So onto the main bit of these posts: bipolar, what it is and almost as important, what it isn’t.
Let’s start with some definitions, cause who doesn’t love those:
“Bipolar disorder, formerly known as manic depression, is a condition that affects your moods, which can swing from one extreme to another. If you have bipolar disorder, you will have periods or episodes of:
- Depression – where you feel very low and lethargic.
- Mania – where you feel very high and overactive (less severe mania is known as hypomania).”
This is taken directly from the NHS page so you’d expect it to be pretty accurate.
And yes, you do have to display episodes of depression and mania to a psychiatrist in order to be formally diagnosed (which is part of the reason diagnosis takes so long; you very rarely go to your appointments when you’re manic because hell, you’re not sick, you’re better than fine, you’re amazing, the most healthy person! Only sick people go to psychiatrists etc etc). So often your psych will only see the depressed or possibly mixed states (I’ll explain that last part later). Which means you just get antidepressants and gosh, just giving antidepressants to bipolar people gets an interesting reaction, as it often send them straight to manic. Not good but it’s often the fastest way to be diagnosed, aside from having an extreme episode of mania where you end up in hospital. For full disclosure, I went the former route. My psych saw me in depression, then in mania, then a long period of mixed state.
I’m using these terms, depression, mania, mixed…but what do they mean, really? Read on, dear readers, read on.
Depression
Biggest misconception about depression: it is just sadness. How many times have you heard (as a depressed person) things like: “everyone gets sad, deal with it, cheer up, focus on the good things, it could be worse, what do you have to be so sad about?” etc. I won’t even go into how much I hate the phrase “man up”, as that’s a whole different blog post waiting to happen.
The “Black Dog”, as coined by Winston Churchill (and taken by Ruby Wax to create the Black Dog Tribe online) is very different to sadness. Much has been said recently about depression and there’s a lot of writing out there that is superior to my own. It is not just sadness, it is so many things and yet nothing at all. When my depression is at its worst, there is nothing, there is an empty void where thoughts should be. That void seems to suck my energy, my interests in everything, my love for my loved ones. I feel nothing, I am nothing. This is actually when I have done the most harm to myself. Sometimes just trying to feel something, sometimes just because if I am nothing then why not hurt myself, damage things around me? Nothing matters. When that emptiness starts to ebb, that’s when sadness, anger, hatred, paranoia, all those fun things happen. It hurts. It’s like something has cracked deep inside and you can’t fix it and you can barely move because everything hurts and you know you deserve this because you are an awful person. Then there’s the searing guilt that you shouldn’t be feeling this way, so many people have it worse than you, what do you even have to be depressed about, which you take as proof of how weak and awful you are. That’s when self-harm as punishment, as release of the pain you’re feeling can come in. I also feel intensely hopeless about everything, and I can’t rid my head of suicidal ideations/plans. You feel so damn tired, but it’s hard to sleep when you need to and even harder to get up when you need to, like there’s a weight pressing down making it so much harder just to move, get out of bed, wash, eat, work, anything. Again, this is my experience, I know some people overeat in their depression which is a way of seeking comfort (as many comfort foods, like chocolate for example, release hormones like oxytocin, making you feel a little better, for a short while. Until you feel bad that you used food as a crutch again, and that feeds the depression, and you feed yourself, and it’s a near endless awful cycle. I’ll talk about coping mechanisms more in part 3). I was like that when I was younger; I swung the other way in my teens when I struggled to eat anything due to feeling so low.
So you know, not a barrel of laughs. You lose interest in most things, you (try to) isolate yourself; you have little-to-no concentration so finding comfort in books, even TV and video games is difficult. This is just a short look into depression, and no two depressed people will experience it alike. So this won’t apply or ring true to everyone, but it’s how it has been for me.
On to the flip side!
