INTRODUCTION:

I speak on behalf of Arun and you may wonder how hundreds of Arun like me are hidden, unknown, unidentified, untreated and struggling with every passing minute of their lives, trying to get a voice to their thoughts.

I was born to a dignified couple of the town 25 years ago. My father is a doctor in Government Hospital and mother works as a teacher in a Higher Secondary School. Before my coming to this world my mother gave birth to a still baby (girl) as I was told when I was eight years old by one of my relatives, however, it was plainly denied by my parents when I enquired curiously.

Difficult to say why but somewhere in the core of my heart this thought got deep rooted that ‘she’ was born and my parents had lied to me; they are hiding, they are not telling me the truth, they teach truthfulness and they themselves are not following it. Reasons remained unknown. In course of time I developed an earnest desire of having my own brother or sister and unknowingly, unintentionally started imagining that my sister is there somewhere, loves me, plays with me and talks to me every now and then especially when I am in trouble or disturbed. Even I started sharing my belongings, my favourite chocolate and other items with her. Moreover, I started buying things in her name. First time when my grandmother noticed it, she got shocked. She called me and very lovingly asked about it. I told her plainly the relative truth that it all was for my sister. She brought it to the cognizance of my father who got furious listening to this and shouted at me very badly. By scolding and beating perhaps he wanted me to understand that my sister was never born, later, the next defence he took was, she came and left, was no more now and she should not have existence in my thoughts even. I wept profusely as I was very much reluctant to accept it, I could not give words to my love towards my sister. I used to call her by her name Arunabha (kept by me). Years passed by and my imagination kept growing stronger and stronger. I began showing poor marks in my academics and eventually was declared as a dull headed student of the class. I was not able to concentrate on my studies and when it came to writing the answers to the questions asked regarding the chapter, I would take lot of time and write the latest story recently cropping up in the mind!

After few years:

The condition worsened when I started refusing to attend the school and in return getting harsh scolding and beatings. It was the most painful time of my life and till date I feel very sorry for my mother. Each session of me getting beaten with cane or belt used to bring tons of tears to her and she used to cry for hours together. I never liked seeing her swollen eyes and red face but I could not help at all. By this time, I developed interest in writing the events and dialogues used to occur between me and my sister. I had a gut feeling that I am a born writer and I would write screen play of many of my imaginary plays and movies. Furthermore, it would be my loving tribute to my dear sister. Before I forget, let me tell you, I didn’t have friends, not even one in the class or the neighbourhood as well. Apparently, I was not able to play their games with rules, judging quickly, pranks etc. Gradually I made a dreamland and moved far away from them. I knew that my class mates would talk to me only when they wanted my help as I had a good command over English and I could give them better ideas also. Sometimes I would feel bad when they spoke ill about me. Although I was very slow in writing since my fingers and fore arm of right hand would get tremors anytime and simultaneously I would get scared seeing a congested page of the book, yet I loved reading if the content was written in capital letters with sufficient space in between. I know I am a talkative boy, actually, I do everything little fast: be it walking, talking or eating. Another problem is that I start stammering as soon as a bucket full of questions is thrown altogether on my head. Due to which I utter what all rubbish comes to my head even without thinking of the consequence.

By this time an understanding of the root causes of my academic difficulties had emerged. Despite vision therapy, I did not have adequate visual tracking skills and my eyes tended to jump while tracking an object. Additionally, I had not achieved dependable binocular function; with red/blue glasses on, I saw red and blue halves on white paper indicating that my eyes were not working well together. On a task called finger tapping, where I tried to copy a simple pattern of touching the thumb to each finger in order, I would complete the pattern in reverse as it was comparatively easy to me. When changed to a skip-finger pattern, I had more difficulty with the sequence.

The instability of my mental status:

A few years later when I could not clear 10^thstandard examination, it warned my parents directly and they decided to get advice from psychiatrist. The imagination of going to the hospital itself was horrifying to me and it was deeply related to the death of my sister. I refused and rebelled but fortunately my doctor was kind enough and I found a sense of relief opening my heart to her. She listened to me patiently, assessed me thoroughly, understood my mental status and having long sessions of interaction and tests with me, diagnosed me as a case of Learning Disability with Bipolar disorder. That day is still present in mind just like a nightmare and gives me a jolt when I remember the violent slaps of my father on my cheek. I do remember the countless late-night sobbing of my mother and sleepless nights of my father. I understand that at times my thought process is severely distorted, making me believe that the picture of a girl in front of me is real, and if I don’t exert all my energy into swatting it, the thing will leave me with a rakhi on my wrist!

