During my young adulthood, I experienced mania first hand in my sophomore year of college in upstate New York. While I won’t get into the specifics of which bipolar diagnosis I was labelled with, one thing is for sure. I was suffering from a mood disorder. My ‘highs’ were mountaintop experiences filled with euphoria, drama, risky behaviour, gambling, and poor judgement calls.
Mix in stimulants and cocaine. My young adulthood had all the ingredients of a recipe for disaster. If it weren’t for my friends in college who were constantly looking out for safety and checking in with me every day, I would have likely dropped off the map in some speedy scene and drug den in the unsavoury side of Binghamton, New York.
I’m not going to mince words. Mania can seem like the best high in the world. Mania is all intoxicating and appears to be the glue binding all your most fiery bodily properties into a cauldron of energy and creativity. I’m not the only person who believes this. Just ask any other person who has experienced extreme mania. The stories and symptom descriptions are all the same.
During a manic episode, it can seem as though you are transcending history and yet entangled with it at various points of reference. Even religious symbolism or iconography will get enmeshed into your new perception and new emerging belief system as the mania takes full effect. At which point, be ready to become incorporated into a bold, new, exciting reality, if only for the moment. At this point, anything is plausible, and there is something very wrong with your affective (mood) regulation.
Identifying a manic episode
Manic episodes have kept me awake for weeks at a time without sleeping or feeling the need for rest. I have witnessed other people so dysregulated from mania that they would do somersaults across the floors of the psychiatric ward floors to find out their bodies would later feel the shock of the poorly planned acrobatic theatrics. With specific diagnoses, manic symptoms become more difficult to identify. People carrying diagnoses that include psychotic symptoms should pay even closer attention to their moods because psychosis can worsen with extreme elevations of mood, which then complicates a person’s insight and judgement into their symptoms further.
For most ‘generic’ mood disorders or bipolar types, be prepared for extreme euphoria, decreased need for sleep, and hyper-sexual arousal. Sometimes, religious ideation can be indicative of activating psychosis or a diagnosis on the schizoaffective spectrum. The usual suspects seem to always be at play when manic symptoms are present. Signs of an underlying issue may start in a subclinical or mostly unproblematic manner in your life but then take a radical turn and escalate. You may be working with hypomania.
Implications for self-management
There are several options for reducing the harmfulness of a manic episode in your interpersonal life in terms of self-management and self-regulation. Stated, your ongoing capacity to execute daily living activities without incident will be your barometer or meterstick for completing ADLs and self-managed tasks successfully to remain as independent as possible during an episode of active mania symptoms. These strategies are dependent on how mania came into being and how severe or intense your symptoms are to manage.
Stimulant and drug-induced mania is just as dangerous as organically, internally driven manic episodes. Considering substance abuse treatment may be an essential step in managing your symptoms for the long haul, if this is your issue. Like most people, even minor stimulant use from caffeine can trigger an episode or lead down the causeway to self-activation. By self-activation, I mean inducing, as much as possible, mania by engaging in unhealthy activities or stopping your medication without medical oversight.
Living a chemical-free lifestyle isn’t for everyone. It is vitally important to consider your baseline mood (everyday mood) when engaging in stimulant or caffeine use like coffee or energy drinks. To gauge whether or not consuming one more coffee or caffeine drink will trigger a manic episode, understand your baseline. First, get a feel of where you are on an average day in mood and energy levels.
For non-chemical-induced episodes, internal and external barometers are essential for knowing your affective status baseline. Listen to your friends and colleagues and take in their assessment (even if informal) of your mood.
Ask yourself these questions to create a barometer to self-assess for mania:
- How do you feel when collaterals think you are upbeat?
- Is this the case? Or are your collaterals misinterpreting your mood?
- How many coffees or hours of sleep did you get, or are you still awake from the previous day?
- How is your behaviour in its congruency to your mood?
- Have there been recent complaints about your behaviour?
- Or are you a model employee at work?
- Are you able to make it to work? Or are you too tired to get out of bed and depressed?
Begin to create markers in your living environment and for your internal guidance system to signal that there may be a potential problem. For example, when you are feeling speedy on the climb up to mania, locate safety areas that you can go to when you aren’t feeling very safe. Mania may feel awesome at first, but, ultimately, it will put your safety at risk. So, find safe zones that will keep you protected when you are manic and lacking your usual insight into your behaviours. While in your safety zone or on the way to it, begin to recalibrate your internal guidance system to register that you are manic and require to return to a calmer, more stable baseline. Visualise what that will look and feel like to begin the recalibration process.
Living with unresolved episodic mania
Ultimately, there will be times when you have to live with unresolved symptoms. Creating a plan for friends and family will significantly reduce the risk of potential harm from an episode. Making new friends and family aware of your mania symptoms and their triggers will help you avoid the ups and downs of mood dysregulation. Friends and family can even help you make decisions if your judgement and insight are too impaired for rational decision-making.
I send warning emails to friends and family, flagging them down when I feel like my moods may be impaired or have impaired my decisions and or might in the future harm others. Preparedness and attention to detail are always essential when managing an illness. Surround yourself with supportive people and allies in your recovery. You should never feel embarrassed by your behaviour, but you always need to accept responsibility for it. That’s how healing works: acknowledging that change is necessary and moving forward in the process of adapting our behaviour until it serves our purposes.
Max E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.
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