I have read dozens of definitions of bipolar, previously known as manic-depression, over the past decade. I have heard it described as a mood disorder, a brain disease, a mental illness, brain damage, even karma. What I have learned is that bipolar is unique to each individual: everybody has a different experience with it, and at the core bipolar is highly personal. However, there are common symptoms and phases that contribute to a diagnosis and I will be discussing these below. I also want to describe how I experienced these phases in the early years before I received a diagnosis. I recommend following this link for a well-referenced, and nicely presented, clinical overview of bipolar from the ‘Best Practice Journal’ (Vol. 62, 2014). I will mainly be providing a more personal account of the symptoms.
What is your current phase? Take the KindBipolar Phase-Finder quiz to find out.
1. Euthymia
A non-depressed, reasonably positive mood: euthymia is simply feeling normal. Euthymia is one of those things that you don’t really think about unless you have a disrupted mental state, as it is the ‘default state’ for people with good mental health. On a ‘0-10’ point mood scale (where ‘0’ is feeling seriously suicidal and ‘10’ is feeling wonderfully euphoric) euthymic mood would probably be around the ‘4-6’ range.
I think that it is natural to look back on life before bipolar and feel a sense of longing for what was normal. I used to feel grief and a sense of injustice that my old self had been taken away from me. This is why feeling normal was my ‘holy grail’ for the five years following my diagnosis, and I was always trying to get back to how I saw myself as a teenager. I would keep track of days when I ‘finally felt like myself again’, which wasn’t difficult as I had fewer than four euthymic mood days in a given year. Over time this led me to question how I had changed, and to redefine what was normal for me now, rather than constantly feeling abnormal. I realised that it was impossible to go back to how things were, I had to choose to move forward by updating my perspective on my life and myself instead.
2. Major Depressive Disorder
Major depressive episodes are dark phases of bipolar. I think society as a whole has become more familiar with depressed moods and clinical depression. A major depressive episode is usually extremely affecting, difficult to understand, and hard to deal with: both for the affected person and those around them. It is a serious condition that can bring life to a complete standstill for those involved. For more detailed information see the clinical diagnosis criteria below.
Read the KindBipolar guide on how to RAMP out of depression here.
My recorded first experience of a major depressive episode, at age 19, was this: ‘For three months I lay on the ground while my body atrophied and my mind disintegrated. I was plastered to the floor of the room I shared with my high-school sweetheart, back when we were in love, by the terrible weight and pressure of self-annihilation. It felt like I had been wrapped in a lead blanket and tossed overboard into the Kermadec trench. On the bottom, everything approached my consciousness through a great distance of mist and excruciating apathy. The whole outside world was quietly wrapped in cotton wool and hidden in a fog my senses couldn’t penetrate. The greyness of the world spilled under the bedroom door and wrapped me up tightly, drowning in knock-out gas. Day and night ceased to exist, my body grew into a husk, and my echoing heart was all darkness.’
Comparing this to the symptoms (linked above) I was clearly experiencing symptoms 1, 2, 3, 4, 5, 6, 7, 8, and 9: I had everything. This was an extremely intense manifestation of depression and after the three months of it my body had lost 15kg and my muscles were wasted, it was the weakest I ever remember being. This depressed episode marks the beginning of my life with bipolar.
3. Subsyndromal Symptomatic Depression (SSD)
SSD can be thought of as a lesser depression below the scope of having a major depressive episode. By definition SSD involves having two or more depression symptoms from the above linked list minus a depressed mood (1) or a diminished interest in pleasure (2). The symptoms must have been present together for two or more weeks and have caused social dysfunction (e.g. isolation, withdrawal, or behaviour changes).
I didn’t experience much SSD in the years before my diagnosis: I was generally either way up or way down almost all of the time, and it was exhausting. As I became more experienced with bipolar I went through five years where SSD was my preferred emotional state because it was productive and predictable. I could get my work done, and have a relationship, and go to work, and even though my life didn’t have much lustre I was making progress towards the things that mattered to me. It was much better than being majorly depressed or manic. It was a cocoon state where I could work on myself. At the time I was happy to trade happiness for stability, and seeing as how I practically never felt euthymic, this is what SSD gave me. It is only in recent years that I have built up enough self-trust and responsibility that I feel safe being outside of the SSD cocoon.
4. Mania
For me mania is the most destructive, uncontrollable, and euphoric of the six phases of bipolar. The words that spring to mind when I think about mania are: joyful frenzy, hyper-awareness, self-confidence, outgoing, possessed, unsleeping, psychopathic, unending energy, waking exhaustion. Mania can lead to hospitalization from exhaustion and in some cases people may exhibit extreme or violent behaviour.
