Writer Mark Brown describes how he experiences one of mental health's most misunderstood conditions.
Imagine yourself at your best. The world around you feels filled with possibility. The sun is like a warm hand on your face. Every conversation you have feels like a joy. You roll out of bed refreshed, bursting with ideas about the ways you might spend your time. Suddenly everything is clicking into place. That idea you had that you couldn't quite make work? Breakthrough. But more than that; there were even larger ideas behind it. A few weeks ago you couldn't concentrate but now, before you've even thought about breakfast you've ticked twelve things off your to-do list. The flowers are so bright, so filled with joyous colour. And the birds, the birdsong is like the most beautiful music. And music, oh music, it's incredible, you've never heard such music before. You must find someone to tell all of this to, you must write it all down so you never forget. Later you make everyone laugh, it's like you have thrown off a lifetime of shyness. You might flirt, might make conversation. You're a good person. A whole person. A person people like. And then, at home again, the ideas and the energy. Why shouldn't you order those things online? You just need to pick up a few extra shifts to pay for them. It's fine. 4am isn't late night, it's just early morning, no one could be angry if you vacuumed now, surely? This is amazing. It must feel great for everyone to see you so alive after all of that time you were depressed. Then imagine that this might not actually be you at your best, but a symptom of a disorder. What would you think then?
In the early years of the 21st century I received a diagnosis of bipolar ii disorder; the kind of bipolar where elevated mood didn’t edge into hearing, seeing or believing things that made the world seem unreal or my thought strange and unfamiliar to me. Sitting in a public library I tried to understand why I'd fallen out of university without a degree, penniless and confused. I read the symptoms of hypomania in a psychology reference book with a kind of horrified shame: grandiosity; decreased need for sleep; more talkative; racing thoughts; increased goal-directed activity (social, work, sex); excessive involvement in activities that have a high potential for painful consequences (unrestrained buying sprees, sexual indiscretions, or foolish business investments). Puns and wordplay were mentioned. All of the symptoms of the hypomanic episodes that characterise bipolar ii were identified as tiresome for others and the potential precursors to another depressive episode. ‘But,’ I thought, ‘I thought that was just me at my best.’
These symptoms described the me that had adventures, talked themselves into jobs, wrote; the me that made leaps of logic and dazzled with wit and charm. It was also the me who ended up walking off endless energy at three in the morning, the me that never finished a project, the me that couldn’t shut up. It was also the me of agitated, irritable depression, somewhere between hypomania and desperately low mood, filled with a kind of bleak, bitter energy of self loathing that could not sit still or be quietened.
"Words that usually attract each other like magnets into passages of clarity become a clockwork where the the cogs do not bite."
Often Bipolar ii is mentioned in the same breath as celebrity meltdowns; assumed to be a codeword for coked off their faces. Bipolar ii isn't the same as bipolar disorder. It isn't the same as depression, either. Often, hypomania isn’t mentioned to a healthcare professional because why would it be? Who’d want to be treated for feeling amazing? A lot of research doesn't really differentiate between bipolar disorder and bipolar ii disorder. The main differentiator is that someone can’t be diagnosed with bipolar ii if they’ve experienced mania. Some people group bipolar ii symptoms into atypical depression, regarding hypomania as a form of emotional dysregulation. Some have suggested that what is diagnosed as bipolar ii might actually be Complex PTSD. Others regard bipolar ii as a contentious diagnosis, looking at whether it might really be another contentious diagnosis: Borderline Personality Disorder. It seems to be a diagnosis that changes back and forth over time depending on how much of a mess you find yourself in and how, when, and by what methods you seek help.
'A stone in a shoe'
When I've written about bipolar ii in the past I've received complaints that I am glorifying mania, downplaying the very real damages that mania causes and valorising a condition that causes much damage and distress. The thing is, though, hypomania is not the same as mania, not in bipolar ii. It isn't a waypoint on the path to loss of insight and to terrifying confusion and becoming a stranger to your own thoughts. It's an experience of its own, a destination in itself. After months of depression it is like the sweetest honey on your tongue, a seductive companion that brings back everything that has been missing. And more, so much more.
For me, most of the time bipolar ii is depression, horrid and thick like layers of waterlogged wool on my back, like drowning but never dying, kicking exhausted as dark sour water fills my mouth with silt and dead weeds. To live like this is to become a negative, a shadow of a person, a troubled ghost of myself clinging with numb fingers to the silver thread of a life that might never return to normal. Everything is sad; everything in broken; everything is a poignant, sorrowful sign that everything is screwed. Even when I'm doing OK it's like there's something in my throat or a stone in my shoe. Is it coming back? Is this just tiredness or grumpiness or is this the beginning of another exile, of another loss of forward motion?
