Bipolar Testimony from Nigeria.
Name: Janice Ekwere Esq.
Location: Calabar, Cross River State, Nigeria, West Africa.
Age: 41
Diagnosis: Bipolar II affective disorder.
Career/Family: The mania aspect of bipolar disorder has given me an overwhelming confidence in my latent skills as a lawyer and life found in aspects of my career, which I could have treated with trepidation I’ve scaled through virtually effortlessly. Academia has always come easily to me. Following through on the academic progress, lecturing Law is something I’ve done in the past, legal practice has been more difficult. I find twenty years into my legal career that I don’t have enough legal published professional writing to my credit. The family relationship has also been tumultuous. I’ve had a stormy relationship over the years with my paternal family. I'm divorced with no children.
My Story
I was diagnosed bipolar in 1989 at the age of 22. I had just had a major emotional upset including a break up with my longstanding boyfriend. I was correctly diagnosed immediately in November 1989 and was treated with carbamazepine (known to me as Tegretol) and the antipsychotic haloperidol, in varying degrees of milligrams as prescribed by my psychiatrist. In retrospect now I believe I was prematurely weaned off the medication too soon, as I was facing major career/lifestyle changes, which resulted in long term depressive episodes. If I’d been properly treated with the accompanying weight gain/loss, depressive/manic episodes – I was rapid cycling and had insomnia; I would have been better able to cope with the bipolar symptoms in my life and balance my work between 1990 and 2006.
I’ve found the treatment that works best for me is a combination of talk therapy and medication as well as counselling sessions with a trained psychologist in addition.
I’ve had a lot of different psychiatrists treat me both in Calabar, Nigeria and in the USA in Atlanta, Georgia and Opelika, Alabama as well as more recently in Washington DC and New York City. I’ve found the treatment that works best for me is a combination of talk therapy and medication as well as counselling sessions with a trained psychologist in addition. Constant monitoring of the liver function tests when I was on sodium valproate (Depakote) and constantly monitoring the weight-gain/weight-loss swings. Keeping an emotional mood journal is helpful as well. Antidepressants and the range of antipsychotic drugs have had the effect of curtailing the lows of the depressive aspects of my manic depression. As I have more episodes of depression than mania and rapid cycling some balance in the see saw mood swings is brought to bear on the mood swings such that hospitalization for emotional crises is minimized and some work-life harmony is achieved in spite of the insomnia.
The mood swings are constant and the seesaw effect on me can result in irrational actions and conduct. In my life I had an overbearing, protective father who imposed a good balance of order on some of my irrational excesses. 
My father passed on in 2007 but at this time I’d met my all time favourite psychiatrist and a wonderful psychiatric nurse who had both talked to me over a period of two years and had told me how to improve my overall mood hygiene and to constantly monitor my moods with an emotional mood journal and effectively create a balanced work/life harmony for myself.
My Christian faith – Pentecostal Christian has also dynamically improved and I’ve learnt how to cope better and to synthesize my internal moods and external stimuli better. So my career track is proving more fruitful now than it has been in the past when it just seemed to stagnate without yielding fruits. I believe I’m a many splendored creation of the Lord our creator and although I’m imperfect being human I’m in the process of becoming perfect by striving to achieve my career goals and hopefully I will leave this world a better place than I found it by reason of the lives I’m able to impact upon. I’m a perfectionist by nature. Sometimes I bite off more than I can chew career wise but somehow with the creators help I’m able to complete my battles and win them, to add value to “his” creation.
My whole personality is affected by my bipolar disorder and I’m the person I am flawed yet flawless because of my bipolar disorder.
National/cultural/treatement issues when living with bipolar disorder in Nigeria.
Being academically bright and going through the Nigerian school system which is largely based on the British curriculum no room is given for emotional “issues” with life perspectives. One is expected to excel academically, finish school and get a good job and assume family financial responsibilities. Somehow my lapses with career/ work balance have not prevented me from achieving career success but I could have had a more successful career trajectory with less shoddy psychiatric treatment in Nigeria. Description of Treatments Experienced Available within Nigeria: The medication I was treated with between 1989 and 1990 namely carbamazapine and haloperidol are regarded as primitive in America. As of 1996 – 2000 I was on monthly injections of the antipsychotic flupenthixol (Depixol) 40 mgs and later Imipramine (a tricyclic antidepressant). From 2001 through 2006 my mood swings were stabilized with sodium valproate 1000mg. However the constant six monthly liver function tests for toxicity and the corresponding weight gain and dizziness were the attendant side effects. In 2007 I was successfully weaned completely off sodium valproate under a psychiatrist's supervision and put on the tricyclic antidepressant best know of as amitriptyline (called Tryptizol here) and the antipsychotic/mood stabiliser risperidone (Risperdal). These drugs work well for me, currently.
Talk therapy in addition has proved good for my “balance”. Talk therapy is not openly encouraged in the typical Nigerian family setting or in the Dr-patient relationship not the way it is encouraged in the western world. Close family structure instead substitutes for emotional support. Where this is unavailable some slippage through the safety net may occur for the bipolar disorder patient.
Generally in Nigeria public awareness to the issues of bipolar disorder is very low. To avoid being castigated as a “mental case” and a threat to society bipolar disorder issues are not openly treated or discussed under bated breath. In the 1990’s in Nigeria bipolar disorder issues gained more prominence because young people of the elite class of society who commonly came forward with bipolar issues. But of course, lower class people may be suffering in silence. There is a lot of social stigma against bipolar disorder patients in Nigeria. To avoid becoming a social outcast or treatment with derision by ones peers patients often forego treatment or like me become accustomed to shoddy mental health treatment.
It wasn’t until I met my New York City psychiatrist and an excellent psychiatric nurse in Washington DC that it became clear to me just how poorly, psychiatrically I’d been treated in Calabar, Nigeria and for almost 16 years prior to being treated well in 2006.
I rest content in the knowledge and belief that these next ten years yet to come will be my most fruitful years in our Lord’s vineyard. It is well, indeed.
Other explanations given e.g. spiritual/demonic:
My ex-husband refused to believe the cause of my illness was mental and purely medical. Since he had pride of place in supervising my treatment rather than my father at the time he was unable to exert pressure on the psychiatrists who were treating me to obtain optimal medical treatment. Rather he believed my problems to be spiritual or demonic in nature and he refused to listen to my parents who were rightly of the view that my challenges were purely medical in nature and could be overcome with a strong dose of Christianity and optimal medical psychiatric treatment as they have been now.
What I wish I’d known earlier on:
I wish I'd met my New York City Psychiatrist and Nurse Theresa Moultrie of Washington DC much earlier on like 10 to 16 years prior in my history of mental health treatment. Along with the life skills I’ve learned in the past five years between 2002 and 2007. However, having learnt these difficult lessons more recently I look forward to the fruitfulness of the next ten years between 2008 and 2018. For I rest content in the knowledge and belief that these next ten years yet to come will be my most fruitful years in our Lord’s vineyard. It is well, indeed.
