what exactly were the personal challenges presented by the medical disorder with which the once obviously gifted educator was afflicted?

Bipolar disorder, which reportedly afflicts between one and two per cent of the world's population, is characterised by a persistently elated or euphoric mental state, with other characteristic features such as irritability, grandiosity, an inflated sense of self-esteem, and easy distractibility, which result in significant social and occupational dysfunction to the patient.

There is also increased goal-directed activity, decreased need for sleep, and increased risk-taking behaviour, such as unprotected sexual promiscuity or endangering self or others by activities such as repeatedly driving fast without a seat belt.

Medical outline has the disorder subdivided into two categories: bipolar I and bipolar II.

The disorder is noted to typically begin in early adolescence or early adulthood, although it is being increasingly recognised in children. People may inherit a tendency to develop the illness, which can then be triggered by environmental factors, such as distressing life events.

Brain development, structure and imbalance of chemicals in the brain are also believed to be influential to the development of bipolar disorder.

The manic episodes that are associated with the disorder usually cause significant impairment in functioning of the individual, and may result in periods of hospitalisation.

Patients with the disorder also present in periods of depression, symptoms and signs of a major depressive episode, which may include sad mood, loss of interest in pleasure from daily activities, easy fatigability, loss of appetite and weight loss.

The disorder is characterised by periods of hypomania, which is a form of sub-threshold mania and has many of the same symptoms as a manic episode, but without loss of daily functioning or the need for hospitalisation.

The priority in treating patients with bipolar disorder is addressing any suicidal or homicidal tendencies the patient may be harbouring, and in-patient hospitalisation as needed, to prevent self-harm.

Hospitalisation may be necessary to conduct proper evaluations and rule out any organic causes of the symptoms which may mimic bipolar disorder, and also to initiate an effective treatment plan.

Mood stabilisers are the mainstay of therapy, and include anticonvulsant agents, atypical antipsychotics and lithium carbonate, and have been relatively effective in managing the symptoms of the disorder.

Commenting on the implications of bipolar disorder in a media interview, consultant psychiatrist, Professor Wendel Abel, said it appears that many Jamaicans suffer from the illness, but mostly in its mildest form.

He said those who tend to have the disorder are mostly high achievers, which is reflected among the movers and shakers of the world.

In noting that persons afflicted by the disorder tend to be upbeat and excited most of the time, Professor Abel said they tend towards risky behaviour like doing drugs, engaging in sexual promiscuity, driving cars fast, gambling a lot, and spending money excessively.

He also cited the factor of such persons being able to go without much sleep, and gradually losing inhibitions, and thus sometimes displaying inappropriate behaviour like making inappropriate sexual comments or passes at people.

He said with the disorder speeding up the brain, the medical treatment for it is geared at slowing down the brain.

He said while the high phase of the disorder will produce intense excitement, the low phase, which involves the slowing down of the brain and a feeling of depression, is of critical importance, as suicidal tendencies sometimes emerge during that period.

Professor Abel also pointed to a report from the Independent Commission of Investigations (INDECOM) in 2013, in relation to the calendar year 2012, which, among other things, cited a 75 per cent fatality rate and 25 per cent injury rate otherwise, in confrontations between members of the security forces (primarily the police) and mentally-ill persons.

While Clacken’s death did not involve public security personnel, Professor Abel said it reflected similar inadequacies in training on how to handle challenges involving such persons.

The INDECOM report noted that the Jamaica Constabulary Force’s (JCF) Training Manual offered guidance regarding the treatment of the mentally ill, including that they should be treated in an unhurried, calm, non-authoritative manner, and that officers should have ‘adequate assistance’, meaning at least five other colleagues nearby.

The INDECOM report noted that despite these guidelines, the police continued to display a lack of patience when dealing with the mentally ill, despite indications that in most cases, the mentally-ill persons were known by the police before the confrontations.

Family members of Clacken have charged that the security officer who shot him on Friday displayed an intemperate disposition towards Clacken because of his mental state, and the fact that he had intruded on their normal work routine.