Happy world mental health day!
So for this years post I thought I’d share the grownup version of explaining what Bipolar is actually like. You may remember this post that I wrote a while back for The Mighty which had to be geared for children as young as 13 which meant writing the mindful, PG version and I figured it may be helpful to write in a little more depth.
So first off Bipolar is generally split into two types, 1 and 2, Bipolar 1 is usually characterised by more mania than depression and Bipolar 2 is usually more depression than mania. For Bipolar 1 the mania usually lasts longer than a week, this may sound like no time at all but when you consider the symptoms of mania as opposed to hypomania you’ll quickly see why it’s not ideal or sustainable to be in this state for long. My Bipolar is type 1 because I initially experienced far more mania and hypomania than depression although now I tend to only experience hypomania and depression because my medication regime is aimed at curbing the mania. Because of the depression element of Bipolar it is often hard to diagnose initially because most people will go to their GP because they feel depressed, not because they feel great (although we’ll explore some of the nuances of that), the Doctor therefore sees their depression, offers them an anti-depressant which will usually send someone with Bipolar high and the cycle continues until someone is able to get an overall picture of how the person is fluctuating over a period of time. This is why I’m a big advocate of CPNs (community psychiatric nurses) because they get to develop a rapport with someone in the community which allows them to notice this in a way that GPs who see someone for short bursts erratically would not.
I would suggest that there are around 6 states for someone with Bipolar, severe depression, low mood, ‘normal’ or stable, hypomania, mania and mixed state. Normal or stable mood is essentially what everyone experiences and doesn’t mean there is no mood fluctuation at all because that would be creepy and weird and a little robotic. Normal mood for everyone involves highs and lows which are healthy and responsive to what is going on around them, it would be strange for someone to have a breakup and not feel rubbish and similarly a birth or a wedding would make most people feel pretty good. Once someone is diagnosed with Bipolar they can struggle to work out what is a normal mood and what is a warning sign for an episode, even I still struggle with this because the fear of getting unwell is so high. Recently I had to end dating someone I really liked so naturally I’m a bit mopey and miserable, that doesn’t mean I’m going down it just means I need to watch Bridget Jones and have a little cry. What someone is like when they are stable will also vary because we all have different personalities; someone who is naturally quiet and introverted might be deemed to be isolated and depressive but their stable state might simply be that they prefer their own company. Similarly I’m normally very chatty and bubbly which could be interpreted as hypomania but just means that my stable state is a bit excitable.
Low mood is essentially feeling flat but looks different for different people, it’s outside the normal fluctuations of a stable mood but it’s not acute. Someone might feel lethargic, struggle to get out of bed, not enjoy the things they usually do, feel tearful and not take care of themselves. Low mood isn’t usually linked to suicidal ideations (thoughts rather plans) but if it goes on for a long time these might develop. Low mood can be hard to distinguish from generally feeling a bit down but I would say it tends to be more prolonged and isn’t always in response to something. When I first began to feel down the most scary thing was that nothing seemed to be causing me to feel this way and up until that point I had never felt so low without it being in response to something. That can be frightening because if the mood isn’t in response to something you can feel helpless and out of control.
Severe depression is characterised by all the of the above but more intensely and can often have anxiety mixed in. For a lot of people their severe depression can be very lethargic but for me severe depression manifests in a very anxious and agitated way. I tend to feel very trapped and out of control and I struggle to regulate or self soothe at all. My severe depression can sometimes include psychosis but this usually features in my mania. For me I am most anxious when I feel this way because the feeling is so intense and awful I feel very trapped in my own skin and unable to escape the feeling. Because severe depression within Bipolar doesn’t have to be in response to stimuli (something causing you to feel this way) it can feel like there is no end in sight which can feel very overwhelming and scary. The best way I can describe severe depression is like the early stages of grief but with no clear cause and no sense that this is a natural response that will get better. My severe depression felt acute and terrifying and I used self harm as a way of feeling in control because physical pain felt more understandable than mental pain. The longer I have had Bipolar the more I understand that an episode will end and the fear around what is happening has lessened although that doesn’t stop it from feeling awful.
Hypomania is feeling elated beyond normal mood fluctuation and the best way to describe this for me is like you’ve had a couple of drinks. Hypomania feels very buzzy and productive (although the reality is that you’re often more chaotic than you realise), you have more energy and you might feel like you don’t need much sleep or food to sustain you. You might go out more (for me that’s a warning sign in itself because I do not go out and choose to live like an elderly lady in a retirement home) and you might find it harder to get drunk because alcohol doesn’t effect you in the way it usually would because you’re already feeling high. Hypomania can often cause people to overspend because they are living in the moment and not seeing the consequences of their actions, namely ‘o shit I’ll actually have no money if I do this’. Similarly people can be hypersexual which can cause them to be promiscuous or be sexually reckless such as sleeping with people they wouldn’t usually or not using contraception. People can feel more confident and assertive although in reality they might seem a little intense and full on to others. Frankly hypomania feels pretty great and my flat is usually the cleanest it can possibly be during this period because I am up cleaning cupboards at 3am but it’s hard to contain it which is why it’s important to recognise and do something about it. When you’re hypomanic you can usually still function but you’re probably more chaotic than you realise and it’s helpful for people to pull you up on that otherwise it’s easy to be like ‘hey I’ll ride this awesome wave forever and be a superhuman’ when the reality is you’re probably going to crash.
Mania can be experienced in very different ways but usually will culminate in feeling agitated and uncomfortable. Mania is like hypomania on speed, so all those good feelings and productivity become more intense and eventually unmanageable. Where you were maybe feeling hypersexual you may now be actively engaging in and seeking out risky situations. What was productivity becomes chaotic and out of control with thoughts that feel rushed and difficult to hold onto; you might become frustrated with yourself and others for not being able to keep up. You may also not realise to what extent this is happening so whilst you may feel hugely energetic and a little buzzy you might not realise that you are talking too quickly or sounding as intense as you do, you might even be saying things that are inappropriate or massively out of character. You might also feel that you are powerful and even have superpowers, that you are untouchable or someone special or chosen. Mania can include psychosis and people may feel that things are talking to them or they are being watched. My mania feels exciting but quickly feels very chaotic and stressful and it was interesting to me when I spoke to other people with Bipolar that some of them found it as euphoric as they did.
Mixed state is not experienced by everyone but is essentially a combination of low mood and hypomania, it can feel really confusing because you are experiencing so many different emotions and sensations and they don’t naturally fall into a particular state. I feel really agitated during these because I am experiencing both hypomanic and anxious states in very quick cycles and I am not sure how to respond or contain it. People can often feel more suicidal and more likely to act on suicidal impulses or ideations because they have the energy of hypomania with the anxiety and agitation of low mood.
As you can see there is a huge amount of variation between episodes and this is why it’s really important to steer away from using terminology that implies Bipolar relates to feeling happy or sad. Images like this are not super helpful and are just misleading..
But things like this are a little better at exploring some of the nuances…
Hopefully that’s been a helpful overview! Please as always feel free to share! If you have any questions just drop them in the comments section below 🙂