Manic Doesn’t Always Mean Euphoric

After mentioning my medication, I recently told a new friend of mine that I have bipolar. He got this knowing look on his face and nodded, a slight smile appearing on his lips. I might have detected a quick, almost negligible eye roll, but that could have been my own insecurity. Why the little smile? The nod? Was the knowing look because he had a family member or spouse with bipolar? Was it because, like a lot of people, he believes we are overmedicated as a society? Or was it because he thinks we are taught to believe that differences must be labeled therefore most of these disorders are not valid, that everyone gets depressed once in a while and what’s wrong with being really happy from time to time? Why should it have to be medicated?

These are all things that well-meaning people have said to me when I revealed my diagnosis, one that I finally received after years of knowing that something was wrong and being misdiagnosed and incorrectly medicated and suffering off and on for decades. And even now that I have had the right diagnosis for two and a half years and am on the correct type of medication, it doesn’t make the bipolar go away. I still live with it and try to function, which I do better than I would without the medication.

And I’ve noticed that there are a lot of misconceptions about bipolar. Probably the biggest one is the first one below. Of course, there may very well be someone with bipolar who is always euphoric when they are manic. Bipolar is a spectrum disorder, meaning that there’s a lot of ground between depressed and manic and a lot of variance in how people experience it. [Note: Misconceptions are in italics.]

• Mania is a state of euphoria. Not always. On rare occasions I’ve been euphoric. I’ve witnessed a few other people I knew who appeared to be euphoric for a brief time. But some people with bipolar never experience euphoria. Often for them manic means what’s called dysphoric mania, which causes extreme agitation, aggression, and angry delusions, which can lead to harming oneself, others, or property, whether accidental or purposeful, with the ensuing arrest and/or hospitalization. This can also happen if someone starts off as being euphoric. Unchecked (unmedicated) mania can lead to acute mania, or psychosis, in which a person can experience hallucinations, both auditory and/or visual. They can be out of touch with reality, delusional, and needing hospitalization. Or the mania might subside on its own, but this is not typical, and often not without damage being done before that point is reached. Being properly medicated can help prevent mania from reaching an acute state.

• A person with bipolar goes between the two extremes of depression and mania. After discussing dysphoric mania, it makes sense to continue on to the topic of the various states of bipolar. First of all, different people experience depression in different ways. Sometimes it’s very emotional, with feelings of hopelessness and extreme sadness, as is the stereotype (which is often true). But sometimes depression is very physical. The mental image of a depressed person in bed is not necessarily about them not being able to face the world; it’s often because it takes every effort to move, even a little bit. Making dinner for your kids becomes a Herculean task. Your arms feel like they’re made out of lead. Your brain feels like solidified honey, and it’s incredibly difficult to focus on anything involving mental energy, such as writing. Then there’s agitated depression. You’re depressed but have a little bit more energy, which is caused by a low-grade mania that is definitely not euphoric. Right – dysphoric again. And severe, unmedicated depression can also lead to psychosis, often including paranoia.

In my opinion, and again, this is just my opinion, based on my own experiences, the worst bipolar state of all is the mixed state. Of people who have bipolar, far more suicides occur in the mixed state than in depression. Some say it’s because in the mixed state you’re depressed but you have the energy of dysphoric mania to make you do something about it. For me it would be because I wanted to make the pain stop. Not the pain of my life – the physical pain caused by the dysfunctional neurochemicals in my brain. This is something most acutely felt before I was diagnosed and correctly medicated, not because of the medication itself, although many people feel that their medication makes them feel worse, and I completely respect that. Some people get overmedicated, and that’s just as bad. When I’m in the mixed state, in which I have spent years of my adult life, there is constant churning in my head. It’s painful, and it makes me want to throw my head into a wall to try to make it stop. I feel a rage inside my head that makes me want to yell and scream in anguish. Then there are other days (and even times during the same day) when it’s all I can do to keep myself from crying. I drag myself through the day – work, kids, appointments, and household duties. But I just want to curl up in a corner and wail and bang my head. You don’t “snap out of it.” The best you can try to do is to power through it, to keep functioning. To hold on until you come out of that place where all you do is wish you would die, so the pain would stop.

• People who have bipolar can’t be trusted/are sex addicts/take too many risks. Those who know that there are more than two states of bipolar have probably heard of hypomania. It’s an elusive state that causes people to get by with less sleep and still feel energetic. They often are highly productive and creative, as well as social and engaging. You’re probably thinking, That sounds pretty good to me! And honestly, quite a handful of people with bipolar wish they could always be hypomanic. The problem is that it can be very difficult to maintain a state of hypomania without surging into full-blown mania. And because it is a type of mania, it can cause problems on its own. You feel great, so you feel really attractive, and your self-esteem is a bit inflated. You dress provocatively. Your skin and senses are heightened. All these things can lead to hypersexuality. Judgment can be compromised. You put an entire summer wardrobe on a credit card. Some are seduced by gambling and risky investments. Regret can be a big part of having bipolar disorder.

• All people with bipolar are alike. People with bipolar are individuals who have a physiological disorder with their brain chemistry. But they are still individuals. Two people with bipolar can have completely different personalities. One might love drama and seek it out in his relationships. The other wants nothing to do with it and minds her own business. Some people with bipolar try to be positive and proactive about the disorder, and some are bitter and negative and uncooperative. Some people with bipolar lie and steal, just like some people who don’t have bipolar and lie and steal. Some people with bipolar cheat on their spouses, just like some people who don’t have bipolar cheat on their spouses. Some people with bipolar have terrible family relationships because of things they’ve done or because their family is unsupportive. Some people with bipolar cultivate loving family relationships and have a supportive family. And both of these scenarios happen in families in which bipolar is not present. Bipolar stereotypes are just that – stereotypes. There may be some psychological symptoms that people with bipolar have in common, which is how bipolar is identified and diagnosed, but even the characteristics of bipolar states themselves can vary from person to person (since it is a spectrum disorder).

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I didn’t ask my new friend what he meant by his reaction to my diagnosis. Some days I don’t have the energy to go into it, or I just want to finish my lunch and get back to work, or I tell myself, Maybe it meant nothing. Maybe he wasn’t sure how to react and that’s why his face went the way it did. Whatever the reason, it spurred me to write this post.

Thanks for reading it.

[Image courtesy of Medical News Today]