In an earlier post I talked about psychosis and how it affects me personally. In this post I aim to highlight the challenges of pathologically elevated mood – hypomania and mania. I also plan to bust a few myths surrounding mood changes in bipolar. Like previous posts, I’m speaking from my own personal experience. I’ve separated my accounts of abnormal thoughts and mood into two different posts, yet it’s important to mention that thoughts and mood are very much intertwined. They can become abnormal simultaneously and can affect each other profoundly.
How taboo is a ‘high’?
In contrast to psychosis and depression, the subject of mania doesn’t seem to be as taboo. People are often fascinated to hear about what it’s like to be truly manic. Talking about depression is a much more difficult task. There also isn’t nearly as much stigma attached to ‘high’ mood, as there is with ‘low’ mood. I’ve found reactions vary greatly when explaining to people about what it’s like to experience ‘high’ moods, and when I’m indeed having an episode of mania or hypomania. Most responses stem from naivety about the disorder itself.
When trying to explain what high mood is really like to friends, reactions have varied from, “Cool! That must be so much fun!”, to “Why aren’t you drinking? Why are you being boring?”, when I’m at a party and avoiding alcohol for the sake of my mental health. Other responses have been a mix of interest and questions, as it’s not so well understood. Another reaction I recall was along the lines of, “I wish I could get high like you, rather than take drugs or alcohol.”
Defining a ‘high’
For those who don’t know what I mean by hypomania: think of it as a bit like the chipper counterpart to mild, high functioning depression. It’s a manageable and elevated mood state, characterised by feeling joyful, energetic and not needing as much sleep to function. Typically speaking there’s no effect on daily living, and can last for roughly seven days in my experience. Hypomania still isn’t normal; nor is it healthy or sustainable. I can manage hypomania well, as my episodes usually just fizzle out and most of the time, don’t revert to depression, or worse – mania.
Mania is the next step up in the mood ladder (more on that to come…). Think of it as the polar opposite to severe depression. My mood is elevated beyond what is sustainable and healthy to the point where it becomes destructive and disruptive. In my experience, it’s almost always accompanied by delusional or psychotic thoughts. During manic episodes, I suffer greatly from insomnia. I take bigger risks, spend more money and am more care-free. I’m therefore more prone to getting injured, or even being taken advantage of. Mania greatly affects my judgement and daily functioning, and is an incredibly dangerous mood state to be in.
When I’ve been manic in the past, I’ve felt euphoric. On top of the world in fact. Although I rarely sleep more than a few hours a night during these episodes, I still get out of bed full of energy. I’m more sociable, chatty and engaging. I also tend to be much more irritable at the smallest inconvenience. My mind is running overtime and my brain simply doesn’t switch off. My senses appear heightened. Food and drink taste better; music sounds immersive and I engage with the lyrics a lot more. I’m much more emotional and will frequently become tearful. I feel more connected with friends and family. My brain is essentially burning the candle at both ends. It’s sprinting a race indefinitely until it hits a wall. I’m on top of the world with no desire to come down, until I lose my footing.
After several days in a manic state, my brain finally runs to exhaustion. If not managed well enough I tend to crash quite hard. I usually revert to severe psychotic depression. This takes some time to recover from, but with the right help and support I come back fighting fit. Thankfully, the medication I’m on helps prevent these episodes from occurring. They’re few and far between, and I’m lucky to have lived through just a small handful of these episodes.
If I could make one point to remember, it’s that mania is far more dangerous than depression. It shouldn’t be celebrated as something fun or novel. It’s dangerous and it can kill people.
The Mood Ladder
To put things into perspective I’ve had far more episodes of hypomania than I have of mania. This makes sense as my mood tends to change in a stepwise fashion. Picture you’re climbing a ladder up a cliff face for the first time. If the ladder has ten rungs, imagine the default mood state for a healthy individual would be between rung five and six on the ladder. This is also known as euthymia. If a person is euthymic, they’re typically neither happy nor sad, and reasonably content with how they’re feeling. The majority of healthy individuals are euthymic a good proportion of their life.
