November 17, 2013

Manic patients aren't mad, just different

By Jack Smith

With a presentation to 50 people a few hours away, I had more energy than a cocaine user on his highest high. Only it was 4:00 a.m. and I had not yet slept.

I felt larger than life, drinking beer after beer while listening to music in my hotel room. I was traveling alone and enjoying a party of one.

Thoughts raced through my mind as the alcohol warmed my blood. I would leave my current job and conquer the world. I would become a high-flying consultant to big companies and write a book. I would be rich and would retire at 50. I might even become famous.

I ordered room service and more booze, giving the waiter an absurdly high tip. I partied alone and plotted my future until 6:00 in the morning. A couple of hours later, on precious few hours of sleep, I walked into the conference room and knocked it out of the park.

The reviews participants left were some of the best I received in my short consulting career. They said they liked my energy and enthusiasm. Some said it was one of the best presentations they had ever seen.

bipolar-symptoms-400x400Later that day, I drove three hours to another city for another gig and did it all over again. I remember being amazed I wasn’t tired after that presentation, which also got good reviews.

Another time I was alone in a big city with no real work obligations. I stayed up most of three days, meeting strangers with ease, buying rounds for people I didn’t know and making repeated trips to the ATM so I could keep gambling, which isn’t something I even know how to do.

That episode ended with a spectacular crash. I was reduced to sobbing on the sofa, calling my wife and confessing what I’d been doing. I so quickly descended into depression and panic, we had to call a friend staying at a different hotel to come and get me. The next day, I made the long drive home, devastated by depression and anxiety.

Depression is not complicated. It is not hard to explain. It hurts in your chest and in your bones. A bad episode of depression is a living hell that average people can spot and doctors can easily diagnose.

Mania is different. It’s hard to diagnose and hard to describe.

I can best describe it from my behavior during manic episodes, which for me can least a few days or a week. My mood is elevated. My energy is high. I don’t need much sleep. I’m impulsive and unpredictable. I talk louder and faster than normal.

Mania probably explains my decision to buy a jeep on a lunch break a few years ago. That might not be that unusual if I hadn’t bought it about 30 minutes after deciding I might like one.

Mania probably explains why I entered two different partnerships to buy land in Florida just before the real estate bubble burst, costing me huge sums of money for land that isn’t worth much today.

Manic episodes aren’t all bad. I can work with laser-focus for hours, losing track of time and often coming home from work two hours after I said I’d be home. I’m more productive and more creative. My mind races so fast I can barely keep up with it.

But I’m also irritable. Too much stimulus makes me jittery and ill-tempered at times.

The problem with mania for me is it always ends either in disaster or depression, and sometimes both. The high always ends in a crash. I consider myself lucky, though. A manic episode has never cost me a job, my marriage or a trip to jail. For many, it has.

About one percent of the population is bipolar. Seventy percent of people with bipolar disorder are incorrectly diagnosed at least once in their lives. The average span of time from onset of symptoms to diagnosis for bipolar disorder is 10 years. For me, it was more like 20 years.

Thirty percent of people with untreated bipolar disorder commit suicide. The good news is lithium, a drug that has been used to treat mania for decades, cuts the risk of suicide. In fact, it is the only drug proven to prevent suicide.

I don’t blame my doctors for missing the diagnosis for so long. I never knew what bipolar disorder was. It never occurred to me to go to my doctor and say, “you wouldn’t believe how great I felt last week! I stayed up late, didn’t feel tired and felt like I could conquer the world!”

So until about two months ago, no doctor had asked if I’d ever felt larger than life. They never asked if I’d ever been reckless and impulsive, or if I’d ever gone through phases where I needed little or no sleep. They never probed to see if I could possibly suffer from bipolar disorder.

The problem with mental health is it’s subjective. There is no blood test or brain scan. Diagnosis is based almost entirely on a patient’s ability to remember and accurately explain what has been going on. And it’s based on a doctor’s subjective analysis of the patient’s explanation.

I share this story as I have others in hopes we can all learn about mental illness. I think some of us think of mad naked men running loose on the streets when we hear the term “manic,” or we think of crazed people who do violent things.

That’s not the kind of manic people I met in treatment.

Maybe the more we all learn about mental illness and each other, the more we will come to realize we really aren’t much different from each other after all.