Please follow this link to one clinical definition, and list of symptoms, of Manic Episodes.
My first manic episode came directly after my first major depressive episode, and the transition felt like being reborn. I was filled with a sense of positivity and general love. I gave away a lot of my possessions (my bass guitar went to a stranger on the street) I spent the last of my funds on registering a company and proceeded to work on it obsessively. I was working in sales at the time, but gave that up to travel around New Zealand in search of answers as to what was happening to me. My first manic episode lasted for almost two years.
‘I was on an idiotic pilgrimage, blind to the world, locked inside the madness. That was the shape that my denial took. I wasn’t sick, I was just seeing the world clearly. I wasn’t escaping, I was purifying. It wasn’t insanity, it was magic. Everything was intense and poignant and profound. Everything was a sign, an omen, or the hint of a reward. I was convinced that I was the protagonist in the greatest love story of our age and that I knew how to fix everything. …I was on an enormous high, barrelling along at breakneck speed.’
Many people love the rush that a manic episode provides, I was once among them. Your mind is supercharged, your energy is limitless and infectious. You are the life of the party. Sometimes sleep ceases to be a necessity (for a while) and you can be extraordinarily productive. Obsession can cause us to work for days without sleeping on some muse or idea. When I did this I felt like a genius but in retrospect I was totally unfocused. Energy I was using (wherever it came from) wasn’t substantial: inside the manic rush I was becoming dangerously depleted. During mania I damaged a lot of important relationships, made plenty of risky decisions, and adopted a habit of subterfuge.
5. Hypomania
Hypomania much milder than mania and is often credited with boosting positivity, energy, productivity, and creativity. Hypomania is sometimes referred to as the ‘entrepreneurs disease’ because hypomanic people tend to be forward-thinking, driven, original, and creative. It can actually be an extremely pleasant and active state as long as you can maintain your emotional and mental balance without escalating to a manic episode. I think of hypomania as riding the wave without getting thrown: you need to BAIL before the crash. Again and again hypomania would escalate into full mania and crash into a major depression. I would be excited by the possibility in every moment, loving life. Soon thoughts would become incessant until sleep would cease, the lines between reality would blur and I would crash. Some people are far more stable within hypomania than I am. My mistakes and lack of control made me prefer SSD: the lesser of two evils.
6. Mixed Episodes
There is no rule that we will experience only one of the phases of bipolar at a time. Mixed episodes come in many flavours and intensities but at the core involve being both manic and depressed, either simultaneously or by cycling rapidly between.
‘Somehow I always knew when it was 3:00 AM. The quality of my exhaustion had a certain taste to it, the sounds of the city around me faded into ambient, and the ratchet in my brain was at maximum tension. Thoughts became cannonballs, slamming into my mind faster than I could grasp, and leaving dark and empty holes as they busted out again. A hundred a minute, a thousand a minute, this mad highway routed through the centre of my conscious mind: I was blinded by them. In the pit of my being I felt powerless. Desperately I would plead with myself but more voices would join the conversation and I would know that I was losing my mind. Dragging myself from bed, yet again, I would work on exhausting my physical body: a hundred push-ups and a hundred sit-ups. How long have I been going? Did I lose count? Then a glass of milk, massage my temples, strip the sheets and remake the bed. Time to lie down again, relax, relax, relax! Still cannonballs, still conversations, and sometimes I would weep or even try to knock myself out. The energy was my curse and all I wanted was to fall asleep, peacefully, for at least a month. By the time 4:30 AM rolled around I could usually drift out into a shallow slumber – until my alarm would ring two and a half hours later. That ten-month long marathon of manic-depressive insomnia…’
The rolling waves
The phases of bipolar, whether depressive, manic, or mixed, are a bit like oceanic waves. They come rolling in from across the horizon, carry you for a distance and then disperse. Learning how to live on my ‘bipolar ocean’ has become a constantly evolving part of my life that does bring me some frustrations but also pride and satisfaction.
I always try to remember that each wave will pass, definitely, but now days I also see the waves as originating from my self: a restless ocean captured in human form. I don’t fear the episodes anymore, even though they can be extremely inconvenient, as each state offers something in exchange. From the absolute bottom of a trough I may see deeply into people’s humanity and at the foaming peaks I may have wonderful ideas I would never otherwise glimpse. The real skill comes in never staying at the extremes for too long and always remembering to step back kindly into a more balanced life.
I hope this article is useful to you, thank you for reading it! I believe that these articles will help to educate people with bipolar and give them skills for a future of mental wellness, not mental illness. Please consider Supporting KindBipolar and joining our email list (we never send spam). Be kind to yourself and have a great day.
