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.

The Insane Guide to Living with Mental Illness: Psychosis

I’d written a long, detailed Insane Guide to Psychosis, but WordPress logged me out and it didn’t save.

If you would be so kind as to hallucinate the post and be under the delusion that it’s here, that would be great.

The Insane Guide to Living with Mental Illness: Mania

I’ve covered depression in part 1 of the Insane Guide to Living With Mental Illness, so now it’s time to cover nature’s way of telling you that you’re number one.  I find mania harder to write about; it’s side by side with mixed episodes as the most destructive part of my illness.

Mania

You’re manic! Fantastic. “Mania” is Greek for “feeling fantastic”. And I bet you do! Don’t listen to anybody who tells you otherwise. What do they know? They’re just trying to bring you down. You’re better than them, anyway. You’re better than everyone. You’re special, you’re chosen. You’re a genius. The world has been waiting for you. If only you could keep that anger under control!

Becoming manic can be sudden or slow. Sometimes, when people experience mania they also experience “psychosis” (just a diagnostic label to belittle your uniqueness). In this chapter, however, we aren’t going to discuss psychosis because you’re not that mad. In fact, you’re not mad at all! You probably have to battle to keep your thoughts o- hey, are you listening to me?

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

Who needs food? Food takes time to prepare and eat and time is something that you don’t have. Everything is so slow! Why on earth do people take so long cooking something? If you have a microwave, put everything in there at once. Have you ever wondered if you can iron chicken to make it cook? Now’s the time to find out! It will make it cook faster.

Alternatively, you may be feeling more hungry than usual. In this case, sweets are best, or, even better, go out and eat in a fancy restaurant! Even though you’ve been spending a lot recently, you’re not worried, the money will come from somewhere.

The place is a mess, everything must be perfect. It might be 4am but get that hoover out! Now, what else can you do? Those CD racks are a mess. Maybe you should go for a walk or do some exercise. You have so much energy these days.

And my, you look delicious at the moment. Slap on some extra make up and the less clothes, the better! You’ll turn heads whereever you go! You’re gorgeous and sexy.

2. Social etiquette

You know your friends want to see you, you’re so bountiful and charming. They are fascinated by you- who wouldn’t be? Drink as much as you like, you’re dazzling! You have so many stories to tell, such wisdom to share. They might be looking at you oddly but it’s only because they’re jealous of your wit! And your friends, they seem so sparkling tonight. You feel as if they’re all your soulmates, all you want to do is kiss them.

Every man and woman in the room wants you. You can seduce anybody you want. You can make new friends, everybody loves you. You find yourself on a man’s knee while your boyfriend watches. You know that you look so beautiful and sexy that nobody can resist you. Your boyfriend walks away and you feel a swell of rage rise up in you.

Try not to get impatient when people are set on staying in one place. Coax them to your way of thinking, let’s go, go somewhere, anywhere.

3. Hobbies

You love writing, you’ve been so great at it lately. You have so many ideas, you just wish you could hold on to them for more than a few minutes. You’ve been up all night and are surrounded by pieces of paper with scribbles on them. You decide to use the computer and you write four chapters in half an hour. But there’s loads of things to look at, too- you find yourself fascinated by the extinct creatures of history.

You try to read, but you can’t focus long enough. You pick up book after book, then find yourself obsessed with one passage. It seems to have a special significance for you- almost as if it was written just for you.

Music is poignant, unbearably so- you can only listen to a few bars before the beauty overwhelms you. You put on CD after CD- many of them new. There is plastic wrapping all over the floor, you tear through it to find more music to listen to.

You try to watch a film but you can’t stop talking. Your partner sits next to you, asking you to be quiet. But there’s so many interesting things to be discussed. Eventually, the film is turned off and you’ve been talking nonstop for two hours…

4. Sleep

n/a

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.

There is no such thing as “too much”- you wish your doctor would stop asking you to take the medication. It’s a waste of time, all it does it dull you and make you depressed. You’ve flushed all those pills away and you’ve never felt better. Nothing is wrong, nothing was ever wrong.

