Introduction: The Question of Mania
It was an exciting time, my psychiatrist had just found this new treatment for me that was, for once, largely side-effect free. It was an over-the-counter medication, and I’d been experiencing incredible success on it. I had been able to reduce one of my medications to a quarter of what it had been and life was greatly improved. I was actually getting up at a decent time, early enough that breakfast wasn’t competing with lunch; early enough that making coffee was now a morning activity. I felt more human, more able to connect with people in the subtle, unspoken ways which had eluded me for so long – I was able to maintain appropriate eye-contact. And, when people told me I looked so much better, I actually agreed with them. I felt just so wonderful. On top of that my sister was visiting, and I felt excited at the prospect of spending time with her.
Appointments with my psychiatrist, up until that point, had been a rather depressing and demoralizing affair. Psychotic episodes were frequent and traumatic; and every week brought with it a new medication change (which inevitably brought with it a period of adjustment as my brain adapted to the new ecosystem of chemicals); I rarely had good news. And while I’m known for having a rather uncanny upbeat and good-natured attitude, no matter what befalls me, it didn’t necessarily make going to my psychiatrist’s office any less demoralizing.
But this particular visit; having given my psychiatrist good news — dramatically reduced psychosis, much better connection and presence in reality, getting up earlier, being able to actually work on things I found meaningful — with my sister there, simply stating that she just loved me and always would, no matter what. It just set my heart soaring. My appointment had gone so marvelously well and things were looking like they were actually improving. And so, on the way home, I was much different from I usually was. I’m normally a pretty reserved person. My usual demeanor is calm and even, more an observer than a participant. I rarely get overtly excited, I don’t typically wear many of my emotions on my sleeve — people call me hard to read or else mysterious. But, since time immemorial, there’s also been the opposite Chris – I get goofy, I get clever. My capacity for wit and repartee, for stunningly funny insights in to the “truth” of things have people saying I ought to be a comedian. I’m entertaining, I’m charming. I oftentimes make friends when I’m in this mood. There’s this sort of stream of conscious-nonsense, couple with clever oftentimes random (and frequently hilarious) insights.
And this is the mood I found myself in when we all left my psychiatrist’s office.
I remember we went out to eat, driving in separate cars, my Dad and I in his car, my sister and my Mom in my Mom’s. I always smoke a cigarette after I eat, so my Dad and I were outside the restaurant while I smoked and the ladies headed to their car to go to my parents’ house where I’d be joining them for my sister’s visit.
I started talking like Sean Connery.
It’s not a very good impression, but my Dad finds it funny. And when I get someone laughing, I just want them to laugh more. The whole way home was a stream of Sean Connery-related nonsense, lots of references to Money Penny, and Dad laughing the whole time. As we got closer to home, I realized I was in a precarious situation. I voiced it to my dad, dropping the Sean Connery impression – Mom is probably going to accuse me of being manic.
But once I’ve adopted this persona, once I’ve gotten into the role of being ridiculous and witty, once I’ve started enjoying myself in having relieved myself from the seriousness of medication, psychosis, routine, discipline, etc. It’s hard to just suddenly switch modes. It’s a bit like being drunk or high. Getting to that point happens relatively quickly, but getting back down, returning to “normal” takes some time.
And, my Mom did “accuse” me of being manic. And I got angry, I got furious. My fury was such that I had to leave the room and go smoke a cigarette and vent that fury to my Dad on the back porch.
But afterwards, we talked about it — in a calm, reasonable way. My Mom asking me if I was manic felt like an accusation, it mostly troubled me because I had predicted it. But even more than that — it was the sense that I couldn’t just enjoy myself. There isn’t a whole lot left in my life of the traditional sorts of fun — and my experience of having bipolar (the affective part of schizoaffective disorder) disorder has been a terrible, dark, almost constant depression.
And in the midst of the conversation, we all seemed to realize that we didn’t have a very good definition of what mania is. We realized that it’s, ultimately, a personal thing. How I experience mania isn’t like it’s depicted in the media; it can’t be detected after an hour or two of excited behavior. But it’s also a serious thing that needs to be considered — because if my mood slips too much then the rest of my mental health can just wash into oblivion too.
And so here I present, a little guide for mania. It’s based off of my own experiences with mania — you or your loved one’s experiences will most likely differ. But I figure at least it can serve as a sort of guide or else insight into how to think about mania.
