2006 Supreme(Kar) 925

Karnataka High Court
NALINI KUMARI - Appellant
Versus
K.S.BOPAIAH - Respondent
Decided On : 11-24-06
Miscellaneous First Appeal No. 1797 of 2000,Miscellaneous First Appeal Nos. 1798 and 1799 of 2000 (FC and G and WC).

Headnote:Marriage and Divorce - Bipolar disorder - Scientific explanation of - If curable - Whether a ground for seeking divorce. [H.L. Dattu and N. Ananda, JJ.]: In National Institute of Mental Health Publication No. 3679, it is stated: Introduction: Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person s mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide. But bipolar disorder can be treated, and people with this illness can lead full and productive lives. What is the Course of Bipolar Disorder? Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment. The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When four or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men. People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated (see below - "How is Bipolar Disorder Treated"). Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared. But in most cases, proper treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain good quality of life. In Health & Medical Information in Psychiatry (Australia s Central Health & Medical Information Resource), it is stated: Bipolar Affective Disorder (BPAD) is a psychological disease. This condition is characterised by alternating syndromes of depression and mania. Depression is a psychiatric syndrome characterised by a subjective feeling of depression, loss of enjoyment in all activities and overwhelming feelings of guilt and worthlessness. Mania represents the opposite end of the spectrum characterised by erratic and disinhibiter, behaviour, poor tolerance or frustration, over-extension of responsibility and vegetative signs. These include raised libido, weight loss with anorexia, decreased need for sleep and excessive energy. Incidence: The prevalence is 1% worldwide. It is equally common in men and women. There is no variation between socioeconomic class or race. The average age of onset is 21. The increased frequency found in divorced people is probably a consequence of the condition. Predisposing Factors: The most significant risk factor for the development of BPAD is a family history of either BPAD or depression. Natural History: The condition of bipolar usually begins between the ages of 30 to 40 years old. There are two types of bipolar affective disorder - Type I and type II. In type I BPAD, patients will meet the criteria for a full manic episode but may never experience an episode of major depression, type II BPAD, the patient will fulfil the criteria for a major depressive episode but will never experience a full manic episode. They may experience a less form of mania called hypomania. The patient in an episode of major depression is at increased risk of self-harm and suicidal behaviour and must be monitored closely for risk factors. The duration of depressive episode varies but usually lasts for approximately six months if left untreated. In the majority of cases, the patient experiencing an episode of mania will generally refrain from self-harm behaviour. They will, however, place their finances and social life at risk by indulging in wreckless behaviour. These episodes again last for around 3-6 months if left untreated by medication. The patient with type I BPAD will typically experience 10 episodes of mania throughout their lives. Prognosis: The average duration of a manic episode is 3-6 months with 95% making a full recovery in time. Recurrence is the rule is bipolar disorders, with up to 90% relapsing within 10 years. In terms of overall prognosis, 15% completely recover from the illness. 50-60% partially recover and one third will retain chronic symptoms resulting in social and occupational dysfunction. Investigation: Patients should be screened for thyroid function and can produce hypothyroidism. During treatment, lithium levels should be checked for 3 months, along with regular thyroid and renal function rents. Treatment Overview: The primary treatment for BPAD involves long-term daily medications. The most commonly used drug in the initial management of BPAD is lithium. The drug takes about 2 weeks to take effect and is effective in stabilising the patient s mood. Other drugs such as valproate and tegretol are more commonly used in the long term to help prevent the recurrence of mania and depression in patients with BPAD. They may also be combined with lithium for greater effect, if one agent proves inadequate to control the symptoms. Psychotherapy is also helpful in the management of BPAD Group therapy, family therapy and individual psychotherapy have been shown to improve the outcome of this condition when combined with the regular use of medications. 22. In Wikipedia, the free encyclopedia, it is stated: Bipolar disorder (previously known as Manic Depression) is a psychiatric diagnostic category describing a class of mood disorders in which the person experiences clinical depression and/or mania, hypomania, and/or mixed stated. The disorder can cause great distress among those afflicted and those living with them. Bipolar disorder can be a disabling condition, with a higher-than-average risk of death through suicide. The difference between bipolar disorder and unipoloar disorder (also called major depression) is that bipolar disorder involves both elevated and depressive mood states. The duration and intensity of mood states varies widely among people with the illness. Fluctuating from one mood state to the next is called "cycling". Mood swings can cause impairment or improved functioning depending on their