Your friends are apparently concerned, but they’re just jealous. They say you seem to be reckless and uninhibited, which isn’t “normal” for you. You dismiss them- you’ve just been having fun. Your partner is exhausted, but you know they’ve been having fun too. They just want quietness and sleep but you wake them up time and time again to talk about things. You snake your hands to their chest, trying to seduce them, knowing how gorgeous and sexual you are, but you’re confused and angry when they tell you to leave them alone. Some people are just killjoys.

Your boss has had a word with you after you sent a five page document detailing ideas you had about your company to the director. He said you were overstepping the mark, you’re only an admin assistant and that you’ve been working much too late recently on projects that aren’t even yours. You leave work and hit the shops and bars, meeting people along the way. People- they walk away from you, but you follow them, determined to make them listen.

6. The Future

Achievement, stardom, success, magic- but you’ve started to feel a little bit strange. People are commenting that you seem angry, they say you’re picking fights. Your thoughts- once so fast and furious- start to get confused and jumbled. You have a hard time keeping them straight, you find that you get stuck on one word that skips like a faulty record. You’re starting to feel paranoid; everybody seems so hostile to you now, unappreciative of your specialness. You forget to eat, your stomach burning with anxiety. And nothing, nowhere, feels safe anymore…

Next: Psychosis

The Insane Guide to Living with Mental Illness: Depression

Contrary to part 1 of my “Sane Guide to Living With Mental Illness“, here is part 1 of my “Insane Guide to Living with Mental Illness: Depression”.

Introduction

So you’re mental! Congratulations! Your journey here may have taken you many years or you could simply have fallen off the doorstep of sanity one day and into the garden of madness. Either way, welcome!

Insanity isn’t an exclusive club; we welcome people of all ages, genders, shapes, races and cultural backgrounds.

Now, let’s get started. Being mad, you’ll want to know just how to wear your madness well, what the etiquette is in our club and how to make the most of your insanity. Each category will have five subcategories:

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

So let’s get started with depression.

Depression

You’re depressed! Well done. It might have started one day: you were walking home from work and you felt the bottom of your world fall out. There was a hole in the earth that you could fall through, forever. And you did. I’ll keep this short; after all, you can’t waste valuable staring-at-the-ceiling time reading this. If you can read it at all. It’s difficult to concentrate when you’re depressed. Reading the back of the pill bottle can be a daunting task- those damn letters just won’t stay still! You might find that your vision is a bit blurry- don’t worry, this is caused by the constant trough of tears that have been welling up in your eyes.

Do you remember what you were like before you were depressed? You probably thought you were a pretty good person. Well, you’re not! Say that to yourself every day: “I am a bad and disgusting person”. All you’ve ever done is make mistakes in your life. There you go!

1. Eating and self-care

When you’re depressed, there’s a limited source of food available. After all, you won’t have the energy to cook something, and if you try, you’ll probably forget and burn it. So stick with these staples: cereal, chocolate, wilted old fruit. If you can get to the shops, that is. If not, just order takeout food. It’ll make you happy!

In fact, you may not be feeling hungry at all. This is normal. Don’t worry about eating. It’s too much of an effort anyway. You could drink tea to keep going or, even better, alcohol! Alcohol is well-known to make you feel better. If you feel depressed, hit the bottle and you’ll be right as rain in no time.

If you do feel hungry, overeat! Overeating makes you feel better. It means you won’t have to eat as much next time. This saves valuable energy. Try to get some fish oil in your diet (omega 3), it’s been clinically proven to be more effective at treating depression than anything else in the world!

You might get a lot fatter but that’s unimportant; no-one cares what you look like, anyway! There is no cure for ugliness! You’re fat and useless even if you’re 110lbs!

