It is 5.30am. Ms Choo Kah Ying is awake but cowering under her blanket, praying for the sun not to rise.
A solution to avoid the horror of a new day comes to mind - she will slash her wrists.
This was the beginning of a dark episode in her life nearly two decades ago. The Singaporean is a former manic depressive starting from her university days in Australia.
Now 37 and the single mother of a 12-year-old autistic son, she has survived to tell the tale in Five Little White Pills... And Then There Were None: A Journey From Manic Depression To Recovery, her memoir about coping with the illness.
The book is launched today at Geylang Serai Community Club's World Mental Health Day Celebration, which will also feature talks related to mental health. World Mental Health Day is on Oct10.
Manic depression, also known as bipolar disorder, is a mental illness characterised by extreme mood swings between mania and depression, according to doctors.
Dr Mok Yee Ming, associate consultant at the department of general psychiatry at the Institute of Mental Health, says that in the mania phase, sufferers may have grandiose plans or even believe they have special powers. They engage in extremely risky behaviour and are generally out of control.
|Five Little White Pills...And Then There Were None: A Journey from Manic Depression To Recovery ($16) will be available in major bookstores from Friday.
For example, Ms Choo recalls she would feel like she could climb Mount Everest if she wanted to.
In the depression phase, patients feel hopeless and can get suicidal.
Dr Mok points out that a misconception about the illness is that the moods can be controlled. 'A lot of people don't understand why a person is behaving this way. But it's the illness and not the person misbehaving,' he adds.
In between such swings, a person may actually appear normal, say doctors. This is also partly why the condition is hard to detect, with 35 per cent of cases usually being diagnosed two years late, according to a recent article in the Singapore Medical Journal.
While there is no data on the prevalence of the illness in Singapore, worldwide studies place the figure at 0.4 to over 1 per cent of a country's population.
Treatment for the condition involves medication in the form of mood-stabilisers, which prevent the extreme swings. Antidepressants may also be prescribed. Education for care-givers and counselling when the patient is in a more stable condition are also provided.
Now a writer and an educator, Ms Choo says she cannot recall much of that dark period during which she suffered from the illness.
'Nothing really stands out,' she says. 'It's the grind of living. Your mind is like a tyrant. It tells you: You're terrible. You're awful.'
She identifies her first and only serious attempt at suicide in 1991 as 'the first real outward cry for help'. Her fragile state of mind was also shaken when her then boyfriend, who was a big part of her life, decided to leave Australia for the United States for his post-graduate studies.
Soon after that, she was formally diagnosed to be suffering from manic depression.
After five doctors and going on and off medication, she says her road to recovery started in 1996 when her son was born.
Upon the second doctor's advice, she went on regular medication. Previously, she had been reluctant to do so.
Her son being autistic further strengthened her resolve to recover. She says: 'I was not very good at living for myself but for my son, Sebastien, I had a reason to live.'
Nine years of medication and coping with the challenges of raising an autistic child followed. Then in 2005, she had an epiphany when she was living in the US.
She was buying health insurance for her medication when the salesman told her that people like her were termed 'medically uninsurable' and had to opt for a different scheme.
'I felt so upset that I had been categorised as though I were an 'untouchable',' she recalls. She then determined that she would wean herself off medication completely and has managed to achieve that since.
Doctors in general advise manic depression victims to stay on medication. They say it is a common mistake to think that patients are fit to stop medication just because their moods appear to be finally in control or because they appear normal in between episodes.
While there is no known cure for the condition, patients can still lead fulfilling lives and contribute to society, as long as they receive proper treatment and care, say experts.
So what advice does a survivor like Ms Choo have for others in a predicament like hers? 'Always provide specific information to the doctor. It's not like a physical illness where you can check for things,' she says.
Also, care-givers and patients alike should read up on the condition. 'You'd be surprised at how simple this seems and yet nobody does it. I didn't.'
This article was first published in The Sunday Times on Oct 26, 2008.