Give me my rapture: psychotic mania
Even now after three decades of living with bipolar, psychosis creeps up on me. I keep a mood diary, take my meds every night and monitor my sleep conscientiously yet still believe I can double bluff the quick thinking, rapid speech, overconfidence and productivity of hypomania.
Self-management of hypomania
I have tried and tested strategies: three consecutive nights of poor sleep during the week means the weekend is spent at home with two nightly tabs of the antipsychotic Olanzapine to recoup the lost hours; no more than three errands a day and if possible a massage or spa treatment to promote relaxation. If this fails, draw the curtains and play soft, chill music, no TV or radio, till bedtime.
The pandemic changed this: after nine years of stability in March 2020 I had tapered off Olanzapine, and as a result of lockdown restrictions and like everyone else, I became more or less housebound. Errands moved online and I got to know my delivery drivers well. Thus my hypomania was a tidal wave to be surfed indoors and for over a year I bounced high with great (or so I thought) ideas, 4am wake-ups and WFH irritability. This time I bucked my personal trend and my mood subsided early this year without escalation.
Are there advantages to bipolar disorder?
I have lived through five manic episodes, all psychotic and been hospitalised four times. During my last admission under section, I spoke at length to one of the nurses about how useful it would be to bottle the enthusiasm and energy of hypomania just before it tips into the chaos of full blown mania. A previous psychiatrist told me that in evolutionary terms people with bipolar are useful to their community because of their quick thinking, problem-solving and ability to get things done. I wasn’t sure if this was his pet theory or if it is peer-reviewed somewhere. Either way it appeals.
I think these two conversations are the only ones I have had with clinicians about the patient’s experience (as opposed to reporting disjointed symptoms) of psychosis, the rest have been in peer support groups or online forums.
My psychotic delusions
I often ponder where the delusions come from, if they have any meaning. Sometimes, I can see a connection with recent events or my experiences, other times they appear quite random. Once I wanted to punish someone I felt had treated me badly so gave their name as mine when admitted to the ward, it didn’t take long for that to be uncovered. As a teenager I had been church-going so the sketchy memories of the New Testament feature in some of my episodes, not least that on more than one occasion I am the Second Coming – and I have proof.
The meaning of my name links to the Martini advert of the seventies with its slogan “The right one, the bright one” i.e. I am special. I also have a connection with the Monty Python film, “Life of Brian”, with its biblical parallels. In another episode and whilst in a unit, I believed I was tasked to walk naked several miles to my place of work “to take the bite (byte) from the apple (Apple Mac computer) “ – a mangled combination of the Garden of Eden and the Via Dolorosa, walk to the crucifixion. When I tried to leave the ward to fulfil this task, it took several staff to restrain me and I put up quite strong resistance I was told later.
Although with hindsight I recognise my vulnerability when psychotic, there is something quite wonderful in the notion of believing you can save the world. It feels what I imagine religious ecstasy to be. I become radiant, tears welling up and my heart bursting with euphoria. On the face of it, making the world a better place – given the chance, who wouldn’t?
Coming down from this can be hard and I am glad I can do so away from people who know me well in the anonymity of the psychiatric ward with people who understand the pain and the positive of mania.
I find a camaraderie on the ward – people from all sorts of backgrounds coming back from their own brink. As in most cases I have been coming down from a high, I am annoyingly cheerful, still hyperactive, cleaning the kitchenette, putting books and magazines in order, tidying the art room. I can be great fun in the evening medication queue, entertaining fellow patients with songs that fit our situation.
Some family and friends who visit can be alarmed at my surroundings and do not return but in the early days of recovery I am oblivious of other people’s behaviour as they may be of mine. As time goes on, I am more aware of how ill some others are and itch to get an hour or so’s leave and finally to return home again. The weekly meeting with the psychiatrist determines these milestones and saying things like “I am Jesus” even as a joke, can extend your stay, as I learnt myself.
I would not say I enjoy my psychotic episodes, but after three decades I navigate them pretty well.
I am no longer afraid of them.