I suffered my third bipolar – mixed state episode in seven months this past week, and it was and still is painful. Mixed states are nasty and disgusting things to myself and those around me. Those around me are usually the people I love the most. I lash out when I feel uncertainty to my “self” and that means at those closest to me because well… they have a close proximity to me. They are there during the most intimate settings where my “self” is exposed. Not if, when I go into mixed state condition, it will manifest itself in full force through me. My loved one’s presence and their reasoning with me perpetuate my mixed state. They reason with me because I look reasonable, but I’m not. I’m paranoid, irrational, and delusional which are psychotic characteristics with mania. I’ve been told it’s like being around a rattlesnake.
Bipolar presents in various ways. The common understanding is that a bipolar person’s mood will swing from an elevated state to depression or vice versa and are separate from each other. The least discussed and misunderstood state is known as a mixed state and considered the rattlesnake of the bipolar clan.
In mixed state, I become vicious and can verbally strike anyone near me that presents an uncertainty to my “self” if I am triggered by lack of routine, lack of sleep, alcohol, too many months in high level hypomania; and again, uncertainty to “self.” Medical literature defines mixed state as elevated state and depression occurring at the same time. The fact that it is close to simultaneous is hard to wrap your head around, but it is true.
The risk associated in this state is primarily to relationships. You teach people to walk on egg shells around you. You are at risk of hurting yourself emotionally, spiritually, and physically. You are at risk of hurting others emotionally with words that do irreparable damage to your relationships. The guilt and shame of the aftermath are overwhelming and cause you to experience a kind of shock. It is never the same. A more detrimental risk associated is the high risk for suicide. When a person experiences mixed state, they are having intrusive dysphoric, maybe suicidal thoughts and now have the energy to take action.
My normal state is neutral to positive, full of appreciation for family and friends. I’m funny. I’ve been an overachiever most of my life and try to be a kind and loving person. However, I exist primarily in a hypomanic state which means I am hypomanic more than normal state. It use to give me what is known as the hypomanic edge. My hypomania without depression does not have intrusive thoughts.
Low grade hypomania without depression is the dreamer of the clan. I view life in merriment and wonder. People and objects are effervescent and bright making everything more interesting. I describe this as, “shiny.” It makes life so wonderful. There is very little self doubt involved, and when done right, it is an absolute positive freedom of the mind. I am sexual. Racing thoughts do not occur during low grade. The risk involved is similar to most who are enjoying life. I consider risk but more outgoing than people without bipolar disorder; therefore, more exposed to doing risky things such as surfing or climbing. I’m “on.”
As hypomania increases it becomes middle grade hypomania without depression which is the child of the clan. I become self-centered and try to empathize and be a good listener but because of my self-centeredness these qualities start to wane. Good judgement starts to escape me. I become naive and gullible to the feelings and intentions of the adult world. I believe what I am told. I just do. My justification for my behavior and perceptions of disregarding adult ways is by believing the adult world is un-enchanted. I happily skip around them full of mirth. I am playful, flirtatious and more sexual. My ability to read social cues starts to loosen. Racing thoughts rarely occur. The risk to self increases because I am more outgoing and safety judgements are reduced. It is primarily about having fun, pushing it, and feeling exhilarated. I find all things fully fascinating. Ideas and problem solving skills seem to become enhanced. When I’m hovering in this mood, I call those with bipolar disorder – primarily hypomanics, “the cool kids.”
For me, high grade hypomania without depression is the philosopher King without a Kingdom of the clan. Now, I become interested in the un-enchanted adult world and want to change it through my wonderful ideas, philosophies and fearlessness. During this phase, I lose filter, and say what I think people need to hear to help them. Is she a helper, a lover, a parent, a friend, a controller, a sage, a leader, a caregiver? I am all these things. Still very self-centered and impatient because after all – I am the King. My patience and filter decrease, and my opinions and actions are abrupt. Flight of ideas occurs with the need to tell everyone my thoughts and pressurized speech picks up the pace. My ability to read social cues diminishes greatly. I experience expansiveness and lose more control of my behavior, my emotions, my reactions. My sexuality goes into overdrive. The risk to “self” increases as I become grandiose and uncaring about safety. My senses change and things like food lose flavor. My visual field seems larger and sharper. I described it to a friend as “it feels like my eyes are open real big.” My capability for complex understanding ideas and problem solving at work increases and I can work at a faster pace. I call high grade hypomania without depression being “Amped.”
Hypomanic existence is all well and good because at its best, I’m fun and exciting to be with, and at its worst, I am grandiose and hard to follow. Still, I am well intentioned. My perception of the world is skewed by positivity and grandiosity not negativity.
High grade hypomania is not to be confused with mania. The line between high grade hypomania and full mania is very wide. However, if depression sets in at this stage or is spurring it to occur then the line between the two becomes very thin and can vanish.
When the depression starts the hypomania stays and the two mix. Depression mixed with hypomania attaches intrusive, almost constant doubts and dysphoric thoughts to my hypomanic energy which amplifies the depression. The depression does not force me into isolation; worse, I have the energy to interact with people. It is here that the trouble begins for me and everyone who comes into contact with me.
The combined moods cause a mixed state which begins with irritability. If lucky, just stays as such. If in the wrong situation, depression can spur hypomania into full mania that can last one hour and enter acute mania for up to a week. I’ve received medical intervention by my doctor before I experienced full mania. Mania causes a disconnect from time and space until medication brings you out of the episode.
My risk to self greatly increases as the depression mixed with hypomania spurs it into mania; where, I experience paranoia and mild delusions of persecution and become unpredictable with my actions. At this point, risk to self is significant because I am terrified and can make a sudden decision and/or movement out of defense of my “self” by using harsh language. I have not been physical against anyone or myself. I believe that I am hopeless and worthless and can scream it loudly in order to gain your sympathy, compassion and love. My mind turns on the “self.” I stop sleeping and eating. For me, mania is a fully agitated, paranoid mixed state. It is the image of the frenetic and paranoid person.
Low grade mixed state can be fraught with intrusive criticism of self and others and complaining. Mid grade mixed state can be fraught with alcohol, drug use, and sexual escapades. High grade mixed state can involve a confrontational attitude, quick tempered arguing, paranoia and always the nasty verbal lash out to someone. It can escalate to even worse-mania- with verbal abuse of loved one where irreparable damage to the self and relationship occurs. My behavior is not always identifiable in such clear delineation and sequentially as provided, but it does normally happen this way–it is the rule for me at this point in my life. The exception to the rule are the grey areas between low, medium and high that bring out many unpredictable behaviors. When I start touching mania, the paranoia and delusions spur new types of thoughts and acting out.
All of my life, I could keep my hypomania in check with proper sleep, diet and exercise. However, my depression has become greater and more frequent and mixing with hypomania because bipolar disorder is a progressive disorder. Now, I require medication to prevent depression which stops mixed state and prevents me from going into mania and being hospitalized.
Depression hits in waves and then a Tsunami if I’m not carefully monitoring triggers. Last week was the Tsunami, and it emotionally and spiritually pummeled me and the man I love. He left me. So here I am, Saturday afternoon on the beach making sense of it all. My bipolar episode occurred because I refused my medication. It was the worst decision because I hurt him.
Due to increased depressive mood states that caused mixed state, I sought help from the mental health community and was clinically diagnosed in September 2015. Now, I’m back on a medication treatment plan in order to live a healthy and good life for myself and others. My goal in life is to be lovable, and I know deep down inside I will be. I’m going to live the life I deserve. All of it and with passion.