A Manual for Mania
Mania is a touchy subject for me. And I think it’s a touchy subject for a lot of people. It’s hard to broach the subject of me being manic without it sounding like an accusation. And, frankly, I enjoy being manic, at least that commonly understood type of mania. Many people, myself included, who experience a bipolar type illness spend the majority of their time in a miserable depression. So, the sudden upswing into mania is most often a welcome relief. To me, if I’m just talking in a Sean Connery voice for a while and making people laugh, to ask if I’m manic (which I often translate as a sort of accusation) just sucks all the joy out of it. I feel as though oftentimes, having a mental illness, I’m not “allowed” to have variance in my demeanor. People, especially my family, are on hyper-alert for any sort of change, and any change is usually interpreted as a bad thing. I understand completely (and even appreciate) this vigilance. But sometimes a man is just enjoying himself; relishing in spending time with his sister and having had a particularly good appointment with his psychiatrist. Sometimes a man just has some hope for his future and expresses that by doing an, honestly pretty terrible, Sean Connery impression.
So here it comes down to definitions, what exactly is mania anyways? I may meet the technical definition of being manic in that my mood is dramatically more elevated than before — but what’s more important to me is: am I suffering?
The end result of this discussion with my family was me being tasked with coming up as complete a definition of mania as I could. I was actually tasked with a lot more than that — defining pretty much everything I experience with my mental illness. I think my family wanted a manual on how to determine what I’m going through and what to do about it, a kind of “Proper Care and Feeding of Chris”. And while I understand how valuable such a thing would be (it would be so nice if, upon meeting someone new, who seems willing and able to support me, I could just hand them a manual on what to do, when to do it, and how to do it) I ultimately passed on most of the proposed “manual”; mental illness is too complex, too vast, and changes constantly; the practicalities and realities of my mental illness change too quickly. Oftentimes something happens just one time and then never again or else it expresses itself in an entirely different way. To keep such a manual up-to-date would be a vast undertaking and not necessarily helpful even if I kept it perfectly up-to-date. Then there’s the risk of the illusion of safety such a manual would present. If we were to start assuming that the manual had all the answers we might lose our ability to think critically and independently. What would happen when, inevitably, something happened that wasn’t covered in the manual?
I did eventually deliver on the mania part, years later and in a rather incomplete way. Mania is a touchy subject for me. Someone asking if I’m psychotic isn’t liable to get me roaring with anger. Similarly, someone asking if I’m experiencing any other symptom of mental illness isn’t likely to get such a negative response. It seems to be misunderstood at a fundamental level. People who haven’t experienced just know it’s bad(it’s a symptom, after all. Aren’t all symptoms of illnesses supposed to be bad, or at least unpleasant?), but to a person experiencing it, it can be just great. Mania is also far more subtle, in its genuinely unpleasant forms, than how manic people are portrayed in movies and television.
Far worse, and malignant, than me annoying the crap out of you with my terrible Sean Connery impersonation or overwhelming you with a near-constant stream of nonsense products, pun-inspired business ideas is when my mania expresses itself in such a way as to affect my sleep or else to make me irrationally angry. If those are out of sorts, if my default way of being seems to be anger or else my sleep is disturbed, then I’m probably manic in a way that I won’t take you asking me if I’m manic as an accusation.
To be clear, this is my personal definition; informed by my experience with mania over the years as well as my own the belief that something is a symptom (which therefore needs to be addressed) when I start suffering from it; when it starts affecting my ability to relate to the real world and the people who occupy it, in a healthy and rational manner. This is not the only definition of mania, and it may not even be accurate for you or your loved one. My intention is first to highlight how complex and nuanced mania can be as well as to offer some insight into what may be a useful way of looking at mania.
I’ve written before about my anger monster, (you can find those articles here and here) so I’ll just keep to the basics. If my anger is irrational — if I’m making cutting remarks for seemingly no reason, if I’m reducing the people I love the most to tears for unreasonable things (such as complimenting me on my good mental health) — that’s mania and it needs to be addressed. There’s nothing but suffering to be had from my irrational, manic-drive anger — the people I lashed out at usually ended up in tears (often in the middle of public) and I’ve never felt like more of a low-life, scum-sucking, douche bag than when I was consumed by the anger monster.
It’s gotten more complicated in the couple-three years that have passed since the incident I related in the introduction, because I’m starting to actually feel feelings — and with my feelings, comes passion. And, frequently my passion, my excitement, my simple enthusiasm for what we’re discussing is mistaken for anger. I think it’s just a consequence of me being such a mild-mannered, calm, rather quiet person most of the time. For most of my adult life, I rarely expressed any sort of strong emotion except when I was either actively psychotic or else consumed by the anger monster. Other than that, I was even-keeled, calm, and might have been considered robotic if I didn’t actually add inflection to my tone of voice. But, having gotten off of some of the medications that seem to have just deadened various emotional registers, I’m now a bit more lively. And I imagine it’s a bit confusing and alarming for me to have more of a breadth in my emotional register. My voice is naturally deep and booming and I’ve been augmenting it for the past few years by being a regular smoker. I oftentimes have a problem with being too loud when using my quiet voice, librarians tend to dislike me. I usually assume that just about everyone can hear me (whether they, or I, like it or not) when I’m in public place that isn’t already super noisy. It’s all fine when I use my deep, booming voice in an emotionally distant sort of way. But when I find myself passionate about something? (especially when I’m not accustomed to being passionate). I understand the various misunderstandings as of late.
