Manic Depression - Bipolar

Kay Jamison, Ph. D., Describes:
"What it is like to be a bipolar."

"There is a particular kind of pain, elation, loneliness, and terror involved in this kind of madness. When you're high it's tremendous. The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there, the power to captivate others a felt certainty. There are interests found in uninteresting people. Sensuality is pervasive and the desire to seduce and be seduced irresistible. Feelings of ease, intensity, power, well-being, financial omnipotence, and euphoria pervade one's marrow. But, somewhere this changes. The fast ideas are too fast, and there are far too many, overwhelming confusion replaces clarity. Memory goes. Humor and absorption on friend's faces are replaced by fear and concern. Everything previously moving with the grain is now against.... you are irritable, angry, frightened, uncontrollable, and emerged totally in the blackest caves of the mind. You never knew those caves were there. It will never end, for madness carves its own reality.

It goes on and on, and finally there are only other's recollections of your behavior.... your bizarre, frantic, aimless behaviors..... for mania has at least some grace in partially obliterating memories. What then after the medications, psychiatrist, despair, depression, and overdose? All those incredible feelings to sort through. Who is being too polite to say what? Who knows what? What did I do? Why? And most hauntingly, when will it happen again? Then, too, are the bitter reminders..... medicine to take, resent, forget, take, resent, and forget, but always to take. Credit cards revoked, bounced checks to cover, explanations due at work, apologies to make, intermittent memories (what did I do?), friendships gone ordained, a ruined marriage. And always, when will it happen again? Which of my feelings are real? Which of the me's is me? The wild impulsive chaotic, energetic, and crazy one? Or the shy, withdrawn, disparate, suicidal, doomed, and tired one? Probably a bit of both, hopefully much that is neither. Virginia Woolf, in her dives and climbs, said it all, "How far do our feelings take their colour from the dive underground? I meant, what is the reality of any feeling?"

AN UNQUIET MIND
Kay Redfield Jamison, 1st edition
NY: A.A. Knopf, 1995.

Manic Depression

Manic Depression/manic depressive illness, or bipolar affective disorder as it is sometimes know, is a medical term used by psychiatrists to describe a form of mental distress which affects someone's mood and behavior. It can mean that people affected by it experience mood swings - periods of feeling terribly low and depressed, as well as periods of feeling high and elated. These changes of mood are not like the general ups and downs of everyday life. They are much more extreme and can be distressing and frightening. They can affect how we behave, how we get on with other people and how we manage our lives.

What is Manic Depression?

Manic Depression is a condition which affects both men and women from all walks of life and of all ages, from early adulthood onwards. It can mean that we experience repeated changes in our mood, with periods of elation when we seem to have endless energy, and other periods of depression and despondency when we are barely able to cope with even the simplest tasks. The pattern manic depression follows varies from one person to the next. These spells of highs and lows may occur one after another, or elements of both may be experienced at the same time. Some people find their mood tends to veer more in one direction, so that they are prone to becoming either depressed or manic. A number of people only have one bout or episode of manic depression but the majority do have some recurrence. Often there are long periods of stability between bouts. Equally, the impact that manic depression has on someone's life differs from one person to another. However, the experiences that people describe have a number of common elements.

If we are going through a manic phase and are high we may:

Be excited and elated and find our thoughts racing. We may talk quickly and rather incoherently.
Have boundless energy and come up with all kinds of apparently wonderful schemes and ideas other people view with some skepticism.
Find we need much less sleep than usual or have difficulty sleeping.
Have difficulty concentrating.
Lose our sense of proportion in dealing with other people and handling our day to day business. We may spend money with unusual extravagance and beyond our means. Or we may become much less inhibited in how we behave towards other people.

At the time we will probably not be aware that anything is wrong or that we are acting at all out of the ordinary. Sometimes we may not have such an extreme experience of elation. There is also a milder form - hypomania - which makes people overly active and excited, and possibly irritable and angry. This can lead to a full blown high.

During a low period when we feel depressed we may:

Feel tired and exhausted all the time.
Become irritable and frustrated.
Find ourselves struggling to cope with even the simplest demands upon us.
Be unable to concentrate or make decision of any kind.
Feel overwhelmed by feelings of utter helplessness and despair.
Find our sleep patterns becoming disturbed so that it is hard to get to sleep, or to sleep long enough. Or we may want to sleep all the time.
Our appetite may be affected, making us eat large amounts, or making us lose interest in eating at all.

