"Up," A New Series: First "Up": Mania

John McManamy Health Guide
  • As some of you may know, I cleared my schedule over Jan and Feb to completely overhaul my mcmanweb site. Once I got Phase I out of the way, I was able to get a life and go about Phases II and III during my normal (ha!) business hours. Last week, this involved scrapping my old articles on the diagnostic issues involving bipolar and replacing them with new ones.

    One new article involved mania. I was in the middle of crossing one of my T’s when suddenly I had one of those knock-me-over-with-a-feather moments: In the more than five years I have been associated with BipolarConnect, never - I repeat never - have I posted a piece on mania.

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    That’s one rather huge omission. Okay, I’m going to make up for that right now. This is the beginning of a new series, but instead of calling it mania I’m going to call it “Up.” Discussing mania makes no sense without discussing the rest of up, which also includes hypomania, exuberance, feeling good, and even feeling less depressed than before. Discussing up, in the meantime, forces us to look at “down,” and the two together compel us to look at everything in between, including our states of wellness.

    This approach is crucial because bipolar is essentially a cycling illness. Our brains are in perpetual motion. In an ideal world, we would be treating the cycle rather than the episode, regulating the steam that turns the wheel rather than applying brakes to the wheel.

    But look at episodes we must. So why don’t we start by dispelling five myths about mania?

    Myth one: We all love our manic episodes.

    Wrong. Way wrong. And it’s surprising how often our doctors buy into this myth. Anyone who has been through mania is terrified at the thought of another one. The reality is most of us are willing to accept miserable half-lives as over-medicated zombies, if that’s what it takes to avoid a repeat of the living nightmare that probably left us without a job to go back to, or much worse. Mania is all about losing control of our brains, which includes our ability to reason and control our impulses. Nothing good ever comes out of these situations.

    Myth two: But nevertheless, while you’re in mania, it’s the most incredible high in the world.

    Only if you think jumping out of a plane without a parachute is fun. Things can turn terrifying very fast when events spin out of control. Way too much is happening way too fast, and the world is far from a friendly place.

    Myth three: But people are elated when manic.

    Maybe some people are. These are your “classic” or “pure” manias that we call “euphoric.” But the reality is that euphoric has a way of turning dysphoric. These are your “mixed” states, mania symptoms mixed with depression symptoms. In my book, “Living Well with Depression and Bipolar Disorder,” I describe it this way:

    If one thinks of pure mania as the music of Duke Ellington and Louis Armstrong on a cool clear summer night, mixed mania is heavy metal and rap in a thunderstorm ...


    Psychiatry is finally waking up to the fact that most of us experience dysphoric or mixed manias, and the next edition of the DSM will reflect this reality.

  • Myth four: But I’ve been super-productive in mania, people loved me, the ideas flowed. I was on my game, I was king of the world, and nothing bad happened to me.

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    Then you were in hypomania, not mania. People often confuse the two. Hypomania - mania lite, so to speak - is not a pathology unto itself. The DSM explicitly states that this condition does not interfere with our ability to function, which translates to being able to work and carry on our relationships. At its best, hypomania may enhance our ability to function. At its worst, we can tolerate the situation. We may do things we may later regret, but we still have a measure of control, we are not entirely beyond reason. But hypomania may be the prelude to mania or depression, so we need to watch ourselves like a hawk - not always easy to do when feeling a bit too good (or agitated) for our own good.

    Myth five: Medications are the best way to prevent mania.

    I would strongly qualify this. Yes, meds are advisable, but doctors tend to over-medicate. Moreover, meds are just part of the equation in mania-prevention, such as regulating our sleep, practicing mindfulness, making smart lifestyle choices, and so on. It’s a different matter in a crisis situation, when over-medicating is the appropriate and indeed compassionate response.


    In future posts, we will go into mania in much more detail, but I could use your help. You are the true experts. Please feel free to share your wisdom and experience. Please fee free to suggest topics. Comments below ...

Published On: April 04, 2011