Recently, I concerned my Mom as she was driving me home by talking excitedly about a 240GB log file I’d found on a computer. A 240GB log file is a rare (and ridiculous) thing and finding it had made my day. In my 20 some-years of fixing computers, I’ve never seen a log file this big. And as she drove me home and I was talking about it and how amazing it was and how wonderful it was, she stopped me and told me that I was getting rather loud. I wasn’t angry at her, I wasn’t angry at anything — it’s just that, apparently, a ridiculously large sized log file is something that gets me truly, genuinely excited.
Earlier this summer, I was riding in the car with two of my best friends. I have no idea what were talking about precisely, but I do remember it was something that had me, again, quite excited. The friend I’d been having the conversation with suddenly got quiet, the kind of quiet that suggested to me I’d said something offensive or else insulting. I asked him what was up and he asked me why I was so angry about something so unworthy of getting angry about? (and I do remember that no one in their right mind would get angry about what we were discussing). Again, I wasn’t angry in the slightest. I was just excited.
In both instances, I think it would be reasonable to think that, based off of my past behavior (showing very little emotion except when either tortured by psychosis or else consumed by my anger monster), I was angry in both those cases. But I wasn’t. I chalk it up to my own inexperience and fumbling with having regular, normal, every-day emotions as well as my friends and family not being used to seeing me having them.
To me there’s a clear difference in my demeanor between when I’m consumed with the rage monster and just genuinely excited about a Log File of Unusual Size. But maybe not. It adds an interesting complication. Generally I’ve told people that you’ll know when I’m angry simply by the fact that I suddenly become terrifying, and that you’ll know if this is an Anger Monster sort of mania-related problem, if you have absolutely no clue why I’m angry but you’re still in tears. But things have changed. I’m kinda new at having regular emotions. For the past 10 years, I haven’t often gotten noticeably excited. And now, apparently me being excited is akin to what my anger used to look like. I haven’t experienced the anger monster, or any other sort of anger that I can remember, since this whole shift toward a normal emotional register began happening. And I simultaneously hope and dread that it’s vastly different from me being excited.
About the only solid difference between my excitement-perceived-as-anger nowadays and my Anger Monster Consumption of the past is the effect it has on people. The Anger Monster was never a fringe case. Definitely not something that could be explained as “Oh, no. I’m sorry. I’m just excited is all.” When I was consumed by the Anger Monster I did damage. There were multiple times where I made my Dad, who isn’t one to cry and especially isn’t one to cry in public, fall into tears in the middle of public. The Anger Monster led to the creation of various (and numerous) rules about how to interact with me in public, one of them being a moratorium on saying anything “random”. This was especially difficult for my Dad, as our relationship is largely based off of appreciating the random and absurd. But after I blew up at him when he made a comment about the side of an ice truck that I hadn’t seen, it seemed only rational and beneficial (to me, to him, and to our relationship) if we (mostly he) refrained from saying things that didn’t make sense to me.
It’s a subtle negotiation sometimes. Mental illness is a constantly changing, constantly evolving thing. The rules I establish are usually only temporary, but they’re essential. The rule banishing randomness was necessary but only temporary. It helped me not deteriorate any further, it helped my Dad not suffer any more unwarranted verbal abuse, until I could figure out the whole Anger Monster situation and take care of it. My Dad and I are now happily enjoying saying the most random, absurd, and ridiculous thing to each other; as has been the staple of our relationship since I was capable of coherent speech.
I think the anger aspect of mania just highlight the need for open, honest, and generous communication. It’s not in my nature to hurt people, verbally or otherwise. I may do peculiar things, things that people don’t agree with, I may be an unusual person (much more so than I let on in this blog) but I almost always have good intentions. I’m thankful that I was able to clarify things with my friends in the car earlier this summer, and I’m thankful my mom mentioned my demeanor while I was talking about the ridiculous log file on our way to my place. I would hope that most anyone would just ask or else mention that I seem rather threatening all of a sudden so I can just tell them that I’m still getting used to having regular emotions that aren’t traumatizing.
