Violation of security and psychological stability due to bipolar disorder

Name: S.E, age:38, status: married, a university graduate from Sanaa.

‘S’ is married and has 10-year old daughter and 7-year old son. She lives with her children and husband in a neighbourhood in Sanaa, the capital. Her husband who works as a teacher in a public School, had psychiatric disorder as a result of stresses of war, salaries cut off, and the deterioration of the economic conditions.  He was diagnosed with "bipolar disorder" so he was suffering from shifts in moods from depression, absolute calmness, sadness, law levels of activity, and introversion that makes him doesn’t talk to his family for up to two weeks to " hypomania " of elation, hyper-activeness, excess energy, troubled sleep, and clear flight of ideas and behaviours. This condition of the husband affected the whole house tranquillity and made the family psychologically unstable and unsecured. One night, while the father was hypomanic he raped his daughter unconscious of what he was doing and that accident elevated the tension and troubles in the house. The daughter had fear and panic from everybody around, became nervous and violent against her younger brother, and suffered from troubled sleep that nightmares were waking her up screaming and crying every hour or two. Whenever she saw or hear her father, she was spasming, trembling, biting her nails and ran to her mother to hide in her lap. Consequently, the mother totally collapsed as she was extremely shocked from the father’s act towards his daughter and her attitude towards him has become extremely aggressive and irritating. The mother was always sad and constantly crying that she lost her ability to play her role in the family and do the household tasks. She shrank with her daughter and never left her for a moment. Her sleep became intermittent or zero and great anxiety had controlled her. Despite her awareness of her husband’s psychiatric disorder and of his need to psychiatric treatment and care, she was heavily insulting and cursing him; blaming him for what he did. She couldn’t afford putting him in hospital or buying his medication, so she was praying to God for help and relief especially that she could not speak about what happened for fear of being stigmatized.

One day, "S "heard about the psychological and social advice line from a companion who was talking about her beneficial experience of it. First, she didn’t believe it but she decided to call and try and she called broken and bitterly crying. The specialist on the line tried to relieve her pain and sympathize with her to calm her down then assured her that everything will be fine and there is a solution for every problem. The specialist noticed that both "S" and her daughter need psychiatric help so she offered her to visit the foundation clinic for free psychiatric treatment.

On the following day, "S" arrived at the foundation and was welcomed and referred to a female psychiatrist who made a psychological assessment for her to highlight and prioritize the problems that will be tackled in the following sessions. On top of these problems were;

  1. The husband’s "bipolar disorder" and unaffordability of his previously prescribed medication; "S" was asked to bring her husband with her for reassessment and help as well and she did. The husband was examined by the psychiatrist of the foundation who confirmed his "bipolar disorder" and his urgent need for medication. Although the foundation was unable to provide the husband’s medication, they communicated his condition to Yamen’s Women Union that did give help by providing a three-month therapeutic dose, renewable only once. The husband condition was improved and stabled by taking his medications and that eases the pressure on his wife and children.
  2. The psychiatric disorder of "S" that was diagnosed as ‘depression’; the psychiatric prescribed her medication to improve her sleep and mood and to relieve her tension and anxiety. She was also listed in cognitive-behavioural treatment programme to train her on techniques of reducing tension and anxiety such as relaxation of the musculoskeletal, walking and playing sports. She was trained on controlling negative thought and was taught problem solving techniques and was monitored for applying these techniques on similar problems during treatment sessions. "S" also received help with getting back gradually to her normal life in regards to behavioural activities and household and family tasks. The treatment programme side by side with her educational level, her will to be treated and her care for children, particularly after her husband improvement, all of that led to obvious improvement in "S" psychiatric condition. Eventually, she has become more qualified to help and support her daughter in her psychiatric treatment.
  3. The problem of the raped daughter; the daughter went through some treatment sessions and the mother was told about the importance of letting a doctor examine the daughter’s hymen; which was the main concern of the mother. After the mother’s consent, the daughter was referred to the gynaecologist who works with the foundation who examined the child and reported that she still virgin and her hymen was just externally damaged; the thing that shocked the mother but relieved her and her daughter (that doesn’t understand what was happening). The daughter condition improved in regards to sleep and panic and the mother was advised to involve the child in more safe and friendly activities in order to get rid of her negative energy of tension and anxiety by playing. The mother tried to list both of her children in these programmes but she couldn’t continue because she couldn’t afford transportation.

The treatment of this family last for almost five months till the end of the programme when the three of them were psychiatrically assessed according to variable psychiatric standards. The results illustrated noticeable improvement in their conditions. The mother was educated how to recognize a setback in her husband’s condition and was trained to make a rescue plan for such situation to protect herself and her children. She needs to keep the children away from the house and ask for relatives help until the father recovers again. She also agreed to a follow up plan for herself, the children and the husband that they need to come to the foundation clinic once a month for three months in row for reassessment and she has to call psychiatric advice line "136” whenever it is necessary.