The rungs above and below euthymia on the mood ladder come in the form of ‘natural’ happiness and ‘natural’ sadness, respectively. What I mean by natural, is that these mood states are usually a proportionate response to external stimuli, or triggers. They are normal and healthy mood states. I.e., you receive good praise in work, or get a promotion – you’re happy as a result. You receive news of a death in the family, or you split up with a partner – you tend to be sad. Natural sadness is often conflated with depression, when in fact depression is a further step down the ladder. Happiness and sadness are perfectly healthy mood states to be in, especially when they occur in response to a particular life event. If you were feeling happy, you wouldn’t take measures to change or fix it. Likewise, feeling a bit down is something that should be embraced, as opposed to being fixed or medicated. Happiness and sadness are fleeting mood states, don’t last particularly long and a healthy individual will eventually deviate back to euthymia.
Individuals without any known mental health issues, or a formal diagnosis typically tend to climb between rungs four and seven on the mood ladder. In bipolar, I can climb anywhere from the bottom to the top. To add more to this analogy, imagine the ladder is made of wood and going up a cliff face. On rungs four to seven, you’re attached to the ladder by a harness, but rungs one to three and eight to ten don’t have the cleat attachments. Halfway up the ladder you’re safe and stable. The risk of falling down or injuring yourself is minimised. Halfway up the ladder you can un-cleat and step on to a ridge in the middle of the cliff face. There’s no need to climb any higher.
At the bottom of the ladder it’s difficult to start climbing because there are no cleat attachments, and your confidence is lacking. You stay put and you catastrophize about what would happen if you fell just before attaching your cleat at rung four. Higher than rung seven, lies the flimsy section of the ladder. Those who dare to climb any higher are regarded as extreme. You don’t have anywhere to attach your cleats, the ladder is not well maintained, you’re higher up and at higher risk of falling a long way down. Only those who have a strong grip and footing can make it to the top, and back down to the ridge without falling. There is a thick wall of cloud towards the top of the cliff face, making it difficult to see anything clearly. Likewise, it’s foggy at the very bottom as well, but at the ridge it’s nice and sunny where you can see clearly.
Manic medic myth busting
Like anyone else, I can be happy or sad without any consequences. Bipolar doesn’t mean my mood automatically shoots up in response to a good trigger; nor does it mean I plummet into psychotic depression immediately after receiving bad news. In fact, this could not be any further from the truth. In the past, I’ve become manic shortly following a bereavement. Conversely, I’ve become depressed and low despite my surroundings being seemingly perfect. My mood does fluctuate, much like everyone else’s. However, I need to keep my mood in check regularly to ensure I don’t start climbing the ladder too high or fall to the bottom. I do have my triggers but it’s often difficult to predict how my mood will change in response to something.
Bipolar does not equate to mood swings. Mania and depression don’t just come and go within the space of a day. I’ve previously heard the term being used as a derogatory remark. “They just snapped. One minute they were happy as Larry, the next minute they were angry and upset. They’re so bipolar.” This kind of rationale is not only insulting to people who have a formal diagnosis; it’s demeaning and patronising to the person who snapped at their friend. It labels mood and emotions as something pathological. This kind of language stigmatises expression of feelings – particularly amongst the male population, who already tend to struggle enough talking openly about their emotions. This language also misrepresents bipolar, which is far more complex and three dimensional than just wildly fluctuating mood. If you cared enough about your friend, you’d ask what was wrong.
As I already mentioned, mania is not as taboo as depression or psychosis. And yet in bipolar, these mood states and disorders are part and parcel of each other. It’s important to not overlook mania. My mood can fluctuate up and down the ladder, usually in a stepwise fashion. It’s not uncommon to fall from the top to the bottom. Being at the extremities of the ladder make it very difficult to see clearly, think rationally and make sound decisions. Use of language is so important when talking about mental health. Crass labels and name calling does nothing but stigmatise genuine issues, and only serves to regress mental health awareness.
Living and dealing with hypomanic and manic episodes has never been simple. It’s becoming easier for me to identify my triggers, and when episodes do occur, they’re now far less frequent and severe than what they used to be. The medication I take helps a lot.
I am keen to stress this point about mania, though: it is dangerous and should not be underestimated. It’s a strange fact that despite these dangers, the early stages of hypomania does have some benefits. I’m more productive, I have more energy and am generally happier with life. That’s not to say I long for the highs. I don’t. I manage each episode with caution and ensure I seek appropriate support from family and friends so I can deviate back to euthymia with care. I understand the risks of being high in mood and its long-term effects on my brain. Which is why, for me, life is about finding a balance whilst on the ladder. It’s also ensuring I stay on the ridge for as long as I can, and avoid climbing any higher.