And that’s another underlying issue with mania. How does one approach a touchy subject? How does one ask someone if they’re manic without making it sound like an accusation? It comes down to knowing who you’re talking to and what kind of state they’re in, which can be a tremendously tall order for someone with a mental illness.
I’m also pretty sure I’m ultimately responsible for how my Mom asked me about being manic in the story in the introduction. I remember my psychiatrist mentioning to me and my mom that it was a touchy subject with most people and suggesting a few ways of phrasing it so as to “lessen the blow”. And I made the mistake of just telling them both that I didn’t see a problem with being asked. So I just told her to just go ahead and ask me if I was manic in a direct, upfront manner. And it backfired terribly. I don’t know if I just wasn’t able to project myself into such a situation at the time of the conversation or if I had a totally different conception of what mania actually is than my Mom did. About the only thing that can help with that is to learn from our mistakes and misconceptions and try to communicate better and more thoroughly in the future.
If I’m manic enough to be getting irrationally angry, things have been going poorly for much too long. My sleep patterns are much more helpful in gauging a more immediate sense of the state of my mood.
I place enormous value on good sleep hygiene (which I talk about below), and doing so means that if I find myself tossing and turning in bed, trying to get to sleep, it’s usually because of elevated mood. The signs (or symptoms, I suppose you could call them) come in distinct categories.
Here are the signs I’ve identified:
- An inability to calm my thoughts enough to sleep.
This is probably the most common (and universally recognized) symptom of mania: the rapid, obsessive, non-stop stream of thoughts. A person who just talks and talks and talks, seemingly with an inexhaustible supply of things to say.
I allow myself all the stream of consciousness thoughts in the world while I’m awake. They’re an essential part of my creative process. Some of them happen to be good enough to turn into short stories or blog posts or ideas for books or else features in books or short stories or blog posts I’m currently writing.
The stream-of-consciousness ideas represent an interesting sort of paradox to me. They present so much like mania that I wouldn’t blame anyone for calling me manic when I’m just putting forth idea after idea after idea. The key questions, however (for me, at least), that differentiates between me being manic and me just being me is can I shut those ideas off when I want to? If I can turn off my stream-of-consciousness, then I’m not going to suffer from them and they’re basically harmless. But if I can’t shut them off, then there needs to be some sort of intervention. It also demonstrates control; if I have control over the stream of thoughts then I can react appropriately to given situations, if I can’t, then I’m manic. The ability to demonstrate self-control is an essential differentiator between manic and not-manic. I suppose it’s sort of like drinking — one is considered an alcoholic when they don’t have self-control. But habitually enjoying a drink at the end of the day doesn’t make a person an alcoholic.
This relates to sleep in that, as soon as I’m trying to go to sleep, those thoughts had better start calming down. I have a rather drawn out bedtime routine, taking about 30-45 minutes. I do the exact same things in the exact same order, all as a kind of signal to my brain and my body that it’s time to start shutting down for the night. I’ve basically programmed myself through routine to know it’s time to start winding down for the day. It works remarkably well. I can be having all sort of rambling, nonstop thoughts at 8:59pm. But come 9:06pm, after I’ve taken my evening pills, have put my morning pills in their appropriate places, and am starting to roll my cigarette, those thoughts are generally calming down.
So, if I’ve gone through a bedtime routine that lengthy, that involved, and that (typically) effective and my thoughts are still racing – I’m probably on my way to getting manic (or else, already am) and need to do something about it. The key I’ve learned is not to embrace the surge of thoughts racing around in me. I have several tricks — a specific Mozart album I only listen to when I’m trying to fall asleep (which I chose because I habitually fell asleep listening to it when I was little), I have a book that I keep handy that generally calms my thoughts, drinking incredibly cold water helps, as does going outside and smoking another cigarette. If things get desperate, I’ll also call my Mom to talk to me; her calming voice has been helping me fall asleep since I was a baby.
There have been nights in the past where none of the tricks have worked. And so I lay in bed with my eyes closed, not sleeping, but also not letting my mind be active. There have been times where getting to sleep is hard work. My meditation technique (which I wrote about here) is particularly useful. But the key I’ve learned is that once my prescribed bed time arrives – I don’t do anything but sleep or else try to sleep.
- Light and sound are unreasonably bothersome
I live in the middle of Denver. To expect there to be silence at 9:30pm as I’m getting into bed to start reading before falling asleep, particularly with a bar about half a block away, is unrealistic. Same with light. I’m lucky enough to live in the back of my building, but there’s still a lot of light that comes into my bedroom. And when I’m manic, any amount of external stimulation — particularly light, is maddening. So if I find that I just can’t get my bedroom dark enough, if even the light from the network switch buried in my closet leaking from underneath the door is bothering me – I’m probably manic and need to address it.
