The Insane Guide to Living With Mental Illness: The Mixed Episode

Ah, here we are. It’s now time for me to introduce the special circle of hell reserved for the manic depressive: the Mixed Episode. These were meant to be funny, sarcastic guides (like the Depression one was) but somewhere, it’s become all serious!

A mixed episode (also known as dysphoric mania or, for depression with hypomania, agitated depression) bears a little explanation. It is literally a mix of manic and depressive symptoms at the same time. It’s generally considered as the most dangerous of mood states, being that if you want to kill yourself, you have all the energy and frantic invention necessary at your disposal with which realise that particular dream.

However, if you believe the DSM-IV, relatively few people with bipolar disorder experience these episodes. The reason? It is strictly defined as mania and depression for a week; leaving out hypomania, thus nobody with bipolar II or cyclothymia has ever had a mixed episode. From my forays into BipolarLand, reading and research, please take it from me (and the dissenting voices in the psychiatric community) that the DSM-IV needs updating. But lucky me, eh, bipolar I, so, by the DSM-IV rules, anything goes.

It lies close to my heart. Dysphoric mania is, by far, the most common episode that I experience. Those much romanticized euphoric manias has almost disappeared as I have grown older, and my manias are now increasingly black and almost always psychotic. It’s why I’ve escaped being diagnosed with depression. I’ve been suicidal and depressed many times in my life, but the manic edge which accompanies my depressions has exempted me from being considered clinically depressed. It is one of the reasons, I suspect, that even when I’ve been in front of a psychiatrist absolutely suicidal, the relentless diagnosis of bipolar I has always been returned.

It is difficult to describe how it feels; imagine the white noise of racing thoughts pitched at total destruction and despair, horrible images, frightening visions, flights of ideas punctured by the bleak feelings of failure, endless energy overriding utter, utter exhaustion, nameless guilt, manic lack of inhibition, rambling and ranting, restlessness, the damaging impulsivity and grandiosity of mania, terrible agitation, rage, anxiety, panic, psychosis, paranoia and fear. It can be constant, or can fling you from mania to depression and back again extremely quickly.

A mixed episode landed me in hospital, and mixed episodes are almost totally at odds with normal functioning; it is simply impossible to go about your normal life when in a mixed episode. Everything is frightening or an insummountable challenge.

Yes. They’re no fun. So, here’s the Insane Guide to the Mixed Episode. I found it difficult to be sarcastic about mania, it’s almost impossible to be lighthearted about the dysphoric kind. So this guide is kind of crap.  Apologies.  Read the previous ones instead by clicking on the category, The Insane Guide…

The Mixed Episode

Manic, depressed, who the hell cares, you can have it all! Welcome to the mixed episode. You may never leave. I really mean that.

1. Eating and self-care

2. Social etiquette

3. Hobbies

4. Sleep

5. How to deal with those around you, who may not be so excited about your insanity as you are! Includes lovers, friends and the medical profession.

6. The future

1. Eating and self-care

Have you eaten? You can’t remember the last time you ate. You probably should eat, but you can’t focus long enough on anything, let alone the thought that you need food. Everything feels like it’s been put there to test you, and you find yourself by the kettle in tears of frustration. You can’t even do that, a task that wouldn’t tax a five year old. You can’t do anything.

You brush your hair and teeth, on automatic, and neglect to put on underwear, simply forgetting. It doesn’t feel very important. You can’t really concentrate, your clothes are a jagged mish mash of colours and shapes, old blood stains seeping through the cheap fabric. You look in the mirror but you can barely focus on the image. There’s pictures in your head, horrible pictures, that seem to permeate everything you try to look at.
2. Social etiquette

You did go out for a drink but found yourself crying at a table alone. You’ve been trying to talk to your friends but you just can’t, you can’t communicate at all. The words, rapid and free flowing, are not making sense. People can’t keep up with you. They listen, for a second, but you’re going too fast, and they drift off, nod, and turn their attention from you. You don’t look right, your eyes are fire in pitch from lack of sleep.

