My first foray into working in this mental health field involved working in a 12-bed residential facility in California where we would work with clients that suffered from severe mental illness. Our clients most commonly presented with Major Depression, Schizophrenia, Bipolar, or Schizoaffective Disorder.
At our facility, clients would get to spend a lot of time in group and individual therapy, and we helped them to gain skills to help them re-integrate once they have become more stable.
Right out of my undergraduate studies I was able to learn a lot about what it looks like to struggle with all of these mental health disorders. Further, I was able to see that even some of the scariest sounding disorders can be managed and those suffering from them can go on to live fulfilling lives.
Here, my hope is to better explain Bipolar Disorder to you, so that you might be better able to spot it both in your self and in your loved ones and find the help that you might need. We well go through what it feels like, what it looks like, and then what it is and is not. This is not meant to be a tool to self diagnose with Bipolar disorder, but rather something to get you thinking and perhaps an impetus to get yourself in to see a counselor so they can further help you ascertain what is really going on.
I would now like to tell you a story. This is not a true story, but it is influenced by individuals I have worked with who were suffering from Bipolar disorder and I will use it to illustrate what Bipolar disorder, and especially mania, can look like.
This story is about Paul, a 20-year-old man born into an affluent family. Growing up, he often seemed larger than life, quite driven and seemingly able to succeed in whatever he sets his mind to. His teenage years were never problematic – in fact, quite the opposite.
He did well in school and was well liked. Paul seemed to be one of those kids who could be good at anything. For those looking from the outside, Paul seems like the kind of person whose only flaw is having so many ideas and projects going on at once that he could never finish all of them.
In college, Paul decided that simply doing his studies was not enough and that he wanted to start making money now. He had ideas that felt brilliant and he began to sleep just 3-4 hours a night. At first, his excitement was contagious. However, as he pursued his ideas he began to almost scare those around him. Paul became frustrated that others couldn’t keep up with the pace at which his mind was moving. For Paul, his mind felt like a race car while everyone else was riding bicycles.
A religious person, Paul began to feel that his ideas were so great, that they were, in fact, coming directly from God, himself. Wanting to pursue righteousness and his business endeavors, he began attending every church service he could and prayed for guidance and prosperity in his life.
One day Paul became frustrated. He felt that no one around him really understood what he was trying to accomplish and what his ambition could do. Fearing he was a candle burning at both ends, his friends and family began trying to tell him to slow down, but that was the last thing Paul wanted to do.
He had goals! He had inspiration! God was telling him directly what to do! Eventually, it became too much for Paul, and when one of his friends confronted him about slowing down, Paul ended up shoving his friend. This escalated to a full on fight, and the police were called. Paul had never been violent, so this seemed incredibly out of character.
Police were called and Paul was eventually taken in and placed on a 72-hour psychiatric hold in the local hospital. Doctors had a suspicion that Paul had gone into what is known as Mania, an elevated stated of emotion and energy. Doctors placed Paul on mood stabilizers to help him come back down to reality.
As he regained a sense of what had happened, Paul experienced tremendous shame and fell into a depressed state. He felt guilty and afraid of what he might be capable of. He was formally given a diagnosis of Bipolar Disorder I, and this came as a great blow to him.
He felt betrayed by God but also questioned what God’s role was in all of this anyway. He still believed in God, but how could he reconcile that with the genuine belief he had previously had that God was directly communicating with him, now that he knew that was part of his disorder.
The road ahead for Paul will be difficult in some respects, but it is not a death sentence. Paul will have to take medication for a long time to manage the symptoms and likely attend counseling or group therapy to help grapple with the fallout of what has happened. However, he can still continue to go on and live a prospering life.
Seeing Bipolar Mania in Yourself
Perhaps reading the story above, you felt like you related to Paul in the beginning; driven, tons of energy, little need for sleep. For those with Bipolar Mania, usually, the feelings are euphoric, almost like being on a drug. You feel like you can accomplish anything and can take on the world. Perhaps you feel a divine calling or hear voices that urge you on. Mania feels good.
So it makes no sense when people tell you to calm down or to slow down. For you, the problem won’t be the direct experience of Bipolar Mania, it’ll be the come down and depressive episode that follows that will hurt. Perhaps you have had these ups and downs in many cycles before.
If so, you know how much the depression after sucks. Perhaps, while feeling so good you have engaged in risky behaviors or spent way too much money. It’s the consequences of Mania that are hard to deal with, not the mania itself.