Sound has become less of a problem. Mostly because I have to deal with bothersome noises regardless of whether I’m manic or not. My apartment is right above an alley and all day and all night long there’s usually some kind of activity — people going through dumpsters, people arguing, people making various sorts of ruckuses for reasons I’m sure I don’t really want to know about. There have been people screaming, people fighting, people doing drugs. But also people just talking to each other, especially during the summer when it’s not as much of an ordeal to sleep outside.
Then there’s my neighbors. Most of them are rather young. Either college age or having just graduated college. I know I’m in the minority of people on my floor who are in bed before 10:00pm every night. And so there’s loud music, there are arguments, and various other noises.
Then there’s also the voices. The voices in my head have lessened in severity and frequency over the years. But I almost always hear them as I’m falling asleep in a new place. Even when I’m sleeping at my parents’ house (the same house I grew up in) – I almost always hear the voices. And they’re a different sort of voice – I usually hear people I know talking. It’s a similar experience to being a little kid, when your parents had company over and you had to go to bed before the company left. You could identify the voices — your mom’s voice or her friends’ voices, but you had no idea what they were saying. The most you could gauge, was the mood of the conversation. My experience with the voices is remarkably similar — only oftentimes the voices I’m hearing, though familiar to me, aren’t in the house and no one is actually talking.
I’ve learned to live with them all, I take a sort of pride in my ability to fall asleep despite an utter lack of peace and quiet. So I know that when it starts to effect my ability to get to sleep and to stay asleep, there’s something up with my mood.
- Amount of sleep
Years ago, I had a much less rigid bedtime routine. And I suffered for it. I remember calling my Mom one morning, shortly after I’d moved out a year after ECT, at around 7:00am, and her commenting with a certain kind of joy in her voice how nice it was that I was up so early. I had to deflate that joy – I was calling her to tell her that I hadn’t been to bed yet and to not call me at 10:00am (like was customary then) because I needed sleep. I’d gotten so involved in a project on my computer that I lost all concept of time and, when I finally took notice of the clock, it was 7:00am.
That was easily solved with a routine and with a certain amount of discipline. Pill time comes around and that’s just the end of my day. There are the occasional exceptions, but generally it doesn’t matter what I’m doing, how involved in it I am — when I take my pills I just go through my bedtime routine and fall asleep. Everything else will have to wait until morning.
But my elevated mood can still affect the amount of sleep I get regardless of how disciplined I am about going to bed on time and making sure I follow my routine. I can go to bed at my usual time and find myself wide awake at 3 or 4:00am. Most days, I have to rely on a stimulant to get me awake enough to function, but on these mornings – I don’t need any such thing. Generally, my only hope is get dressed as minimally as possible (enough so I can be out in public but not so much I’ve psychologically prepared myself for the day) and hope that my morning cigarette will put me right back to sleep. Outright fatigue after my morning cigarette is fairly common sometimes, though it’s not common enough (or predictable enough) to be relied on. Still, it’s tremendously difficult to put yourself back to sleep when you’re wide awake.
An opposite phenomenon can also happen. I read virtually every night before going to bed — most often a novel. The vast majority of the time, I have to stop reading when my incredibly sedating medications kick in. And then, it’s sort of a race to take my glasses off, put my book on the bedside table, and turn off the light. But every so often (most often when my mood is elevated), I’ll be engrossed in my novel and it’ll occur to me that it’s been longer than usual. I look at the clock and it’s well past the time I normally (and ideally) fall asleep. And I’m not even sleepy.
This last phenomenon is a bit different now that I’m not on as many sedating medications as I used to be. I used to take 3 different antipsychotics at night and now I only take one (but the one I’m on is also the most sedating). So it’s not as significant for me to be so engrossed in my book that my brain “forgets” to be sleepy. But still, it’s data, and any data is useful in determining my mood.
- The “Second-Wind”
One interesting, fairly universal, experience of having schizoaffective disorder (as well as bipolar disorder), is the “second-wind”.
There’s a sort of sweet-spot for me being able to fall asleep. And my bedtime routine tries to leverage this sweet spot as much as possible. If I miss that sweet spot (generally a 1-1.5 hours after I take my pills), chances are I’ll get my second-wind. If I get my second-wind, I can be awake for hours or else even over 24-hours until it’s time to take my evening pills again. It’s like, if I can get over the initial sedating effects of my medication, then sleep isn’t really needed.