Self pity kicks in, and you’re convinced that everybody hates you, more than hates you, wants you dead. You are ferociously, wildly, suicidal and you begin to feel angry at those around you- why can’t they see that, why can’t they help you? The strong desire for someone to reach out is not as strong as your desire to be alone, so you leave, and walk quickly into a cold night, frightened at every single sound that you hear.

3. Hobbies

Nothing from the outside makes a difference; you can’t concentrate on a film, the things that used to calm you down don’t and your panic is rising. How can you slow the thoughts in your mind? So you have new hobbies- running on the spot, talking to yourself, anything to calm down. You’re exhausted, your whole body is screaming out to stop, but you can’t. Relentless, frantic energy grips you and there’s nothing you can do to get rid of it. Absolute rage and frustration courses through you, and the room is wrecked. You get up and write disjointed prose, the words jumbling up, making no sense at all.
4. Sleep

You tried to sleep, you lay down, but your head felt like someone was chainsawing inside, so you got up again. You want to sleep, but you can’t, you’re restless and anxious and the dark shadowy shapes in the room seem to be moving.

5. How to deal with those around you, who may not be so excited about your insanity as you are! Includes lovers, friends and the medical profession.

You’re depressed, you know you’re depressed, despair, sorrow and complete hopelessness is flooring you, but the doctor doesn’t know what’s wrong- you’re not eating too much or sleeping too much, you’ve had more energy than you’d had for some time and although you sit and talk for half an hour, nothing makes a difference.

Your friends are long gone- something you did or said, you can’t remember. Loved ones keep their distance, unable to cope anymore with your shouting and seemingly untriggered crying fits. It just compounds your guilt- you’re a bad person, and you know it.

6. The Future

You can’t think straight- tomorrow seems like it’s a thousand years away. You have no idea what you’re doing or what you’re going to do. You’ve been awake for days and are starting to become very paranoid. You don’t know how to feel safe or how to stop, you just want the agitation to calm down, for one second.

Crap guide there. I find it hard to write about. It’s just a horrible way of being and all I want to write is, “I’M SORRY” to anyone who might be going through one. To be honest, I’ve been getting so panicked and bizarre lately that I think I’m not doing too well myself. Today has been a White Noise Day, that is, very rapid, quite scary sequences of thoughts and voices going over and over in my head that frightens me and makes it impossible to concentrate.

Sometimes, I’m tempted to write down everything my brain voices say so that I can understand it. But I can’t, because they move so damn fast that it seems like malevolent gibberish.

44 Responses

  1. This has been the best survival guide for me. This is my worst problem…and I think I’m sliding toward one now.

  2. Sometimes, I’m tempted to write down everything my brain voices say so that I can understand it. But I can’t, because they move so damn fast that it seems like malevolent gibberish.

    I tried that once. For a while I got my thougts down (or at least some of them). The only thing is, it is utterly impossible to read…

    I’m one of those with bipolar II and mixed, I know it’s mixed.

  3. i thought point three said ‘Hobbes’!

    I wondered how you were going to tie her in…

  4. I think that’s the best so far. Maybe not the funniest, but definitely the most like the way you think in real life (and definitely applicable to BPII!)

  5. […] The Insane Guide to Living With Mental Illness: The Mixed Episode […]

  6. […] was over, that getting older was supposed to make it go away. (sigh). just googled and came across a very awesome web page on a site subtitled “the insane guide to living with mental illness,” and i absolutely […]

  7. an extremely well-done writeup. thank you so much for escaping the clinically dry and sterile attempt of the dsm to categorize and neatly segment us fine human beings.

  8. I read this, I cried and I laughed simultaneously. Beautifully put, if only I could manage to be this coherent 🙂

    I won’t share stories as this blog is your space. And I will now resume to lurking and admiring from a shy distance.

  9. Great explanation of mixed episode. I am struggling with the racing thoughts and horrific images when I close my eyes. Right now I’m on so many meds everything else is calm, or relatively so, it’s just my brain. I’m not glad to see someone else is suffering the same way, but it helps me not to feel alone. Thank you.