In addition to that my widow aunt (father’s cousin) started advising my father to adopt legally her own son so that the assets belonging to my father could be utilized by a man of head in the years ahead. It did nothing but added fuel to the fire of pain and agony, needless to say anything about the results. I felt hopeless about the future and decided that life was not worth living. I tried to commit suicide twice and incidentally could not succeed. Eventually, in order to protect myself from all this nonsense I made myself locked in the shell created by me and I didn’t wish to talk to anyone in the world except my sister. I am 25 now, still struggling with my B.A. examination, overloaded with studies. I accept whole heartedly that the major problem of mine is not being able to get rid of the years-long habit of giving words to my imagination in writing and having no control on my own thoughts of dethroning my father considering him responsible for my sister’s death and hiding the truth from me. Currently I have almost 150 notebooks, all filled with the screen plays of my dream. A few years back it so happened that my father wanted to burn them all, by chance my grandmother came forward and pleaded him not to do so as, without my knowledge she had read some of the pages written by me. She assured my father that I would stop doing this but these pages were really very much precious to me and I might not be able to survive without them. Somehow, she made my father convinced and kept all records with her. I knew that I would get everything from her as she loved me a lot, probably being the only successor of the family. I understand from within that it consumes almost 90% precious time of mine which I could have given to the studies. Even if I wish to type it all in my smart phone also, it takes hours but I am totally helpless, finding it absolutely impossible to check. I visualize as both of us (I and my sister) are staying together, busy with our domestic responsibilities of spouse and children, however, we love each other a lot.I have been undergoing medication and at times when the stress reaches its peak, I become totally unable to do anything except galloping medicines and feeling drowsy all the time. I have been battling my brain in a big way the last few years. I’m stuck on an obsession that people are here only to hurt me and bring me deeper into depression and anxiety. I am desperately unhappy. Small things like going to the shops and talking to people leave me wracked with depression. I have developed lots of physical aches and pains. I just tend to think I am miserable by nature.

Knowing the disorders with me:

Bipolar Disorder:

Bipolar disorder is a condition with extreme shifts in mood and fluctuations in energy and activity levels that can make day-to-day living difficult. Previously known as manic depression, it is a serious mental illness that, if left untreated, can destroy relationships, undermine career prospects, and seriously affect academic performance. In some cases, it can lead to suicide. Its symptoms vary among people, and according to mood. Some people have clear mood swings, with symptoms of mania and then of depression each lasting for several months, or with months of stability between them. Some spend months or years in a "high" or "low" mood.A "mixed state" is when a manic and a depressive episode happen at the same time. The person may feel negative, as with depression, but they may also feel "wired" and restless. During a manic episode, a person may engage in risky behaviour, such as spending excessive amounts of money. Other symptoms are below mentioned:

· Impaired judgment

· A sense of distraction or boredom

· Missing work or school, or underperforming

· Likelihood of engaging in risky behaviour

· A sense of being on top of the world, exhilarated, or euphoric

· Excessive self-confidence, an inflated sense of self-esteem and self-importance

· Excessive and rapid talking, pressurized speech that may jump from one topic to another

· "Racing" thoughts that come and go quickly, and bizarre ideas that the person may act upon

What is Co-morbidity? A Literature Review:

Originating in the medical world, the term originally refers to the presence of at least two diseases. An issue inherent in mental health is that definitive biological structures are often not assured, and so in dealing with disorders and their classification makes the process more complex and ill-defined, however, it should be taken to mean the presence of two or more conditions or disabilities. For example, if a person is diagnosed with ADHD and an Anxiety Disorder, they are said to be comorbid for these two disorders. Conversely, those who report being easily distracted and forgetful is not comorbid for these symptoms, rather their co-occurrence suggest morbidity for a single disorder, ADHD (Kring et al., 2007). The consequences of comorbid condition, particularly if they go unidentified and untreated, may be severe to the extent of committing suicide or drug abusing in several ways.

Individuals with ADHD are at significant risk for developing secondary psychological problems, such as depression or aggression. These have been attributed to negative experiences, academic failures, frustration and rejection (Herbert, 2003; Silver, 2003). Co-morbidity may increase this vulnerability further and it may go beyond the borderline. Furthermore, the combination of difficulties makes emotional and behavioural problems more likely. For example, young people with ADHD and a learning disability were found to have significant more behavioural problems (e.g., aggression or withdraw) that those who had either one of these diagnosis, moreover, it may lead to other fatal conditions too (Cruddace, 2006).
In addition, comorbidity creates more problems than just one disability added to another. In a study by Cruddance and Riddell (2006) young people with ADHD and a comorbid learning disability had more sever learning problems than children who have a learning disorder but no ADHD, and also more sever attentional problems than those with ADHD but no learning disorder.