direction (up or down) and severity (mild to severe). There can be change in one s energy level, sleep pattern, activity level, social rhythms and cognitive functioning. Some people may have difficulty functioning during these times. Domains of the bipolar spectrum: Bipolar disorder is often a life-long condition that must be carefully managed. Because there is so much variation in severity and nature of mood problems, it is increasingly being called bipolar spectrum disorder. The spectrum concept refers to subtypes of bipolar disorder or a continuant of mood problems, that can include sub-syndromal (below the symptom threshold for categorical diagnosis) symptoms. Nassir Ghaemi, M.D., has also contributed to the development of a bipolar spectrum questionnaire. The full bipolar spectrum includes all states or phases of the bipolar disorders. Kraepelin s (1921) construct is useful for primary care clinicians, patients and families. It describes variations in two directions (mania and depression) and of three aspects: mood, activity and thinking. Bipolar depression: According to the Mayo Clinic, in the depressive phase, signs and symptoms include: persistent feelings of sadness, anxiety, guilt, anger, isolation and/or hopelessness, disturbances in sleep and appetite, fatigue and loss of interest in daily activities, problems concentrating, irritability, chronic pain without a known cause, recurring thoughts of suicide. A 2003 study by Robert Hirschfeld, M.D., of the University of Texas Medical Branch, Galveston found bipolar patients fared worse in their depressions than unipolar patients. In terms of disability, lost years of productivity, and potential for suicide, bipolar depression, which is different (in terms of treatment), from unipolar depression, is now recognized as the most insidious aspect of the illness. Severe depression may be accompanied by symptoms of psychosis. These symptoms include hallucinations (hearing, seeing or otherwise sensing the presence of stimuli that are not there) and delusions (false personal beliefs that are not subject to reason or contradictory evidence and are not explained by a person s cultural concepts). They may also suffer from paranoid thoughts of being persecuted or monitored by some powerful entity such as the government or a hostile force or become paranoid that they ll be abandoned and left by those close to them. Intense and unusual religious beliefs may also be present, such as patients strong insistence that they have a God-given role to play in the world, a great and historic mission to accomplish, or even that they possess supernatural powers. Delusions in a depression may be far more distressing, sometimes taking the form of intense guilt for supposed wrongs that the patient believes he or she has inflicted on your others. There are a number of conflicting theories on what can be considered the cause of bipolar depression, and what may be a symptom, none of which are yet widely accepted as correct. It is crucially important to understand that there is no blood test or brain scan that expresses distinctly that this disorder exists. Diagnosis: Diagnostic criteria: Flux is the fundamental nature of bipolar disorder. Both within and between individuals with the illness, energy, mood, thought, sleep, and activity are among the continually changing biological markers of the disorder. The diagnostic subtypes of bipolar disorder are thus static descriptions - snapshots, perhaps - of an illness in continual change. Individuals may stay in one subtype, or change into another, over the course of their illness. The DSMV, to be published in 2011, will likely include further and more accurate sub-typing (Akiskal and Ghaemi, 2006). There are currently four types of bipolar illness. The DSM-IV-TR details four categories of bipolar disorder, Bipolar I, Bipolar II, Cyclothymia, and Bipolar Disorder NOS (Not Otherwise Specified). According to the DSM-IV-TR, a diagnosis of Bipolar I disorder requires one or more manic or mixed episodes. A depressive episode is not required for a diagnosis of BP I disorder, although the overwhelming majority of people with BP I suffer from them as well. Bipolar II, the more common but by no means less severe type of the disorder, is usually characterized by one or more episodes of hypomania and one or more severe depressions. A diagnosis of bipolar II disorder requires only one hypomanic episode. This stipulation is used mainly to differentiate it from unipolar depression. Although a patient may be depressed, it is very important to find out from the patient or the patient s family or friends if hypomania has ever been present, using careful questioning. This, again, avoids the antidepressant problem. Recent screening tools such as the Hypomanic Check List Questionnaire (HCL-32) have been developed to assist the quite often difficult detection of Bipolar II disorders. A diagnosis of Cyclothymic Disorder requires the presence of numerous hypomanic episodes, intermingled with depressive episodes that do not meet full criteria for major depressive episodes. The main idea here is that there is a low-grade cycling of mood which appears to the observer as a personality trait, but interferes with functioning. If an individual clearly seems to be suffering from some type of bipolar disorder but does not meet the criteria for one of the subtypes above, he or she receives a diagnosis of Bipolar Disorder NOS (Not Otherwise Specified). Misdiagnosis: There are many problems with symptom accuracy, relevance, and reliability in making a diagnosis of bipolar disorder using the DSM-IV-TR. These problems all too often lead to misdiagnosis. Infact, University of California at San