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Hopelessly adrift

The mood swings of manic depression, from elation to despair, can destroy lives. Teachers tell Nicki Household about their experiences.

It makes me cringe, now, to think about the way I behaved. I wafted about the school in bare feet, stopped being punctual, decorated the classroom really wildly and generally threw caution to the winds. The kids were delighted, they saw me as someone fresh and exciting. But my colleagues were worried because my conduct was weird and unprofessional."

All this happened five years ago, when Jay Hesmonhalgh, then 36, had just taken up a new appointment as deputy head of a school in Shepherd's Bush, west London. Her previous job, as head of education in a Barnardos residential unit for emotionally troubled young women had been very stressful, so she was hugely relieved to find herself in a school that was happy and well-managed.

"I thought my feelings of elation were all to do with that," she says, "but looking back, I realise I had been severely depressed in the other job and was now swinging the other way, which is the classic manic-depressive pattern. " Hesmonhalgh describes her mood at that time as "happiness that just went on escalating". She invited complete strangers home, threw parties every night and gave away large sums of money. But it wasn't until she began to hear voices and became convinced that she was the Second Coming that she was finally sectioned and diagnosed as suffering from manic depression.

When she came out of hospital several weeks later, her 16-year teaching career was over. "In a sense, it was a relief to be pensioned off because I couldn't possibly have faced the school again. I felt very ashamed and a terrible failure." She also felt very lonely, because her former friends couldn't cope with the stigma of manic depression or the way massive doses of anti-psychotic drugs had flattened her personality. "My education colleagues reacted worse than anyone. I think they were really frightened that it could happen to them." Eight months after her discharge from hospital, Hesmonhalgh swung so low that she attempted suicide. Although the next two years included more "highs" and "lows" and a further three-month hospitalisation, Hesmonhalgh's story is ultimately one of victory, because she is now managing her illness without drugs and has had no relapses for three years. "I'm not suggesting that other people should throw away their pills - every case is different. But I felt so much better when I was off my medication that my GP agreed to let me stay off it."

Hesmonhalgh now has a 22-month-old daughter and a full life in Torquay, where she moved to be near her parents. Although she hasn't gone back to teaching, she designs and runs training courses for mental health nurses and social workers and was recently appointed Mental Health Act Commissioner for the South West. She's also the co-ordinator of her local Manic Depression Fellowship self-help group.

Manic depression, which affects one in 100 people, also afflicts the brilliant and talented (Spike Milligan is a sufferer as were Virginia Woolf and Tchaikovsky). Its main characteristics are massive mood swings from extreme, often suicidal, depression to elation and hyperactivity. The causes of the illness are unknown, although it is thought to be due to inherited factors interacting with environmental factors, such as stress. Once triggered, it follows a pattern of remissions and relapses until, in most cases, it burns itself out.

Hanging on to your job, especially one as demanding as teaching, is difficult after a diagnosis of manic depression. But Jean James, another sufferer, carried on as an infant teacher in Newport, south Wales for 20 years until she took early retirement, despite eight sectionings and a suicide attempt. "My ability as a teacher was forged by the time I developed the illness," she explains, "so I don't think I ever behaved oddly with the children. My job was actually a stabilising influence because all the pressures in my life were at home. Obviously I took time off when I was in hospital, but I had a very organised approach to teaching and within a week or two of going back, the job had usually sorted me out."

James made no secret of her illness and found most of her head teachers sympathetic and supportive. "There was one foul one who definitely wanted to shake me out and another slightly problem one who I ripped into once when I was hypo-manic (in the early stages of a manic episode) and quickly asked for a transfer. But the parents and children were very supportive. I regarded teaching as my refuge."

James still experiences mild episodes, despite taking the mood stabiliser lithium, but like many other long-term sufferers, she has learned to "self- manage" the illness. She recognises the early signs of a high or low and takes evasive action - usually tranquillisers or anti-depressants. Since giving up full-time teaching, she has taught English to ethnic communities, set up the Welsh office of the Manic Depression Fellowship and been appointed a lay social services assessor by the Welsh Office.

Not surprisingly, life can be very difficult for the families of manic depressives, especially their children. James, who was a single parent, believes she succeeded in protecting her son and daughter from the worst effects of her illness, though she admits "I suspect my son would say that when you're 16 and have got a psychotic mother on your hands late at night, you shouldn't have to wait until morning to contact someone who can arrange her admission to hospital. Even now, there is still no 24-hour crisis cover, which means that far too many children are left in charge of very frightening situations."

As manic depression is a great destroyer of relationships, a high proportion of sufferers are lone parents who rely on their children to look after them when things get bad. Yet there are no registers of children caring for mentally ill parents, so most of them get little help. Guy Pearson, who runs a project for young carers at the Crossroads group in Kensington, west London, believes that there are more than 200 such children in his borough, but is in touch with only ten.

Resilient children can become quite skilful at dealing with the roller coaster moods of their manic depressive parents. When ten-year-old Matthew's mother turned up at the school gates in her nightdress, he told his gawping friends that she was on her way to a pyjama party, then escorted her home and phoned her doctor.

But others cope less well. Child and family psychiatrist Dr Adrian Falkov, who has researched the effects on young people of having mentally ill parents, wishes there were better links between health services, social services and schools, so teachers could be fully aware of what some of their pupils are having to cope with at home. "Generally speaking, manic depressives are not bad parents and their children are not at risk. But that doesn't alter the fact that there are eight-year-olds who have to check that their mother has taken her tablets and not left the gas on before they go to school. Others feel guilty about going to school at all, because the parent doesn't want to be left alone."

Such children often find it difficult to concentrate in class, and may be disruptive, withdrawn or low achievers. If an acute episode is taking place at home, they may also be tearful and frightened. But the stigma attached to manic depression is so great and the school probably won't know they have a mentally ill parent. "It's easy to identify the child who externalises his or her feelings, or whose parents barge into the school, displaying clearly psychotic symptoms. But there are as many others who will retreat into themselves and avoid making friends because they don't want to take anyone home."

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