The physical space of depression is unbrushed teeth and unwashed hair; dirty towels, unreturned phone calls and unanswered emails. The desire to eat more and to sleep more to regain some energy is bottomless, a dark well to climb where the circle of clear sky never gets any closer. I stuff my face and watch days pass from my bed. Apparently, depression in bipolar ii tends more to hypersomnia and overeating I'm told. A staircase is a mountain. A simple task is like learning a new language. Running out of food or clean plates means hours sitting in hot and agitated indecision before action can be summoned. Words that usually attract each other like magnets into passages of clarity and sometimes even beauty become a clockwork where the the cogs do not bite. A one sentence text message takes a week. Ideas spin slowly in stale air echoing and sad; tongue dead and lifeless in my mouth, my throat closed up with shame at my new inarticulate self. To even make eye contact with another person is an agony of exposure and failure. Unrelenting and inescapable, life is a watery twilight filled with the softly whispering shades of past failures.
But there's also another version of me, like a mirror twin. From the vantage point of depression, this other shining version of myself is like a kind of god; hypomanic energy and drive making me capable of obtaining prizes and pulling off last minute escapes that seem like a kind of frictionless dream of incessant forward motion. The velocity, the wit, the amazing world-vaulting leaps of cognition and connection; hypomanias are like being able to stride from mountaintop to mountaintop without effort while others scrambled in the foothills, tripping on scree and scrub. When I can feel the impedance of depression and exhaustion mounting, I yearn for that flashing-eyed, charming, talkative version of myself to take centre stage. Just a few days, I think, and I could be back on top.
Everything depression me is, hypomanic me is the opposite. The version of myself with elevated mood is confident, has a mind that works quickly and intuitively, can stay focused well into the night and through into the early morning, can assemble and communicate ideas with ease. To slide into hypomania is like suddenly being able to master figure skating when previously you have been clinging to the wall of the rink. Instead of tentative, fumbling steps you are suddenly sweeping across the ice, gaining speed without losing control; a creature of grace and confidence, arabesques and sit spins; enjoying the ease and flow and the spotlight upon you. You feel competent, confident, outgoing. Suddenly what is paralysing during depression or even during more 'normal' periods is effortless.
And then, just as quickly, it isn’t again. The mistakes mount up; the costs accrue, the life and soul of the party becomes its most crashing bore, drunk on the sound of their own incessant voice. And then you have to pay the cheques your mouth wrote; pick through the embers of the grand ideas for things worth salvaging; find ways to manage the monstrous amount of things you agreed to or suggested, shamefully repair the boundaries you cross. The problem with quick thinking, smooth talking and grandiose ideas is that sometimes you actually find you have to deliver upon them.
For years after my diagnosis I tried to hide from this other me, certain that even the merest hint of the confident smile or rushing thought would signal another spiral into disaster, debt and disorder. I considered myself saturnine, plodding, slow. The quick-witted, mercurial me was just hypomania, a kind of biochemical trickster ready to lead me away from safe paths. Now, that hypomanic edge is something I flirt with, something I recognise as part of me. I work across a number of areas where grandiose ideas are expected; mandatory even, where getting stuff done quickly matters. I’m lucky I can work in spurts, but still the ever-present depression erodes my consistency. Sometimes, I’m embarrassed by the difference between what I was previously and what I am on any given day.
The greatest power hypomania has as an experience is to seduce the person who experiences it. I feel a recklessness admitting that hypomania, at its best, is the most alive I have ever felt. Hypomania is like lightning in the dark, as unpredictable and invigorating and as destructive. I used to ask: 'Why can't I feel like this all of the time?' Now I’m older, there have been other real successes and achievements, other times of real, objective joy and excitement. Hypomania is still there, as is depression. I respect both of them. All hypomania, as do many depressions, leaves behind wreckage of one sort or another; destroying things built up over years. If you’re lucky hypomania leaves behind just a dent in your overdraft, too many commitments or people asking why you’re such a self-important, loudmouthed dick. Knowing my hypomania and my depression means I can do as much as I can to make sure that if they are to be guests, they don’t trash everything while they’re here. They’re a part of me, but they’re not all of me and certainly not the best of me.
Mark Brown is a regular contributor to Mental Health Today. Sign up to our newsletter to catch all his future articles.