  10. You have my admiration in large doses about now!
    You know that feeling when things click into place in your head when you’re thinking about something? That’s what this post was like.
    You’ve managed to make it all make perfect sense but not lose how complicated it really is. Very cool.

  11. You nailed it! I found a site that I sent to some of my loved ones to sort of help them…It’s interesting and a little helpful for those who care about us. So I’ll pass it along:

    I have bipolar II, rapid cycler. Having bipolar is complicated enough, and hard enough to deal with, but when you’re a rapid cycler it is beyond words yet you did a good job of explaining it.

  12. background: male, 29 years old. diagnosed bipolar 13 years ago. massive drug addict for 15 years (benzos, opiates) up until suicide attempt one month ago. was abruptly taken off paxil and benzos (abused up to 10mg xanax daily), so w/d is horrific. currently still waiting for lithium levels to stabilize, getting zero therapeutic benefit now.

    the mixed ep i’m dealing with currently is the worst of my life. the rage and hostility is manifesting itself in violence, and is reawakening the desire to commit suicide again. the depression is very severe. i spend my days see-sawing between extreme agitiation and extreme laziness. exercise 50 minutes daily, diet is immaculate, blood tests excellent.

    i see my doc in 2 days, and will request something for the meantime until the infamous lith kicks in. the w/d symptoms, specifically delirium tremens, adds to the whole experience, making the issue that much harder to deal with. i have severe nightmares which interfere with my sleep schedule. large feeling of anhedonia makes every task of life seem menial and pointless, yet i can’t shake off the anger.

    thank you for such a well-written article, as describing a mixed ep is very difficult unless you are having one yourself. i honestly believe no med exists to directly deal with the issue, and only time really makes it go away. VERY dangerous and unpredictable situation, esp. for those who are unafraid to follow thru with suicide.

  13. I know this post is old and I now keep up with your most current posts, but this one really, really helped me. I’m trying to decipher if what I’m currently experiencing is a week-long panic attack or if it is a mixed episode (I’m bipolar ii, I’m not supposed to have mixed episodes). This blog post totally describes what I’m feeling and really is beginning to answer my questions.

    Thank you so much! (breaks down into sobs of relief)

  14. that was actually amazing.
    100% accurate.

  15. that brought tears to my eyes it is so right. I searched the internet for an accurate description b/c i dont even know what i think anymore and this is what i found…wow

  16. […] The Insane Guide to Living with Mental Illness- Mixed Episode […]

  17. Thank you. Refreshing to read and encouraging since I’ve been in a growing mixed episode for a few weeks. I’m enjoying a break form it now. With luck it is over.

  18. After my first terrifying and destructive mixed episode, this was the link I sent to my friends as an explanation about both bipolar and this kind of state. It served me very well and i managed to get many of my friends who had been reluctant to believe me, back. SO refreshing to find something so cleverly crafted and so incredibly accurate to an experience I couldn’t fully articulate. Well done!!

  19. Way cool! Some extremely valid points! I appreciate
    you penning this post and also the rest of the site is also really good.

  20. finally someone who i can relate to …………. this is my 2nd mixed episode in 3 years … i haven’t slept in 3 days…. took the dog for a walk and was convinced the flowers in the field was turning purple … panic set in and ended up crying in a field .. and i cant explain to anyone what is going on in my head for fear they think i am crazy …..

  21. Together with every little thing which appears to be building within this subject matter, many of your opinions are generally
    relatively stimulating. Nonetheless, I appologize, but I do not give credence to your entire plan, all be it exciting none the less.

    It seems to everybody that your commentary are generally not
    completely justified and in fact you are generally your self not even entirely confident
    of your assertion. In any case I did enjoy reading through it.

    • I feel like the post I’m commenting on is saying this article and everyone else’s comments are something that truly does not exist but is entertaining to read.

  22. Thanks a lot. I cried while reading this. You have written everything I was trying to explain to those around me, to myself… so clear… I am sitting here crying.