Diego s Hagop Akiskal M.D., believes that the way the bipolar disorders in the DSM are conceptualized and presented routinely lead many primary care doctors and mental health professionals to misdiagnose bipolar patients with unipolar depression, when a careful history from patient, family, and/or friends would yield the correct diagnosis. If misdiagnosed with depression, patients are usually prescribed antidepressants, and the person with bipolar depression can become agitated, angry, hostile, suicidal, and even homicidal (these are all symptoms of hypomania, mania, and mixed states). Treatment: Currently, bipolar disorder cannot be cured, though psychiatrists and psychologists believe that it can be managed. The emphasis of treatment is on effective management of the long-term course of the illness, which usually involves treatment of emergent symptoms. Treatment methods include pharmacological and psychotherapeutic techniques. Leading bipolar specialist, Gillian Townley, has researched the effect of the Ferret Rabbit process. Prognosis and the goals of long-term treatment: A good prognosis results from good treatment which, in turn, results, from an accurate diagnosis. Because bipolar disorder continues to have a high rate of both under-diagnosis and misdiagnosis, it is often difficult for individuals with the illness to receive timely and competent treatment. Bipolar disorder is a severely disabling medical condition. In fact, it is the 6th leading cause of disability in the world, according to the World Health Organization. However, with appropriate treatment, many individuals with bipolar disorder can live full and satisfying lives. Persons with bipolar disorder are likely to have periods of normal or near normal functioning between episodes. Ultimately one s prognosis depends on many factors, which are, infact, under the individual s control; the right medicines; the right does of each; a very informed patient; a good working relationship with a competent medical doctor; a competent, supportive and warm therapist; a supportive family or significant other; and a balanced lifestyle including a regulated stress level, regular exercise and regular sleep and wake times. There are obviously other factors that lead to a good prognosis, as well, such as being very aware of small changes in one s energy, mood, sleep and eating behaviors, as well as having a plan in conjunction with one s doctor for how to manage subtle changes that might indicate the beginning of a mood swing. Some people find that keeping a log of their moods can help them in predicting changes. The goals of long-term optimal treatment are to help the individual achieve the highest level of functioning while avoiding lapse. The following is a quote from a successfully treated individual with bipolar disorder (from the U.S. National Institute of Mental Health): Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness which is biological yet looks and feels psychological, one that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide. I am fortunate that I have not died from my illness, fortunate in having received the best medical care available, and fortunate of having the friends, colleagues, and family that I do. Bipolar disorder and creativity: Bipolar disorder is found in disproportionate numbers in people with creative talent such as artists, musicians, authors, performers, poets and scientists, and some credit the condition for their creativity. Many famous historical figures gifted with creative talents commonly are believed to have been affected by bipolar disorder, and were "diagnosed" after their deaths based on letters, correspondence, contemporaneous accounts, or other material. It has been speculated that the mechanisms, which cause the disorder may also spur creativity. Kay Redfield Jamison, who herself has bipolar disorder and is considered a leading expert on the disease, has written several books that explore this idea, including Touched with Fire. Research indicates that while mania may contribute to creativity (See Andreasen, 1988), hypomanic phases experienced in bipolar I, II, and in cyclothymia appear to have the greatest contribution in creativity (See Richarges, 1988). This is perhaps due to the distress and impairment associated with full-blown mania, which may be preceded by symptoms of hypomania (i.e. increased energy, confidence, activity), but soon spirals into a state much too debilitating to allow creative endeavour. Hypomanic phases of the illness allow for heightened concentration on activities, and the manic phases allow for around-the-clock work with minimal need for sleep. Another theory is that the rapid thinking associated with mania generates a higher volume of ideas and as well associations drawn between a wide range of seemingly unrelated information. The increased energy also allows for grater volume of production. The research made and published in the National Institute of Mental Health Publication gives out a positive hope that the bipolar disorder can be treated and people with this illness can lead full and productive lives. People with bipolar disorder can lead healthy and productive lives when the illness was effectively treated. The duration of depressive episode varies but usually lasts for approximately six months if left untreated by medication. The average duration of manic episode is 3-6 months with 95% making a full recovery in time. Recurrence is the rule in bipolar disorders, with up-to 90% relapsing within 10 years. In terms of over all prognosis, 15% completely recover from illness. 50-60% partially recovers and one-third will retain chronic symptoms resulting in social and occupational dysfunction.

