Are You Manic?

Are you manic? What's that even mean? You might've heard of manic-depressive without really sitting down and giving a thought as to how this looks like, maybe this post might elucidate a few things for you then.

I remember a client of mine (let's call him Alberto) came in one day attempting to work on relapse prevention. Addicted to (or recovering from, at times I didn't know) sex, drugs, working out, and the list goes on, it was quite a case. In fact, he described himself along the lines of so many others that have struggled with addiction... That is, "I have an addictive personality."

But how does that relate to mania? I remember when Alberto didn't show up for a few sessions we had to close his episode of care (i.e. take him off the system given his lack of motivation to attend sessions). I consulted with a colleague of mine and described Alberto as being "sporadically dedicated." When he did something, he did it to its ends. For example, when coming in for his intake, he had determined to see myself, get an assessment and begin counselling. He was also living with a mate that he was helping come off his own addiction to alcohol. Then after session he went to see a GP. He was administered the K10 to measure stress and anxiety levels (which were through the roof). He came with all this information the next session, and then proceeded to miss three sessions afterwards. His reasons were that "everything was going awesome!"

Then when he decided to return to therapy he described his circumstance at that time. He was sought after by many organisations for his work in fitness. He had an awesome relationship with his family and was living back at home (although his partner still irritated him, and they were in the process of a divorce), and he was bench-pressing 175 kgs - only 150 kgs behind Eric Spoto (world bench pressing champion!). But then again, Alberto lifted his 175 kgs with one hand, so he might even have it up on Mr. Spoto himself!

What I'm trying to paint is a picture of a man that's obviously 'sporadically dedicated'. He could be embellishing his experience, and he could be telling the truth. Whatever the case, he's certainly great to work with! 

And not only that, he's enacting precisely what I'm about to describe in the context of this current post; that is, the manic man.

The DSM-5 describes mania as a symptom in a variety of disorders, however it's not a psychiatrically defined disorder in itself (for now anyway...). For example, the term appears 273 times in the manual, and is inherent in disorders such as OCD, Bipolar I and II, substance-use, traumatic brain injury, and others. 

The most commonly cited (or popularly known) disorder with a distinct feature being mania has been Bipolar I Disorder. Here we see a patient (or client, or person, whatever you want to call him or her) presenting with a distinct manic period lasting at least one week and being present pretty much all day every day during that period of time.

A manic period is usually symptomised by stupefyingly increased self-esteem and grandiosity ("I'm Superman!"), being extra talkative, decreased need for sleep, and an increased amount of goal-oriented behaviour (could be sex, gym, work, or school, etc.).

Then, in Bipolar I, we have what's called a hypomanic episode. This is where there's an increased level of activity and energy that carry with it the same symptoms of a manic period (or episode), however last about 4 or more days, and aren't at the expansive level as that of a manic episode. To see a more in-depth look at hypomanic versus manic, click here.

Looking at Bipolar II for a bit, we only see the hypomanic episode rather than the manic episode, coupled with a depressed state. It's the latter that we'll turn to now.

We've spoken about Major Depressive Disorder in a previous post, so to get more on the depressive symptoms see the prior link. But for Bipolar to be considered Bipolar one must present with a Major Depressive Episode that lasts over a two-week period. This usually means the person is depressed for most of the day, can't find pleasure in activities that they'd enjoyed previously, experience weight loss or gain, experience more or less sleep than usual, are fatigued, and feel worthless (APA, 2013).

To turn back to Alberto for a little while, we see his scoring on the K10 as reminiscent of these symptoms. As the K10 records anxiety and depression, these are the areas of focus, so it doesn't help us much when trying to ascertain a persons mania. However, when we take a look at his behaviour (or assess it using a psychological tool), we can see his symptoms of fitting into a hypomanic state. Given, full-blown mania is a rush of thoughts and feelings that usually aren't able to be processed as adequate speeds, and later lead to anger and annoyance we can't see them in Alberto's case. However, were we to measure his behaviour to a hypomanic episode we'd see a bit more of a congruence.

What does this mean? Well it could mean that coming to see a counsellor or psychologist for some talk therapy might be the way to go. We'd also see that opportunities for psychoactive medication (e.g. Lithium) might be helpful to control mood swings on both sides of the spectrum (i.e. mania and depression).

To end, we shall take a look at the words of a person that's lived with Bipolar, and has realised a number of "invaluable life lessons". "1) You don't have to deny your mania; and 2) You don't have to despair when it's gone. What emerges in mania's absence may be far more moving than you ever expected." (Cheney, 2014)

References

American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Cheney, T. (2014). For Robin William: The honorary Bipolar award. Psychology Today. Retrieved from http://www.psychologytoday.com/blog/the-bipolar-lens/201408/robin-williams-the-honorary-bipolar-award.

Images retrieved from:

http://fc07.deviantart.net/fs23/i/2008/026/f/f/Manic_Depression_by_DecadentDementia.jpg

http://www.irtces.com/img/bipolar-disorder.jpg

http://whereapy.com/sites/default/files/styles/large/public/resource_images/psychotherapy-chair-vintage.jpg?itok=GWDtEjOM