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Bipolar Disorder in the Hellenic Community

For this story, I break journalistic rules. I do not have to interview an outside source.  I can speak as one.

My father was described by everyone in the family as “nevrikos.”  He was aggressive and easily angered. Little things would bother him like the sound of plastic bags churning in the back seat while he was driving.  He would pick fights with random people; for example, the person who made the mistake of asking him for the time got the third degree “Why are you asking me for the time? You can’t find a watch yourself. What do you want from me?”  He even beat up a middle school teaser in my class just because he touched my hair.   When my mother would place the glass of water or the salt bottle a little too far from his grasp, he would shout insults and epithets that involved the persons of the Holy Trinity and the Theotokos in a rude life function.  There would be periods when he had so much energy, he would work a 12 hour shift, come home demolish old bathrooms, and reconstruct floors from scratch.  When he talked you thought he was screaming and he’d punch his hands on the table to emphasize his points so much so that the entire kitchen trembled.  And yet, there were other times he would sleep for long periods at a time, mostly on the weekends.  We thought it was because he was making up for so many hours of working long shifts.

As a child, I knew there was something wrong with him.  The case was made clear one afternoon in the summer.  Baba would always take us to play at the local park with other Greek families while he would take part in a game of soccer with other soccer loving cultures.  On one occassion, one of the fathers of the boys saw him coming across the field having finished a game early and immediately warned the others, “Hey look ‘o trellos’ is coming. Let’s go.”  And before I could realize, three couples and their children had vanished in the time it took my father to walk from the soccer field to the playground where we were playing.  Later on waiting in the car to go home,  a 10-year-old me deliberated with myself, “Should I tell Baba what they had said about him or not?” Would my telling him insult him or did he have a right to know what others thought of him?  “Baba, I said timidly, “Yanna’s father called you crazy.”  To my chagrin, he looked at his hands on the steering wheel and confessed, “I know, child, I know.”

Years later in AP Psychology class in high school, I read a description in the “Abnormal Psychology” chapter of the textbook that word for word captured my father in a nutshell.  “Manic depression,” it read, “is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out daily tasks.”  It was like someone who had never seen my father could describe his behavior to exactness, “people with manic depression may be explosive and irritable during a mood episode . . . extreme changes in energy, activity, sleep and behavior go along with these changes in mood” “damaged relationships, poor job or school performance . . . some people are rapid changers cycling through two or more mood episodes in a day” “the disorder often appears in the late teens or early adult years” (www.nimh.nih.gov).  I remember my giagia in hushed tones speaking about the time when they had to put my father away in an asylum just before he was released from the army at around 22.  His case fit the diagnosis perfectly.

Although it did not make the pain of growing up with a mentally ill father easier, the ability to diagnose the behavior gave me some sort of relief.  Now I could understand that those nights he woke us up at 2 am, lined us up single file against his bedroom wall and lectured us about “the important things in life”: how it is important to do the dishes and pick up your underwear, how you have to listen to your father, the conspiracy theories about how people were plotting to overtake the government, how he was being stalked at work, his nonsense made sense.  It was part of the disease.  My father was crazy but his craziness had a particular name and ran a particular course.  He was what’s known as a “rapid changer.” His moods would swing from gentle reassurance to aggressive, in-your-face rage.  He’d alternate between periods of energetic creation and crash times when he would sleep for the majority of the day. However, even though everyone knew there was something wrong with him, no one could do anything about it.  He spent his entire life unmedicated and untreated, without ever receiving a concrete diagnosis, without ever taking a single medication or pill—ever.  He suffered and so did everyone around him.  It made our lives a living hell.

It turned out my father was not the only one in the family to develop symptoms of mental illness.  My first cousin was diagnosed with schizophrenia at 26; lucky for him and his family, he was diagnosed with cancer of the liver a bit later and died quickly thereafter.  He was spared the agony of living with this.  My other cousin, however, suffered.  A well-to-do young banker with an advanced degree from the London School of Economics, he started to exhibit erratic mood swings accompanied by anti-social behavior.  He smashed all the computers in his bank office. He’d lie asleep for hours, withdrawn and morose.  He eventually committed suicide in a gruesome form–he hung himself from the limb of the tree in his parents’ back yard.

