Treatment for Bipolar Disorder is based on a menu of medications. They Are a diverse group from Lithium, antieliptics, antianxiety to antipsychotics. Depending on where you lie in the spectrum of your disorder, the med menu will change. You may be challenged with having to take a polypharmacy and manage the side effects of many pills or be on monotherapy and contend with much fewer side effects. I am one of the lucky ones because monotherapy has been successful for me.
My treatment was determined by the bipolar symptoms I told my psychiatrist. This is very difficult because, in my first visit, I could not remember all the key things to tell my doctor. I did display some pressurized speech so that was a clue that I was in acute mania…again. But this was my first visit so it was not definitive. Maybe I was a chatty person. The doctor did not know. Determining your mental illness is similar to a treasure hunt. The psychiatrist discusses your behaviors, looking for bipolar indicators, and determining where you exist in the spectrum. Do I exist in the spectrum? Or does the spectrum exist as a sliver in me? We only had one hour to figure this out because one thing was for certain-I was in an episode of some sort. I sat in the doctor’s office laughing, hyperactive, and certainly mentally ill. There, I said it…mentally ill. My initial diagnosis was Bipolar Disorder II but later on it changed to Bipolar Disorder I.
Did I behave a certain way because I was tired, stressed, anxious or because I was in a bipolar episode? Some behaviors are evident such as manic and depressed behavior, but they have to be witnessed by a medical team in an inpatient setting to be certain; otherwise, they are considered subjective. In the beginning, my mental health picture had not formed. So you start with the moving target, and if you do not get it right, you start a “chance” of a med. The next time, you now have to explain to your doctor why you behaved a certain way but on a psychiatric med. Layers start to form from the side effects.
Once you are prescribed your med, the waiting game of seeing which side effect will occur begins. Do you need another med to counter a side effect? You have to wait and see if the new med stops mania or if it pushes you into mania. Bipolar Disorder is push and pull of your mind. You can stabilize, but now you have to be on the look out for break through episodes of mania indicating the med did not work. All this while you are living your daily life, interacting with loved ones, and trying to keep your career from imploding. Exploding. Side winding. The name of the game is to hang on while snowboarding an avalanche. Hang on. With your eyes open. Hang on.
Treatment is not a sure bet in the beginning which caused me great unease. Some people in our community are treatment resistant which means the menu of meds does not treat the disorder. Mentally, I was not prepared for the reality of psychiatric meds because of the uncertainty but more importantly, I had this idea that meds were my last resort. What if they did not work? I still had a long life ahead of me. Initially, I thought I would need them in my twilight years. Just in case, you know? Because now, I am strong, young, and could handle this through pure willpower, but I was oh so wrong. I since learned that this thinking is backwards. In order to not be the crazy later on, I have to be on a med plan now.
The uncertainty of it all was disconcerting. I wanted to hold on to something that was a sure thing because I could no longer hang on to my foundation since it was crumbling. Cracks a mile long were forming. Mentally, I was hanging on a cliff and could feel my fingers slipping. Just hang on. I wanted certainty. For instance, I know I can take an aspirin for a headache, and the headache goes away. There is a definite cause effect that can be experienced. When I realized that my med was not a sure bet, I became scared and opted out the first time. I was not ready to contend with the “possibilities” of “might” getting well or more worrisome that my med would not work. I stopped Lithium cold, and two months later succumbed to another manic episode. This one was fast and furious. I remember each one sort of. There was the one in Salinas, which was a drug and alcohol fueled binge; the second one was a flashback of Iraq and my first psychotic episode; and the third one I call Utah, which was my second psychotic episode. I am a rapid cycler and like clock work, I experienced my third episode in nine months.
During Utah, I called my doctor and well..I was in Utah and refused to voluntarily admit myself to an Emergency Room so my treatment could not start until I returned home. I have a short story on Utah called, “The Poop Story and Other Tales of Love.” The good thing about Utah was that I displayed very distinct bipolar behaviors such as psychosis that gave us the ammunition to pick a more precise med. Initially, I was on Lithium, and although this is known as the gold standard, it was not for me. I felt…like…the sound you make when you place your tongue on the roof of your mouth and click it. That sound. For me, that sound was how Lithium felt on my mind. After I made the click sound with my tongue my doctor asked, “You mean you feel blunted?” Her training and experience was good because that was the word for it. Blunted. For me, blunted is the sound of your tongue clicking off the roof of your mouth. After this episode, my diagnosis changed from Bipolar Disorder II to Bipolar Disorder I with Psychotic Features.
