By Max E. Guttman, LCSW
I first experienced mania during my sophomore year of college. My highs were mountaintop experiences filled with euphoria, drama, risky behavior, gambling, substance use and poor judgment calls.
Mania is intoxicating and can feel like a force binding all your physicality into a cauldron of energy and creativity. During a manic episode, it can seem as though you are transcending history and yet entangled into it. It can feel “right” in a way that does not make you realize that something is wrong. In other words, when going through mania, it can be hard to recognize what is happening or that medical attention is necessary.
If it weren’t for my friends in college who were constantly looking out for my safety and checking in with me every day, I would have likely dropped off the map with my risky behavior, rather than getting help.
As I know firsthand how difficult it is to identify, self-assess and manage a manic episode, I want to help others experiencing something similar. Here are my tips on how to navigate mania.
Signs of an underlying issue may start in a mostly “unproblematic” manner in your life, such as feeling very energetic or impulsive — this is often referred to as hypomania — but if unaddressed, it can quickly escalate to a manic episode.
During an episode, many people experience extreme euphoria, decreased need for sleep and hyper-sexual arousal. Manic episodes often kept me awake for weeks at a time without feeling the need for rest. I have even witnessed patients doing somersaults across the floors of the psychiatric ward, as they were so dysregulated during manic episodes.
With specific diagnoses, manic symptoms become more difficult to identify. People with diagnoses that include psychotic symptoms should pay even closer attention to their moods because psychosis can worsen with extreme elevations of mood, which then further complicates a person’s judgment and insight into their symptoms. Sometimes, religious ideation can be indicative of activating psychosis.
If you notice any change in your energy levels, thought patterns, impulsivity, etc., it is best to address it right away before symptoms escalate.
If you identify that you are experiencing a manic episode, there are several options for reducing the harm to your interpersonal life using self-management and self-regulation tools.
One tool you can use is completing Activities of Daily Living (ADL) checklists to remain as independent as possible during an episode of active mania symptoms. Your ongoing capacity to execute daily living activities without incident is always a good measure of how well you are managing your mania symptoms. For example, someone eating, bathing, sleeping and coping with life stressors is on the road to self-managing their symptoms. The more life tasks you meet without incident, the less your manic symptoms are interfering with your life and your goals.
Stimulant and drug-induced mania can be just as dangerous as organically, internally driven manic episodes. Considering substance use treatment may be an essential step in managing your symptoms for the long-term.
Like most people, even minor stimulant use from caffeine can trigger an episode or lead to self-activation, which means inducing mania by engaging in unhealthy activities or stopping medication without medical oversight.
Accordingly, it is critical to consider your baseline mood (everyday mood) when engaging in stimulant or caffeine use like coffee or energy drinks. Understanding your baseline will allow you to gauge, for instance, whether consuming one more coffee or can of soda will trigger a manic episode.
Internal and external barometers are essential for knowing your baseline. Listen to your friends and colleagues and take in their assessment (even if informal) of your mood.
Ask yourself these questions to create a barometer to self-assess for mania:
Some folks find it helpful to create markers in their local environment. Identifying these spots, small safe havens to migrate to when a potential problem may be in the works. For example, when you are feeling speedy on the climb up to mania, locate one of these spots you can go to when you aren’t feeling safe.
Examples of safe zones include:
Mania may feel good at first, but, ultimately, it will put your safety at risk. So, find safe zones that will keep you protected when you are manic and lacking your usual insight into your behaviors. While in your safety zone or on the way to it, you can begin to recalibrate your internal guidance system to register that you are manic and need to return to a calmer, more stable baseline. Visualize what that will look and feel like to begin the recalibration process.
Ultimately, there will be times when you have to live with unresolved symptoms. Creating a plan for friends and family will significantly reduce the risk of potential harm from an episode. Friends and family can also help you make decisions if your judgment and insight are too impaired for rational decision-making.
I send warning emails to friends and family, flagging them down when I feel like my moods may have impaired my decisions and/or might affect others in the future. Preparedness and attention to detail are always essential when managing an illness. Surrounding yourself with supportive people and allies can bolster recovery.
While you should never feel embarrassed by your behavior during an episode, you do need to accept responsibility for it. That’s how healing works — acknowledging that change is necessary and moving forward in the process of adapting our behavior to build a healthy, fulfilling life.
Max E. Guttman is a Licensed Clinical Social Worker, mental health therapist and disability rights advocate. He has worked in various systems of care in New York State, both as a clinician and as a peer. Max is also the editor-in-chief of Mental Health Affairs, a website for the mental health prosumer.
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