Mania (and hypomania)
Hypomania is the “light” or lesser version of mania. This doesn’t mean that it’s easy to deal with by any means but people don’t get to the extreme end of symptoms when experience hypomania, and often, it doesn’t last as long as full manic episodes. Hypomania can be the only type of mania a bipolar patient gets (for example if they have Bipolar II, or if they have rapid cycling bipolar) or it could be the stage before a person reaches mania, so sometimes with the right intervention, full mania can be avoided.
Symptoms of hypomania are similar to those of mania. These include (but are not limited to):
- Excess energy.
- Little need for sleep.
- Unusual exhilaration.
- Excessive irritability, excitement or aggression.
- Increased confidence/self-esteem.
- Very fast speech and thoughts that others find hard (sometimes impossible to follow).
- Unable to concentrate on one thing, easily distracted by their latest idea (an example: I once had made several drinks, in different parts of my flat, had half done dish washing, university work “done”, new art projects started, and new guitar tab music up on my laptop to do. All at the same time).
- Abnormal hypersexuality.
- Increased outlandish and uncharacterised risk taking.
For it to count as a hypomanic episode, there must be a sustained period of these symptoms during the entire episode. The emotions experienced are often unconnected to anything going on in the person’s life, though a person can be tipped into an episode by life events/stressors.
The main difference between mania and hypomania is the person does not experience psychosis or related symptoms, such as hallucinations, delusions, severe paranoia etc.
Mania, as I mentioned is similar. You again experience the excessive energy, along with things like extravagant and impulsive behaviour, excess/uncontrolled/impulsive spending, hallucinations (auditory/visual). To class as mania it must last at least a week and have a sustained abnormally elevated/expansive/irritable mood. It normally causes problems in the person’s social and work life, and can often (especially if they are not taking their medication) will lead to hospitalisation.
I guess what I would like to emphasise about mania is the common misconception that these periods are “fun”. I have myself sometimes felt so desperately low that I have stopped taking my medication in the hopes of eliciting a high episode, because surely it has to be better than depression right? Not necessarily (shockingly, depressed Kathy is not great at thinking rationally about this).
For me personally, mania is terrifying. I get paranoid, I have hallucinations. I don’t enjoy the excess creativity that is often spoken about bipolar sufferers. Admittedly, sometimes I *think* I’m a creative genius who can be working on three different creative projects at once and they are all breathtaking but that is rare and, in my case, definitely not true. I used to think mania was fun, at the beginning, but the effects are what truly get to me, and are why I hate it so much. My ex would tell me that it scared her when I was like it, I’m quick to anger frequently because everyone else is moving too slow, can’t know what I’m thinking, doesn’t understand my ideas and “brilliance” (usually because it’s unintelligible garbage). I’ve come close to cheating, because my energy just fuels all the awful impulses and urges in my head. I’m lucky in that so far, I’ve managed to catch myself before anything happens, but from reading other experiences I know that it does sadly happen (especially when you are untreated).
Finally:
Mixed State
It sort of is what it sounds like, state that is a mix of manic and depressive symptoms. So you could have the energy and racing thoughts, but the depressive thoughts, suicidal ideation etc. It is an intensely uncomfortable state to be in, to be excitable and energetic yet at the same time, apathetic and closed off and alone. I spend more time than I’d like to admit in this state I think, especially since my current medication mostly staves off the full-blown manic episodes (though life sometimes happens and pushes me there, but it’s a work in progress to try and reduce this). I also get incredibly anxious in this state, heart racing, indecisive, racing thoughts, but all about the negative potential possibilities. Makes it incredibly difficult to concentrate or sleep. The latter is important to try and get as many people with bipolar are hugely sensitive to sleep change (an almost sure fire way for me to go high is lack of sleep for a night or two).
There’s more I wanted to go into but this post is already longer than I’d planned. I hope this has provided a more rounded idea of what people with bipolar go through, it’s not like what I’d seen in the movies anyway.
As I will keep repeating, this is just my experience of the illness. If you disagree or experience episodes differently, I am not trying to dismiss you! We all experience the illness differently; feel free to comment on if you agree/disagree/think I’ve missed out something in the comments 🙂
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