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