Over the years I have worked with a number of patients who have been diagnosed with Bipolar Disorder. Once known by the classification as Manic Depressive Disorder, this mental illness often goes undiagnosed in many people. The classic characterization is someone who has high highs, and low lows. The highs are known as the manic stage and the lows are the depressive stage of this cyclical disorder. Each person has their own wavelength they traverse, so one person could be in the manic stage for a day or two, while another may experience this mania for a month. And the same is true for the depressive cycle. This article is geared for family and friends of those with Bipolar Disorder to help give more understanding to this unique mental illness. This article does not go into the entire depth of this mental illness and for that I have provided resources at the end.
Because there is a great fluctuation in how Bipolar Disorder is represented what I say is there are many “flavors” of this mental illness. The depressive cycle for some Bipolar patients can be particularly deep and dark and during this stage they often contemplate suicide as they feel extremely hopeless. Then as the illness cycles within the person’s brain and body chemistry, they begin to “climb out of” the depressive cycle and feel better and more balanced. For some this cycle continues onto the manic or elevated mood stage and they feel really good – sometimes too good.
When the person is in the elevated stage they never want to leave this euphoric feeling with their racing thoughts inspiring them to think of new ideas and feel incredibly inspired with racing thoughts of all the things they want to do. They feel alive, invigorated, with insights, boundless creativity and a great thirst for anything new and exciting. As you can imagine the manic phase is an incredible high and must feel amazing, but the person is also at great risk during this phase of the cycle. It is at this time when the person seeks whatever they are addicted to, obsess over whatever they have an interests in, or in some cases they choose the most random things to do that they have never even thought about before. This is when the person will say the most out of the blue statements about something you have never heard them talk about before. And you wonder what is going on, but they are so convinced that they should for example start a campaign to save all of the elephants in Africa, and sometimes they are so convincing that you can’t help but think this is a good idea too.
The manic phase represents an over-abundance of brain activity and that’s why I call it the fireworks stage or when they person has a popcorn machine going off in their brain. This overstimulation is a time of great excitement and it is during this phase of the cycle when the great inventors throughout the ages created inspired music, developed incredible military strategies, and created inventions that propelled humanity into the next age. Sometimes there is a fine line between creativity and madness, and Bipolar Disorder surfs that razor’s edge. Anger and irritability can also be present during this manic phase and I have had some patients tell me that this is one of their first indicators that they shifting out of the depressive cycle into the manic cycle.
So, how does this compare to a person who does not have Bipolar Disorder? For most people there is a normal range of moods where sometimes they feel super excited and other times they feel very depressed. This mood fluctuation is usually based on something that is happening in their environment versus what their body chemistry is producing. Within a normal range the highs or lows return naturally to a baseline and this person does not have the continuing cycles. The difference with the Bipolar patient is that their cycles are ongoing and the volume gets really turned up in their brain and the loud party boom boom music is so distracting that they cannot make good decisions – coupled with their racing thoughts and all the exciting things they are imagining. And then the crash happens where they are thrust into the dark lonely room in the depths of despair and for many people all they want to do is die. There is a sweet spot where they are at a baseline or their moods are stable, but for most patients this does not last a long time.
Bipolar Disorder is termed a mood disorder and to manage these up and down symptoms mood stabilizing drugs are prescribed. It is the goal of these medications to level-out the moods so they do not have the extreme highs or lows. Today we have many types of medications available to help do just that and usually Bipolar patients are prescribed a mood stabilizing drug and an anti-depressant for example to manage the symptoms. As their moods are leveled out, some patients describe this as such a let down and kind of boring. They feel that this baseline stabilization is hard to adjust to and not as much fun as the roller coaster. They miss the intense adrenaline rush of the manic phase and they struggle to keep taking their medication.
When the patient is in the manic phase they will often say they feel great and they don’t need their medication anymore. What I have noticed is that with these patients they don’t want to think of themselves as “sick” or needing medicine to level out their moods. They want to feel normal as they probably did at a younger age before the illness manifested in their bodies usually during puberty or early adulthood. It’s as if they don’t want to miss the opportunity to have this euphoric or up feeling, so many will put up with the depressive cycle. I once worked with a man who was a great inventor and had many patents to his name, but it was very difficult for him to maintain a job because he was always distracted with new ideas, or at his low points didn’t want to get out of bed. His illness prevented him from being able to carry out his daily activities consistently and he knew this was a problem, but did not want any medications because then he would not have the ideas for his next invention.