As for your appearance, you have two choices: either remove all mirrors from your room (who’d want to look at you anyway? ) or stand staring into one for hours on end measuring your every flaw, and let’s face it, you have many!
Since you won’t be leaving the house much, there’s no point in brushing your hair and teeth and absolutely no point in changing or washing your clothes. As you’re depressed, you’re not going anywhere so who cares what you look like! If anybody- lovers, friends, social workers- express concern, lie and say you changed your pants earlier! They’ll soon back off.

2. Social Etiquette

Who needs friends? Not you! Let your friends know that you don’t need them by pulling the phone out of the wall or ignoring your mobile as it rings for the fifth time that day. Try not to panic if that tinny ringtone irritates you; everything is going to irritate you, or, you just might not care at all! It’s great to be free of these social conventions.

Your friends will stop ringing eventually. But if you want to make a half-hearted attempt at sociability, make sure you meet your friends in a pub. That way you can drink! It may be very difficult for you to go outside, after all, the world is a hideous place. Show your friends you care by crying on them, shouting at them or treating them to miserable, stony silence. It’s okay; they don’t really like you anyway.

3. Hobbies

Before you became depressed, there may have been things in your life that you enjoyed doing. You may find that now you have no absolutely no interest in these things; in fact, the thought of doing them fills you with dread or total indifference. This is normal. None of it matters. Nothing matters.

4. Sleep

Sleep is important so you should get as much of it as possible! It’s much better to sleep in the day time because that’s when all those boring things you don’t care about; your job, your family commitments, your friends; are at their most demanding.

Of course, feel free to sleep at night time, too. When you are awake, remember that nothing is as fulfilling as lying there looking at the ceiling- what a fun way to collect your thoughts!

You may be finding it difficult to sleep. Panic and anxiety could be tearing through you, making you feel as though your own skin is infected. You may feel like you’re dying. Never fear, abusing prescription medication (which can be obtained from the doctors, more in part 5) or alcohol can help.

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!

So, you’re depressed! Those around you may not be so excited about this as you are. But who cares about them? They don’t care about you.

Your friends and family may plead with you to talk to them. Don’t! They are trying to bring you to their side. Who wants to be there? You’re certainly not good enough for that. They may say they love you and care for you; they don’t! Don’t succumb to guilt. It’s all a ruse!

They may convince you to go a doctor; resist this for as long as possible! Nothing’s wrong with you- you’re wasting their time! Being depressed is all your fault. There’s nothing they can do to help. It’s all up to you! You don’t have depression. You’re depressed. Big difference! Depression is serious. Do you really think you’re that important?

The doctor may prescribe antidepressants. He’s trying to control you! He wants you to be a happy pill popping patient! Can’t he understand that there’s nothing wrong with you? Being happy is overrated- you’ll never be happy again.

However, if you’re finding sleep difficult, just tell the doctor that you’re depressed due to lack of sleep. Bingo! Happy little sleeping pills for you so you can spend all day every day in bed! Score!

Your employers or tutors may be worried about you. You’ve missed a lot of school or work, haven’t you? Tell them that you’re fine. They’ll believe you! If you lose your job or school place because you don’t have the energy, all the better! It wouldn’t have done you any good anyway.

Your lover may lie next to you night after night wondering why you don’t want to touch them.  Or they may have stopped calling.  It doesn’t matter.   They don’t really care.

6. The future

Ha, this is a joke category. What future? You don’t have a future. I mean, look at you, you can barely get out of bed and cook yourself a meal. You spend your whole day abandoned to the horrible thoughts in your mind, you could be shot and you wouldn’t feel it. Everybody hates you and you’re a failure at everything you do. The world isn’t meant for people like you- you should just kill yourself. Why not kill yourself? Then you wouldn’t feel like this anymore. You will never feel like anything else ever again. It’s either death or this is the rest of your life. Can you imagine this being the rest of your life? Then kill yourself. No one will miss you. Nobody cares.

I hope you enjoyed part 1 of the Insane Guide to Mental Illness! Tomorrow: Mania- Nature’s way of telling you that you’re the best.