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Egypt

Cairo Bipolar, A Tale Of Stage Management And Survival

An Egyptian writer shares her struggle with keeping bipolar disorder from invading everything she does and everyone she knows.

Looking down in Cairo
Looking down in Cairo
Pam Labib

-Essay-

CAIRO — I try to be the ideal bipolar. I try to perform my illness in the most rational and grounded way. I contain my episodes so they do not seep into my intimate and close relationships. Contain it and contain myself, so I don't offend you with my instability and intensity. I try to be the acceptable bipolar, the one who can talk about the disease as if it's as inconvenient as a hang nail, lest I allow it to unsettle you with its erraticness or its unpredictability.

I listen to your comments as you internally congratulate yourself on your acceptance and tolerance of neural diversity. You make the joke that everyone is bipolar too and how labels are so passé. I nod and hide my cringing insides under a tightly pursed smile. You tell me you love me, but my intensity can be exhausting, because you love giving constructive feedback. I swallow that slap across the face and let out a little chuckle and vow to never display my intensity to you again. I will learn to do better next time. I tell you about my sadness, about my grief, about my anger and anxiety. You hear me out with an invisible little smirk. I can feel it and see it. I hear it loudly, even though you don't say it.

My flooding emotions are not valid, since you cannot see a causal reality linked to them. My emotions burden you, whether or not they touch you, whether or not they invade your choices and will. Their presence disturbs you even though they ask nothing of you. When my mind is reduced to utter nonsense you find it hard to hear me. You find it even harder to hear me after you witness my mind and cognition falter, even when time has passed and they no longer falter. I drop some names, Foucault and Derrida and I drop some words: "subject" and "difference." I pray that I have redeemed myself with my intellect so you can restart to hear me. You don't want to isolate me and you wish me the best from a distance where my bipolar cannot disturb you. I absorb your judgment and try to do better next time. I try and educate you, so that I do not feel your judgment. I do so because I do not want to be isolated.

Half of all people with bipolar disorders have attempted suicide at least once, and 20% have succeeded. In both April 2013 and April 2017, I got so close to what would probably have been botched attempts, but miraculously, at 37, I have managed to dodge being a statistic. Both times, I was having a manic episode.

As someone with bipolar 1, I tend to have more manic episodes than depressive episodes and I tend to have more mixed episodes than I do simple manias. In a manic episode, there is a lot of energy. I can feel euphoric, elated at times; the mania colors the world as I perceive it. Colors are brighter and more saturated, empty space is speckled with glitter, catching and reflecting light in a million different colors. I am more likely to trust strangers and place myself in risky and unsafe situations. I will not only feel loved by the people around me, but worshiped and adored. My thoughts, writings and ideas are great — no, not just great, phenomenal. For about five minutes.

And then, with the same charge, I will feel despised, worthless, and regretful of all my life choices. As I alternate between one state and the other, with no rhyme or reason, my perception of depth becomes altered, the solidity of things becomes questionable and I become confused and anxious, losing touch with my existence within my lived chronology and body. I become haunted by the shadows that flit across my field of vision to a soundtrack of deafening sounds and screams. I can imagine how hard this must be for you to witness, so please, I understand, do keep your distance.

For years, I refused to be on medication. I had a really bad experience when I was first diagnosed 18 years ago. As of April 2017, I have managed to find the right combination of therapy and medication. For years, I put all my energy into holding the pieces of reality together as my brain waged a war against my senses, my logic and thought processes. I had never imagined that a pill could do this for me — hold my mind together so I can continue with my life, uninterrupted.

Drawing by Ola Abulshalashel, the late artist in Cairo who struggled with mental health.

