What Is An Episode Like?

I’d like to explain what a typical bipolar episode is like for me.

I have rapid-cycling, mixed-state episodes with psychotic features. 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. I get hallucinations as well as paranoid delusions during mixed-state episodes, and those are what the “psychotic features” part of my diagnosis refers to. I do not get harmful, hostile, violent or dangerous, I just experience things that the people around me are not experiencing. My episodes are also rapid-cycling, which means that they are short and intense, usually between 4 and 7 hours, and I have them three days in a row at about the same time of day. I am sometimes able to stop this process if I get 14 hours of sleep in a night, which interrupts the cycle and prevents an episode the next day. I am an atypical bipolar person in terms of my episodes, and also have co-morbid diagnoses of major depressive disorder and generalized anxiety disorder. They sometimes hit all at once. I have met many bipolar people, and only one of them has my same diagnosis and symptoms. There are many ways bipolar can present. There are fully functional people who had bipolar in the past on one side of the bipolar disorder spectrum, and there are people like me who are disabled and sometimes incapacitated by it at the opposite end. Past that, people commit suicide.

First things first, I’d like to make some clarifications about psychosis. My psychosis consists of paranoia, delusions, and visual, tactile, auditory and olfactory hallucinations. They present themselves in any combination they please. A real-life example of having a hallucination in conjunction with a paranoid delusion 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 hear the front door open (hallucination) and believe that there is an intruder in the house (paranoid delusion), or to feel very afraid and not know why (paranoia/anxiety). As you can see, this does not harm anyone. My psychosis only hurts me. When I am psychotic, I am not a different or lesser person. I am simply perceiving things or threats that are not there. I do not get violent. I have never hurt anyone. I have never endangered anyone. I’m just lost and scared and looking for comfort. Usually, being reassured periodically that I am safe is, by itself, very comforting. Helping people with mental illness is not that complicated, even though it can be challenging. Just act empathetically, let them go through the hell in their mind without striving to fix them, and say kind and true things. “We’re both safe here, and I love you” is a fantastic place to start.

To describe a mixed-state episode coming on, I usually use the metaphor of a thunderstorm. First, the barometric pressure drops. This feels like an empty, sinking feeling inside of myself. At this point, I know I’m headed into an episode, and will probably reach the peak in the next two or three hours. I take an anti-anxiety pill to prepare for the storm rolling in. 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 also 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; I worry I am making my loved ones miserable because they have to take care of me. The coping skill I use at this time is seeking truth from a loved one so I know what’s real.

Then the lightning starts, which is when my manic 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 visual 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 with multiple steps. My memory is shot, so even a task I do every day, like making coffee, is impossible. I also get jerking motions in my arms and body that make me drop or spill things. This is the point at which loved ones have to step in and tell me that most tasks are a bad idea, because even after 12 years, I still do not come to that realization on my own, and will try to do things that I have no business trying to do. The rules I do remember to follow are the dangerous 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) 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. Mania and depression both decrease. 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 and my ability to cope. After about another hour (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 stutter, forget some words, and stumble over the ones I do remember, even though in regular life I have no speech impediments.

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, usually a comedy special, 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 episodes the following two days. If I do not get that much sleep, I am likely to have an episode the next day, and the day after. At the end of an episode, I go to sleep.

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’s never fun, but it isn’t always hell anymore. It continues to get better.


By Emily Harrington, The Goldfish Painter

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