Being bipolar in Pakistan has not been easy, especially when people call you “pagal”

Published: July 3, 2018
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These highs of bipolar are fun when they start of but this hyper and happy state usually ends in tremendous chaos. PHOTO: SHUTTERSTOCK

The squeaky voice of a trolley passing by woke me up. I was on a hospital bed. I slowly tried to get up while still trying to remember what brought me here. I was alone in the room, and the bed next to mine was neatly made up, with fruits and snacks lined up on the edge of the wall.

‘I had to be somewhere really important’ was all that I could remember. But where exactly?

Nowhere! It was all just an illusion, a very dangerous one.

I later learned that I have been diagnosed with bipolar disorder (or maybe it was schizoaffective disorder – they never found out for sure) which causes serious shifts in mood, energy, thinking and behaviour – from the highs of mania on one extreme, to the lows of depression on the other.

When people ask me what it actually feels like to have bipolar disorder, I usually pass the question. Bipolar disorder is quite serious and very often a misunderstood mental illness. Basically, this disorder creates chemical imbalances in the brain. This causes the dramatic shifts in mood, energy and activity levels which you can do nothing about.

Hallucinations, grandiosity and delusions are common in bipolar along with some other indescribable experiences. The most recent episode made me believe that Karachi was under attack and I was being summoned by an intelligence agency to help out against the threats. I was being communicated with through some sort of telekinetic communication (yeah, the Professor X sort). It sounds a little silly and erratic right now, but it all seemed very real at the time. Even though I was in a manic state (the highs of bipolar), no one could really help me tell the difference between reality and everything that was happening.

I was certain I was being followed by some group of unknown people, my phone was tapped, and everything I was doing or thinking was being noted by someone. The whole world was giving me signs and it was all extremely exhausting. During one of my episodes, I thought I could talk to souls because I would hear voices of people in front of me, subconsciously in my mind. The voices were a terrible symptom; you couldn’t make them stop. They would tell you to do things, they would laugh at you, make you worry about things you weren’t worried about – they were a nuisance.

Religiosity was another big problem, especially in a place like Pakistan. I was adamant someone had done some sort of black magic on me. I was suspicious of people, even my relatives and closest friends. I had started to assume that I was a special being who could talk to souls, see into the future, and talk to God. I started praying a lot, even my family was concerned about what had gotten into me, but at the time I was a special being and I didn’t care about anyone or anything else.

These highs of bipolar are fun when they start but this hyper and happy state usually ends in tremendous chaos. There is a sweet spot that you hit before everything goes out of your control. When it starts, you are extra productive, extremely chatty, immensely creative, and you feel great about yourself more than you have ever felt before. But it is not like that all the time and the fun doesn’t last for long. It all spirals out of control pretty quickly.

All these highs bring irritability, anger and paranoia along with them. You start spending too much money, put yourself into compromising situations, you act out sexually, and you just cannot stop talking. The people around you are either surprised, confused or stunned. You sleep too much, or don’t sleep at all. You become obsessive and start seeing things others cannot. The hallucinations are the scary part and that’s when you realise something is terribly wrong.

These are the highs of bipolar and then there are the dreadful lows. The extreme depression where you feel like a vegetable, locked up in your room, sleeping the days off. You don’t feel like talking to anyone, you don’t feel like doing anything, you are basically just a body that’s breathing and can’t do anything more than that. The lows of bipolar are miserable to say the least. You experience severe symptoms of depression which can be extremely debilitating. These symptoms include but are not limited to feelings of sadness or anxiety, low self-esteem, extreme fatigue and tiredness, feelings of guilt and hopelessness, thoughts of death and suicide, and basically every terrible feeling you can think of.

I have never really talked openly about my mental health, maybe because I am too embarrassed by it or too embarrassed about what people will think of me. Things often become awkward and some people have even chosen to stop talking to me altogether. That’s because many of them just don’t get it. That’s okay. There are a lot of illnesses I do not understand either. Many people even get annoyed and often say,

“How can you be sad, what do you have to be sad about, you have a great life?”

If you have a bipolar friend or know someone who is suffering from a mental illness, there are some things you should be aware of. It is not okay to tease someone about their mental illness. Hopefully, most people know that being unpleasant to someone about their mental illness is inappropriate and ignorant – but to be honest, it’s plain cruel.

Time To Change, a mental health campaign in England, carried out some research, speaking to more than 7,000 people with mental health problems, and discovered that nearly two thirds had been left feeling isolated (64%), worthless (61%) and ashamed (60%) because of the discrimination they have previously faced.

