Welcome to the ride!

I many times thought peace had come,
When peace was far away...

Emily Dickinson

Bipolar disorder is a painful, recurring pattern of variation of exaggerated mood, activity and thinking that causes damage to one or more important aspects of life. The pain can be relieved or prevented with psychiatric medicines and the potential damage limited by the sufferer. Bipolar disorder is thought to confer on some the capacity for greatness in the arts, literature and leadership.

The experiences of bipolar disorder can be roughly grouped into three states: mania, depression and wellness.

Mania and Hypomania

Also called ‘high’, mania is a dangerous state of extreme elation along with hyperactivity and fast or otherwise altered thinking. Mania is at the extreme end of the scale while hypomania (literally ‘little mania’) is milder.

Carole described a manic episode to me:

I don’t remember how long I’d been on this high and I was pretty high, actually. I was in hospital and I remember the night nurse came around in a very colorful dress. The dress became like it was alive—really glistening and the colors were really exaggerated and beautiful. The next day I started cleaning out the  clothes that I’d brought to hospital—and I can’t remember why—but I was doing a lot of things, going from one thing to another. I got this idea that I had to purify myself. So I started cleaning everything out. I started throwing out all my makeup. I threw out my hairbrushes—I was going to use my fingers to comb my hair. I threw out the tissues because I wasn’t going to cry anymore. Just anything and everything. Then I had a shower. I completely changed my hospital bed.

My parents had come in to visit with flowers and the sheepskin I used for my sore back. I wrapped the flowers in the sheepskin and went and threw them in the rubbish bin—in a symbolic way. That was a very symbolic time—everything I was doing was very symbolic. So I walked down the street and threw 'Mum and Dad’ in the rubbish bin.

... And then I went and had a shower and I threw out all my soap and everything. Now I only had Velvet soap which was pure. I had a shower, and washed my hair. I washed myself, scrubbed myself up and then got out of the shower and then I was feeling really thirsty. I couldn’t use a glass so I had to use my hand like Jesus so I was drinking with my cupped hand.

Let’s tease out the elements that go to make up mania—mood, activity and thinking.

Mood

Hypomania can be bliss. We have a high level of self-confidence, a positive outlook on the world and our own prospects. Anything is possible. We have largesse. Others, swayed by us, feed from our ebullience. Such a good feeling makes us reluctant to notice if we are escalating into mania.

Elation is the key mood of mania although it may not always be present. Along with elation are supreme self-confidence, a sense of purpose, even a calling. Everything is larger than life. We are invincible—utterly. Others call us grandiose. They tell us to slow down; there is fear in their eyes; we get incredibly frustrated with them as they cannot keep up with us. We become spiritual—even non-Christians find themselves in a church during mania, overwhelmed with the mystery and majesty of religious icons and spaces. We have a mission and there is no time to lose. Carole continues her story:

And then I got dressed up in all my clean clothes, signed out for a walk  and rolled along to St. Mary’s. When I got there all the lights and everything—the statues—everything was really glittering at me, like really strong lighting, jumping at me. What time of day was this? I think it was the late afternoon. I think I was going to go and take communion.

All these lights were really dazzling me and I fainted and the next minute I was out in the vestry with all these people trying to get me to come to.

Many times when I was on a high I did go to St. Mary’s. I’m not Catholic but I was sort of brought up as a Catholic. The whole thing was so beautiful—I was sitting there crying and all these nuns were concerned. I wasn’t crying because I was sad, I was crying because it was so beautiful. That actually happened in another church too, I went to church at Easter time. I fainted—everything was so beautiful—it overwhelms you, I suppose you’d say.

Activity

In hypomania, we get lots done, whatever our field. Sleep becomes less important. Rachel’s painting is confident and ambitious when she’s a little high:

You get an awful lot achieved. My painting...If you go off on a tangent and you’re doing something you particularly want to finish, if you’re slightly manic you get it done an awful lot quicker than if you’re not...

I started this 6 by 4 foot canvas eighteen months ago—but the  hypomania ran out before I finished it.

As hypomania starts to escalate into mania, we talk to our friends on the phone—twenty calls in an evening is not unheard of. We don’t sleep, we can’t sleep and we don’t want to because we have so much to do. We write poetry all through the night. We talk at the rate of a speeded-up film. We paint, draw, sew. We do extraordinary things, outrageous things, unlawful things. We might want to bonk everything in sight—and sometimes do—all to no satisfaction. We drink a lot. A helluva lot. We spend our money. We spend the bank’s money. We spend our friends’ money. We buy three cars and $5,000 worth of clothing. Or take out a loan for $300,000 to buy shares in a newly-listed gold mining venture.

Thinking

We can make people laugh—we’re the life of the party. We can’t stop ‘contributing’ to class; jokes and puns keep popping into our brains.

I felt a clearing in my mind
As if my brain had split;
I tried to match it, seam by seam,
But could not make them fit.

The thought behind I strove to join
Unto the thought before,
But sequence ravelled out of reach
Like balls upon a floor.

Emily Dickinson

As mania approaches, we can’t stop seeing connections between the most obscure things. We have brilliant ideas in business, literature, finance, farming, politics, religion, then we link them up in a grand unifying theory which we forget by next week. We are irresistibly persuasive. As mania escalates, we might see things that aren’t there and be terrified. We might believe we are the Virgin Mary, Jesus Christ or the Devil. Elation becomes confusion, which gives way to chaos.

Thinking in hypomania is clearer, more incisive, more creative than normal. We are personable and witty without being indecipherable. Rachel told me:

You’re up there. You can answer every question on Sale of the Century. You’re on this little journey on the borderline where nothing can hurt you, nothing can harm you and you have a great old time.