  23. This is the best explanation of part of what I deal with and have not been able to put into words. Im BP 1, mixed with psychotic features, and also have PTSD. Some days it is two seperate problems but most it is a mashup of both and the unnormal normal of a mixed episode is incredibly amplified. Thanks for writing this.

  24. Thanks for helping me figure out whats wrongwith me. I have bipolar #2 and have been feeling really odd and i cant explain it properly to anyone around me. This is almost exactly how ive been for over a week now and have been thinking ive lost it! You really made a difference for me thanks so much for writing this.

  25. Reblogged this on My true name is Joy. and commented:
    Hits the nail on the head about a Mixed Episode!

  26. I’ve gone through the same thing; though I’ve also had catatonia along with Dysphoric Mania. I would be quiet and calm throughout the day; though my thoughts were going a million miles per hour, terrified, anxious, psychotic, paranoid. Then at night I would burst into a total frenzy; releasing the built up energy.

    As a month passed the catatonia went away mostly, though my experience was exactly like yours for another 3 months. It was the worst episode I’ve ever experienced, also had my most severe crash after it.

  27. This is the best description I’ve ever read on mixed episodes. So accurate and spot-on. With the many different mood states I’ve experienced from wonderful, joyful euphoria to the empty pit of depression, I dread the mixed states. This has been the type of episode I seem prone to and it really sucks. Hopeless, enraged, agitation beyond belief and more… Great job explaining your experience. Thx

  28. Thank you. You’ve summed up the past month of my life perfectly.

  29. Its hard watching someone you love go through a mised episode. You feel angry at them when there agitation reaches its peak. You can see it coming before it erupts. So you start walking on eggshells around them. However you love them so you try to be strong for them. You make life as peaceful as you can for them however there is always something that sets them off. Its even harder when you know you are bipolar too.

  30. All of this seems eerily familiar, thanks for translating the experience into words. I’m hoping meds will help me get out of this hell?

  31. hypomania is still based off the symptoms of mania, so even cyclothymia or bipolar II people can have a few of the symptoms of mania without ever having a manic episode. DSM says some not all, so you can have both technically

  32. Ugh. Going through one right now… I was stable for nearly two years then had a baby now I am in the middle of one now so uncomfortable.. Thanks for the acurate description of one.

  33. THANK YOU!

  34. Thank you so much for writing this! I’m coming out of my first mixed episode and it was horrible. I kept trying to find information and everything else I could find was so sterile, kind of non-specific too. Your article was the only thing that made sense. I shared it with my family to help them understand what’s been happening. Thank you again!
    How do I find more of your writing that’s more recent?

  35. Saw the Psychiatrist today….changing meds, what’s worked for anyone on a mixed manic….feeling as desperate as you all have been and are at the minute, so glad I discovered this little treasure blog! Bxx

    • Lots of daily communication with my doctor, texts, phone calls and also a switch of meds. I’d been stable on Lamictal and Seroquel but even a huge bump in my beloved Seroquel failed – switched to Geodon but it was too sedating for me. Had to ride it out for at least a month and a half and then hit bottom hard – added Abilify to the Lamictal and all has been (mostly) well since then. Wishing you a speedy recovery!

  36. Best explanation I’ve heard

  37. great info. nice to know I,m not alone.

    Thank you.

  38. I am so thankful for you writing this. I’m in a mixed episode and didn’t even realize there was a name for it. I’m misting up for you and with you inside but the lamictal won’t let me release and have a good cry. So please relish this victory that you saved me tonight. Knowledge is power and now that this horrible horrible beast of having both poles at once has a name therefore it can be conquered by understanding what it is how it feels And it’s so much better now that I know that I am definitely not alone.

  39. I am in tears reading this as I sit at my podcast office. These are the exact words I would use to describe what the hell is wrong with me. I have been so lost and confused with my behavior! Thank you so much for sharing this!!!

  40. I’m going through an awful mixed episode and I’ve struggled so hard to tell loved ones how I feel but this is perfect, I feel so validated I cried. Thank you so much, I hope things get easier for you too.

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