I was prescribed an antipsychotic that has worked well for me. Up until today, I have been in denial and embarrassed that I have to take an antipsychotic. It is the word is it not? A med that clearly states that I can become psychotic. This is a tough pill to swallow. However, the antipsychotic is helping me by allowing me to be mentally free. It keeps me somewhat in hypomania which is where I want to be. I am more of my creative self then mania ever allowed me to be. My med also helps me manage my daily stressors, which I am not so good at anymore. Stressors mentally fatigue me in ways I never could imagine. I am on a new path in my journey. It use to be that I was a “mental mountain.” Now, I need help. Even though I am managing my disorder, my core being is changing. It has to change I think. Not so much outwardly that people might notice right away. Certainly, your thoughts change; therefore, be and then become happens. You become a new normal.
The good thing about meds is, when you get the right kind and dose, the effect isolates the mood disorder. This enables you to see the paths to managing a stable daily life. You can separate from the disorder. It helps you discern trigger effects on your mood and behavior. Enables you to develop stress release actions and form crisis plans. Also, they reduce the cycles of bipolar episodes and protect my beautiful, sweet brain, which I love so much. Meds can be effective. It is what I call my good, hard work. My goal is to swallow this pill and stay of healthy mind, peaceful, and loving of heart. For this, it is not such a tough pill to swallow.
Psychosis is a special word isn’t it? It certainly conjures up scary images of insanity. Like bipolar disorder, psychosis exists on a spectrum. I am either a little psychotic or a lot of psychotic. Either way, it is a definitive state that is disconnected from time and space; meaning, I have been disconnected from reality. I have experienced psychosis in two episodes–one last summer and another just last month. My clinical diagnosis is Bipolar Disorder Not Otherwise Specified (NOS) with Psychotic Features. (Read my first post titled, “Rattlesnake, Dreamer, Child and King”)
Being told I had psychotic features, sent me quickly into denial. I mean, basically telling me I had Bipolar Disorder for rest of my life was hard enough to handle, but to tell me I had psychotic features was another twist. Of my mind. The word itself “Psychotic” sounds well… like the center of all things insane. Bipolar Disorder is a mood disorder and psychosis is another realm of the mind. “Psychotic” each syllable sounds surgical and succinct. Like a drill. I have spent many nights researching the word Psychosis. Psychotic means having psychosis. Medline plus defines it as
“Psychosis occurs when a person loses contact with reality. The person may:
- Have false beliefs about what is taking place, or who one is (delusions).
- See or hear things that are not there (hallucinations).”1
What I learned is that psychosis occurs from a chemical imbalance in the brain and not from an internal disposition. Studies have shown cause and effect with an imbalance of dopamine and serotonin. That’s why anti-psychotics are used for it. They balance the dopamine and serotonin. Medication treatment is the only way to not experience psychosis. No herbal remedies, sleep, yoga or meditation can prevent psychosis from occurring. However, my psychosis is triggered from mania–I have to be in mania for psychosis to occur. I have not experienced it in the reverse order. All the stars have to be completely fucked up and misaligned.
So what does psychosis feel like? I can assure you that when I experienced it, I knew to be terrified by the disconnect from time and space. Terror becomes the basis for my irrational behavior. It swallows me up whole. Psychosis is an intruder. It is an invader that enters and quickly removes the ropes that keep me firmly tied to time and space–reality. I cannot tell when it starts happening because the ropes are released all at once. All this while I’m in the throes of mania.
At the time, I am not able to say, “okay, I need to chill cause I’ve disconnected from time and space” and then go lie down or stay quiet. However, as I lose grasp, I will scream at you “What is real?” or “Is this real?” or ask if what you are doing “Is it real?” The first psychotic episode this past summer, I thought I was back in Iraq and thought it was 2008; but really, I was laying on my carpet in the middle of my living room and crying. These behaviors are my cry for help and indicators that the ropes have unraveled. I am in great distress as it happens.