An essential part of good mental health, especially with bipolar/schizoaffective disorder is good sleep. Which means both getting sleep at the “proper” time (i.e., during the night) as well as getting enough sleep (the doctor recommended 8-10 hours). With good sleep, a lot of problems are lessened or else easier to manage: mood is more stable, symptoms are less extreme. It’s been my tendency to be a night owl for as long as I can remember — certainly since high school. But I’ve denied myself that tendency and have come to believe that’s a big reason why I do so well.
The Nature of Mania
Mania is an overactive mind, a mind on overdrive. A mind that’s out-of-control. There’s little self-control, or else attempts at self-control are futile.
There’s really no amount of discipline or routine that can overcome mania when it’s set in. But discipline and routine are certainly helpful in being proactive about preventing and detecting mania detecting mania. I’ve found that I have to approach my own mania at an oblique angle — my mania is not straightforward and obvious (as mentioned above – I can seem manic but not actually be manic). I don’t know as if anyone’s mania is as straightforward and obvious as is generally defined and explained by mental health experts, medical literature, and (especially) the media.
It comes down to knowing yourself. I’m able to successfully deal with most of my manic bouts well before they get out of hand because I know myself well enough to have established criteria which define what mania is to me as well as outline the progression of it expressing itself. Having a clearly defined concept of the nature of my mania is incredibly useful. As my Dad is fond of saying when a problem comes up at his work, “Go back to the definition”. In the argument with my family I described in the Introduction, the problem was that we were operating off of two different definitions of mania.
It’s important to define what any aspect of you or your loved one’s illness is. It certainly can’t be done right away, it takes time, a certain relationship with the intricacies and idiosyncrasies of a mental illness before one can define what they are and (just as important) what to do about them. I chose mania largely because it represents a sort of grey-area for me.
For the longest time, being manic was some of the only times I had when I enjoyed life, when I felt alive, when I was anything approaching what’s commonly thought of as happy. And it genuinely offended me, angered me, when my “fun” was ruined by someone asking me if I was manic. (And at the time, it didn’t feel so much like an asking so much as it did an accusation. And it often still feels like an accusation). It’s a touchy subject. It’s not as clear cut as psychosis. Psychosis may be a mysterious thing to people who haven’t experienced it — but it’s pretty obvious that it’s a terrible thing to go through. But I personally oftentimes enjoy being manic, my friends with bipolar disorder or schizoaffective disorder, tend to agree. When you’re manic you feel like you’re getting everything in world done, you feel powerful, you feel like a genius. You feel witty and funny and intelligent and tremendously charming. With my baseline mood generally being a variation on depressed, it’s refreshing. About the only thing I can compare it to is when I was in grade school and a Friday afternoon was dragging on. I probably had some new video game I was looking forward to playing and, for whatever reason, the clock was going tremendously slow. School was torturous, it was never-ending, there was absolutely nothing pleasant about it. And then, 3:15pm would come around — and I was the most joyous person on earth. At the time, there was no better feeling in the world than getting out of school on a Friday and knowing that I had a whole weekend to just enjoy myself with a new video game.
Lately, my definition of mania has been tested somewhat.
Actively reducing my medication for the first time ever has brought a whole range of new experiences for me. I feel even more human than I did when my psychiatrist added the over-the-counter medication that has been such a wonder drug for me over the past few years. My capacity for thought has become enormous compared to what it was before. The stream of consciousness, the nonsense, the witticisms, the clever remarks, sometimes seem to just come at me constantly. I’m a much different person than I was a year ago — and it’s taken some getting used to, some necessary adjustments.
In having these seemingly constant streams of thought, I’ve wondered myself a number of times if I’m not actually manic. The sheer volume of thought is staggering. And I’ve gone through a sort of crisis in feeling like I have to record all of these thoughts, but not physically being able to. Thoughts like these, original thought, used to come to me so rarely. I place extraordinary value on original thought — on new ideas and novel concepts. They were once such a rare and precious thing. I had developed a variety of rituals in trying to summon them, I also prepared myself for when they would occasionally pop into my head — making sure I’ve had my pocket notebook with me has been more important than having my wallet or my keys or my phone. Then, upon experiencing this sudden influx of ideas and thoughts and concepts – I found myself filling up one of my notebooks in a couple of weeks. A notebook used to last me a good two or three months.
I likened it to having been in a desert for 10 years — any amount of water is precious and worth either consuming or storing. And now suddenly I was in a lush tropical forest — “water” was everywhere!
But in explaining this to my therapist, she just sort of set forth the idea that maybe I was manic. That maybe this constant stream of thoughts was an indication of something about to go poorly.
And I’m going to have to think about it.