I have often panicked in front of the mirror.  What if I too carried the curse?  I have felt for many years that our family was some multi-generational trilogy in Greek tragedy that was doomed to repeat horror in each successive generation. I have days when I whirl about in a fury of thoughts and projects begun and begun again but never finished and I wonder if I too have the curse.  I look at my eldest daughter—hyper-emotional, bringing disorder in her wake, extremely moody and do my cross, “Oh God, please, not her too.  Let it just be teenage angst and the ping pongs of adolescence.”   What is the link then between our people and this disorder?  I have tried to explore this issue in this article, but this is just the tip of the iceberg.

Ancient References: Cyclamidia and “Inspirations”

aretreausAs with many other famous firsts in medical diagnosis, bipolar disorder was first documented in ancient Greece and was termed “cyclamidia” referring to the cycles of elated and deflated mood in its victims.   As stated in a Psychology Today article, “The idea of a relationship between melancholy and mania can be traced back to the Ancient Greeks, and particularly to Aretaeus of Cappadocia, who was a physician and philosopher in the time of Nero or Vespasian (first century AD). Aretaeus described a group of patients that who ‘laugh, play, dance night and day, and sometimes go openly to the market crowned, as if victors in some contest of skill’ only to be ‘torpid, dull, and sorrowful’ at other times. Although he suggested that both patterns of behavior resulted from one and the same disorder, this idea did not gain currency until the modern era.”

Aretaeus seemed to see that there was a connection between the two states and not that they were two separate illnesses as revealed in the following excerpt comes from his book ‘On the Aetiology and Symptomatology of Chronic Diseases’:

‘‘ . . . I think that melancholia is the beginning and a part of mania . . . The development of a mania is really a worsening of the disease (melan-cholia) rather than a change into another disease. . . In most of them (melancholics) the sadness became better after various lengths of time and changed into happiness; the patients then developed a mania’’. Aretaeus of Cappadocia (150 AD)

Plato too analyzed the different types of bi-polar illness in his book Phaedrus.  He said there were two types of mania—one that originated from a bodily cause and the other from a divine cause.  Apollo, he claimed, inspired several types of mania in his subjects which he termed “euphoric mania.”  Plato also mentions psychogenic manias which he called “inspirations”—an erotic inspiration sent down by Eros, another sent by the Muses, and a third “prophetic inspiration” by Apollo.  The ancients were keen to make the connection between bipolar disorder and creativity, as proven in the long list of famous artists, poets, and other creative types who had the disease throughout the centuries.

The Case of Ellen Frudakis: From Patient to Reformer

Ellen Frudakis, herself a sufferer of the disease, became a powerful spokesperson for bipolar disorder in young adults who went on to found Impact Young Adults, a not-for-profit that works to create social events and decrease the stigma in young adults with the disorder.

Ellen Frudakis, herself a sufferer of the disease, became a powerful spokesperson for bipolar disorder in young adults who went on to found Impact Young Adults, a not-for-profit that works to create social events and decrease the stigma in young adults with the disorder.

Ellen Frudakis had just turned 20  when she started developing symptoms of the disorder.  In an interview she gave for the newsletter of the hospital where she was diagnosed and admitted for treatment, she stated, “I had done well in school growing up, and always believed I would be successful at whatever I did. So, I was devastated when I was diagnosed. I assumed that having a mental illness meant that I’d only be able to hold down a part-time job, at best. I had misconceptions that mentally ill people were scary, isolated, dangerous — and never young. I felt it just wasn’t cool to have a mental illness, especially as a young adult!”

