The more you talk about mental illness the more "normal" it becomes

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Midtown Toronto's Karen Liberman longs for the day when she will be at a barbecue and fellow guests will talk about the ailments they are suffering from. One person will mention he has diabetes, while another will mention she has heart disease and Liberman herself will say she has clinical depression - and not one person will bat an eye.

And while the apparent stigma surrounding mental illness certainly seems to have lessened over the years, there are still people with the disease that don't feel comfortable speaking freely about it.

But why?

Good question, said Liberman.

"It beats the hell out of me. I am on a one-woman campaign to talk about it," said Liberman, the executive director of the Mood Disorders Association of Ontario in midtown Toronto. "A lot of it has to do with various stigmas over the years. ... It's years and years of secrecy."

Liberman said at one point, the "C-word" (cancer) was not talked about yet now millions of dollars are raised to fight the disease. In time she said she hopes the same will be said about mental illness.

"Five thousand (people with mental illness) died of suicide," she said. People "still talk about depression and bipolar disorder in hushed tones."

But things are changing, she said.

Journalists writing articles about mental illnesses certainly helps, as do the people suffering from mental illness who talk about their struggles to survive.

"We keep talking until having a mood disorder is as boring as having high cholesterol."

One of the programs the association started is called Headstrong, which works like Canadian Idol. Liberman said she goes around the province and invites people to stand up and share their stories of dealing with mental illness.

Stories include genuine examples of people suffering, she said.

People who battle back from bipolar disorder or other mental illnesses are "some of the most courageous and resilient people in the world," Liberman said.

Mental illness is a disease of the mind. And bipolar disorder, which was called manic depression until the late 1990s, is just one type of mental illness.

"Basically (bipolar disorder) is two extremes of mood," said Liberman, who volunteered for the organization for four years before becoming its executive director in 2001.

Liberman herself has treatment-resistant clinical depression, which at one point saw her on 27 medications, hospitalized and undergoing electroconvulsive therapy. But with constant vigilance and daily medication she has been healthy since 1997.

People with bipolar disorder have periods of depression and periods of mania, which Liberman said is like life being on speed dial for some, while others feel angry and irrational.

Depression, she said, is easily recognized with people having feelings of self-loathing and profound sadness, while mania "is a bit trickier because a true manic person almost becomes larger than life, they feel like they can conquer the world and anything is possible."

Bipolar disorder shows no discrimination and can affect people of all races, ages and genders. People with mental illness "probably look like you and me."

People tend to have their first bipolar episode in their late adolescence, although it's not unheard of to hear about mental illness appearing in a person's early childhood or late 40s or 50s, according to Treatment of Bipolar Disorder: A Guide for Patients and Families by doctors David A. Kahn, Ruth Ross, David J. Printz and Gary S. Sachs.

While there have been documented cases of mental illness going back thousands of years, today people are people diagnosed more often, said Dr. Roger S. McIntyre, head of the mood disorders psychopharmacology unit, University Health Network, and associate professor of psychiatry and pharmacology at the University of Toronto.

In adults "the diagnoses rate has increased, doubled in adults ... which raises many questions," McIntyre said. "In many cases, the diagnoses of bipolar disorder is inappropriate."

The problem with bipolar disorder, Liberman said, is that it is often misdiagnosed, particularly if those who have it don't tell their doctors all of the signs.

According to Treatment of Bipolar Disorder, many people with the illness do not go to the doctor when they are in a manic period simply because they like how it feels and don't think there is anything wrong. It's when the manic stage comes crashing to the depression stage that sufferers may go to the doctor. But if patients only tell their physicians about their depression, without mentioning their mania, doctors may prescribe an anti-depressant, which in fact causes manic symptoms.

Instead, those with bipolar should be prescribed a mood stabilizer.

"An anti-depressant is counter-indicative," Liberman said. "It lifts a person out of a depression but it spikes into a mania, which is not good."

Although people who have periods of mania may often have heightened energy, creativity and social ease, they also can do a lot of damage to themselves and to their families. People in a manic episode do larger-than-life things such as gambling excessively, losing their sexual inhibitions and, in extreme cases where sufferers also have psychotic episodes such as hallucinations and delusions, might feel they can climb a building and fly.