Provoking the Manic

Good afternoon!
Its a quiet Sunday and I've just completed the first week of an online course I'm taking about developmental psychology in children and adolescence. The University of Edinburg have done a fabulous job of presenting its content in a professional, yet very natural way. Some parts of the class are actually filmed in a children's playground, and while Dr Jo speaks about language development, little noisy creatures running from imaginary dinosaurs are around her. It is funny and very interesting!
Mental health is a big deal and understanding it and working with people with ailments in that sphere, is a treasure to society. However, most of my friends who already know of my interest in psychiatry seem to downplay the importance of psychiatry in medicine. Thinking it is something probably para-science or para-medicine. And I have never given up on coming up with arguments to try to prove to them its importance. Yesterday something happened that, without much effort from my side, left a friend of mine (who is particularly pro-clinical and anti-psychiatry) astounded and tachycardic :D
We were sitting in campus and a woman came up to us with a pain of slippers in her hand. A 40-ish looking woman, speaking quickly and with quite an animated face. Initially I thought she was trying to sell me the slippers. So, as I usually do to mobile vendors, I look at them, listen for a few seconds then say "No thanks" and look away.
When I did so, the woman protested "I'm not trying to sell you these slippers! I'm trying to tell you that the people in the toxicological centre are making plots against me, trying to make me buy expensive slippers!!"
She looked offended as she spoke and probably expected me to agree with her.
I immediately picked up that there was something psychologically wrong with this woman...hmmm perhaps delusions of persecution? paranoia?
I asked "aaah so there's people plotting against you? Who else is plotting against you?"
The woman immediately answered and gave me names of people and organizations who are out against her trying to make her life difficult. And she was especially frustrated about this slipper plot she was facing.

Yep. Delusions and Paranoia.
Nice.
Speaking alot, inappropriately animated, irritable, hyperactivity.
This woman was probably in mania right now.
Bipolar with paranoia. 
I smiled to myself. Welcome to my world.
I looked over to my friend, to find her staring at me, quite shocked.
"lets get up and go, okey?"
"No way dude, we're staying. I want to prove something to you"
 The woman walked away and sat around 2 meters away from us. And as I spoke to my friend, the lady was speaking loudly to herself (hmmm auditory hallucinations?)...and when she caught our eyes, she tried to talk to us too. Mainly she was going over and over about how horrible these people who plotted against her were, and "who do they think they are? Do they think I'm stupid or retarded or what?"

My friend, looked like a threatened kitten, cornered. I could tell from her body language that she was genuinely afraid of this woman and what she could do. I, on the other hand was completely relaxed. Yes, this woman could get aggressive...but it is unlikely that she'd be, unless provoked.
I wanted to sit there and observe what other symptoms this woman would exhibit and more importantly I wanted to demonstrate to my friend, that psychiatric illnesses are a real thing. It's not just crazy, homeless people roaming the streets. It could be in very ordinary looking people and it could (and almost always does) destroy their lives and the lives of those around them.
Psychiatry isn't JUST people who have problems at home and relationships who need to talk. Or people bouncing off the walls and talking to themselves. And psychiatry doesn't involve JUST listening to people cry their hearts out and offering support. It is this massive umbrella of therapy for people who have dysfunction in their ability to operate in their everyday life.
Just like hepatology deals with dysfunctional livers.
Psychiatry deals with dysfunctional psyches.

And for functioning I'm referring to the basic things that we all need to do
1. Fulfilling our basic needs (sleep, eating, biological functions, financial sourcing)
2. Fulfilling social needs (interpersonal) (forming and maintaining relationships, adjusting to societal and cultural norms)
3. Working, learning, striving towards something.
4. Ability to maintain a relatively stable intrapersonal state of being (ie average mood with healthy fluctuations, resilience to difficulty and adaptability)


Some of the reasons for the inability to do the above things may be purely societal (eg poverty and illiteracy preventing one being financially independent) or purely medical (thyrotoxicosis preventing one from sleeping well) or purely psychological reasons (a deep seated fear of social situations and people, leading to inability to go out and work and form relationships).
 But often more times than not, the reasons are an overlap of the three.
Psychiatry aims to treat people who are dysfunctional in their lives by excluding medical factors, recognizing and attempting to reduce the social influences (mainly the job of social workers who work closely with psychiatrists and psychologists) and focusing on treating the patient's psychological state. Through adjustment of the neurotransmitter imbalances (which oftentimes do provide visible improvements especially in biplor and schizophrenics) and by providing the patient with cognitive and behavioral techniques to help them manage their dysfunction.

Now lets go back to the story of me and my friend on the campus bench with a bipolar lady nearby.
My friend has already seen that psychologically disturbed people can be weird and unpredictable
I wanted to show her more than that. I wanted to show her that they can also be a threat to themselves and their environments, should they be left unhelped.
I'd like to show her that without psychiatric help, how bad these patients could be and I was hoping that she'd finally admit that the field of psychiatry isn't only real but necessary.
The point isn't that OUR system of psychiatry is totally correct.
The point is, a specialty is needed that can help these people, because simply, no other field can help them.

So how do I go about proving this to her?
Other than provoking the patient to make the scary side show even more?
I know how immoral and terrible it is to do something like this. But, the little challenging side of  me arose and said "I dare you. Prove it to her"
The lady came back to stand before us and started to talk again. I asked her the question that most psychotic patients would find very offensive and would immediately start denying. Psychotic patients are disconnected from reality and hence have a very difficult time differentiating between what's in their mind and what is real.
So, I asked her "Ma'aam, are you being treated in our psychiatric clinics?"
And just as I suspected the woman's face changed. An interesting beetroot red colour danced on her cheeks.
She took one step towards us and leaned her face in and said
"What did you just say? psychiatric??"
She gave out a disproportionately loud, ridiculing laugh, raising her head to the sky
"HUH?? PSYCHIATRIC? You think I'm crazy?"
Another laugh.
By then, my friend was fully petrified. I could almost smell the adrenalin she was hyper-secreting.
The woman came so close to our faces. And looked so threatening, I was just waiting for her to grab me by my blouse.
The events that ensued need not be written here, but I'm sure you'll be relieved (or perhaps not) to hear that I was not beaten up by her. Which is kind of disappointing, since I was so keen to show my friend how these people could get physically aggressive. However the way the woman acted was a framed certificate of how a mentally unstable patient could be an adversity to our society.
And in a matter of 10 minutes, one can fully grasp the idea of why we need a solid system for psychiatric help to our people.