Seeing Bipolar Mania in Others
Perhaps you didn’t relate to Paul personally, but you know a Paul; the high energy friend who seems to get them self into trouble when out of control. Often, it feels scary being on the outside. You can see the path down which they are headed and you fear what lies beyond. Maybe you are afraid they are becoming violent.
Often people with Bipolar will feel generally “intense,” and then when mania hits it ramps it to a whole new level. Things to look for in your loved ones are elevated mood, high energy, a lack of sleep but not feeling tired, and even at times hearing voices or feeling like they hold a special place in humanity (such a prophet, or the subject of government investigation). However, know that by helping your loved one find treatment you can help them to manage these symptoms and get to a place where you can feel like there is more stability in your life.
What it isn’t
Often, I hear people say things like “oh, they are so bipolar,” and much of the time there is a total misunderstanding of what bipolar disorder is. Bipolar disorder is not (usually) rapid mood swings or anger. When your friend one minute can seem to be so close but then the next be completely angry, that is not usually bipolar disorder.
Further, bipolar disorder is not a miserable life sentence. Many people live full and rewarding lives while dealing with their diagnosis. At the same time, it is no small matter, either. It is a serious condition that requires treatment to manage the symptoms.
Finally, bipolar is not even necessarily mania combined with depression. We used to call this disorder Manic Depression, but we can, in fact, diagnose bipolar with only symptoms of mania without the depression. However, most will also experience depression as well.
Some other disorders that are often mistaken for bipolar disorder are Schizophrenia and Borderline Personality Disorder. Schizophrenia occurs when multiple psychosis symptoms (such as hallucinations, delusions, catatonia, or feelings of persecution) occur over a period of time. In a panicked state, it can look like bipolar mania as well, but they represent a different set of symptoms.
However, sometimes people can experience both bipolar and schizophrenia. You may hear of this referred to as a type of Schizoaffective Disorder. When people have quick mood fluctuations between adoration and hatred, and/or appear quite reactive to those around them, this can often be more explained by Borderline Personality Disorder. The colloquial “they are so bipolar” is often attributed to individuals suffering from Borderline Personality Disorder. Again, these are not necessarily mutually exclusive and can co-occur.
Types of Bipolar Disorder
In general, there exist two types of Bipolar Disorder, with a third very similar condition. First, there is Bipolar Disorder I (BPI). This is the “bigger” type of bipolar, wherein individuals go into full blown manic states. This looks like what I described earlier with Paul. They may or may not also rotate to depressive states.
At times, psychosis can occur with BPI, hearing voices or believing in delusions of grandeur. In general we think of Bipolar as a mood disorder, but when psychosis occurs it becomes a thought disorder as well. The struggles of someone with full blown manic episodes will be in the come down as they deal with the fallout of their actions while manic.
The second type of bipolar disorder is Bipolar Disorder II (BPII), where in there is hypo-mania, or just a littler smaller mania. There exists a checklist of symptoms to differentiate hypo and full mania, but ultimately it is a matter of degree. This might look more like intensity and lack of sleep than fully destructive behaviors. However, most will also deal with the depressive states and these can be quite disheartening and dangerous.
Note that in both of these disorders the cycling of emotions occurs over longer terms. Full mania, in order to be diagnosed as such, lasts at least a week, while hypomania is over in 4 days at a maximum. Rapid cycling, where there are mood swings within a day, are actually quite rare and might be better explained by something else.
Finally, there exists Cyclothymic Disorder, which is a much longer term and “milder” version of Bipolar Disorder. It occurs over a course of two years at a minimum and an individual has some symptoms of depression and hypo mania, but not enough to fully diagnose either. This can be a long term frustration and existential struggle.
Treatment for Bipolar Disorder
For individuals with bipolar disorder, the best treatment is often a combination of medication and counseling. In working with a doctor, you can begin to find a mood stabilizer that helps you manage the ups and downs and enables you to feel level. This can involve a bit of trial and error, so it is always my suggestion to begin as soon as possible.
As for counseling, working with a therapist or counselor allows you to help manage your symptoms, receive a reality check, and then work through those depressive episodes. Bipolar mania often leaves a host of damages in its wake which require mending, so working with a counselor you can help mend relationships with family and individual counseling.
Whether it is you or a loved one that is struggling with Bipolar Disorder, remember that you can work through this and live a happy and fulfilled life. Begin the process of working through this as soon as you can reach out to a counselor and find doctor who can help you to get on the right medications. Medication may sound scary, but know that it can enable you to live a life full of reward. Reach out today to a counselor like myself and you can begin to take back control of your life!
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