Frudakis turned her illness into fuel for her mission—to change the stigma of mental illness in young adults.  After receiving a Masters in Non-Profit Management from the University of San Diego, Frudakis cofounded the nonprofit organization Impact Young Adults (IYA), with the mission “to enrich the lives of young adults with mental illness with experiences of acceptance, personal growth and accomplishment.” The group hosts weekly social and community events, including hikes, picnics and talent shows, where members, ages 18 to 35, and their friends and family can build relationships and have fun.  The group recently celebrated over a decade of service to young adults with a record of more than 500 get-togethers and community events..  Frudakis initially had been reluctant to come out with her diagnosis and had spent much time huddled in secrecy.

Ellen Frudakis, with another member of Impact Young Adults, at one of the 500+ social events organized by the group to allow young adults to network and socialize.

Ellen Frudakis, with another member of Impact Young Adults, at one of the 500+ social events organized by the group to allow young adults to network and socialize.

“But I really needed to be able to connect with other people like myself, to remind me that I was bigger and more than the diagnosis,” Frudakis recalled. Her involvement in the organization she has founded has given her the courage to become a vocal spokesperson for the disorder and champion of young people with mental illness.  She was eventually invited to become one of the executive board  members of the International Bipolar Foundation.

 

International Bipolar Foundation

Located in San Diego, California, the IBF seeks to educate the wider world in the disorder, fund research for ongoing understanding and treatment of the disease, as well as serve as a clearinghouse for information about the illness as it is manifests in a country by country approach.  From the feel of its website, it feels also as if it is also an advocacy for the illness and those affected by it, in allegiance with disability as identity movement.

bipolar-symptoms-300x200

Bipolar disorder is characterized by fluctuating periods of high energy, euphoria, sleeplessness alternating with periods of depressed mood, low energy, and even overinflated pride and grandiosity.

“Culture plays a huge role in how the illness manifests and how it is viewed,” Ashley Jacobs, a spokesperson for the Institute, asserts.  Jacobs points out that the difficulty in having bipolar disorder to the fact that it manifests so diversely in different people.  There is not just one classification of “bipolar disorder” but actually three: Bipolar 1, bipolar 2 and the mixed type.  It would be more accurate to classify symptoms along a spectrum of intensity much like autism.

Some of the Institute’s research on bipolar disorder in Greece does shed some light on the current situation.  A report published in early 2005 cited Greece as having some of the lowest rates in mental illness in all of Europe.  According to Eurobarometer, 5% of the population report to have or have had chronic anxiety or depression, and 5% say that are undergoing medical treatment for this reason. These figures are far below of the EU average. Children´s Mental Health: Greece is one of the countries with lowest bullying (13 year olds) with 15% girls- 32% boys reporting bullying others and 23% girls- 28% boys being bullied at least once in the previous couple of months (HBSC statistics).

But that is not the case any longer.  Ten years later, a study published just last month in BMJ Open cited  “A month-by-month analysis of the suicides revealed that the passage of Greece’s unpopular austerity measures were associated with “a significant, abrupt and sustained increase” in suicides — an increase much higher than that associated with the start of the recession itself.

After the global economic recession began, in October 2008, the suicide rate among men in Greece rose 13 percent, the equivalent of an extra 3.2 suicides a month, the study found. Immediately after the austerity measures were instigated in June 2011, however, the rate jumped another 18.5 percent, or 5.2 additional suicides per month — among men and women  — and stayed that way for the rest of the year and throughout 2012.

In fact, the month with the most number of suicides during was June 2012, with 64. (The months with the least number were February 1983 and November 1999, each with 14.)

The study also identified a short-lived 30-percent rise in suicides (9.8 deaths a month) that began in April 2012, after a 77-year-old retired pharmacist killed himself outside the parliament building in Athens, saying he would rather die than suffer the humiliation of “scrounging for food from the rubbish.” That tragic and much-publicized event may have encouraged copycat suicides, the researchers, a team of Greek and Greek American psychologists headquartered in the University of Pennsylvania, suggest.(http://bmjopen.bmj.com/content/5/1/e005619)

Although no concrete data for bipolar disorder in the general Greek population exists, the general trend in depression rates has been exacerbated.

