Manic Panic

Posted by fxckfeelings on July 16, 2012

While plenty of crazy people make their mental state known with a tell-tale twitch or tinfoil hat, a severely manic person can look relatively sane and still be completely bonkers when it comes to making decisions about life, love, and money. Our laws allow them to fly under the commitment radar until their behavior gets so erratic that they’re about to fly off a mental cliff, whereupon the police (with your help) can take them off to treatment. So if you wish to help someone who is mildly manic, don’t hesitate to offer good advice. If someone is very manic, however, your helpful words may cause nothing but fear, aggravation, and mental jet fuel, so you will need to be quiet, patient, and knowledgeable about commitment law to be helpful when things get out of hand and the tinfoil hats come on.
–Dr. Lastname

I was diagnosed bipolar as an adult and usually take some lithium to deal with it, but, for a few weeks last month, I started to get manic. I rode it out by spending all my time in church and buying a lot of philosophy books. It wasn’t too bad—I just wasted a little money and a lot of time, but otherwise, I felt kinda great, and I haven’t felt depressed, at least not yet. Now I’m back to my old self, but I’m not sure where the mania came from, or when/if it’s going to come back. My goal is to figure out what it happened.

What happened when you got manic is that you got manic, forgetting who you are and what you wanted to do with your mania. That’s what mania tends to do.

It gives you strong feelings that need immediate expression because you feel more real and “in the moment.” It tells you what to do, whether it’s cleaning the house all night, sleeping with as many strangers as possible, or spending your bankroll on religious literature.

What you want—you, as a person and manager of your own interests, rather than a manic diagnosis—is to figure out, during a sane moment, how much manic behavior is safe, where to draw the line, and what you want done about it by you, and if you’re out of commission, what you want done by others. You say nothing about that in your letter; unfortunately, you don’t seem to be present other than as a passive eyewitness to your symptomatic self.

Your recent mania obviously encroached on your ability to make a living and carry on important relationships. As the main guardian of your values and interests, identify how many hours and dollars you can allow manic priorities to take from your limited resources and other commitments before you believe action should be taken. Then, do whatever research is necessary to mandate the treatments that should begin when those limits are exceeded. For mildly manic behavior, you may require nothing more than an improvement in sleep hygiene and locking up your credit cards.

For more severe symptoms, decide what dose of medication will slow you down, but don’t take medication or any other treatment because of what other people want you to do. Give careful thought to the tradeoff between mania and your life priorities so that you can become a competent manager of your illness.

If you stand by and watch the wave of bipolar emotion carry you into the future without having an emergency plan to activate, you’ll have left yourself alone with no adult in charge and you’ll become your diagnosis. If you do your homework, however, you may still go to church from time to time, but not because you’ve gone insane.

STATEMENT:
“I’m not as interested in my bipolar feelings as I am in what they do to my behavior, commitments, and ability to make a living and be a good guy. I can’t stop my symptoms from surging up and trying to carry me away, but I can give myself directions for managing my symptoms and holding my life together, and that’s what’s important.”

Without meds, my mother acts crazy, but she won’t listen to me when we tell her she needs them. When she first started talking fast and giving gifts to everyone, we all thought it was funny, but after she got irritable and maxed out her credit card, we stopped laughing and her friends drifted away. For awhile, she accepted the idea of seeing a shrink and taking some medication, which made her almost normal, except that she thought she had never been sick, that the pills took away her creativity, and that she didn’t need them or want to depend on them. She had one really bad psychotic break a long time ago, and was doing well for so long. Now she ‘s spiraling out of control and pushing my father into bankruptcy and her friends don’t pick up the phone when she calls…if she has another break, I know from research that it’s going to be really hard to get her back to anything like normal. My goal is to get her to take her meds before she goes off the deep end for good, takes my dad with her, and we all lose her forever.

Even if you feel confident that getting your mother back on her medications could restore her health, you won’t be much use to her until you accept that you don’t really have much control and things could get much worse. This is because laws that were designed to protect people against social intolerance have the inadvertent effect of protecting her illness from being treated until her symptoms become an obvious danger to her or others’ safety. Only then can she get treatment without her consent (which, of course, her illness will not give).

While waiting for that day to come and never knowing whether it will, don’t try too hard to push treatment on her, because that will threaten her and reduce your influence. The most you can do is urge her to think of treatment as the best protection, even if it’s uncertain, because the risks that come with it are lower than the ones she’s experiencing in her current, un-medicated condition.

Respect the fact that she’s the only one who can make treatment decisions, even if her illness may prevent her from making a reasonable decision about this or anything else. The only opportunity you’ll have to force her into treatment is under circumstances you would otherwise like to avoid; when her symptoms put her or others in real, immediate danger, allowing the police to intervene.

If that time comes, the best way to get her help is to give the police a description of whatever she said or did that made you worry for her safety, whether she likes it or not. If you talk to them about her past history of seeming weird, they’ll think you want to get her hospitalized to make her better, not because she’s in danger; so stay on point or they’ll disregard your concerns. Then repeat the same information to the emergency room clinician, who is bound by the same rules.

You may not be able to do much in the short run, but if you’re patient, avoid alienating her with ineffectual help, and stay prepared to step in if she’s in danger, you may eventually have an opportunity to bring her back. In the meantime, you have to let her get close to the edge.

STATEMENT:
“I’ve lost my mother and I’m afraid I may never get her back, but I remember who she is and I will try to avoid driving her away while I watch over her and try to keep her safe.”