I have only been hospitalised for mania once (you can read about my experience here). My memory of that time is hazy and distorted by the manic lenses I was wearing but to say that it was dramatic is putting it lightly. I had just turned 23, was newly diagnosed with bipolar (I had been diagnosed with bipolar type II less than 6 months before but needless to say that diagnosis turned into bipolar type I) and had been hospitalised for the first time a few months prior for a depressive episode (which was traumatic for everyone involved). I was psychotic, combative and had an extremely labile mood.
As far as we know, no one else in our family had been diagnosed with bipolar type I or had experienced psychosis. My parents and brother had not been diagnosed with any form of mental illness. So this was all new to us. We had barely found our feet with a bipolar type II diagnosis before my family was confronted with a daughter who was manic and psychotic, and not at all like the person they knew. It was a very steep learning curve for all of us. I was in hospital for two months and that was two years ago.
The evolution of that manic episode was both slow and sudden. I had been hypomanic for a couple of months which no on was too concerned about as I was safe and closely monitored and my hypomanias usually manifest as increased productivity – I generally function best while hypomanic. However after the festive season and New Year’s celebrations my mood escalated very quickly from someone who was mildly hypomanic with insight to someone who was manic with no insight. I believed I didn’t have bipolar so I stopped taking my medications. Within about a week I was very manic and in less than two weeks I was psychotic. The psychosis literally happened overnight (a night that didn’t involve any sleep). I was hospitalised a few days after the onset of delusions and visual hallucinations.
Since that episode I have been hypomanic a few times and have had breakthrough episodes of mania that didn’t involve psychosis or last more than a week. I have been psychotic again but that was while I was depressed, not manic. Luckily I have avoided another psychotic manic episode because I am monitored closely when elevated, have a strict medication regime and have one-off ECT treatments when my mood begins to really climb.
Yet, I can’t guarantee that I’ll never become psychotically manic to the point of needing hospitalisation again. Whenever my family and I discuss that time it always ends with my parents saying, “Please don’t go off your medications again. You must make sure that never happens.” I must admit I find this offensive. It implies that I was myself and in a rationale mindset when I stopped taking my medications, which is not the case. It was not actually my decision to discontinue my medications because I was already severely unwell with a mental illness that clouded my judgment. I had lost insight and was incapable of making informed decisions.
It is this reason that I can never say I won’t become psychotically manic again. I have every intention to remain well and I work everyday to keep myself from becoming acutely unwell, but everyone saw how I can lose insight and go downhill very quickly.
Tensions in my family were high for weeks after that episode and friendships were damaged because people couldn’t understand my inability to make rationale decisions so they thought it was my fault I became so severely unwell. This made me feel responsible for what happened and subsequently the guilt that followed was immense. I worry that if I need to be hospitalised for mania again then people will blame me for it.
Though, that is the unfortunate nature of my illness. It can insidiously or suddenly sneak up on me so I have to be prepared. I’ve educated the people around me about circumstances outside of my control that can lead to mania (such as medication changes or coming down with a physical illness that prevents me from keeping down tablets) and how when I’ve lost insight I’m unable to be responsible for my mental health. I’ve also identified what aspects of bipolar I can control such as self-management strategies so I can minimise severe episodes and be prepared for the parts of bipolar I can’t control.