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2. General observations
2.1. Change can be rapid
For many the change from being low to being high can be rapid. In Tina's case this occurred within 24 hours and for only a few hours during that time (perhaps only 4 to 6 hours) did she recognise that something was wrong. After those few hours had passed she was convinced that she was 'well' despite being very unwell.
2.2. False beliefs are real to the person with manic depression
The delusions believed during the highs are very real to that person. "When I was saying I was Jesus, I was there, I was that person." Carers and professionals need to handle this very sensitively.
2.3. Commitment
The commitment to carrying out even quite bizarre ideas is overwhelming for the person with manic depression and cunning, persuasion, deceit, pretence and lies (often none of which are dominant in the person's usual character) are all used to achieve the goals. "Being Jesus, I must carry out my good works." Such determined commitment when most other insight has apparently been lost is difficult for others to understand.
2.4. Deception and depression
During the depressed phase, the illness will often make people try to deceive but in a different way from the deception during a high. The motivation may be for example to stay in bed longer. "Are you getting up earlier now?" "Yes, I'm managing to get up by 10.00am." This person wasn't managing to get up until 5.30pm.
2.5. Effect on relationships
The demands on a carer are high but the change when a person with manic depression goes from high to low or low to high can be the most traumatic for the carer. Stress and extreme fatigue is common amongst carers. During highs, and to a lesser extent during lows, the person with manic depression will often turn against those closest to them and the carer will often have a negligible influence on the person who is ill. The illness usually creates extreme tension within the family particularly during highs. There can be real hostility between the person with manic depression and the carer; hostility that did not exist prior to the illness striking that family.
2.6. Self management of manic depression
Self management in this context is a process of taking increasing responsibility for your own health. The indications are that people who self manage their illness have improved life-styles. The MDF publish a guide to the self management of manic depression entitled 'Inside Out' and also facilitate a pioneering and research based national self management training course. Self management is not anti-medication, though awareness of inappropriate medication is a most important issue.
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