Don’t generalise your bipolar friends’ problems. Everyone experiences a range of emotions. But everyone does not have a condition that has changed some chemicals in your brain, making you feel in a particular way, which you can do nothing about. All mental illnesses are not the same. If you really care about someone, do some research in order to get a better idea of what they are going through.

Also avoid telling your bipolar friend to “just pray about it”. Don’t get me wrong. Prayer can be extremely powerful for some people and it is very important in our society. But when you have a headache, you take a Panadol to get better and not “just pray about it”. If you have some helpful advice or a treatment strategy, it would be a much better input.

Having a mental disorder in Pakistan is not something you’d see people talk about very often; it is considered abnormal. While having a mental illness itself is abnormal, it does not make the person suffering from it the same. Mental health disorders in this country are taboos that lead to discrimination. A good example is the new nickname of “pagal” (crazy) I have earned from my group of close friends.

According to recent statistics, as many as 51 million people worldwide suffer from bipolar disorder. Out of the 80 million Pakistanis suffering from mental illness, a number of people in Pakistan suffer from these conditions under hiding. Why? Because people in our society are extremely judgmental! If someone finds out a girl has a mental illness, they immediately question who would marry her? And if someone finds out you have a shrink, they might call you a mental case. In these circumstances, who would want to talk about their illness?

Being bipolar in Pakistan has not been easy for me, especially because no one really knows what the disease is. You can’t talk to anyone about it and even your closest friends don’t really understand what’s wrong with you. Actually, no one can!

Going through this journey was a life-changing experience for me. More importantly, it was an eye opener in terms of the fact that there are so many stigmas and taboos in Pakistan which other parts of the world have completely grown out of. Please take special care of people with special needs – they deserve it, they need it!

Habib Sajid

Habib Sajid

The author is a Content Marketer, travel enthusiast, Liverpool fanatic and tabdeeli advocate. He tweets as @habibsajidmir (twitter.com/habibsajidmir)

The views expressed by the writer and the reader comments do not necessarily reflect the views and policies of The Express Tribune.

  • Very brave of the author to speak so openly, clearly, and helpfully about mental illness from his own experience. This article is an opportunity for readers to pause and think about the stigma mental illness often carries and lack of adequate treatment which often accompanies it. Such thinking can lead to greater empathy and helpful action.Recommend

  • Eddie

    Thank you so much. I badly needed to read this. My brother is suffering from bipolor disorder too. Apart from other symptomsyou mentioned, he loses weight quite drastically too when he quits his medicine. Love you bro from all my heart, you have no idea you have helped me, i have read alot about it but not from the POV of patient himself. May Allah help you achieve all what you want.Recommend

  • Saladin1Chamchawala

    Very courageous of you to share your personal story.
    It is very difficult to deal with this illness anywhere but Pakistan is likely the most difficult place to deal with it.

    Depressive phase is very painful and high risk period in terms of suicide risk but highs (manic episodes) are very disruptive and patient is at risk for causing severe damage to himself or herself because of spending money, damaging relationship and affecting employment.

    Key is to educate immediate family.
    An American voluntary organization called NAMI (National Alliance on Mental Illness) has lot of resources in terms of family education and support.

    Just a word of caution; post mania phase can feel like a depressive episode and there is impulse on part of psychiatrist and patient to start anti depressants.
    I believe that approach is misguided and puts patient at high risk of relapse into mania or a Mixed Episode (practically mania.)
    I strongly recommend to my patients (I am a board certified psychiatrist) to avoid any anti depressant medication in Bipolar depression and would recommend mood stabilizers (Lithium and Valproate) with neuroleptics (or anti psychotics) when patient is experiencing psychotic symptoms.

    Unfortunately there is no cure and best hope is to manage the illness by decreasing the frequency and severity of episodes.
    Diagnostic label is not important; key is to control symptoms and manage the symptoms.

    You are not my patient but from your organized, coherent thought process; it appears that you are in full remission, which points to classic Bipolar disorder with psychotic features during acute relapses rather than schizo-affective or any other psychotic disorder.

    Thanks for sharing your story and best wishes.Recommend

  • Syed

    It’s not easy everywhere. Unfortunate.Recommend

  • ZauFishan Qureshi

    Stay strong, Pal. Incredibly insightful of you.Recommend

  • AJ

    Thank you for writing on such an inportant issue and sharing your experience. Quite recently I came to know about my friend being a bipolar. Your blog will help me to understand her situation and be more suppotive.Recommend

  • Habib Sajid

    Thank you for your kind words. I hope the best for your brother.Recommend

  • Habib Sajid

    Thank you for your informative input.
    I’m in good hands as far as medications are concerned. But you are right about everything you mentioned.Recommend

  • Habib Sajid

    Glad I could helpRecommend