Is the label worse than the illness?

Is the label worse than the illness? Just the diagnosis of manic depression can be a shattering event, one sufferer tells his story.

Over Christmas 1998, a change came over 44-year-old Dr Allan Levi, a high-flying heart disease researcher. For the previous few months, he had been depressed and lethargic, sitting on the sofa, staring into space.
Roy Lichtenstein’s Crying Girl
‘If employers know, they can make allowances; if they don’t know, they can sack you’

But when he returned to work at Bristol University Medical School in the new year, he was frighteningly energetic: bubbling with ideas, firing off memos non-stop, and, without consulting his colleagues, inviting all and sundry to the opening of a new laboratory for his cardiovascular research. Before long, relationships were so bad that Allan had to leave.

Meanwhile at home, his wife, Jackie, a GP, was finding him difficult. “He scarcely slept and would do strange things like try to take the children out late at night. When I objected, he could be quite unpleasant. The children started calling him ‘mad dad’.”

Allan had suffered from depression several times before, but never from this manically elevated mood. His psychiatrist diagnosed manic depression – also known as bipolar disorder – because of the extremes displayed. At the time, he didn’t quibble: indeed, he joined the Manic Depression Fellowship, a charity for those affected, which afflicts one person in 100 – some 600,000 people in Britain – at some point.

Allan was at home, trying to come to terms with the end of his hopes of a professorship, when – through the MDF – he was approached by Jonathan Goodman Levitt, a young American director and research psychologist, who had come to Britain on a scholarship. Levitt wanted to make a film about living with the disorder, and Allan, with his medical background, sounded ideal. He was also happy to take part: “I thought it would be exciting.”

The result is Sunny Intervals and Showers, which has been screened at film festivals around the world and has provoked prolonged debate about the diagnosis of manic depression. The intimate documentary, to be broadcast on BBC Four tonight, starts by showing an engaging, high-spirited man and his loyal wife struggling with his suddenly jobless state and diagnosis.

Without giving away too much, the film illustrates how fragile even the most apparently sturdy relationships can be when someone is diagnosed with a mental illness. With the rate of diagnosis increasing, this raises important issues.

“Nobody really questions whether diagnosis is a good thing,” says Levitt. “Often the consequences of labelling are more damaging than the mental illness itself, because there is such a stigma attached to it.”

Certainly, Allan found his diagnosis changed his life in ways he hadn’t anticipated. “You begin to look at yourself closely,” he says. “You wonder if what you regarded as normal reactions – telling a joke or playing around with word associations – are part of the illness.

“My wife also began to look at me in a different way – as someone with a potentially serious disorder that could affect those around me, especially our children. She works in clinical medicine, where there is a view that people with bipolar disorder are seriously ill.”

Six years on, he wonders whether he should have been given that diagnosis. “I have met people who had it far more severely; they had delusions and hallucinations.

“But I don’t think I was ever truly manic depressive. I had hypomania – mild mania. I was more active than I should have been, I was working at great speed, but I did not lose contact with reality – and, since 1999, I haven’t had further episodes. I believe the hypomania was brought on by the anti-depressants. Certain drugs elevate your mood to a normal level, but if you continue taking them, they can elevate it higher still.”

Professor Chris Thompson, healthcare director of the Priory Group, which provides mental health services, says: “There is a debate about whether anti-depressants can bring on mania in the two thirds of cases where depression precedes it. But it appears that just as many switched to mania before they were prescribed anti-depressants. A third of sufferers do only have one manic episode – that doesn’t mean they don’t have manic depression.”

Jackie also challenges Allan’s perspective, believing her husband was much more ill than he admits. “He wouldn’t go in to hospital, which would have given everyone a breather, because he was not able to appreciate the effect of his behaviour on others,” she says. “He didn’t want others controlling him. But if you shove these things under the carpet, you create more problems.”

She believes diagnosis is important. “If employers know, they can make allowances – sufferers are covered by the Disability Discrimination Act; if they don’t know, they can sack you. It also makes it easier for carers to know how to give support.”

Brenda Fontain, administrator of the MDF, is also familiar with sufferers who deny their diagnosis: “Because there is so much stigma attached to mental health, some members who are still coming to terms with it find it easiest to say they never had it. But diagnosis is good.”

Yannis Malliaris, a psychologist working on bipolar disorder at the Institute of Psychiatry in London, says: “There can be a delay in the diagnosis of bipolar disorder because early episodes are often not recognised. Diagnosis can create problems, but for many people it puts their life back in line because they get specialist help.”

Allan has received help and now works as a doctor in occupational health. However, such is the stigma that he hasn’t told his employers. “Anyone like a solicitor or an accountant who is given such a diagnosis would not wish to reveal it. I know a successful architect for whom it caused big problems, because he was thought incapable of acting responsibly. I imagine my employers would be concerned if they knew.”

Because of the film, Allan’s secret will soon be out, so he has reason to wish that he had never let Levitt’s cameras into his life. “Six years later,” he says, “I would probably have made a different decision.”

All he can do is point to his current stable mental state. Should he ever again show worrying signs, he will know to seek help before it escalates. In the meantime, he avoids over-working and lack of sleep, which would put him at risk. “As a research scientist, I was under huge pressure to obtain funding and write papers – I was working all hours. It would be unwise to work that hard again.”

On that, he and Jackie agree. She emphasises to patients the importance of a balanced and healthy life: “The factors that affect physical health also affect mental health.” And, while being diagnosed with a mental illness can have life-wrecking consequences, prevention has none.
Source:- Cassandra Jardine (c) Telegraph Group Limited

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