Dealing with a Mixed State when Suffering from Bipolar Disorder

Bipolar disorder (manic-depression) is a mental illness where a person has times they feel very high (manic episodes) and times they feel very low (depression episodes). The episodes are also referred to as cycles and generally happen in adults with less frequently than they happen in children. Children can cycle rapidly, sometimes many times each day but in adults generally; the manic and depression (depressive) episodes happen perhaps once a month or perhaps even less. There is no standard guideline for the frequency of either manic or depressive episodes, every bipolar person is different.

When a bipolar person is having a manic episode, they are very up; full of energy, their thoughts racing rapidly from topic to topic and they have no real concept of cause and effect. What I mean by that is that they aren't necessarily going to understand that the decisions they make while they are having a manic episode will come back to haunt them later. One example of this is when a bipolar person is in a manic episode and decides they are going to go shopping and buy themselves a new car, even though they really can't afford it and it isn't a good time for such a decision. The bipolar person will go buy the car because it seems like such a good idea, never thinking about having to pay for the car and all its accompanying fees, tax, tags, insurance etc.

Then when the bipolar person cycles into a depressive episode, they become very down, depressed, and emotionally withdraw from family, unable to even get out of bed. They just can't seem to face the day because its prospects are so bleak and there's just no point in even getting out of bed. They may also be faced with the consequences of their actions, such as buying that new car and be faced with the fact that there is no way possible to pay for it. This can cause them to spiral into such a deep depression that they just want to kill themselves; telling them that it would be better if they were dead.

At least this has been my personal experience with bipolar disorder. My friend Natty* has bipolar disorder. My friend Phlet's* husband has bipolar disorder. I have been with Natty during different episodes and the symptoms of her bipolar disorder are difficult for her to deal with but it's also difficult to be with her. I spend a lot of time with Natty especially and there's times I just have to back off and not even talk to her. I don't mean that she gets mean or violent because she does not, at least I have never seen her act like that. I just try to respect her space and leave her alone and try to realize that how Natty is acting has nothing to do with me or anything that I have done but instead that it is symptoms of her mental illness that she has no control over. I've also spent hours listening to Phlet as she talks about her husband's bipolar symptoms and how they affect her. Natty and Phlet's husband are both on different medications which definitely help lessen the severity of the manic/depressive episodes but it doesn't completely wipe them out. But there is one time that I have never seen Natty or Phlet's husband and that is when they are having a mixed episode.

A bipolar mixed episode is when there is a mix of both manic and depressive episodes AT THE SAME TIME. They display both manic symptoms and depression symptoms simultaneously. So I asked Natty if she ever had mixed episodes, since I'd never seen her have one. I had some sort of idea that maybe she never had mixed episodes and that maybe her meds kept from having them. I'm not even entirely certain what I was thinking but I was mistaken in all my thinking. At first Natty wasn't sure what I meant by a mixed episode because she hadn't heard the term before but once I explained that it was having both the manic and depressive episodes at the same time, she knew exactly what I meant. And to my surprise she says she has had them and then she went on to explain further.

Natty told me that I will NOT be seeing her have a mixed episode because they are so bad that she leaves and stays completely away from all people (well unless she really hates them) until they are over. Natty told me that she can feel the mixed episode coming on and that it feels awful like these horrible "feelings are coming from deep inside her gut."

Wikipedia says about bipolar mixed episodes; "In the context of bipolar disorder, a mixed state is a condition during which symptoms of mania and clinical depression occur simultaneously (for example, agitation, anxiety, aggressiveness or belligerence, confusion, fatigue, impulsiveness, insomnia, irritability, morbid and/or suicidal ideation, panic, paranoia, persecutory delusions, pressured speech, racing thoughts, restlessness, and rage)."

Natty also told me that she feels violent and has a hard time stopping herself from kicking walls and especially from throwing things. Natty's example that she told me was "see that kid's ball there on the floor (I nodded, noticing one of my grandson's toys on the floor of the room), during a [mixed] episode, I would kick that &%$# [bad word censored here] ball as hard as I could, clear across the room, through the wall if I could."

Phlet told me that because of her husband's bipolar disorder; she has to keep tight control of his habits. She monitors him closely, doesn't give him passwords to any of their bank accounts or ebay accounts and doesn't give him much money at any one time. She doesn't keep much soda, ice cream or candy in the house because whatever is there, her husband will eat in one setting. She drives him to and from work and keeps on him about his job telling him that there is no way that he can quit since they need him to keep working to support them and because they need the medical insurance. So when her husband has a mixed episode, he can be a bit mean, Phlet told me. I suspect it is because Phlet won't give in and let up about the control she has to keep because otherwise her husband will spend his entire wages on soda and candy and other things that do NOT include the rent or utilities. Phlet has her brother live with them because sometimes she is afraid that her husband might become violent. Phlet loves her husband but sometimes she cries when we talk because her husband's bipolar symptoms can be hard to live with.

I'm not sure how every bipolar person (and their families) handle it when they are dealing with the mixed state but Natty handles her mixed state episodes by isolating herself from her friends and family so she won't hurt them (either emotionally or physically). And Phlet and her husband handle his mixed state by having her brother live with them (just in case of violence) and keeping any money out of his hands. So far, these plans seem to be working for both Natty and Phlet's husband and their respective friends and family.

There are places to go for help for the person with bipolar disorder. Because bipolar disorder is a mental illness that requires both a psychiatrist and a medical doctor, I suggest keeping in close contact with both. Visit them regularly and don't forget to keep taking your medications every day. When the person with bipolar disorder is not having an episode or mixed state, it can seem like a good idea to quit taking their meds and visiting their therapist. We, as family and friends, need to encourage them NOT to do this since it will only make their illness worse and harder to handle for everyone; the person themselves and their family.

The National Institute of Mental Health (NIMH) says "Many people with bipolar disorder benefit from joining support groups such as those sponsored by the National Depressive and Manic Depressive Association (NDMDA), the National Alliance for the Mentally Ill (NAMI), and the National Mental Health Association (NMHA). Families and friends can also benefit from support groups offered by these organizations."

Another place to get help and support that I know about is an organization called H.E.A.R.T. Connections that is for families with special needs. I believe you can find any of these organizations by looking them up in your local phone book or even online.

I realize that being a close friend or family member of a person with bipolar disorder and specifically one who suffers from the mixed state can be very difficult. I believe that education and support groups are very important if you want to live a happy and emotionally healthy life with your person with bipolar disorder but love is probably the most important support that you can give to each other.

*Names have been changed.

Resources:
National Institute of Mental Health (NIMH). Bipolar Disorder Publications.
Personal interview with Natty; September 2008.
Wikipedia, the free encyclopedia. Bipolar Disorder.