I have not experienced auditory or visual hallucinations or maybe I did and that is why I believed I was in Iraq. I am not quiet sure because I cannot remember. My manic response to the delusions in psychosis is paranoia. The two start working together to assault my understanding of my “self.” My being. My identity. The worst part is that they play off each other like dominoes slamming down next to each other. I think I know I have lost a grip with reality and that explains why I am terrified. I must feel like there is nothing to hold on to but not for certain because I cannot remember. I cannot stop it and probably feel like I’ve fallen into worse than an abyss–an unknown.
Each episode ended because my good friend was there to somehow help me out of it. In a psychotic mania, I can be dark, abusive, delusional and irrational. I have not been physically violent and have not felt an inclination for it.
The second time, he was a godsend at at our expense, but his presence and words also perpetuated it too. Anyone’s presence and help would perpetuate it. It gets tricky to help me. During this episode, he gently took my hand, and my psychosis ended in the snap of a finger. Like the ropes instantly tied me back to reality again. I have come out of each episode not understanding what I’ve just said or done. Out of sorts. Confused. Tired. Later on, I had flashbacks of what happened during the psychosis, and that is how I start to remember these episodes and a little of how I felt–through flashbacks.
The first time I think I was in psychosis for less than an hour, but the second time I was in psychosis for one hour. After each episode, as I sifted through the insanity of what I said or felt, there can be no doubt that I felt terrified. Mania with psychotic feature is an assault of the mind on the “self.” On my beautiful, hypomanic, joyful self.
Recently, I wrote a short story titled, “The Shower Screams” and then I translated it into Spanish, “Los Gritos de la Ducha.” Initially, I translated the story for my friend’s mother who lives with bipolar disorder. My good friend confides in me about his mother’s behavior that she has presented him throughout his life. Some of it hilarious because his stories are told with such love and animation. Other stories are not so funny because well…. they are about her struggles and his struggles with it. Their struggles and love for each other tugged at my heart.
I felt at ease telling him about my disorder in order to give him insight, and how I somewhat understood his mother. Bipolar is the same spectrum yet different for each of us. Differing in time and space, name and face. His mom only speaks and understands Spanish, so I offered him a Spanish translation of my feelings, sometimes, when I have to take a shower. I want her to know that those of us with this disorder share these moods and energies that make us hilarious or make us despair and never forget those around us who care for us and their struggle. But we can all agree that major depression, mixed state, and mania can make us forget all too real.
I wanted her to know that she wasn’t alone with this disorder. There is me along with my Rattlesnake, Dreamer, Child and King, the we, and all of us. In some respects, when we not in the throes of the disorder, we are not that different at all. We share our ideas, dreams, and feelings that are universal. Of course, there are the parts with the disorder that we all know, too well, that sets us apart. In some cases, WAY apart.
Just two months ago, my neighbor’s (also a friend) mother was taken from his apartment in the middle of her paranoid delusional mania. She was rolled away on an ambulance stretcher out of his apartment and into the ambulance. I heard her defiance and without thinking sort of hunched over and covered my ears. She didn’t see me. Noone did.
Through it all, we want to live, love, and laugh like everyone else. Keep your chin up.
During my last manic episode, I was in another city for a business training event. A 5-day long business training event. My mania had started on a Thursday evening, I left for the business trip on Sunday morning out of LAX. Why did I go? Wasn’t I in mania? Yes, I was but not a complete breakdown. I had experienced the complete breakdown with loss of time and space-known as psychosis-on Friday morning and emotionally hurt someone very dear. I recklessly tossed my meds out the window a few months earlier which is how I ended up in this situation.
During the weekend, I was in what is called acute mania. Not like the one you think of from TV where the person is frantic, screaming or doing full paint body art on the walls with their bodies or being hospitalized. However, my moods and energy were quickly over days becoming more manic. I was gradually being swallowed hole. Ultimately, I would have ended up in the hospital had it not been for The Poop Story and Other Tales of Love.
