CRC received a call from Mr. Prasanna, professor of First Grade college for women. He wanted help with the problem he was having with one of his students. Arundhati* was a pretty girl. She did not care to be fashionably dressed, and did not talk loudly or laugh like the other girls. He used to glance at her as she sat quietly in the second row of his class. He praised her talent in a few hobby classes, where she excelled.
Unfortunately she misunderstood him. She had come to believe that Prasanna loved her. One day she met him and asked him to marry her.
Prasanna was aghast. “This is not possible”, he told her.” I married recently. I do not have any of the feelings you attribute to me. It is common for adolescent girls to become infatuated like this. Give up this infatuation and focus on your studies.”
She became agitated. “You are cheating me. First you encouraged me to love you and now you are trying to wriggle out of commitment.”
She complained to the principal. “Make Prasanna teacher marry me”, she demanded. The principal tried to try to reason with her and cure her of her infatuation.
A few days later Arundhati tried to commit suicide. She was admitted to hospital. They took her to a private psychiatrist, but her delusion persisted.
Prasanna asked CRC, “She is now blaming all of us – me, her parents, and the Principal. Her mother has had to resign from her job and stay at home to care for daughter. She picks on small things, or imagines slights, and throws tantrums. In college, she attends classes like a robot. Is it possible for you to treat her illness?”
“Yes, we will try to treat her. Bring her here,” CRC replied. Arundhati was brought to NIMHANS by her parents.
“From her childhood she has been obstinate. Now she hates her parents. She expects everyone around to serve her. She considers her younger brother to be her rival. ‘You are treating him like a king and ignoring me’, she accuses us. Despite all of our attempts to convince her otherwise, she sticks to her stand. ‘You are shielding Prasanna, who cheated me. You must get him debarred from college if he does not agree to marry me.’ This is her demand every day. It is becoming impossible for her to take care of her at home”, narrated her parents with tears in their eyes.
The girl listened to all of this impassively. There was no expression on her face.
“Arundhati, what is your opinion about what your parents have said? What is the solution to your problem?”
She did not reply. Her lips were pressed tightly closed; there were tears in her eyes. She kept pulling at her handkerchief obsessively.
CRC recalled what he had been taught by Professor Shyamsundar about drawing out patients who refused to speak : “You have to keep talking to them, suggesting various possible analysis and conclusions. When an analysis strikes home, the patient will start talking freely.”
He talked to her for quarter of an hour, describing possible states of her mind, what she could be going through and encouraging her to react. Five sessions passed like this.
CRC prescribed her medication for depression. He asked her parents to take special care of her, tolerate her mood swings and tirades. “Let us wait and observe if she improves.”
After two months she showed marked improvement. She started speaking normally and her eyes came to life. She gave up her demand that Prasanna should marry her. “How is it possible for him to marry me?” she reasoned.
But the demons within her had not been quelled. After some time, CRC got a call from her father.
“Doctor, Aruna became violent recently. She attacked us by beating us. She kept throwing out costly items out of the house. She talked continuously and would get angry and aggressive. We have forcibly admitted her to Ramiah Medical College Hospital. It is difficult to keep her in general ward. It has become necessary to keep in closed ward of NIMHANS.”
CRC concluded that Arundhati was suffering from bipolar affective disorder (mania-depression). He realized that what was depression earlier had progressed to manic depression. Instead of just counseling, she needed medication to control her raging mind and calm it.
She was admitted to NIMHANS and treatment was started. She recovered and was discharged. She continued to get manic episodes once or twice a year. These were caused by her stopping medication.
“You call me mad and insult me”, she railed at her parents and doctors. “Even if I am dying, I will not come to NIMHANS”. Her parents were terrified of her during such episodes.
“Do not bring her to NIMHANS henceforth; take to a private psychiatrist or hospital,” CRC advised the parents.
After few months, Arundhati started pestering her parents. “Get me married soon or I will run away with a man”, she threatened. Her parents managed to marry her to a distant relative, giving the dowry that was demanded. They explained her illness to the husband, and asked him to ensure that she took lithium tablet daily without fail.
She seemed to settle down in her new home. But she refused to take her medication. “My parents made me mad by giving tablets, and now you are trying to do the same”. The helpless man gave up trying. After two months the mania episode recurred. She verbally abused her husband and in-laws. She packed her things and left for her parents’ house.
Her husband called up her father. “Please take care of her, and get her treated. I will pay for all the expenses. We cannot manage her in my house.”
Aruna took to visiting her husband’s office. She would abuse him in front of his colleagues. She questioned his masculinity. Unable to take the insult and harassment, the man got himself transferred to a different town. He left without revealing his whereabouts to her.
Six months later her father got a letter from her husband. “Forgive me, I cannot keep her. You please take care of her and do not send her back to me”, he pleaded.
One fine day Arundhati marched to the police. She alleged that she was being tortured and asked that her parents and in-laws be arrested at once. Police came to enquire at the house. Her father showed them her prescriptions and explained that she was suffering from frequent manic episodes. The police went away and Aruna had to return home. The parents had to face her wrath. She started breaking things in the house. They were forced to lock her in a room.
Her father called CRC. “Please bring an ambulance and admit her in NIMHANS and save us,” he pleaded.
Arundhati was admitted once again to NIMHANS. When she became better, she convinced doctors that she would take her medication regularly and got herself discharged. But the doctors and parents had little confidence in her promise. They knew that the cycle of her stopping to take medication, getting admitted and then getting discharged would continue to occur.
In a majority of Bipolar affective disorder (BPAD) cases, the person has to take medication lifelong to function normally.
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