Next "Up": Dysphoric Mania

John McManamy Health Guide
  • Tabby took the words right out of my mouth:

    I'm on edge constantly.  Like a cat on a hot tin roof, prickly and claws baring.  This sudden and rising imploding pressure building and building within me.  I have to move, I have to run, I have to speak faster and faster.  I can't stop speaking, I can't stop moving, I can't stop running.

    Oh, yeh, for a little while - maybe a week or two - “the colors of life start to unfold again,” but then:

    I get highly irritable, agitated, and angry.  Everyone is moving too slow.  Everyone is so stupid and won't get out of my way. ... My mind whirls like a turbo at 2000 RPMs and I can no longer make sense of any of my thoughts. ... I want to run but I can't move.  I want to scream but no sound will escape. I want to pull all my hair out by its roots.

    Add This Infographic to Your Website or Blog With This Code:

    There is no let-up, no respite. You need sleep for that. Sleep?

    I know something has gone so horribly wrong and I can't make it stop. I can't make it stop and I so do not feel good. I feel terrified.

    Now, compare Tabby’s account to something I wrote 11 years ago:

    I awoke from a drunken stupor in a strange city in a strange country, jobless and friendless and nearly penniless. You don't really want to be sober, for aside from the unwelcome intrusion of reality, you also find your psyche playing host to the type of cold fusion nuclear reaction that demands instant release. Rage - Goddess, sing the rage - a line from Homer ...

    Does this sound like we’re having the time of our lives to you? Seriously, any time I hear an idiot doctor say that we don’t take our meds because we’re addicted to our highs, well don’t get me started. My head literally exploded in slow motion. With me at ground zero, experiencing every excruciating millisecond in a state of preternatural hyper-awareness, no let-up, no escape, days on end, weeks. You don’t need to describe hell to me. Been there, done that.

    In my book, “Living Well with Depression and Bipolar Disorder,” I quoted this from Meow:

    A small poem on Bipolar ...
    Did you hear that?
    That was me;
    Inside my head.
    I wish I was dead

    The biggest myth by far in all of bipolar is that mania is a super-happy state. Even our doctors subscribe to this blatant falsehood. Yes, some of us some of the time do experience moments of extreme elation and expansiveness - the technical term is euphoric - but inevitably our brains have a way of turning on us. One minute, we’re in our race cars, joyfully leaving the world behind in our rear view mirrors, the next we are stuck in traffic, engine revving hard, banging our heads against the dash in despair, sucking other people’s fumes.

    It’s as if our internal hour hand is whirring like a second hand. As I describe it on mcmanweb:

    Nothing goes right in this state of time. Every rock, every tree, everything God has placed on earth has turned against me and me alone. People conspire to make my life miserable, computers find new ways to throw up error codes, numbers and their values change right before my very eyes, and being placed on hold is enough to reduce me to tears.

  • This is bipolar’s dirty dark secret - dysphoric mania. The DSM-IV categorizes this state as a “mixed episode” or “mixed mania” to distinguish it from classic or “pure” mania, the kind of mania we associate with euphoria. DSM mixed mania is mania overlaid with depression - but this comes nowhere near close to describing it. Moreover, because the DSM demands a full manic episode combined with full depression, the condition is seriously under-counted and regarded as if it were an anomaly.

    Add This Infographic to Your Website or Blog With This Code:

    The DSM-5, due out in 2013, makes a small step in the right direction by simply requiring three depressive symptoms (instead of five) inside mania, and would apply this criteria to hypomania (mania lite), as well. Unbelievably, the current DSM does not recognize mixed hypomanias.

    But the DSM focus on symptom-counting overlooks the real issue. What we are really looking for is evidence of anything that may turn a euphoric state (whether hypomanic or manic) into a dysphoric one. It may take just one depressive symptom for that to happen. Or it may involve a bit of anxiety.

    Or the simple fact may be that our manias have turned on us with no input from depression of anxiety at all. That simple thought never seems to have entered psychiatry’s collective mind. Yes, we all love it when our brains are operating on rocket fuel - who wouldn’t? - but now everything inside and outside of us is going way too fast for our own comfort. It’s as if we’ve suddenly discovered the accelerator super-glued to the floor with the brake cable cut.

    We want it to stop - right now! We want to get off - right now! But there we are, stuck, trapped in our runaway brains, in the full knowledge that something terrible, really terrible, is about to happen. As Naomi describes it in my book:

    Stop my brain. Stop my brain from thinking. Stop my brain stop my brain stop my brain stop stop stop stop stop stop stop stop stop ...

    And how is someone like Naomi feeling? Well, not exactly euphoric or super-happy or elated.

    And psychiatry actually has the nerve to tell us we don’t take our meds because we are addicted to our manic highs? Too late, now you got me started ...


    This is the third in my series on “up,” based on your input. You are the real experts. Let’s keep the discussion going. Comments below ...

    Previous posts:


    "Up," a New Series

    Does Anyone Truly Understand Up?

Published On: April 23, 2011