The inability to have a stable life is the confusing part for those of us who do not have Bipolar Disorder because we may look at this person and say why wouldn’t you want to take your medication to help you keep your job and your relationships? All of this would be logical, but to the Bipolar person, they know how it feels during this manic phase and they don’t want to give up their high point on the roller coaster. I respect this when patients will say this to me and I believe they know what they need to do to maintain a stable life, they just don’t want to and sometimes they really have a hard time doing just that.
What the patient doesn’t realize is that the rest of us are being dragged up and down on the roller coaster with them. And usually during the high or manic phase that person is hard to reach because of this overstimulation in their brain and their minds are racing a mile a minute. So, the last thing they want to do then is take their medication to slow their brain activity down. They don’t realize at this point how they can be a danger to themselves or others. Not that they are going to kill themselves, but that they will make foolish or risky choices. I had one man leave his job in the middle of the morning in Chicago, take a cab to O’Hare airport and he went up to the first ticket counter he saw and bought a ticket to New York which was their next flight out. He got to New York and stayed in a hotel and partied for three days and did who knows what else. Toward the end of the third day is when his manic phase was coming down. He was coming off of his high and back to earth. But, he also came back to some real world realities – one of which is he lost his job due to abandonment.
So, there are some sad realities to the highs and I have heard countless tales of daring and super exciting adventures people have had while in the manic stage. Luckily, many of them survived unscathed, but others lost relationships and jobs and had to explain to their loved ones the “why” they did what they did. But of course, there is no logical explanation as it was their mental illness and the overstimulation of brain activity which was coming up with the ideas for them.
It is very difficult for the Bipolar patient who is in the middle of a manic episode to think about long term consequences – all they are interested in are the short term gains and what they can do next. This is part of the reason why it is hard to reach the person in the manic phase because you may be trying to talk with them about a long term consequence of a sporadic decision and all they care about it having fun and continuing the excitement outside of themselves that they are feeling inside. They want the party to continue and you are there saying, no we need to turn the music down and be responsible.
The same is true for the depressive cycle. Oftentimes their lows are so low that they are hard to reach and to reason with. All they want to do is crawl into a hole. To continue my earlier analogy, it is like they have been partying and having this incredible time and then someone kicked over the speakers and shut the place down. It’s a huge let down and a big difference from how they felt just a few days ago. They can’t see that far in front of themselves when they are depressed, so they won’t be very good at long term planning or talking about things that are coming up that they need to do. They are just interested in licking their wounds and avoiding others.
All of this being said, even tho plenty of patients don’t take their medication or are undiagnosed, there are probably more Bipolar patients out there who are managing their illness and creating and maintaining wonderful lives with family and friends. They have learned early on and maybe even tested countless medication combinations before they came upon the one that worked for them and managed their symptoms. These individuals have had a great struggle and for many their struggle to maintain an equilibrium and balance is a daily job.
If you know someone who has Bipolar Disorder and they struggle with managing it, see if you can sit down with them and explain what it is like for you when they are experiencing their manic phase and their depressive phase. Explain to them that when they are either high or low in their cycle they are hard to talk to (because they won’t listen), and how you may feel isolated and very concerned for their wellbeing. The best thing you can do is to get that person in to see their psychiatrist for a medication evaluation especially when they are talking about suicide or making very risky choices. Either their meds that they are on are not working, or they may not have been taking them at all which is a common issue.
In my experience the Bipolar patient is exceedingly bright and I would even say calculating in the way that they try to hide their symptoms from the rest of us so they can feel that high. It can mimic the addictive process in many patients as they will wait patiently for that high to come around again so they can surf that intensity.
In this article I have talked a lot about the downfalls of the manic cycle for the Bipolar patient and those around them. Not every person who has Bipolar Disorder always feels this intensity and some may have a bit of an elevated mood, or they may have had one classic type of manic episode in their lifetime, but otherwise they feel depressed most of the time. For many patients this is a confusing journey in understanding their illness and how to work with it so they can have a functional life. This is particularly true with younger patients as their natural excitement for the world and starting out often gets confused with manic symptoms primarily by others.
The key is to help the person with Bipolar understand their cycles. They know their bodies more than anyone else, so they can tell you what is happening. It also helps to keep a daily journal or chart to track these up and down moods and to use this as a discussion as to what other coping skills need to be brought in rather than just relying on medications to help manage the symptoms
Robert Jackman, LCPC 2016
http://www.nimh.nih.gov (National Institute for Mental Health)
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