The Mystery of Mania

The Mystery of Mania

written by: Dr. Christina Bjorndal
by: Dr. Christina Bjorndal
Shutterstock 152116073-1000x520 Shutterstock 152116073-1000x520

When I studied Naturopathic Medicine at the Canadian College of Naturopathic Medicine in Toronto, I was asked to be on a steering committee regarding the direction of the program for future students. In the discussion, the subject of mental health and psychology was discussed and one of the students raised a question about bipolar disorder. My response was "Which type of bipolar disorder are you referring too?" And her response was "How many types are there?" Therein lied the problem for me – here was a student that I highly regarded – and she didn't know that there are two types of bipolar disorder. At that time, I was stuck in the stigma and shame of my diagnosis, but now – over a decade later – I am "coming out" about the truth. So, for those of you that don't know, there are two types of bipolar disorder. Simply put, in type 1, you experience delusional psychotic mania and in type 2, you don't have psychosis, but are in a "hypo-manic" state. What follows below is an excerpt from my upcoming book "Beyond the Label: Achieving Mental Wellness with Naturopathic Medicine". I am posting this blog in honour of Mental Health Awareness Week.

BOOK EXCERPT: After feeling so much better when I started Dr. Hoffer's protocol, I began to wonder if I was "cured." Maybe the doctors had been wrong and I didn't have bipolar disorder type 1. After all, I had never had a psychotic episode naturally. I had always been on some form of psychotropic medication when it happened. When I had questioned my psychiatrist about this, he told me that a "normal" person would never experience mania on medication; only those with the genetic tendency for mania would. Since I am adopted, I didn't have a family history to verify the validity of that statement. This left a suspicion in the back of my mind, or maybe it was a refusal to accept the label. I continued to take my medication, along with the supplements, for fear of getting sick again. It had now been a decade since I had been manic, and I began to question whether it would ever happen again.

Well, it did. And as the next episodes unfolded, what never sat well with me was that I never became manic on my own—I was always under the influence of prescribed pharmaceuticals. While the allure of mania has been described as addictive, for me, it is a state that I have feared and have tried desperately to keep hidden. The irony with that is mania is impossible to hide. It begs to be seen. And while it can be fun to be in a hypomanic state leading up to a full blown psychotic event, it usually comes with an inevitable down swing into depression as the pendulum swings the other way. Mania is the yang to the yin of depression.

Back to school—and another manic episode

The first two months after leaving HSBC were good. Initially, I was excited about my studies. Slowly, though, my insecurities got the best of me. I started to feel overwhelmed about the length of time it was going to take to become an ND. Would I even be accepted into the program? Would I pass once I got there? I began exploring other career options that would guarantee me a paycheque sooner rather than later, such as teaching or becoming an RCMP officer or city police officer. I thought maybe I could use my business skills in a transferable position in the health field. Or maybe my boyfriend would propose and I could get married and become a mom.

Partly because of the struggles my boyfriend and I were having in our relationship, we attended a personal growth course called "The Art of Happiness." Leading up to the course, I had been sleeping well, but after the first night, I only got a few hours of sleep. During the course, there was some intense emotional work, and I found that I was very triggered by the energy of the other group members.

I escalated into mania on the third day of the course and ended up jumping into the Fraser River. In hindsight, the course organizer should have called an ambulance for me, but instead, she sent me in a cab to St. Paul's Hospital, where I was left—in a state of psychosis—to check myself into the hospital. This was not going very well for me, as I was losing my mind and I am sure I looked like a street person in the baggy clothes I had been given to wear after changing out of my wet clothes.

I ended up calling my friend, Lisa, who contacted our mutual friend, Janet, who was a resident in emergency medicine at the hospital. We had initially connected when we were exploring the idea of creating an organic baby formula. Lisa had already played an instrumental role in supporting me with my health challenges, and now I believe that Janet also was in my life for the same reason. Ultimately, we all helped each other move our lives in alignment with our spiritual paths as we were all searching for courage to make big changes in our lives but didn't know how.

Here is an account of the experience, written from her perspective:

The phone rang as I was washing dishes on a cloudy Sunday afternoon. "Janet, Chris just called me from emergency. She said to call you and then hung up. Something's wrong." I was at the hospital in minutes, where I found my friend at triage crying. She clung to me, and as she spoke, things became clear. I recognized the pressured speech, the loud voice, and the hyperactive behaviour. As an emergency resident, I had encountered it many times. However, this time it was my friend, and the experience changed forever the way that I view psychiatric patients and the medical system as a whole.

