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3. The hidden highs
3.1. Denial of the illness
A common feature is denial of the illness particularly when high. It appears to us that this type of denial is a feature of the illness itself, and not just an unwillingness by the person to accept the illness although superficially this theory would appear plausible. "When high I feel incredibly well." These denials will usually be very persuasive and appear quite logical. Even when the person is quite deluded and has lost insight in other respects, this denial and apparent quasi-appropriate behaviour can last for perhaps up to an hour when being assessed by a mental health professional.
3.2. The denial of the illness is convincing
To believe, for example, that you alone must save the world whilst hiding this from those who might try to stop you doing it and 'going through the motions of what a well person would do' is a difficult concept, but we think an important one of which to be aware. Through our local and national contacts with many people with manic depression who are now fully recovered, we believe that professionals have often been convinced by the person with manic depression that they are not as ill as they really are. "I didn't tell Dr X that I am Jesus."
3.3. Masking the highs
Once MD is diagnosed we feel that many MDF members would say that during a 15 minute meeting with a mental health professional
THE LOWS are usually difficult to hide
THE HIGHS are often easy to hide.
We believe it is more common than not for a person to mask the illness in front of a mental health professional, particularly during a high.
3.4. Revealing the highs
The unmasking of the illness by a mental health professional can create an uncomfortable, even hostile relationship between himself/herself and the person with MD. We suspect that in order to retain a friendly relationship, diligent attempts to reveal a high are not always made by mental health care workers, and important opportunities for appropriate and effective help can therefore be missed at these times.
3.5. The implications of not revealing the highs
If the illness is entering a severe phase and the person is developing a worsening high which is not swiftly revealed, the resultant lack of intervention can cause significant harm in the longer term as the worse an illness is allowed to become, the longer recovery seems to take.
A common misconception is that people have to be a danger to themselves or others before they can receive hospital help. The Mental Health Act (in England and Wales) enables people to be admitted to hospital solely in the interests of their own health "...in the interests of his own health or safety or with a view to the protection of other persons." Note that the wording specifically uses "…ors…" and not "…ands…" for the three criteria. [Section 2-(2)(b) and Section 3-(2)(c) Mental Health Act 1983].
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