Because I understand that from the standpoint of symptoms, I was manic. That near-constant stream of thoughts often led to me talking just about anyone’s ear off that happened to be available. I started having thoughts that maybe I was an intolerable person — hard to be around because I suddenly had so much to say. I think the mistake I was making at the time was that I hadn’t adjusted my attitude and behavior to match my new experience. I was a desert dweller, in a lush tropical forest with water available whenever I wanted it, but I hadn’t shifted my attitude to accept the abundance. It seems to me that most of the problem wasn’t the de-facto existence of plentiful thought, but rather that I still thought (and attempted) to record every single one of them.
Then I was hanging out with one of my good friends, and she made the comment that my memory has improved dramatically since we first became friends. I hadn’t remembered, but apparently when she first met me, I wouldn’t have had a memory of us having hung out the previous day — she would have to recount to me what we did and talked about, where we went, and so on. My obsession with recording all of my ideas is largely the result of my historically poor memory. If I had a thought or an idea and I didn’t record it immediately — it would be gone forever. (or else, it wasn’t, and I just didn’t recognize it when it popped up again). But now, I can actually have a thought cross my mind and know that it will come back again if I don’t write it down immediately. In fact, I’ve learned that this is a sort of filter — good ideas tend to repeat themselves whereas less-good ideas just disappear.
My mind, which I haven’t been able to trust with much of anything since my last ECT appointment on May 3, 2010, is actually becoming a capable tool again. I can actually trust my mind. So it’s eliminated a great deal of my anxiety about the onrush of thoughts. Which has me thinking — maybe it wasn’t so much mania in the sense of actually being mania but instead an anxious reaction about what to do with the thoughts because I didn’t know I could trust my mind to filter my thoughts and present them to me again at another time?
One thing I’ve learned about my mental illness is that it’s always changing, always adapting, always evolving. My illness expresses itself in different ways at different times. There’s a certain rhythm to different seasons and times of year — being manic in spring time feels fundamentally different from being manic during the winter, for instance. And there are many varieties within those times too (getting psychotic is generally different for me from Dec. 12 – Jan. 01 than it is during any other time of the year and even during the winter, for example). To speak of concrete specifics isn’t always helpful if the goal is to come up with a plan for how to help, how to approach mental illness. Those specifics can change at any time — not only the specifics of what helps most (the treatment) but also the specifics of what goes wrong, how it goes wrong, and why it goes wrong.
I met the technical criteria for mania. I experienced a constant stream of thoughts that came to me largely unbidden. The thought stream was overwhelming enough, constant enough, that my therapist noticed just how worn out I looked. And I was worn out. It was exhausting to try to ride with those thoughts.
But to me, there has to be component of suffering. I may have been exhausted, but it wasn’t not because of the thoughts themselves, it was because of the responsibility I felt in having those thoughts. Because I could shut those thoughts off if I wanted to. There were a number of times when I found myself wanting to take my afternoon nap while the constant thoughts were still gurgling and buzzing. And my solution was to just stop thinking about them. I had a choice in having these thoughts — to me, mania (in the traditional sense) doesn’t come with a choice. When I’m manic, I have little-to-no self-control. I’m awake when I don’t want to be, I’m angry when I have no reason to be, and my thoughts are so out-of-control that I cannot help thinking them.
But with these thoughts, if I want to take a nap, I can. It’s kind of like turning off the TV or the radio. “Normal” means when I press the button it turns off. “Manic” means the TV or the radio is on whether or not I want it to be.
I suppose, from a certain point of view, the main component of my definition of whether or not I’m manic (and, to further extrapolate, my definition really deals more with “am I manic enough to need to do something about it?”) comes down to how much control I can exert on my behavior. My capacity for free will. When I get irrationally angry, I don’t have a whole lot of control over myself — it just sort of comes out of me like I’ve eaten food that doesn’t agree with me; I’m largely an observer to myself saying terribly hurtful things. I’m still responsible. But I believe my responsibility comes chiefly in being proactive about preventing such things as well as taking ownership over what I’ve said (which is a whole other topic — “is a mentally ill person responsible for the hurtful things they said that they had no control over saying in the first place?” my parents are interesting people to talk to about this).
So the existence of these semi-unbidden, almost constant stream of thoughts is a bit confounding. I can actively turn them off if I want to. I’ve figured out a number of methods to quiet my mind — meditation, reading, laying in bed with Kerrin. According to my definition – I’m manic when I can no longer exert control or influence over my thoughts or behavior. So the fact that I can shut them down at will means that, according to my definition, I’m not manic.