It is estimated that the prevalence of mental health problems amongst adults with a learning disability is approximately 40% (McCarron et al. 2011; Cooper et al. 2007). This is more than double the estimated point prevalence rate of mental health problems in the general population (Mind 2016a; McManus et al. 2009; Jacobi et al. 2004). Children with a learning disability are also more likely to suffer from mental health problems than children without a learning disability, with approximately 36% of children with a learning disability also reported to have a psychiatric disorder (Emerson and Hatton, 2007). Before a person with a learning disability can access mental health treatments, their mental health problems need to be recognised. However, research by Taylor et al. (2008) has identified four reasons why mental health problems amongst people with a learning disability are not always recognised or diagnosed:

1. There is a gap between mental health services and learning disability services:

Mental health and learning disability services are often separate, and do not always work together (Taylor et al. 2008). Additionally, mental health services are not always accessible to people with a learning disability. It refers to a gap in provision for those who suffer from mental health problems and have a learning disability. There is evidence suggesting that people with a learning disability miss out on government funded initiatives such as Improving Access to Psychological Therapies (IAPT) and memory clinics (Chinn et al. 2014; Kroese et al. 2013).

On the other hand, those with more severe learning disabilities and mental health problems will most likely present to learning disability services. Therefore, it is important that front line workers in both these services are aware of the symptoms of mental health when presented by people with a learning disability.

2. Assessment measures to detect mental health problems in people with a learning disability are not always well developed:

Even if an individual is identified as having a learning disability, medical professionals can face considerable problems diagnosing mental health problems. Many people with learning disability experience communication difficulties, which can make it more difficult to give an accurate diagnosis (Department of Health 2013).

3. Diagnostic overshadowing:

Diagnostic overshadowing is where symptoms presented by someone with a learning disability are attributed to their learning disability rather than the true underlying problem (Mason and Scior 2004). It says that mental health problems go undiagnosed.

4. Challenging behaviours:

Staff supporting people with a learning disability “are likely to use a challenging behaviour rather than a mental health conceptual framework to understand problematic behaviours” (Taylor et al. 2008). This could mean that underlying mental health problems are not recognised or not treated effectively. Broadly, there are two ways that we treat mental health problems: with medication or through talking therapies such as psychotherapy or cognitive behavioural therapy (CBT). The effectiveness of a treatment will depend on the individual and the type of mental health problem. For many people, a combination of medication and talking therapy is the best approach.

· Depressive symptoms

· During a depressive episode, the person may experience:

· A feeling of gloom, blackness, despair, and hopelessness

· Extreme sadness

· Insomnia

· Anxiety about trivial things

· Pain or physical problems that do not respond to treatment

· Guilt, and a feeling that everything that goes wrong or appears to be wrong is their fault

· Changes in eating patterns, whether eating more or eating less

· Weight loss or weight gain

· Extreme tiredness and fatigue

· An inability to enjoy activities or interests that usually give pleasure

· Low attention span and difficulty remembering

· Irritation, possibly triggered by noises, smells, tight clothing, and other things that would usually be tolerated or ignored

· An inability to face going to work or school, possibly leading to underperformance

Learning Disability:

The 2004 amendments to the Individuals with Disabilities Education Act (IDEA), defines Learning Disabilities as ‘learning disability means a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which disorder may manifest itself in imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations’.

Learning Disability is a complex neurodevelopmental disorder that affects 5 to 10% of school-age children. This condition consists in a specific learning disability with a neurological origin. These learning difficulties are unexpected in relation to other cognitive abilities and the provision of efficient classroom instruction. A range of neurobiological investigations suggests that disruption of the parieto-temporo-occipital systems underlies a failure of skilled reading to develop. The observation that dyslexia is both a familial and heritable problem was made early on and was confirmed by twin studies.

There is a continuum of neurologically based disorders that are frequently found together. The basic concept is that if something impacts on the developing brain, resulting in an area or system being “weird differently,” it is possible that other areas might be involved as well.

The correlation between Learning Disability and Bipolar Disorder:

It is not fully clear if this disorder should be seen as a comorbid disorder. It may be present if someone has Learning Disability. The primary behavioural pattern relates to mood swings. These swings might be from depression to a state of super happy, referred to as manic behaviour. The mind is racing and full of thoughts. It is difficult to stop talking or acting or to relax. Behaviour is driven and may appear to be inappropriate. Another possible mood swing is from calm to irritability or rage. As with the other related disorders, these behaviours show a chronic and pervasive history and there is often a family history.