During hypomania, the thought disorder isn’t really off the beam and many of us carry out brilliant work, like Jonathan, who published 15 academic research papers in as many years.

The process of thinking during mania has been compared to the process of creative writing. In one study, it was found that writers and people in a manic phase consider more ideas and concepts, and sort and categorize ideas in more, and more unusual, ways than other people. [i]

Depression

Mood

Everything is grey; the color has seeped out of everything around us. Nothing matters much at all. We wake and feel the millstone thudding on our chests. We’d shrug our shoulders if we could be bothered. Depression is ‘lessness’—pointlessness, hopelessness, haplessness, helplessness [ii] .

Even angerlessness, unless we are irritable, in which case we have tolerancelessness! In deep depression we have emotionlessness.

Carole describes the ‘lessness’

For about 12 months I used to say I had lost my feelings. I couldn’t feel anything. If somebody that I love or one of my family members had’ve got run over in front of me, I wouldn’t have reacted. I used to describe it as being a shell of a person—everything inside of me died and I had just my physical body that I was walking around in. It’s total emotional shutdown. My face was like a mask. It had no expression.

Activity

We prefer to, and sometimes do, spend days on end in bed. We don’t go out. We let the answering machine take all the calls, and then we don’t ring people back. We don’t eat, we lose weight. We don’t shower and we wear yesterday’s clothes for a week. We don’t read to the children, or take them to the park or help with homework. Writer Jan Stumbles put it this way:

The skills, ease of movement, expressions on the face...all become locked. Locked up, away, out of reach of their owner, much less anybody else, so that finally, even walking is awkward...If you can no longer move, speak, think, but can only grit your teeth and wait, ride the waiting, then possibility is fully exorcised perhaps banished. [iii]

Thinking

Mild depression can leave us unable to concentrate or have difficulty making otherwise-easy decisions.

In severe depression, it’s as if your brain has seized up. If you can think at all, you might think: ‘I can’t do anything.’ (Which is probably true at this point!) You might go on: ‘Therefore I’m not pulling my weight in this family/organization. I won’t ever feel any better because I’ve felt this way for so long. I’m a burden on everyone. Not only can I not do anything, I’m bad, irretrievably bad. So I should kill myself.’

There might be paranoia as well: Stephen told me ‘I can tell I’m getting depressed when I start suspecting that people at work are trying to sabotage my projects.’

Mixed States

Mixed states occur where symptoms of depression are mixed with symptoms of mania. Between 40 and 48 per cent of people with bipolar disorder have ‘mixed’ symptoms. [iv]

Given this, it is no wonder that many of us feel we don’t really fit the term ‘bipolar’ or the usual descriptions of just distinct mania and depression. You could be forgiven if you concluded that none of that applies to you and they must have the diagnosis wrong.

My experiences are almost always mixed. I typically have a depressed mood, along with anxiety about relationships or money. This is accompanied by a frenzied rush to get something completed or symbolically running away from home. My thinking is usually way off mark and I usually make incorrect judgments about the intentions of those around me.

Wellness

After gradually recovering from months or years of illness, it’s sometimes difficult for us and those around us to identify when we are well. As Mary observed:

Once people become aware that you are ‘a manic-depressive’, they simply will not allow you to have a bad day. Only ‘normal’ people are allowed to have ‘bad days’. If a ‘manic-depressive’ has a day that is worse than average we’re not allowed to write it off as a ‘bad day.’ ‘Carers’ latch onto the tiniest thing and before you know it they’re ringing the psychiatrist.

When we’re well, most days are easy to cope with. We can plan, we can socialize and do everything that others take for granted but it is important to recognize that wellness includes having an ‘ordinary bad day’ and an ‘ordinary good day’ from time to time.

Once a lengthy period of wellness has been established, we can enjoy the sunrise with neither dread of day nor terrifying elation. And we might say ‘Thank you’ to whomever: Lithium, God, Dr X or Fate. And pat ourselves on the back every time we experience something for what it is.

Mood

When we are well, we don’t really notice our moods. Neither suicidal nor supremely self-confident, we are able to just get on with the business of living. We may have ups and downs that are a little larger than everyone else’s but are manageable nonetheless.

Activity

We sleep regularly. We participate in family life and we can put in a good day’s work. We don’t get as much done as we did if we were hypomanic and this is often a source of frustration. Our ups and downs might bother us if we notice that our output at work or at home goes in fits and starts—but it’s nothing like lurching ship of a major episode.

Thinking

We notice that others are neither afraid of us nor trying to cheer us up. If we’ve been hypomanic before, we grieve for the loss of intellectual or creative power. We can tell we’re well because our thoughts are neither running away into chaos nor bogged in dust.

Buy your copy now

and see for yourself the range of resources for people with bipolar disorder. Or click on the book image to arrange your download.

[i]    Andreasen, NJC, Powers PS: ‘Creativity and psychosis: An examination of conceptual style’ Arch Gen Psychiatry,  32:70–73, 1975 cited in Goodwin, FK & KR Jamison, Manic Depressive Illness Oxford New York 1990 p251

[ii] Barbeau, Clayton C Dealing with Depression Franciscan Publications Los Angeles 1987 (video)

[iii] Stumbles J ‘Here we go again’ Voices of the River Disability Employment Action Centre Melbourne 1996

[iv] Winokur (1969) quoted in Goodwin, FK & KR Jamison, Manic Depressive Illness Oxford New York 1990 p48