During the weekend before my trip, I was home where I live on my own. The following day after my psychotic episode, I puttered around my home and kept busy. I laid in bed for 4 hours and tried to read, but I couldn’t because I couldn’t focus on the words or thoughts of the authors. I tried magazines but focus eluded me. It feels like the words and pictures stop right at my eyes but are denied entry by my mind. For some reason, in acute mania, the mind only wants to consider things from within. I ended up laying in bed, staring at the ceiling and the walls. It’s a nice feeling by the way. It’s not like I’m laying there getting pummeled by thoughts. My thoughts can be intrusive but not consistently. They become worrisome when the negative ones start to have their way. The rest of the day just passed, but I didn’t go to sleep or eat. 24 hours.
I finally made the trip to Utah to attend my business training event while I was in acute mania. I felt agitated, helpless, hyper and exhausted from a mental marathon but still maintained my grip on time and space. The rest of the day just passed, but I didn’t go to sleep and only drank coffee, water and 400 calories of snacks. 48 hours.
I attended my first day and appeared presentable. However, during an initial professional discussion with my new group, I spoke with confidence, but what I said did not make sense. It happened to the first man I spoke to. I saw the perplexed look on his face so I stopped talking. Then I tried again to the man next to him, but I spoke in an expansive manner. A few sentences of gibberish pushed out of my lips. He too looked perplexed. I stopped and realized that I was using the lexicon, but my expansiveness was making my reasoning loosely related to what we were discussing; thus, making me unintelligible. I was able to casually laugh, and said I was kidding. They relaxed, and I sat there feeling like I was being defeated. This disorder. This thing.
I went to my hotel room and laid in bed and stared at the ceiling and walls. As evening fell, I started crying and became incredibly agitated and felt lost. I was slowly losing my grip on time and space which meant I was becoming psychotic. I could tell because of my agitation and also my intrusive thoughts were increasingly involving thoughts of persecution and paranoia. I hadn’t slept and ate 800 calories in 60 hours. So I called my best friend and cried for her to help me. She recommended I take a Benadryl to knock me out, but I wouldn’t drive to the store to buy it. Because, who knows what I would do if I drove off in a car at this moment in the night. It was 10 degrees fahrenheit outside. So I stayed safely in place. I was still able to make safe judgement calls. It truly is a battle within the mind. One mood allowing me to remain planted firmly holding on to safety, and the manic mood tugging, pulling, pushing for the other to fall over and make way.
My best friend and I knew that I hadn’t slept for 60 hours, and we both knew without speaking what that meant. That I had to sleep. If I didn’t……..That mania would take total control and then what would happen to me? So she told me to get in bed because she was going to talk me through the night to put me to sleep. She said she would talk to me for however long it would take–hours, days, years–until I fell asleep. What ever it took. So I turned out the lights and got in bed. I laid my head down and covered up. In the dark, I heard her say. “okay…..where should I start?……Would you like to hear a poop story?” I smiled and we laughed.
She and I have been best friends over 30 years, and we have this thing where we share stories of our and others’ poop. I don’t know when we started it, but it was because she use to talk about her poop to make me uncomfortable when I was much younger. As time passed over the years, I joined her in her game. Our poop stories.
Through the night, she told me our tales of young and old. Our tales of bright and dark. Our tales of come and go. Our tales of love.
I fell asleep.
I have to adhere to a strict grooming schedule since I tend to not shower if my mood is a certain way. So here I go, first thing in the morning…. I stay in bed….. and speculate my strategy into the shower. I stare at the ceiling and shudder at my fate. My fate of surrendering to the feeling and sound of the shower. Of the me, standing there in the center of it. The sound of the shower screaming on my skin.
The sound of the shower starts off slicing through the silence of the morning. The steam from the shower stuns my face as I stare into the tub. Into the space, into the stall, into the steam, and into the shower here I fall. Sniveling sounds escape from my lips as the water swallows me into pieces. Water sputtering and stacatto-ing and sinking into my sensitive skin. Streaking in cacophonous sounds that are swift and shrill. Each drop steering itself down scrutinizing my surface, stealing glances from the precipice that is my head to my toes as they descend to the drain. Strain.
