Manic Depression


Since I wrote my last article on the subject, I’ve often been asked to elaborate a bit more about the nature of Bipolar. After all, if I was going to insist repeatedly that there needed to be individual attention to each person’s experience of the illness, then I might as well digress on mine.

The critical advantage I think I can offer people when I talk about Bipolar is that I’ve lived with my diagnoses for long enough to see various methods of treatment be devised, implemented, derided and then upgraded; and none of them are any weaker for being tailored to an individual rather than a document describing some symptoms. All of this can be said of any ‘major’ illness but I’ve always had the privilege of amusement and bemusement (and just a little existential frustration) when I get to witness first hand the response to my manic states – or at least what’s perceived as one. This wasn’t always the case; I didn’t know in the beginning what exactly was happening to me, so now that I do it would be a foolhardy insult to others who struggle with Bipolar and other learning difficulties not to fully utilise that advantage.

So, to take one end of the spectrum, you’re going about your day and a couple of familiar signs start appearing. Sleep hasn’t been easy, neither has concentration – at least without getting bored very quickly. You don’t really feel that tired or even that irritable but everything is taking so long and you have no patience for it. These are some of my early signs of having a manic episode – a stark contrast from the circumstances and biochemistry of a depressive episode but not a binary opposite.

Two things are essential from this point on: firstly that no one friend or family member is allowed to over exaggerate the level trepidation my mood is indicating and secondly that we get a proper idea of just how manic I am going by allowing me a cooldown period. Immediately hospitalising someone with Bipolar the minute they begin to go manic can only worsen feelings of entrapment and hypersensitivity and the panic only goes further hand in hand with the state of mania. An opportunity to have the manic person offer themselves to treatment and to look forward to getting better, can all to easily be squandered by increasing the levels of panic around them.

The considerations shouldn’t stop when the individual has committed to treatment. We know that wherever the person goes it won’t be their home and that, at some point, they will be subject to intensive clinical procedure. Comfort can be supplied by giving the maximum amount of space possible and by allowing the individual to assert some degree of control over it. A ward common room, a hotel room, even an individual room on a ward with a television or radio in it to fiddle with. Being able to have autonomy over these small environmental factors can stop someone who is going manic from spiralling down further – it’s these small things that can relegate a person into their comfort zone from within which having anything to do is better than having nothing at all.

Equally vital is that the Bipolar individual is kept separate from those individuals that doctors love to lump in with them. There is, for example, nothing productive to be gained from putting someone who is going into a manic Bipolar state in close proximity with those who are in major depression. Both the treatments and the personalities in question here are utterly incompatible and the impressionable yet contagious nature of a Bipolar person in a manic state will not be appreciated by either party. Worse still is the confusion between Bipolar and Paranoid Schizophrenia where there are, again, common symptoms and where there is, again, very poor judgement in shoving those personalities together. It’s a tethering of these symptoms to a condition; it’s something that helps put doctors back in their comfort zones and in some cases allows them to take action on treatment but it does so on a false pretence.

So what if we were to allow the patient to define some of those parameters themselves? To give back some of that autonomy? Just because they’ve been hospitalised it doesn’t necessarily mean that those energy levels and burgeoning streaks of hyperactivity are going anywhere. Medication can take weeks to begin to have an effect, meanwhile the Bipolar individual has been stripped of anything they might do for fun or even basic stimulation; I’ve commented before on the degree to which treatment can become awfully parental very quickly. Such importance is placed on removing the external signs of a manic state that little consideration is given to making sure that the patient doesn’t slip in to the equally dangerous depressive state. Outside of one or two soundbites from particularly eloquent celebrities, there is little public awareness of just how dangerous the latter is. At their worst, a person with Bipolar disorder can arguably suffer all the afflictions of someone with major depressive disorder and someone with an identifiable kind of alexythymia or hyperactivity – in my case also having ADHD doesn’t help.

A particularly effective model for dealing with Bipolar then, would reset the patient between these two extremes whilst also giving them the autonomy to make sure they feel comfortable, in control and reassured of their place in reality. Grounding techniques, for example, are present when it comes to almost any well-known mental illness or unwanted mental state. People who are experiencing low mood or panic attacks or bouts of rage or anxiety are told to smash ice cubes and wriggle around in blankets because those sensations connect them to things in the real world, why are we so quick to abolish that faculty when it comes to Bipolar people who need it most?

Now consider the inverse of having those things that make us ready to be in control and be in a tangible world: our triggers. Again, the concept of triggers as it has emerged from Pavlovian psychology is applied massively when it comes to treating mental illness and coping with learning difficulties, only to be shrouded in mystery when it comes to Bipolar. Just because a patient isn’t necessarily going to be condemned to committing violence or histrionics as soon as they feel a trigger it doesn’t diminish the importance of them not exposing themselves to harm.

Again, this is something the patient can get done themselves; they’re the best source advice for what’s going to be too much and what’s going to happen when it gets too much. This is the basis of your action plan: what you’re going to do whilst you’re lucid and between the extremes to take care of yourself should you tip over one way or the other. The most effective action plans protect the right of the patient to autonomy, safety and comfort well in advance of any incident – and who better to tell us what the needs are than those suffering with it.

Some mental illnesses impeded the afflicted’s ability to properly communicate or judge or concentrate or even take it away entirely. It’s a blessing, then, that the trappings of Bipolar often improve these faculties – so let’s have these people use the positive aspects of their illness and take back control for themselves.

Leave a Comment