Before I continue, let me say that this is not a criticism of the dedicated staff at this hospital and other emergency rooms across the country. We all do the best we can in the crunch that is acute medicine. However, I hope that my experience may help people step outside of "the box," if just for a moment. The box is our comfort zone. Inside it we exist in a state of clinical detachment, using characteristic language and attitudes with respect to patients; both are defence mechanisms that enable us to do this challenging work. For example, I was shocked to hear my friend referred to as "the bipolar," forgetting my own frequent similar references to patients. I honestly can't remember referring to a patient by their name in the emergency department. Unfortunately, I will probably step back into that familiar box in a matter of days or hours, but wanted to record this experience at a time when I was able to view things from an eye-opening perspective.

Before I arrived, Chris had been told there were no psychiatric beds available, and that there would be none available for days. She possessed enough insight to know that she needed inpatient treatment, but was rather dramatic about it because of her condition. As well, before arriving at the hospital, she had jumped into a river and lost some of her clothes. She came across as an angry street person, perhaps even strung out on coke. Not the vivacious, inspiring young professional who until recently had been a high-level manager in an international corporation.

I don't mean to imply that her "status" should entitle her to more respect or better care. However, I'm sure many in the waiting room would have been surprised by the information. Alone, afraid, and paranoid, there was no way she could check herself into triage without some help, and she wasn't getting it. Luckily I arrived just as she was considering going back out onto the street. The last time she was this sick, she made a serious suicide attempt and ended up in the ICU.

As soon as I had calmed her down, I started to grasp at strings. I knew the on-duty emergency physician, who made some calls and informed me that there were no psych beds in the city, and that I should try to get her admitted. Meanwhile, Chris had been insisting loudly that she needed her psychiatrist's number, saying that he wanted her to call him at home. Of course, we'd never dream of giving a physician's home number to any patient, much less a psychotic screaming one. I was skeptical myself, but used my hospital badge to get into the nursing station, where I asked the unit clerk for the psychiatrist's number. It wasn't listed, so I picked up a phone, identified myself as a resident to the switchboard, and got it.

I then called the psychiatrist, who confirmed that he had given her his number and said that he would contact the on-call psychiatrist, making her an urgent priority for admission. When I told the triage clerk, he repeated that there were no beds and that she would likely not be admitted, as there were eight people in line ahead of her. He was quite unfriendly, even though he knew that I worked there. He was probably justifiably annoyed that in the midst of a backed emergency department, I was using my connections to push a friend through. However, I persisted, and got her checked in.

When I went to visit her the next day, she was ensconced in her corner of the acute psychiatric unit, surrounded by flowers and friends. All, including Chris, were thankful that she was alive and safe. In addition, I was feeling some disconcerting emotions. Seeing a friend in a psychotic state had been profound. Despite her "crazy" condition, she had still been very much herself. Beneath the bizarre behaviour and delusions, it was actually quite easy to find the person I knew. With a chill of awareness, I had to acknowledge that I had regarded psychotic patients as being somehow not of themselves. I hadn't considered that the healthy person might be preserved within, aware at some level of what was happening. I don't mean to be putting forward a theory on psychosis or mania; I am only trying to express what I discovered about myself. I'm sad to say that I had not been seeing or treating these patients as people.

Furthermore, I had discovered what it was like to be on the outside, desperate to get care for a loved one and running into one brick wall after another. "Sorry, you'll have to wait" and "there are no beds," echo in hospitals across our country every day. I'm used to saying these words, not hearing them. I chose to ignore these words because of my position, which I'm sure many would criticize me for. When you're desperate you'll try anything. My heart goes out to those who don't have anything to try.

Thus ends my story, with a happy ending for my friend and a number of lessons for me. Hopefully I won't forget them; that was part of my motivation for putting this to paper. If you even gain a fraction of the awareness that I achieved from writing this, it will make this effort worthwhile to me.

The above article was submitted for publication in the CMA journal, but was rejected. I am extremely grateful for how my friend was able to help me, that she was home to answer the phone and the risks she took to get me safely admitted.

This was my third manic episode while on prescription medications. I began to wonder what the point was of taking a mood stabilizing medication if it couldn't prevent mania. My psychiatrist explained that there isn't a medication strong enough that you can take on a daily basis to override mania and still function in some capacity. Trying to prevent mania is analogous to trying to stop a volcano from erupting. While the supplement regime had been effective at stabilizing my mood from a depression and anxiety perspective, I questioned the need for pharmaceutical medication that wasn't doing its job in that area, nor with preventing mania. I began to search for answers on how to prevent mania from ever happening again.

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