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4. Recognising the illness
4.1. Previous history of the known course of the illness
The previous history of a person's illness can be a good yardstick to compare what is happening now with what is likely to happen soon. What happened on previous occasions just before a high or a low?
4.2. How did this person behave when they did not have the illness?
It is always helpful to compare the present behaviour with how the person usually behaved before they became ill. Talking with other people who know the person well is a crucial part of the process of trying to ensure a more complete understanding of what is happening now, and what is likely to happen.
41.3. Nights without sleep
Lack of sleep is a common indicator of the onset of a high. Though more active than usual, people with MD who may have missed two or three nights sleep will often appear quite rational, presentable and usually not tired. This is easily misinterpreted by observers so that they think the person is well.
4.4. Refusing to take medication
Openly or covertly stopping taking medication that has been known to help alleviate the illness for that person in the past is a common sign of relapse.
4.5. "I can see it in her eyes"
People who closely know the person with MD, and have been through previous episodes of severe illness with them, can often sense when a relapse or crisis is imminent even though they may not be able to explain fully how they know this.
4.6. Responsible assessment of current condition
Professionals may be misled by the capabilities of the person with manic depression to exhibit superficial short term appropriate behaviour whilst becoming, and being, quite deluded. We think the opinions of people who know how that person behaves when they are well are, at least, helpful, and often essential, in order to make a valid and responsible assessment.
It is not our experience that carers of those who have experienced manic depression act out of spite and want to get them 'locked away in hospital'. It is our experience, however, that carers may become extremely frustrated when their attempts to get the help for the one they love who is becoming very ill, help that has proved both necessary and beneficial in the past, are rebuffed. This rebuff may emanate from well-meaning care workers who have misinformed themselves by observing only a limited snapshot of current behaviour.
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