“At first, we did not think it was serious because we (thought) it was the stress of writing exams but we were wrong,” says Busi’s older sister Nelly. “Sometimes we would find her sitting alone laughing and singing.”

“When we got complaints that she was beating kids up without any reason we knew it was more serious than we thought,” she tells OurHealth.

Bipolar disorder causes extreme mood changes that include emotional highs, also known as mania or hypomania, as well as lows or depression, according to the US non-profit Mayo Clinic. The condition, which was formally called manic depression, can also feature psychotic episodes.

Although the causes of bipolar are still unknown, several factors are believed to play a role including genetics, brain chemicals and even pregnancy, according to the Australian Mental Health non-profit The Black Dog Institute, which has worked closely with the World Health Organisation on mental health advocacy.

According to the institute, for women who are already genetically or biologically predisposed to developing bipolar disorder, the period after child birth can coincide with a first episode of bipolar disorder.

Stigma keeps illness in the dark

Busi was put on treatment for bipolar. Her baby unfortunately died, but Busi soon became pregnant again. Nelly says the family is making sure that she adheres to treatment to control the symptoms but says communities like theirs in rural Mpumalanga need more mental health education.

“Before my sister was diagnosed with bipolar, people had already suggested causes of her illness,” Nelly said. “Some said she was bewitched (and) many suggested the family began seeking the help of a traditional healer, but this did not help even a bit.”

Fear of stigma led the Sibande family to decide that the father of Busi’s child must never know that she is living with bipolar.

Local nurse Siphiwe Nkosi says that many people do not understand mental illness. She said that quick access to treatment is crucial for people living with mental illness and that families should support family members in adhering to treatment to control symptoms.

*Names changed upon request

• Read more: Learning to love life with bipolar