Decoding the confusion between personality and illness

Aparna Piramal Raje on the stigma associated with bipolar disorder


Joydeep Sengupta

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Published: Thu 21 Apr 2022, 9:32 PM

Aparna Piramal Raje is a thought leader on business, design, and workplaces. Her first book, Working Out of the Box: 40 stories of leading CEOs was published in September 2015. She speaks and teaches on leadership, business and design. She is the former CEO of BP Ergo, one of India’s largest modular office furniture companies. Piramal Raje holds an MBA degree from Harvard Business School and read Economics, Politics and Philosophy at Oxford University. Her second book Chemical Khichdi: How I Hacked My Mental Health will release on May 6. KT spoke with Piramal Raje during her recent trip to Dubai.

Aparna Piramal Raje
Aparna Piramal Raje

Edited excerpts of the interview:

What’s the stigma associated with bipolar disorder?

I think the biggest challenge with bipolar disorder is the same challenge with any mental health condition — the confusion between ‘personality’ and ‘illness’, leading to stigma, lack of understanding and judgment. If someone has a physical ailment such as a broken leg, they are willing to accept help from others to get around. But if they are suffering from a mental health condition such as bipolarity, they are reluctant to seek help because they feel others might be judgmental or it might be misunderstood. That is why I try and differentiate ‘personality’ and ‘illness’. The way I see it, I have a ‘normal’ personality, but I also have a mental health condition, which makes me unwell, from time to time. That illness is not ‘me’, there is much more to me than my condition, just like the broken leg is only a part of me, for example. This distinction normalises the condition in my head and makes it easier for me to talk about it. But it can be difficult to accept and then to explain it to others.

When did you first figure out you were bipolar and what were the tell-tale signs of it?

I was 24 when I first showed symptoms of mania — I was losing sleep, my behaviour, speech, facial expressions, and energy levels were very different from normal. I had lots of ideas, grand plans, and there were many uncontrolled thoughts and emotions. Neither my family nor I understood what was going on at the time, though. Once the hypomanic episode ended, I felt very depressed for quite a long time, with a sense of hopelessness. These ups and downs persisted for many years. Hypomania (lesser form of mania) and mania would occur for a few weeks, followed by depression for a longer period.

There were also long stretches of normalcy, for months and years at a time, without mood swings. For the last four years, I’ve not had any major mood swings, although there are everyday ups and downs. I know the major swings can re-occur at any time, so I need to be careful, and continue with medication and talk therapy.

What are the seven therapies that your book delineates?

The ‘seven therapies’ are a template to manage mental health and wellness for anyone, not just someone with bipolarity. Medical therapies are about accepting a diagnosis and understanding the difference between ‘personality’ and ‘illness’. Love therapy is about the important role of caregivers. Allies and the therapy of empathy discusses how friends, mentors and community members can support a loved one. Work therapy is about how work can progress from being stressful to therapeutic. Self-therapy emphasises the need to have conversations with oneself and understand one’s triggers better. Spiritual therapy outlines ways in which an awareness of faith, purpose, dharma, gratitude, and other universal concepts can help to find the peace within. And finally, lifestyle therapy underlines the need to manage sleep, nutrition, exercise, and play. Do note that these are just suggestions based on my experience, and not a textbook for mental health management.

Why is the book a story of hope?

In general, the stories one hears about anyone with a serious mental health condition are not very encouraging. Individuals living with such conditions are often not able to function effectively in their personal, social or professional lives, or live to their fullest potential. Such illnesses take a huge toll on families too. I have been very fortunate in my journey and learnt lessons that could be helpful to anyone who would want to enhance their mental health and well-being. So, the book is a story of hope because it offers a template for learning to live and thrive with a vulnerability. Essentially, it is a story of resilience, a quality we have collectively relied on, to get us through these last two years of the pandemic. I hope it will resonate.

Why do you think that mental health, a matter of great significance, is grossly misunderstood in India?

Mental health is misunderstood all over the world, for three main reasons. The invisible nature of the condition makes it harder to detect and diagnose than a purely physical ailment. No one wants to share their deepest, most private vulnerabilities. Awareness, within the medical system itself and within patients and families, is limited, as are resources to treat mental health conditions. And as I said, it is easy to attribute a medical condition to personality-led issues or life circumstances. It took a Covid-19 pandemic for us to realise just how universal and pervasive mental health challenges are, than just being private matters.

How can caregivers help patients overcome the disorder?

After medical practitioners, caregivers are the most important stakeholders in helping any patient learn to live and thrive with a mental health condition. In the book, I suggest a combination of four ‘ts’ for any caregiver: trust, trigger management, therapy, and team sports. If the patient does not trust the caregiver, then the caregiver will not be able to take care of the patient in times of turbulence. It is important to build this trust during peacetime when communication is easier. Caregivers are also best placed to spot triggers and red flags and prevent escalation, even if the patient is not prepared to listen. Third, therapy is as important for caregivers as it is for patients, as there is so much burnout. Finally, being a caregiver is what I call ‘love therapy’ and love therapy is a team sport. It’s best to have more than one caregiver because it is a very demanding role.

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