Nov 18

Bipolar Disorder: Caught between depression and excitement

John always felt that his wife was ‘changeful’ – but it took both of them years to find out that she was in fact suffering from so-called ‘bipolar disorder’. People with what was formerly called ‘manic depressive disorder’ cycle between unusually intense emotional states that occur in distinct periods: ‘manic episodes’ are defined by overly joyful or overexcited states, and ‘depressive episodes’ by extremely sad or hopeless feelings. However, sometimes symptoms of one state may also occur during the other, depending on the variation of the disorder which has been estimated to afflict about one of every 45 adults, independent of sex, culture or ethnic group.

One of the most common problems of persons dealing with this disorder is that they have serious difficulty set ting and achieving goals and maintaining stable relationships in their lives. During their manic episodes, they often experience an increase in energy, set themselves highly ambitious goals and might break up their relationships with people they consider as inferior or slowing them down. They tend to self-medicate, often through substance abuse (particularly stimulants or depressants, alcohol, cocaine or sleeping pills). Some of them tend to gambling, others might become aggressive or violent or experience a break with reality. As soon as the depressive episode kicks in, almost nothing of that remains: now, feelings of sadness, anxiety and guilt are dominating, and the person might feel isolated and hopeless. The formerly high sexual drive now almost disappears, fatigue, apathy or even suicidal thoughts may occur: The rate of bipolar patients committing suicide at certain points in their lives is very high.

Today, we still know little about the causes for bipolar disorders, but studies have indicated a substantial genetic contribution, as well as environmental influence (like an unstable or traumatic childhood). It is also likely that certain triggers are required to cause an outbreak of the disorder in some people, particularly relationship issues, cultural or job-related stress or physical illness. The basis of treatment usually consists of medication (which especially for this kind of disorder should really only be prescribed by a psychiatrist!) and complimentary psychotherapy to work on environmental triggers and efficiently learn to deal with the symptoms. The prognosis for most individuals with bipolar disorder is a good one – provided that they were diagnosed accurately and received the correct treatment.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2010)

Sep 14

Many people enjoy gambling, whether betting on a horse or playing poker on their computer. Most of these people don’t have a problem, but some lose control over their gambling. They bet high amounts of money on card games, in casinos or playing slot machines. Today, people don’t even have to leave their homes to satisfy their drive to gamble anymore: the Internet allows one to spend unlimited hours playing games or placing bets without anyone interfering by asking uncomfortable questions – actually, many of the respective companies behind such websites try to keep people gambling as long and for as much money as possible. But once used to the rituals involved in a game, it is very hard for most to resist the urge of doing it again – if ‘only one more time’ in order to reverse their losses…

Typical signs of a serious gambling problem include:

  • Always thinking about gambling
  • Lying about gambling
  • Gambling during work
  • Spending family time gambling
  • Feeling bad after you gamble – but still not quitting
  • Gambling with money needed for other things – asking friends or family members for money or even breaking the law in order to obtain gambling money or recover gambling losses

The difference between a casual gambler and a compulsive gambler is that the latter one feels restless or irritated when they can’t gamble. They need the kick of betting money and will use gambling to relieve tension. While they may have tried to reduce gambling, they were not successful in the end. Effectively, they are losing not only money, but also valuable time from their lives, which are affected not only by the addiction itself but also by the long-term damage it causes them. An Australian study recently showed that 17% of suicidal people were problem gamblers.

Effective treatments for problem gambling involve a combination of counseling, step-based programs, self-help and peer-support. Sometimes medication is prescribed as well, however, only using one of these treatments alone is not considered to be sufficiently efficacious and no medications have been approved for the treatment of pathological gambling by the US Food and Drug Administration (FDA).

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2010)

06.01.16