Learning Disability is affecting more and more children every year, and although most educators would agree that dyslexics are "not people who see backwards," there is still no solid theory on why dyslexics cannot differentiate between the sounds "or" and "ro." At the same time, bipolar disorder is becoming more and more understood by scientists as more and more people, especially children, are diagnosed with every year. These two seemingly different disorders, both lacking a cure, are often found within the same children, and yet no substantial research has been conducted nor have educators been taught how to teach someone who is both dyslexic and bipolar.

The most universal diagnosis of bipolar disorder consists of massive mood swings, ranging from manic to severe depression, all within a few hours. Manic episodes often consist of long periods, in which sufferers may feel elevated, think that they are invincible, have trouble focusing on one topic, and need little to no sleep.

Bipolar disorder, especially found in children and adolescents, is not just a phase that they can hope to outgrow. It is a biological phenomenon in which the brain overworks in some areas to compensate for others not working hard enough. Neurotransmitters are cells that send signals between brain cells using chemicals, such as serotonin and dopamine. In bipolar patients, "40 percent have a loss of the serotonin 1a receptor, which may contribute to the atrophy of neurons, and may set off depression." This lack of neurons affects the other parts of the brain that control understandings of rewards, possible dangers, and emotions. By not having as many messenger cells, these areas of the brain are not as connected to each other, meaning that sufferers' brains are not able to control themselves as much as a person without bipolar disorder because their brains are "weird differently."

Bipolar disorder used to be thought of as an adults-only disorder. While only 1-2 percent of the adult populations suffer from this disorder, it is now thought that up to one third or 3.4 million children may be exhibiting symptoms of bipolar disorder. Bipolar disorder by itself would seem bad enough, but "it is suspected that a significant number of children diagnosed in the United States with attention-deficit disorder with hyperactivity (ADHD) have early onset bipolar disorder instead of, or along with, ADHD.”

What could be done?

· Identification and referral

Parents or others caring for people with learning disabilities should consider a mental health problem if a person with learning disabilities shows any changes in behaviour, for example:

· Take account of:

Potential medication interactions

The potential impact of medication on other health conditions

The potential impact of other health conditions on the medication

When necessary consult with specialists to minimise possible interactions

Develop or adapt reliable and valid tools for the case identification of common mental health problems in people with learning disabilities, for routine use in primary care, social care and education settings.

Psychological interventions (such as cognitive behavioural therapy and interpersonal therapy) are suggested to be adapted and tested in large randomised controlled trials.

Psychological interventions such as cognitive behavioural therapy (CBT) are clinically and cost-effective treatments for anxiety and depression within the general population. While there is some evidence to suggest that these interventions may be useful in treating depression in people with learning disabilities, this is limited. Further research is also needed for CBT for anxiety disorders such as generalised anxiety disorder, obsessive compulsive disorder and post-traumatic stress disorder along with Learning Disabilities.

Individuals with learning disabilities sometimes exhibit unusual side effects that are not always outlined in the clinical profile of the medication. It is common practice to provide a comprehensive assessment of the problem, start medication on lower doses and slowly increase to achieve maximum benefit with minimal side effects.

What I should do as a person with Learning Disability & Bipolar Disorder:

I must be a full and active participant in my own treatment. I should learn everything I can about Learning Disability and Bipolar Disorder. I should study up on the symptoms, so I can recognize myself when in trouble. The more informed I am, the better prepared I’ll be to deal with symptoms and make good choices for myself. Using what I have learned about my disorders, I should collaborate with my doctor or therapist in the treatment planning process. I need not to be afraid to voice my opinions or questions. I should believe that therapy can help me learn how to deal with my disorder, cope with problems, regulate my mood, change the way I think, and improve my learnings.

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21 http://www.bpkids.com

22 https://ldaamerica.org/what-you-should-know-about-related-disorders-of-learning-disability

23 https://www. handle.org

24 https://www.childpsychology.com - a database for articles and links for psychological disorders

25 https://www.delawareonline.com

26 https://www.exn.ca/Stories/1999/04/21/53.asp

27 https://www.jama.ama~assn.org

28 https://www.news.bbc.co.uk/1/hi/health/343139

29 https://www.ortonacademy.org
https://educationrights.wordpress.com/2012/02/11/how-is-a-learning-disability-defined-under-the-idea

Received on 04.10.2017 Modified on 08.12.2017

Res. J. Humanities and Social Sciences. 2018; 9(1): 29-34.

DOI: 10.5958/2321-5828.2018.00006.2