In case you don’t already know, I have bipolar II, mixed state, rapid cycling episodes with psychotic features. I get hallucinations as well as paranoid delusions during manic and depressive episodes, which is part of having mixed state episodes. A mixed state episode can lean one way or another so it can be helpful to refer to them as manic or depressive for purposes of communication, but every mixed state episode has features of both mania and depression.
A real-life example of a troubling psychotic episode would be that I can hear the clouds above me whispering (hallucination) and even though I can’t hear what they’re saying, I know they are talking about me and are going to come down and hurt me (paranoid delusion). This happens often in episodes that lean toward mania. In an episode that leans toward depression, it is common for me to believe that there is an intruder in the house (paranoid delusion), or to feel very afraid and not know why (paranoia). Every episode has features of both mania and depression at the same time often in conjunction with hallucinations or paranoia. My episodes are rapid cycling, which means that they are short and intense, usually between 4 hours and 12 hours, and I have them three days in a row at about the same time of day, unless I am able to get 14 hours of sleep in a night, which interrupts the cycle and prevents an episode the next day.
I usually use the metaphor of a thunderstorm to explain how an episode unfolds. First, the barometric pressure drops. This feels like an empty, sinking feeling inside of myself. At his point, I know I’m headed into an episode, and will probably reach peak in the next two or three hours. Then, the wind starts to blow. This feels like my thoughts are speeding up, and an uncomfortable energy starts to build in my body. Then it starts to rain, which is when I am filled with intense sadness, guilt, and fear, and usually is when I start to cry. The rain gets heavier and heavier, and I cry harder and harder, becoming more afraid and starting to hallucinate and have paranoid delusions. I also feel very guilty for everything I have ever done to hurt anyone, and for having the episode itself, because I worry I am making my loved ones miserable because they have to take care of me. Then the lightning starts, which is when my thoughts are flashing by so fast that I cannot even grab hold of one before it is replaced by the next, and then the next. The thoughts are lightning flashes in my brain. This is where the metaphor started, because there is no better description of manic thoughts that I have ever come up with. As the episode peaks, usually in hour two, I am incapacitated and cannot complete even very simple tasks, because I do not have the mental capacity to do anything. My memory is shot, so even a task I do every day, like making coffee, is impossible. This is the point at which loved ones have to step in and tell me that tasks are a bad idea, because I do not come to that realization on my own. I also get jerking motions in my arms and body that make me drop or spill things. I have rules laid out for myself for things I am not allowed to do in episodes, including texting my son, trying to use any gas-powered appliances, doing dishes (I drop them when I jerk), cleaning house, driving, and using knives. All of these things have posed a danger to me in the past. This part of the storm is characterized by heavy rain and lots of lightning and thunder, because my thoughts are racing, I am crying very hard, I am incredibly sad and afraid, I am hallucinating, and I am having paranoid delusions. As the peak of the episode passes, the lightning becomes less and the rain lightens. When this happens, I start to feel some relief, and even a little bit of improvement makes a big difference in the level of my pain. After about another hour (in hour three or four), I stop crying, and my thoughts slow down enough to identify each one. I continue to hallucinate, but my fear and guilt are lessened. I still cannot complete tasks, and cannot converse normally, because I don’t have the mental capacity. I forget words, and stumble over the ones I do remember, even though in regular life I have no speech impediments. However, by this point I am feeling definite relief, and I start to just feel empty in my core, the way your stomach feels when you’ve been fasting for a day or so. I get very tired. My manic thoughts slow down to normal, and the rain becomes just a drizzle. I may cry off and on, but not continuously. By hour five or six, I am lightly hallucinating and still cannot converse or complete tasks, so I just watch something on Netflix that I have seen many times, because that is comforting and I can’t make sense of any new information. The rain stops, and the clouds disperse. At this point, I am utterly exhausted, so regardless of the timing of the episode that day, at 8 pm I take a combination of sleeping pills (prescribed by my psychiatrist) in the hope of getting 14 or more hours of sleep so that I do not have another episode the next two days. If I do not get that much sleep, I am likely to have an episode the next day, and the day after.
My episodes are fairly predictable, and I know many of my triggers. I have been working through this for 12 years, and I’ve learned very well how to cope. It gets easier. It will keep getting easier.
