Without Mania, Bipolar would not exist. It is mania which distinguishes Bipolar from other forms of mental illness such as Depression, Borderline Personality Disorder and other mood related problems. It is also mania that can cause a patient to do the most erratic things that range from somewhat funny anecdotes all the way to the unthinkable. In fact, most professionals will declare one Bipolar after a single manic episode. This can be a source of great frustration to patients and loved ones as there can be symptoms of mania that cause misunderstanding and doubt about the diagnosis. This can be particularly frustrating for those who have experienced only one episode yet they are then labeled for the rest of their lives as having Bipolar.
Most medical sources will define two primary types of Bipolar. Bipolar I which includes full blown manic episodes, and Bipolar II which, in general is more depressive and the associated episodes are not as severe and “high” as those associated with Bipolar I. Bipolar II patients typically experience “hypomania” and not full blown, unbridled mania. For the Bipolar II patient, this hypomanic state can be very misleading. It is not uncommon for this hypomania to be characterized by periods (sometimes long periods) of intense focus and an endless amount of energy which results in temporary productivity and personal achievements. For the casual observer, when the BPII patient is in this state, it appears that they have “finally gotten their life together”. Unfortunately this period of achievement is temporary and the mood inevitably shifts into a depressive state that can be just as low and as long as the hypomanic state.
Bipolar I is where our story lives. Justin was not only diagnosed as BPI but has also dealt with many manic episodes which have resulted in multiple hospital visits and countless months of load balancing in his mind, hours of counsel and dozens of various “cocktails”. In the world of mental disorders, a “cocktail” is a blend of medicines intended to stabilize the patient. Victims are given medicine to bring them down….but not too far; and then more medicine to keep them up….but not too far. More meds then to reduce anxiety and then another to help them sleep; and oh yes, all of this medicine produces side effects so they need another pill to curb the side effects. Now combine this with a mind that is racing out of control, a myriad of dozens of available drugs, insurance companies which will only pay for some names and not others; and then two or three doctors who disagree on treatment, and then……..well, you get the idea. The process itself is maddening and in the meantime the patient struggles to find balance and self-control.
The full blown manic episode can be a very frightful experience for everyone involved. It is typically a result of these episodes that cause patients to lose their jobs, to be alienated from their families and to be black listed by their friends (or I should say… ex-friends). Our story is no different. We have experienced and accumulated so many stories throughout the survival of our personal episodes. For the protection of Justin’s privacy, I will not go into details about our experiences but it is fair to say that we have experienced pain, fear, anger and deep compassion all at the same time. As for specifics, I plan to soon interview Justin and several other patients and post their interviews on this blog. If Justin chooses to share details there, that will be his decision and not mine.
I will talk in general about some of the stories I have heard and seen from other people. When in a full blown episode, the internal decision making process within the mind is like a funnel trying to handle the pressure of a fire hose. As mentioned in past posts, the tendencies of the patient at the time of the episode will often dictate the behavior exhibited during the episode. So the religious BP1 will go from Bible studies and prayer meetings to being a prophet and wanting to cast out demons and perform miraculous healings. The ambitious will normally be seeking advancement within a career while that same person with BP1 will vow to become the world’s next billionaire without even having to work. The sexually active person with BP1 will spin out of control sexually and will engage in activities he would never think of when normal. Faithful BP1 husbands will now sleep with prostitutes and BP1 wives will experiment in unmentionable activities. And then there are those with violent tendencies that become a terror to themselves and others. The statistics of harm are alarming. The headlines related to these episodes are alarming. In fact I can’t bring myself yet to actually state the statistics that I know are true.
It is the manic episode that results in hospitalization of the patient of Bipolar I. They are locked down until the medicine and therapy can return them to a balance state of mind. Sometimes this can happen in a couple of weeks, but sadly this process often takes months. During this time the patient lives in agony, the doctors practice in frustration, the families live in fear and the friends…well most of them are long gone anyway.
As Justin’s father, I have to admit that it is very easy to feel sorry for myself when having to deal with this silent enemy. But one day I was pouring my heart out to a man who I thought would return my tears with sympathy and what he said was “I can’t imagine what it must feel like to be Justin”. And he was right. What a horrible feeling it must be to spin out of control and not have a clue what to do about it. I pray that I will continually be reminded of this man’s compassionate words.