I’m being treated for acute mania until I start the next phase of treatment in 2 weeks. Yes that right, I’ll be in acute mania for awhile. The online medical dictionary defines Mania as
“a period of predominantly elevated, expansive, or irritable mood accompanied by some of the following symptoms: inflated self-esteem, decreased need for sleep, talkativeness, flight of ideas, distractibility, hyperactivity, hypersexuality, and recklessness.”
I agree with most of that definition; however, I don’t agree with the “irritable” part being any part of the word “mania.” Based on personal experience, anytime I experience irritability, it’s because I’m experiencing mixed state which means depression is mixing with the hypomania or mania.
Hypomania and acute Mania have so many levels and are elevated and expansive. A primarily positive outlook. More positive outlook than people without bipolar disorder. Let’s say the definition supports the rule. I am the exception, and I suspect a lot of other people are too. I support the medical community and their guidance, but we have to stay vigilant and help them help us. I wish the medical community dissected mental health like they dissected cells and atoms, our treatment options would improve. In my opinion, A person who has the bipolar disorder is a complex system but tends to be generalized.
Back to my acute mania. This should subside next week on my current medication and then on to maintenance therapy. After my 5 day depression and low hypomania passed on Sunday, I had to go back to work. Yes, an actual job with a lot of people and lots to do. Thankfully, I had the mental strength and fortitude to get this done because I WILL myself.
In this blog post, I want to add another understanding of acute mania in addition to the definition above. Mania is serious, but the bipolar disorder is a multidimensional disorder. Mental health is on a spectrum. Health is on a spectrum as are love and life. Stop stigmatizing me. I got a life to live and passions to fan.
When I experience acute mania without depression, it feels like the moods interchange with high level hypomania so I’m still unsure of it but not all things can be completely categorized either – a physical sensation occurs and everything in my visual field appear sharper and the colors more intense. My taste buds lose sense so I won’t eat that much because food taste stale like crackers. Even meat taste like stale crackers. My caloric intake drops between 400 – 800 a day. My skin becomes very sensitive, and I do not like to shower because the part exposed to air feels …. unpleasant (read my post “The Shower Screams”). That’s the only way I can describe it. It not prickly, or cold or anything like that. It indescribable. The sensation of the water on my skin is overwhelming, and I whimper like a little girl in the shower. During these manic times, I use to not shower a lot, but now, I stick to a strict grooming schedule. My skin is sensitive, and I’m hypersexual. Just rubbing any part of my body feels pleasant except for shower water.
Music sounds incredibly vibrant and more sweet sounding, but I tend to loop music more if I find a sound pleasurable because a variety of musical sounds is too something. Silence is soothing. Television becomes incredibly uninteresting. I can still read for pleasure. I can read music and strum my guitar but I can’t learn new music. My creative writing flows, and I’ve written this entire blog in acute mania. Yet, technical writing becomes more difficult. However, my drawing creativity doesn’t spike like when I’m in hypomania because acute mania seems more distracting. In this state, I’m not delusional or paranoid. Negative thoughts do not plague me and what I say is based on true “self”, a shared reality, is meaningful and true.
I suspect if I was forced to eat, take a lot of showers, listen to all sorts of music, watch TV or technically write against my will then perhaps I would be irritable. However, people who act against their will would also be irritable. I will tolerate things I’m not comfortable with; for instance, if I have to attend a luncheon, I’ll eat but it won’t be pleasurable. There are nuances like there are with all things in life.
While at work, I felt elated and stable like after a really good exercise work out. Mentally, I’m zooming high. I’m in a very good mood with the benefits of confidence and humor. I have a nervous energy, but not because I’m nervous in a scared way. Just more hyped. At lunch, I felt giddy and my taste buds started to work again, and I ate potato chips that tasted sumptuous. Since I don’t have intrusive thoughts unless I’m in mixed state, I’m able to take care of business at hand. I do have to focus my attention more and slow myself down, but since I know I’m in an acute manic state, I pick the type of work that I will succeed at. It difficult to do work such as giving a presentation because I can go off on a tangent or act inappropriately, silly, and display mirth. A colleague from Washington, DC was in the office and when we saw each other he extended his arms, and I gave him a bear hug bigger than I think everyone expected in front of everyone. LOL. Oh boy.
