It was difficult to reconcile that the mild-mannered young man sitting across from me, neatly dressed and quietly spoken with downcast eyes, had just weeks earlier been in the grips of a severe manic episode.

Charlie*, 23, had been diagnosed with bipolar disorder after experiencing mania, followed by a bout of extreme depression. Charlie had always been the life of the party and revelled in his creativity and extroverted personality, but increasingly volatile behaviour had raised the concern of his family and friends. Charlie’s chatty nature later gave way to insensitive and crude comments, together with both online and in-person self-revelatory and self-aggrandising diatribes. His speech was faster and louder than usual, he would perseverate during conversations, and jokes became increasingly risque. He had little appetite and subsisted on a few hours of sleep. Risk-taking behaviour resulted in thousands of dollars’ worth of speeding and parking fines. He spent equally large amounts on gambling, cash donations to strangers and online shopping.

But what goes up must come down. Following the month-long manic episode, Charlie slumped into a period of severe depression. His low mood was compounded as the reality of his behaviour and its consequences slowly dawned on him. Charlie felt ashamed and embarrassed. He was particularly mortified by the hazy recollections of hostile interactions with family and........

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