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 By Tito Kulindi

Weeks ago, the public has been livid over the death of Emmanuel Tegu, a third year Makerere University student, who was ostensibly killed by members of a security patrol team. What really caught most people’s attention, including mine, was the police’s response to Tegu’s killing in which they said the deceased was alleged to have a mental illness that prompted abnormal behaviours. Police’s earlier statements and what was revealed later exposed the force’s weaknesses, in particular; and the inadequacies by our security organs, institutions, and society in general on how issues to do with mental health are viewed. What came to my mind is how could the whole Uganda Police not have a mental health assessment on Tegu to justify he had bipolar. The police would have taken the student for a mental state exam (MSE) to find out his real condition instead of making assumptions. We all know untreated bipolar can lead to extremely manic and disruptive behavior as well as depressive, and suicidal tendencies. The more we, as a society, pay less attention to mental illness, the more stigma the mentally ill will suffer.

It is very important for us as a society to understand mental illnesses such as bipolar. What happened to Tegu should never happen to any one’s son or daughter. Who knows how many people have been killed in the same manner Tegu was just because of misjudgment on the police personnel’s side, the evils of mob justice, and misinformation?  As a society, we are misinformed about issues to do with mental illness. This leads me ask how are we going to foster, and advocate for mental health in our societies, because once we do, we shall create a compassionate society filled with strong values of tolerance and committed actions towards our developmental goals.

Here are some aspects of bipolar that might be important to understand, hence fighting social stigma:

Bipolar can be seen as a chronic or episodic mental disorder occurring occasionally and at irregular intervals. According to the diagnostic and statistical manual for mental disorders (DSM-5), bipolar is well-defined by the exhibiton of manic episodes such as irritable mood, and increased hyperactivity. The symptoms consist of racing thoughts or flight of ideas, reduced need for sleep, low self-esteem which could be termed as grandiosity, rapid speech, reckless and risky behavior such as distractibility, unreasonable spending and hypersexual activity. These symptoms may be persistent for one week and present most of the day which results into functional impairment.

However, to understand bipolar it is important to note terms such as a manic episode, hypomanic episode, and major depressive episode.

A manic episode can be seen as a distinct period of abnormally and persistent expansive, elevated, or ranked irritable mood which increases goal-directed activity or energy. Its duration can last at least one week and presents every day or any duration. It can also cause functional impairment. For example, an individual can’t work, or socialize with others.

A hypomanic episode can be described as a distinct period of persistent and abnormally expansive, elevated and irritable or distressed mood with persistent and abnormal increased energy or activity and lasts at least four consecutive days or present nearly every day.  A major depressive episode can be defined by symptoms of depressed mood and loss of interest or pleasure in activities. Symptoms must be present for a period of two weeks and affects normal functioning.

Bipolar, just like any other chronic illness, has subtypes which include: bipolar I, bipolar II, cyclothymic disorder, and other specified and unspecified bipolar and related disorders.

Bipolar I Disorder can be defined by manic episodes that last at least seven days most of the day, nearly every day or when manic symptoms are so severe that hospital care is needed. Usually, separate depressive episodes occur as well, typically lasting at least two weeks. Episodes of mood disturbance with mixed features having depression and manic symptoms at the same time are also possible. Bipolar II Disorder is defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above. Cyclothymic Disorder also called cyclothymia is defined by persistent hypomanic and depressive symptoms that are not intense enough or do not last long enough to qualify as hypomanic or depressive episodes. The symptoms usually occur for at least two years in adults and for one year in children and teenagers. Other Specified and Unspecified Bipolar and Related Disorders is a category that refers to bipolar disorder symptoms that do not match any of the recognized categories.

It is important to note that the symptoms of bipolar vary. An individual with bipolar disorder may have manic episodes, depressive episodes or mixed episodes. A mixed episode entails of both manic and depressive symptoms. These mode episodes cause symptoms that last a week or two or longer. Symptoms include the following; feeling very high or extremely irritable, racing thoughts, decreased need for sleep, flight of ideas or talking fast, increased hyperactivity, grandiosity.

Many people with bipolar also have other comorbid mental health conditions such as psychosis. Some people with severe episodes of mania or depression have psychotic features such as hallucinations and delusions. Anxiety disorders and attention deficit or hyperactivity disorder are often diagnosed in people with bipolar.

The possible causes of bipolar disorder include heredity or genetic factors. Bipolar runs in families. Research shows that people with certain genes are more likely to develop bipolar than others. Also, the existence of stressful life events evidence shows prolonged psychosocial stress can lead to a depressive episode, also events such as loss, grief etc, can be a big cause. People’s cognitive styles work as mediating variables between life events and affective-behavioral symptoms. Negative attributional styles have been found to be related to the onset of both depressive and manic episodes following stressful life events. Environmental factors show bipolar is more frequent in high income than low income countries. Divorced separated widowed people have possessed higher rates of bipolar 1 disorder than people who are married and never been married.

The treatment of bipolar helps many individuals even those with the most severe form of bipolar. Bipolar is treated with medications such as mood stabilizers which can be taken on a long term basis thus controlling or lessening the swings from high to low and psychotherapy (talk therapy) keeping active. Getting enough sleep and eating well can be helpful. So, mostly a combination of both treatments is very effective and has had significant outcomes.

We need to come together and be informed about mental health issues in society. That’s how we shall fight the stigma that surrounds mental health, since mental illness can be crippling thus impacting relationships, and all aspects of everyday life. Bipolar is a life threatening condition. An estimated 1 in 5 people diagnosed with bipolar disorder dies of suicide.

The Uganda police needs to set a side trainings and workshops to educate the officers about mental illness (psycho-education) in various issues such as trauma, substance use etc. because in most cases, the police are often first responders to incidents involving mental illness. Crisis intervention trainings teach officers about signs and symptoms of mental illnesses. These also provide information that will help in changing officers’ attitude, thus leading by example when it comes to advocating for mental health issues in society.

To a greater extent, collaborations between community mental health departments such as the school of psychology at Makerere or institutions such as Butabika National Referral Hospital and police departments can help in resolving such issues.

Furthermore, the community perception on mental illness needs to be changed. We need to break the cultural myths attached to mental illness. The fact that community perception is dynamic, it tends to change with time as awareness and education occurs. Education and social media are major factors which can be used to create awareness. If we don’t focus more on mental illness and give it much attention just like we do recognize physical health issues more, then we will never get people the treatment that they need.

As we all know, crucial change doesn’t come easy. If humanity gets to know the complexity of mental illness, then we shall progressively learn more about human conditions such as depression, bipolar and schizophrenia, etc. thus becoming more tolerant and considerate towards others.

The writer is a clinical psychologist

Disclaimer: The views expressed in Mulengera News’ Opinions Section are those of individual writers and do not represent the official position of Mulengera Media, its directors, management and staff on the issue(s) addressed. Writers are individually responsible and liable for the omissions and misrepresentations in the work published on this news medium.

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