Every episode had required a cleaning up period following it, whether it be physical injuries needing to be tended to, or professional, social and romantic redemption. Life was often unforgiving, so instead I tried to forgive myself and forgive the bipolar disorder, yet work harder on containing it. I accumulated exhaustion with every episode, with the amount of time, energy and resources that were required in my everyday life to manage them. Schedules, routines, nutrition, therapy, writing, processing, sleep, exercise and reflection help minimize their frequency and intensity, but the cruel joke is that these are the very same things that an episode dismantles before reaching its crescendo. You kept my inconvenience at arm's length. Every time I pulled through, I either did it on my own, or had invested in deconstructing your biases, vetting and educating you so that you could be there next to me.

My ability to resist and to be optimistic is worn out

The times I wanted to end my life, there were three thoughts slamming about and around in my head, throwing snippets of other thoughts and self-perceptions into the air like confetti. One: I couldn't take the pain I was experiencing right now and wanted it to end now; Two: I couldn't take the pain resulting from wanting it to end it now and being fearful and resistant to ending it now; Three: even if this pain passes, as it always does, it will also come back again, as it always does.

Over the years, my ability to resist and to be optimistic has become worn out. Being able to go on, before the medication, came with having an extensive support system of friends that could hold my hand and bring me down from the edge, whenever I was endangering my life. My life depends on a support network that has taken decades to create. This support network is large enough that I can strategically rotate through it. In those moments, living wasn't a question of what I wanted or didn't, but whether or not, by relying on my support system, I was able to get through the episode intact.

Finally, being on the right medication has really helped me, but it took over a decade for me to be able to trust that the mental health establishment would be able to help me. I have been to more harmful therapists than I have been to ones that could actually help me. I have taken more medication that has exacerbated my condition than I have medication that actually helps. I have known more people whose words and actions, subtle and overt, conscious and unconscious, have alienated me, than were able to embrace me.

The level at which I am able to manage this condition is not proportional to the support that was readily available to me, but to the labor that I was able to devote to creating a support system, a task I will never deny was made easier because of class privilege. I resent that those of us who have chronic mental illnesses have to do this to survive, above and beyond the energy that is exerted merely to live with a forever unstable and shifting reality.

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Society

In Northern Kenya, Where Climate Change Is Measured In Starving Children

The worst drought in 40 years, which has deepened from the effects of climate change, is hitting the young the hardest around the Horn of Africa. A close-up look at the victims, and attempts to save lives and limit lasting effects on an already fragile region in Kenya.

Photo of five mothers holding their malnourished children

At feeding time, nurses and aides encourage mothers to socialize their children and stimulate them to eat.

Georgina Gustin

KAKUMA — The words "Stabilization Ward" are painted in uneven black letters above the entrance, but everyone in this massive refugee camp in Kakuma, Kenya, calls it ya maziwa: The place of milk.

Rescue workers and doctors, mothers and fathers, have carried hundreds of starving children through the doors of this one-room hospital wing, which is sometimes so crowded that babies and toddlers have to share beds. A pediatric unit is only a few steps away, but malnourished children don’t go there. They need special care, and even that doesn’t always save them.

In an office of the International Rescue Committee nearby, Vincent Opinya sits behind a desk with figures on dry-erase boards and a map of the camp on the walls around him. “We’ve lost 45 children this year due to malnutrition,” he says, juggling emergencies, phone calls, and texts. “We’re seeing a significant increase in malnutrition cases as a result of the drought — the worst we’ve faced in 40 years.”

From January to June, the ward experienced an 800 percent rise in admissions of children under 5 who needed treatment for malnourishment — a surge that aid groups blame mostly on a climate change-fueled drought that has turned the region into a parched barren.

Opinya, the nutrition manager for the IRC here, has had to rattle off these statistics many times, but the reality of the numbers is starting to crack his professional armor. “It’s a very sad situation,” he says, wearily. And he believes it will only get worse. A third year of drought is likely on the way.

More children may die. But millions will survive malnutrition and hunger only to live through a compromised future, researchers say. The longer-term health effects of this drought — weakened immune systems, developmental problems — will persist for a generation or more, with consequences that will cascade into communities and societies for decades.

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