By Emily Harrington, The Goldfish Painter
3 Replies to “How An Episode Unfolds, and What It Feels Like”
Hello there Emily Harrington, how are you doing today? Have you had any more episodes since this post? I myself have just recently went through this a few days ago and i can tell you it is a really horrible feeling. The role that triggered my “episode” was due to a guilty conscience. I would like to spare you more details but I don’t think I will at this moment. I’m interested in how you manage to keep your “episodes” in control, So they don’t happen anymore? I would also like to know how long you’ve been going through these really Exhausting hard times for? That is if you are open to discussing what you’ve been going through. No pressure at all, I understand if you’re not open to talking about these kind of, i would describe for myself as “Issues” in life. Most of the time I don’t talk to anyone about my problems unless I feel really comfortable with someone & if I feel I can really trust them. I would ask if you can please write me back so I can get someone else’s point of view on this matter, and if you just need someone to talk to i’ll be right here ok. Stay safe and take care of yourself.
Since my reply to this (which is very late, I’m sorry about that) will be posted, I’d like to encourage you to email me directly so that we can talk. I’m reachable at email@example.com , and that’s something I check every day. I will share some answers to your questions, at least the ones relevant to the site, but please email me (as long as you’re comfortable with that). I always like hearing people’s stories.
I’ve been bipolar for 13 years now. I attempted to hang myself about 2 weeks after I got my diagnosis because by the time I sought treatment I was already planning to die. Getting the diagnosis itself was great because it meant I was not alone and there were ways for me to get better, but I didn’t have any coping skills at that point, and suicide often looked like my best option.
I do still have episodes. They are less severe and less frequent, and there is a lot about my own internal emotional landscape that I have finally figured out after 13 years of doing this, which is a great help. I sit through them pretty patiently, even though they still really hurt. I have things I do to keep them under control.
Keeping my episodes in control breaks down into two levels of coping. The first/top level is situational control. There are things I know are likely to trigger an episode, and I try to avoid those things or “cope ahead” and plan what I will do to cope when and if the episode comes. Some episodes I volunteer for, like when I had to get up at 3 am to travel with my family from Texas to Nebraska to see my grandfather a few days before his death. I knew getting up that early, being in a car for 24 hours, and seeing family ON TOP of starting to grieve my grandpa was definitely going to cause several episodes over the course of a few days. I knew that, but I volunteered for those episodes because it was an event I couldn’t miss. By contrast, the last time my parents went to Los Angeles, I declined to go. I have been before, and there was no major or important event involved in going, so I chose to not volunteer for those episodes and stayed at home. To prevent episodes I do things like taking all my meds on time, getting enough sleep (with the help of one or two very strong sleep aids), avoiding some situations, minimizing time in uncomfortable places or situations, and not let my blood sugar get low. Those are goals I have every day. Sometimes I succeed in doing all of them, and sometimes I only do a few. We are all works in progress, I suppose.
The second layer of coping is internal. I try not to thought spiral. An example of a thought spiral would be “Chris (my husband) said something mean. That was hurtful. I’m hurt. What if he was right? What if I really am a bad person? Oh, no, I’m going into an episode. Oh no, I’m crying and everyone will see and know how weak I am. Oh my god, I’m so weak and pathetic. Who would ever love me?” There is a scientific explanation for this. When we think some things, we do not think them first and then create the emotion; we have an emotion first in our subconscious and THEN we have a thought in order to explain the emotion to ourselves. So I start feeling awful, and THEN my brain comes up with a reason why. I’m getting better at stopping thought spirals and just sitting and being in pain without attaching it to a negative cognition. I call these episodes “pure pain episodes” because I just sit and feel hard things without linking it to myself or my life. It’s way better to have a pure pain episode than to have a thought spiral. I’m still improving.
I’d be happy to discuss this with you more, just email me.
Thank you for visiting!
I’m 58 years old and just got diagnosed with bipolar/mixed states a couple of months ago. I have been fired or let go from every job I’ve had over the last 30 years, usually due to explosive behavior. I finally found a psychiatrist who identified my symptoms, and put me on a lithium/depakote/clonazapam regimen which has slowed me down enough to the point where I can actually think before I act.
The other thing that helps is DBT/CBT, and I attend classes every week along with other people who suffer from this demon of a condition. To anyone out there reading this, please talk to a doctor or medical professional as soon as possible. This thing has ruined and stolen most of my life, and I wouldn’t wish it on my worst enemy.
Good luck to all fellow sufferers.