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Bipolar disorder and other mental-health problems represent an immense "undefined burden" for families, communities, and countries.


"THERE ARE times when your heart is overflowing with love for her," says Ruby of her mother. "And there are times when you really want to kill her."

Ruby is not her real name. Her mother, now 62, was diagnosed with bipolar disorder 24 years ago. Also called manic-depressive illness, what her mother has is a long-term brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. While every person goes through normal ups and downs in his or her life, people with bipolar disorder suffer from severe symptoms that can result in damaged relationships, poor performance at work or school, and, for many, even suicide.

Ruby, however, describes the illness simply as "heartbreaking and cruel." How else could she describe it? Her mother can spiral down fast to depression and become completely non-functional, then just as quickly swing to mania to a point where she becomes a stranger even to her own daughter. Whenever that happens, says Ruby, the gentle and caring mother she loves is replaced by a woman who is selfish, crass, abusive. And Ruby finds herself thinking: "This could not be the same woman who, night after night, used to lull me to sleep with soft lullabies."

There was a time Ruby wished she could will her mother's problem away. But right now, she thinks she has come to accept that her mother is ill and will be for the rest of her life. Yet that is not the same as saying that she is used to seeing her mother become a stranger almost in a flash, because that is almost always a shock, even if it has already happened a thousand times before, and will happen a thousand more times in the future.

Ruby says she detests the illness, and too often, she finds it hard not to hate the woman it inhabits, too. When resentment sets in, she says she wants to yell to her mother: "You were supposed to take care of me, my siblings, and instead we are taking care of you! If that is not betrayal, what is?"

The World Health Organization (WHO) estimates that globally, some 27 million people are affected by bipolar disorder. According to WHO, bipolar disorder and other mental-health problems represent an immense "undefined burden" for families, communities, and countries. "Although obviously substantial," WHO says, this burden has not been measured efficiently because of the "lack of quantitative data and difficulties in measuring and evaluating." But it is a burden that weighs heaviest on immediate family members, because all the love one feels for a child, parent, or grandparent with mental illness can be so quickly replaced by hate that then gets transformed into guilt and self-loathing.

"It is the most horrible feeling, to want your mother to die," says Ruby. "I do. I want to kill her. Please just die, just die, evil person!"

Just as many cases of mental illness remain hidden and unreported, so do the anguish and pain their family go through remain unaddressed. Oftentimes, those who have the mental disorder and those who take care of them both go without the professional help that they need. In Ruby's case, her anguish is shared by her father, and her six sisters and brothers. Yet instead of diminishing the pain, sharing seems to have more magnified it.

"WE KNOW it's prevalent," Philippine General Hospital psychiatrist Norieta Calma-Balderama says of bipolar disorder in the Philippines. "We just don't know yet the exact numbers." There is an absence of comprehensive studies about bipolar disorder as well, which is not really surprising in a country where having even a hint of mental illness in the family could still hurt reputations.

Psychiatrists now know much more about bipolar disorder than they did three decades ago, when Ruby's mother first began showing signs that she was unwell. At the time, someone who showed symptoms of mental illness was dismissed as "insane" and brought to a mental institution, with almost no hope of rejoining society. Today, says Balderama, "we know that a person with bipolar disorder, if treated properly, can function normally and lead a productive life."

Tell that to Ruby, however, and she will say you don't know what you're talking about because you're not taking care of a loved one who is manic depressive. Her mother was not institutionalized. She was treated by specialists. The family formed a protective cocoon around her. But all these didn't seem to make a difference at least as far as Ruby can tell. Perhaps it was because the treatment then was simply not as effective as those available now. All Ruby knows is this: "My mother could have done so much if she were not ill. The quality of her life has diminished."

Ruby says her mother was a voracious reader. "If Mama did not read, and if she did not fill our house with books, I never would have learned to read too," she says. "I read because she reads."

Her mother accomplished a lot while she was young, says Ruby. A consistent class topnotcher, she snagged a scholarship at 16, and was sent to the States to study there for a year. "Imagine that this was the '60s and it was a very big deal," Ruby says with pride. "There was a fiesta before she left."

Ruby's mother was a popular student at the University of the Philippines, where she was a student council member. She was vivacious, Ruby says, adding, "People really expected her star to rise. I think that has been a great source of disappointment for her, being unable to do what she wanted to."

As a young bride, her mother had quit teaching to concentrate on raising a big family. But she also continued to have an interest in the arts, which Ruby's father encouraged. Yet once the bipolar disorder had her in its grip, Ruby's mother could no longer sustain anything she started. Says Ruby: "Maybe that is the curse of this illness. It becomes extremely difficult for them to live their lives to the fullest."

"She was such a gifted storyteller," she recalls wistfully. Her mother, Ruby says, did not only read stories to them, she also made her own stories, with her children as the characters. Most importantly, she encouraged her children to enjoy their young lives, welcoming them with a smile even when they came home sporting deep tans after a day spent under the sun. "A mother like mine," says Ruby, "who encouraged her children to learn and to play is certainly one who was kind."

Her mother is kind, she says, correcting herself. And laidback "Mama was never complicated." Until she began to have her "episodes," that is.

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