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DR MAX PEMBERTON: Kanye West’s crisis and the toll of bipolar on loved ones 

Rapper Kanye West has long had a reputation for attention-seeking and so, when he announced on July 4 that he was going to stand for the presidency, it was hard to know whether he was being serious or just seeking publicity.

But as his behaviour become increasingly erratic, it began to look as if West, who was diagnosed with bipolar disorder in 2016, was in the throes of a manic episode.

Once known as manic depression, sufferers experience extreme mood swings, with periods of depression — during which they feel extremely low and lethargic — punctuated by manic episodes, when they feel very high and are overactive.

Unlike the mood swings that we are all subject to at one time or another, each extreme episode of bipolar disorder can last for several weeks (or even longer).

And given West’s status as one of the biggest celebrities on the planet, if he has a mental meltdown, it is on display for all to see.

The first signs that all was not well came when he gave a rambling, four-hour interview to the business magazine Forbes but it was when he addressed a campaign rally last weekend sporting a bulletproof vest and with the year ‘2020’ shaved into his hair that his conduct gave major cause for alarm.

His behaviour has attracted as much mockery as concern yet to me this all suggests someone who is in the throes of something very serious. 

It deserves our compassion and understanding, regardless of how rich or famous he is.

Of course, there’s no way of knowing precisely what’s going on in his mind and it would be wrong to speculate.

However, his wife — the reality show star Kim Kardashian — publicly addressed the issue on Instagram, describing him as ‘brilliant but complicated’.

On his bipolar condition, she said: ‘Anyone who has this or has a loved one in their life who does, knows how incredibly complicated and painful it is to understand.’ 

She said the family were ‘powerless’ and added that ‘people who are unaware or far removed from this experience can be judgmental and not understand that the individual themselves have to engage in the process of getting help no matter how hard family and friends try’.

For me this really summed up the awful impact bipolar can have, not just on the individual but also on those around them.

I know the toll it can take as, sadly, I have both friends and family members who have this illness and it really can be exhausting trying to care for someone when they are in the midst of a manic episode.

It is only afterwards that they come to realise the outlandish way they behaved and are overwhelmed with embarrassment. What can follow is a crash into crippling depression.

The pressure this cycle places on those close to the person can be so great I’ve known it to tear families apart.

Bipolar is the fourth most common mental health problem in the UK after depression, anxiety and schizophrenia, with an estimated 3 million sufferers.

Younger people are more likely to have it than older ones, with 3.4 per cent of 16 to 24 year olds screened positive compared with only 0.4 per cent of 65 to 74 year olds.

Bipolar disorder can be treated with a variety of talking therapies and drugs known as ‘mood stabilisers’, such as lithium, and anti-psychotic medicines.

Sufferers are also advised to take regular exercise, eat a balanced diet and ensure they get a good night’s sleep.

I wince whenever I hear people talk flippantly about ‘being a bit bipolar’ when they describe behaviour that is erratic or temperamental, for, in reality, it is a hugely disabling condition.

While doctors and campaigners have spent years encouraging people to be open about their struggles with mental health, the downside has been that many celebrities have opened up about their battle with bipolar and, as a result, it has come to be viewed as a ‘glamorous’ condition.

Indeed, I’ve had many patients come to me with regular mood swings who have been quite disappointed when I tell them they don’t have it.

Of course, as with many conditions, some have more serious symptoms than others. I know doctors, lawyers, and teachers with the condition who hold down jobs and maintain relationships.

But it is a condition that requires careful monitoring and, for many, serious psychiatric medication — sometimes for life. It’s certainly nothing to joke about. 

It’s the standard form of greeting in many Western countries but the days of the handshake could be well and truly over.

Baron Piot, a Belgian professor and microbiologist from the London School of Hygiene and Tropical Medicine, told the Science and Technology Committee this week that the UK should adopt a Japanese-style of greeting to prevent further outbreaks of Covid-19.

I’m quite a fan of the deferential, stately bow — much better than the jocular elbow bump that we briefly flirted with before lockdown.

And am I the only one who’s also a little relieved that the pandemic means we can’t hurry back to hugging people as a form of greeting?

We’ve known for some time that professional footballers are at increased risk of neurodegenerative disorders such as dementia. 

However, a Glasgow University study called Football’s Influence On Lifelong Health And Dementia (FIELD) this week found that former footballers are at a considerably lower risk of being hospitalised with depression than the general population.

This would suggest that being a footballer somehow protects against mental illness but I would counter that what it demonstrates is the ‘healthy worker’ effect — the stresses and strains of entering such a competitive area favours those who are less predisposed to developing mental health problems in the first place.

So it’s not that football protects from mental illness, more that those with mental health problems are less likely to make it in professional football.

I’ll admit it: since lockdown, my diet hasn’t always been great, lacking fibre in particular. In fact, most of us need to eat more fibre — it leads to a lower risk of heart disease, strokes, Type 2 diabetes and bowel cancer.

We are increasingly appreciating the vital role that our ‘microbiome’ (the types of bacteria we have in our guts) has, not only in our physical health but also our mental health, with bad bacteria being linked to stress, anxiety and depression. 

So I’ve been taking Bimuno, which contains a type of fibre that helps nurture the good bacteria in your gut. It comes in small sachets of tasteless powder, which you can sprinkle over food or mix into drinks that you take daily. And it aims to work within a week.

This week, the journal Ethical Human Psychology and Psychiatry published a study of ECT, the controversial electric shock therapy used to treat severe depression, that claimed it causes side-effects, such as memory problems, and should therefore be banned.

A group of 40 clinicians, researchers and patients then sent a letter condemning the practice to Health Secretary Matt Hancock.

For many years, I also had concerns about the practice. When I was a junior doctor I was so unsure about the ethics of the procedure that I risked being formally disciplined, when I refused to utilise it until I had investigated it further.

I think ECT has had a bad press because of the way it was used years ago.

Certainly, the image I had was of a screaming patient, tied to a bed in a grotty back room of a 1950s asylum, being given electric shocks until they were gibbering wrecks.

What I found, however, was a treatment that gave hope when all hope was lost. ECT takes place in an operating theatre, where the patient is anaesthetised and given a muscle relaxant to stop them jerking during the seizure.

It also has far fewer side-effects than many of the anti-depressants I happily prescribe. The truth is that depression kills and ECT can be a lifesaver.

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