       Matrimonial Causes - Consent Divorce - Petition filed before completion of one year form date of marriage - Exemption sought - Refusal - If proper.

       Words and Phrases - Fraud - Means deceit.

       Applied Psychology - Bipolar disorder - Meaning - Scientific analysis - Whether curable. See, Marriage and Divorce.

       Hindu Marriage Act, 1955 - Section 12(1)(c) - Bipolar disorder - concealment of - If amounts to fraud. [H.L. Dattu and N. Ananda, JJ.]: Considering the evidence on record and particularly, the testimony of the two Doctors, who had been examined as P.W. 2 and P.W.3, we have no hesitation in holding, that the respondent/wife had been treated for bipolar disease and she was completely cured of the same much earlier to the marriage solemnised between the petitioner and the respondent. We are therefore, of the opinion, that non-disclosure or concealment of a disease which was cured much earlier to the marriage does not amount to fraud within the meaning of the word used in Section 12(1)(c) of the Hindu Marriage Act, 1955.

       Hindu Marriage Act, 1955 - Section 12(1)(c) - Fraud - Meaning and scope of the word - When a concealment amounts to. [H.L. Dattu and N. Ananda, JJ.]: The test in this type of cases should be, whether the disease is of such nature that concealment of the disease would constitute a fraud relating to a material fact or circumstance concerning the respondent within the meaning of Section 12(1)(c) of the Act. The bipolar disease may not be curable disease, but is controllable and treatable disease by regular medication and is not such a disease, which would effect a person from leading a married life. We hasten to add, that concealment or misrepresentation of diseases of serious nature/incurable disease may be enough for annulment of marriage on the ground of fraud. The word fraud used in Section 12(1)(c) of the Hindu Marriage Act does not speak of fraud in any general way, nor does it mean every misrepresentation or concealment, which may be fraudulent, but fraud as to the nature of ceremony or as to material fact or circumstance concerning the respondent. Fraud according to Chambers Dictionary means, "deceit". Thus, in case where the consent to the marriage has been obtained by deception, it was liable to be annulled under Section 12(1)(c) of the Act, before the amendment of Clause (c) of Section 12(1) of the Act, and insertion of the words "as to the nature of the ceremony or as to any material fact concerning the respondent". Thus, after the amendment of Clause (c) of Section 12(1) of the Act by Marriage Laws (Amendment) Act, 1976, the emphasis cannot be laid only regarding the nature of the ceremony or factum of marriage, but, in case there is deception as to any material fact or circumstances concerning the respondent, the said case would also be covered by Sub-clause (c) of Section 12(1) of the Act.

       Hindu Marriage Act, 1955 - Section 12(2) - Petition for annulling marriage - If filed a ground of force or fraud - Conditions. [H.L. Dattu and N. Ananda, JJ.]: Under Section 12(2) of the Act, a petition to annul a marriage on the ground of force or fraud has to be filed within one year after the force had ceased to operate or as the case may be, the fraud has been discovered. The second condition for the maintainability of the petition is, that the petitioner has not, with his or her full consent lived with the other party to the marriage as husband and wife after the force had ceased to operate or as the case may be, the fraud has been discovered.

       Hindu Marriage Act, 1955 - Section 12(2)(b)(ii) - Divorce petition - Time prescribed for preferring of - Marriage taking place in 1992 - Some ailmant alleged against wife - Husband coming to know about in 1993 - Choosing to cohabit inspite of - Hence, it is filed beyond time prescribed inspite of coming to know about ailment earlier and that a fraud was played on him as the said ailment was pre-existing, he over looked the same - Held, he said to have lived with full content - Petition requires to be rejected. [H.L. Dattu and N. Ananda, JJ.]: The condition laid down in Sub-section (2)(b)(ii) of Section 12 of the Act that the petition must be filed within one year as prescribed is absolute and a petition will not lie under this clause after that period has lapsed, even if fraud had been practised on the petitioner as to any material fact or circumstances concerning the respondent. The Sub-section does not prescribe a period of limitation but creates a statutory bar to the entertainment of the petition. The narration of facts and the dates by us in the course of the order would amply demonstrate, that the petitioner was fully aware of the ailment suffered by the respondent-wife some time in the year 1993 itself but choose to cohabit with the respondent till 1996 and it is only on 26.6.1996, has filed a petition under Section 12(1)(c) of the Act. The petition so filed is beyond the period prescribed under the Act. Secondly, petitioner with his full consent lived with the respondent as her husband. If the husband or the wife as the case may be, overlooks the alleged fraud and condones it, with the result there is reconciliation, the petitioner can be said to have lived with full consent with the respondent. The evidence shows that the petitioner after the alleged fraud was discovered, lived together for nearly three years from the date of the solemnisation of the marriage as husband and wife with full consent. Therefore, this ground was also sufficient for not entertaining the petition for annulling the marriage. Therefore, on these two grounds, petition filed by the petitioner requires to be rejected.