Understanding Manic Depression

It is difficult to say what precisely causes someone to develop manic depression. A number of different suggestions have been put forward. Some of the possible causes include:

Genetic factors which would mean that a tendency to develop manic depression could be passed on from one generation to the next.
Biochemical imbalances in the body which then influence how we feel and think.
Early childhood experiences which may have left someone emotionally fragile and vulnerable.
Stressful events or major changes in someone's life, such as the death of a loved one.
Possible hormonal changes - sometimes manic depression occurs in women after childbirth or during the menopause.

Many people now agree that a combination of these factors is probably involved, and that the significance of each varies from person to person. It is also possible to make a distinction between what may have caused someone to develop manic depression in the first place, and what may trigger off a recurrence of symptoms subsequently. For instance, someone's genetic or biochemical make-up may mean that they are particularly susceptible to developing manic depression if they run up against traumatic events in later life.

Medical Treatment

Often a family doctor will refer someone with manic depression to a psychiatrist for expert advice and help. At times some people become very distressed or may be at risk of harming themselves or other people, either because they are extremely depressed and withdrawn, or because they are high and very agitated. Under these sort of circumstances a person may be taken into hospital for assessment and treatment. There are now a number of leaflets outlining your rights and the conditions under which you may be taken into hospital on a doctor's recommendation. For other people this may not be necessary, and medication combined with other forms of support can be sufficient.

Counseling and Therapy

It can be valuable to talk things over with someone outside our circle of family and friends. Counseling and therapy are sometimes called "talking treatments" because they give people an opportunity to talk through their difficulties and feelings. Counseling tends to have a practical focus and to concentrate on present day feelings and difficulties. Therapy, of which there are many types, tends to be longer-term and to be more concerned with explaining and coming to terms with past events. In either it is important to find a counselor or therapist you can relate to and trust, and whose approach seems appropriate to your own situation.

Self Help

A lot can be gained from meeting other people who have experienced manic depression themselves. It can be valuable to find out how others cope with similar sorts of difficulties, and to realize that we are not alone. Self help groups can sometimes be more accepting and welcoming that other people. Members know at first had what we're going through, whereas even those closest to us may be at a loss about how to react towards us. The direct experiences of others in the group can be an important influence on how we learn to adapt to living with manic depression.

What You Can Do

Manic depression can be very distressing. You may feel frightened both by the symptoms and by being told you have manic depression. Or you may find it hard to accept that other people think that there is something wrong, particularly if you are high and feel better than ever before!

Without necessarily being aware of doing so, you may upset and disturb those close to you. They may be left not knowing what to do for the best. You may take important decisions and take actions which later seem misguided and may have unfortunate consequences. Looking back, this can all be extremely bewildering and un-nerving, as your life seems to be out of control. However with help, you can begin to set about putting your life in order again. It is important to remember that if you did anything unwise during a bout of illness, it was because you were ill. Try to talk things over with your professional helpers and those who've been through similar experiences. You may want to make some adjustments to your life so that you are in better position to take more control rather than letting manic depression control you.

What helps may be different for each of us, but here are some general suggestions which other people have found helpful:

Try to seek help early, rather than waiting until you are very distressed or unwell.
Avoid situations which may be stressful, as far as you can.
Learn to recognize the early warning signs which may mean symptoms are likely to come back.

However, try to keep this in proportion, and don't let it rule your life. For example, it is only to be expected that certain situations, such as moving house, will make most people very tense and anxious, and this does not necessarily mean that you are becoming unwell again.

When you are feeling depressed or down:

Take care of yourself, pamper yourself, give yourself small treats.
Try to get enough rest, get into a routine at bedtime to help you unwind.
Do some exercise to help you relax, it needn't be anything strenuous, a short walk or a swim.
Try to eat regular meals, if you have no appetite, tell yourself food is medicine, in time your appetite will return.
Take one day or even part of a day at a time, try to pay attention to the good times and good feelings, rare as they might seem just now, the will become more frequent.
Make an effort to keep in touch with people if you can.
Allow yourself time, and the dark spell with gradually pass, but it isn't easy and it isn't quick.

When you feel you're getting high:

See you doctor, your medication may need adjusting.
Remember to take care of yourself, eat and rest regularly, even though you may not feel you need to.
Find ways of using all that energy, perhaps by writing or exercising.
Avoid taking decisions of any importance.
Write down ideas and plans as they come to you, to look at later when you're calmer.
Steer clear of situations that could be difficult - meetings, social events, work situations.
Try to listen to the advice of those close to you. Remember how things went when you were high before.