I’m also sleeping well at night. I’ve maintained my bedtime routine, gone to sleep without trouble (maybe woken up in the middle of the night a couple times (but that’s not unusual — it’s probably just in my genetic makeup as I have fond memories of my Mom telling me not to worry when we visited my grandparents: if there were scary noises in the night it was just my grandpa “prowling around”)), and woken up in the morning after getting an appropriate amount of sleep.
So maybe there’s an underlying problem with my definition — maybe I need to rethink it or modify it or else throw it out altogether.
Some Shortcomings of Using Definitions
Definitions are oftentimes seen as the end-all-be-all of disagreements and negotiations (like my dad says, “Go back to the definition”). But there’s a certain inadequacy to my definition of mania — it seems to only focus on mania itself, and not on the various (and numerous) other aspects of my illness. There’s this tendency to sandbox each feature of an illness like schizoaffective disorder (which covers the experiences of both schizophrenia and bipolar disorder — both of which are tremendously vast experiences on their own) as if they occurred in an isolated fashion. But they don’t. Simplification is oftentimes a very necessary component in trying to understand a mental illness. Having a set of rules, procedures, rituals, and routines is helpful. But they’re only helpful if they’re not rigid. It’s also necessary to be flexible, to be adaptable.
Just because I didn’t meet my current definition of mania didn’t mean I could just continue along like I had been. Coming in to an appointment with your therapist at 3:00pm and being noticeably exhausted isn’t such a good thing. Further relating to your therapist, upon her commenting on your state of exhaustion, that you had the conscious thought that you were ready for the weekend on Monday night is another issue.
Part of the reason I focus so much of my life on getting adequate and good quality rest is because being well-rested has proven essential to my mental health. No one is mentally sharp when they’re exhausted, and my mental illness demands that I be sharp at all times. Put succinctly — the more tired I am, the more likely I am to experience psychosis or delusions or paranoia or voices or the staggering overwhelming hopelessness that used to plague me every afternoon at about 2:15pm. The more I experience the symptoms of my illness, the more tired I’m going to get, the less rest I’m going to be able to get. Good mental health builds on itself over time, but poor mental health can do the exact same thing. And it’s an unfortunate fact that most of the time it’s easier (and faster) to accumulate bad mental health than it is good. Good mental health can take months and years to build itself up. Bad mental health can build itself up in weeks or even days.
Which is why flexibility and adaptability are key. Because some symptoms of mental illness defy explanation and categorization. To simply be satisfied with the fact that I don’t meet my definition of mania and call it good, is folly. The exhaustion thing concerned me, as well as the consistent thought that I was being intolerable.
There’s oftentimes this fine balance between finding the answer and letting the answer present itself. There’s a certain satisfaction that you’re “doing something” if you’re actively trying to find an answer to a mental health question (with the question being the sort that only you can provide). But those sorts of answers aren’t generally correct or useful. I’ve had the experience a number of times throughout my life working on especially difficult computer problems. There’s always a big part of me that just wants to keep trying things, keep working on it, keep actively trying to think of what the solution could be. But I also know that, when I get into that position, it’s best to just take a break. If I go for a walk with my dog, if I go smoke a cigarette, if I go do anything other than think directly about the problem, the solution generally presents itself. My Dad taught me that, and it’s probably one of the most useful pieces of advice for fixing (or trying to create) anything. If you’re stumped and just not making any progress — go do something else. I also use it with an almost 100% success rate when I’m writing and experience the dreaded writer’s block. If I go out and smoke a cigarette on my stoop and am conscious to not just actively distract myself by checking my phone, when I finish that cigarette 12 minutes later (and oftentimes sooner), I know exactly what to write next.
My therapist likes to call it “trusting the universe,” and I suppose that’s exactly what it is. Or else it’s divine inspiration. Or else it’s just a law of physics.
And so I experienced such a thing when my good friend mentioned how much my memory has improved in the 8 or 9 years since we met. It was like everything connected and things started to make sense. Maybe part of the mania was tricky not because of the thoughts themselves, but because of my reaction to them. The anxious, desert dweller in a lush tropical forest, reaction I talked about above.
I don’t know how this new information will affect my definition of mania. I suspect it won’t so much change the definition itself as much as broaden my awareness of how everything is interconnected.
It may be convenient and even necessary to simplify my mental illness into separate, distinct entities. But that doesn’t change the reality that they’re all quite interconnected, all influencing each other in ways that don’t necessarily make sense or are even apparent or logical.
Once again, it’s about being flexible. It’s about being adaptable. As I’ve mentioned a number of times on this blog as well as in my talks — the successful reed (the reed that survives) is the reed that bends with the ebb and flow of the current. Too rigid the reed snaps. Too limber the reed just drowns.
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