A GREEK PHENOMENON: THE CASE OF NATASSA VASILAKI, BIPOLAR VICTIM AND CHAMPION

Natassa Valikaki is both a bearer and an advocate of the illness.  She experienced her first depressive-manic episode while studying as a foreign student for an intensive summer program.  The stress of the program, combined with pulling too many all-nighters and taking too many stimulants, induced her first psychotic episode at the age of 25.  This trigger event then cycled into full-blown bipolar disorder that she has been dealing with until now into her 40s.

“The Greek temperament predisposes you to bipolar disorder,” she claims. Greeks do not like to experience life in the happy medium which registers as tedium but instead relish their extremes of life—the agony and ecstasy of experience. Therefore, they are prone to inducing bipolar states on themselves, she explains.

Valikakis also points out that because of the loss of the larger extended family in urban Greek society, the nuclear family has microscoped its attention on children resulting in more of  “anchopaidia, a term she uses to describe the overprotective, highly sensitive breed of children that are fostered.  The family environment created for these children, whether via nurture or nature,is a factor that predisposes them to bipolar psychopathology, Vasilaki explains.

Valikaki runs a support group for sufferers and families of the disorder in Greece as well as acting as an advocate for alternative therapies for it (more info at alternativebipolar.gr). She has made her illness the cause celebre of her existence.   After a lifetime of having to deal with the molecular damage brought on by the pharmaceutical remedies, she advocates for a holistic approach to the disease. “My big dream is to bring ortho-molecular psychiatry into the mainstream,” she states, “Conventional medicine focuses on the symptoms without looking at the root causes.  This is a bad approach.”

Nevertheless, she acknowledges that the stigma of the disease has yet to go away in Greek culture.  The general population has very little connection to mental illness and she finds that those who do attend talks and conventions about the illness are those with direct experience of the illness, in other words the saved in the choir.  Those who most need to know about the illness who bear the greatest stigma are the ones least connected to it.   The only long-term solution for eradicating the stigma on the mentally ill, she posits, involves a direct mainstreaming of those with disability into society.  “The mentally ill cannot  fitozoon, she advocates,” because then  they are then seen as parasites on society.  They should be but that they should be made to feel exactly like normal people and become active members, marrying and working like everyone else.”

EDO:The Hellenic Bipolar Organization

Hellenic Bipolar Foundation

Dr Yianni Malliari, founder of EDO, Hellenic Bipolar Organization, an agency for support, advocacy, research, and education in Greece.

Another bastion of support in the understanding and treatment of the disorder is EDO, or the Hellenic Bioplar Organization. The organization came into existence thanks to the efforts of Dr. Yianni Malliaris.  A PhD graduate at the Institute of Psychiatry, King’s College London in 2002, Malliaris was motivated no doubt by the fact that his father had grappled with the disorder until his death.  Dr. Malliaris runs monthly support groups from his offices in Rafina and Athens.  Malliarakis launched BiPolarLab in 2011 which is proclaimed on its site as “a pioneering private clinical practice that delivers specialist evidence-based diagnostic and treatment programmes for patients with Bipolar disorder and recurrent depression all over the world.”

Actigraph of bipolar disorder published by Dr. Yianni Malliaris

Actigraph of bipolar disorder published by Dr. Yianni Malliaris

Malliaris has recently launched e-lab, a networked approach to supporting bipolar patients.  Volunteers from all parts of the globe with an internet connection and a few hours a week can become internet chat pals with patients.  Engaging with patients breaks them out of their isolation and can provide needed clinical interactions for students of psychology.

CONCLUSION

After reviewing the evidence, there are no clear-cut facts to prove that bipolar disorder is more prevalent in the Hellenic community as it is among other ethnic groups.  However, given that Greek culture thrives at the extremes of the emotional spectrum, it makes this illness, in comparison to all the others, perhaps the one that is closest to our psyche.