In conclusion, a person experiencing acute mania without depression can also function at work and not be reckless. But, the issue with bipolar is you can lose dramatic control of your moods and behavior and can become reckless (read Rattlesnake, Dreamer, Child and King). I trust myself at this point at work if I’m not in mixed state, but I have to remain vigilant because overtime my defenses weaken. This is why I have to take medication because bipolar disorder is progressive. I was able to experience acute mania at work because I stopped taking my medication and sailed into another bipolar episode (read The Poop Story and Other Tales of Love). This post is valuable because I can share with you this experience. Now that I’m back on meds, I will not experience acute mania at work again.
My bipolar diagnosis scared me because it meant I was not in control of my mind. I was told that only medication could stabilize me and prevent cycling into another mixed state episode. The basics were discussed such as no alcohol, caffeine and a regulated sleep schedule. Apparently, sleep plays a significant role in bipolar cycles. The sleep schedule seemed doable but no alcohol? I was a hypomanic party girl after all. How do I change this part of me that was so cherished and prominent.
To others, it sounds simple-stop partying. Not so easy. I was raised by a hypomanic party father. Partying is not just drinking, it is a lifestyle, a frame of mind and a kind of social group you pick to be around. This was my identity. If I’m not in this lifestyle, then what other lifestyle is there? The non party lifestyle I suppose, but I have seen that, and it seems so unappealing.
My first medication treatment kept my mood and energy even during the first month; yet, I started to become uncomfortable at the thought of my moods and energy being unnatural. If my moods and energy are unnatural then is my self unnatural too? This question plagued me. The doctor recommended that I mourn hypomanic party girl through the 5 stages of grief: Denial, Anger, Bargaining, Depression and Acceptance. Acceptance? Acceptance and then what? To become what? Fear of the unknown set in.
The first time I didn’t make it through bargaining. I bargained my medication away and decided that if I just stayed clear of all the triggers and slept well then I would be fine. No cycling could possibly occur. I would stay in my zone. Mental health problem cured.
I started monitoring my mood on a mood app and journalizing, sleeping well, taking supplements and abstaining from alcohol. But the old lifestyle return. One drink here and there. It’s all good, right? The one thing I can’t control are my business travels and here became my downfall. Lack of sleep and now in Washington, DC and a willing to drink my sworn enemy: red wine. It quicklyunraveled from there. I fell into a full mixed state and hurt someone very dear to me.
I stayed awake and only drank coffee for 60 hours and became exhausted. However, bipolar people are not weak. We still can maintain an inner mental strength. We have to right? It not easy being hypomanic bipolar. My mental strength got me through once again. I successfully finished an important business conference and was able to interact in a stable manner with those around me. Even in the middle of this depression and kiss goodbye to hypomanic party girl, the intensity of my love for my life remained.
I went out with my business group and of course hypomanic party girl still wanted to play through the tears. Since I was intermittently crying throughout the day, my black eyeliner was smeared around my eyes, lipstick applied sloppily, and my hair disheveled. I looked like a beautiful wreck. One of the men came on to me hard because some men can smell and see crazy, and they like it. It made me feel so good that for a second I thought about sleeping with him. To just feel someone against me and escape my tragedy. Because I knew I was going home to no one after what I had done to my friend during the last episode. I backed down and excused myself politely.
Because I forced my hand, I was done bargaining and entered depression for 5 days over my last episode and this entire diagnosis. Through the week, I cried and ruminated about my life. My life flashed before me. I remembered myself from little girl up until present and thought of all the people I loved, and hurt, all my adventures and experiences. I tried to soak them in and focused on seeing my face in all these memories and looked at myself from afar. How beautiful and kind I was and am. Images of me laughing, smiling and all the good with the bad. My guilt and shame for the hurt I had caused had no depth or darkness because the pain I caused others is not and will never be lost on me. If I could take all their pain away from what I did or said, I would. It was a long week of self reflection and this blog is the acceptance. When I returned home, I couldn’t wait to get on medication. I no longer have a fear of the unknown future because the unknown future is here, now.
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.