Mixed-manic episodes are not as common as manic episodes or depressive episodes, but tend to last longer. Here one sees various admixtures of manic and depressive symptoms, sometimes in sequence, sometimes simultaneously. Euphoric patients, hyperactive and pressured in speech, may suddenly plunge into despair and collapse weeping into chairs, only to rise again within hours to their former elated state. Even more extraordinary, patients may be weeping uncontrollably, with a look of unutterable despair on their faces, yet say that they are elated, that they never felt so well in their lives, and then go on to execute a lively dance, all the while with tears still streaming down their faces. Or a depressed and psychomotorically retarded patient may consistently dress in the brightest of clothes, showing a fixed smile on an otherwise expressionless face. These mixed-manic episodes must be distinguished from the transitional periods that may appear in patients who “cycle” directly from a manic into a depressive episode, or vice versa, without any intervening euthymic interval. These transitional periods are often marked by an admixture of both manic and depressive symptoms; however, they do not “stand alone” as episodes of illness unto themselves, but are always both immediately preceded and followed by a more typical episode of homogenous manic or homogenous depressive symptoms. In contrast the mixed-manic episode “stands alone.” It starts with mixed symptoms, endures with them, and finishes with them, and is neither immediately preceded nor immediately followed by an episode of mania or by an episode of depression.
At this point, before proceeding to a consideration of course, two other disorders that are strongly associated with bipolar disorder should be mentioned, namely alcoholism and cocaine addiction. During manic episodes, patients with these addictions are especially likely to take cocaine or drink even more heavily, and the effects of these substances may cloud the clinical picture.
That is rapid cycling at its finest. Wacky rapid fast and I had it when I was an alcoholic. Each hour is punctuated by a different mood.
The moods can also combine.
The results drive me insane.
My first attempt came in one of these moods.
I felt great.
I tried to die.
The waves felt amazing.
They now scare the living shit out of me whenever they appear.
We have a fireplace that was supposed to work. The flue was open but we discovered that it was the least of our problems when we tried to start a fire in it and filled the house with smoke and ash. There was no chimney. Though, this is not the first time this has happened in Madison while living with Grace.
April of every year Grace and I would watch the Draft. Every year. Each year with Spotted Cow. That was tradition. This year was the same. Rachel didn’t understand, neither did Harold or Cliff. Us sitting around listening to names be called off in order like an auction of various body types for various positions in the hope of playing maybe a third string for a few years (or even being relegated to a practice squad) and then promoted through retirements, trades, or injuries. We had our lists. We had read ESPN inSider religiously. I had a subscription to Pro Football Focus. We knew what was going to happen and half the thrill was finding which chess pieces were going to be selected. It was an unofficial contest that we sparred over and half of it was us critiquing the other’s opinions on what the Niners or the Packers needed most in the draft. I had running backs, we got Lacy and Franklin. Thank god. I really wanted Montee Ball, a Badger, because he was better zone than Franklin but Lacy was a steal. The Packers might be the best team out there when it comes to drafting, they don’t reposition themselves up and down willy nilly, they don’t play the free agency game, they just get talent and develop it and farm it out five years later when they can get another rookie either in the draft or undrafted free agents for less and teach him to do the same thing. Being a veteran on the team means you’re golden.
I scare myself sometimes. I scare myself to death, till death actually. I have thoughts that do not coincide with my impulses. I have impulses that drive me toward suicide with frightening force while my conscious brain rebels and tries its damnedest to survive as it is driven to live. My usual blasé attitude toward life gets torn in half and propelled in opposite directions. It becomes a terrifying sequence of events where I struggle to stay alive. Clinically, it’s a mixed state. One part of my brain wants to die, the other doesn’t. Which side wins out is luck.
In April I experienced just this. My mood came on like a invasion of shock troops flipping switches in my brain turning my stable mindset into a confusing blur. As quickly as it happened I didn’t notice it one bit. Moving from consciousness to unconsciousness back to consciousness in my sleep cycle I lost the memory of what it was like to be stable and normal and safe and accepted the new equilibrium that danced between moods that left me unable to see what was plain to anyone watching me for more than two hours, or talking to me for one. A morning cup of coffee seemed normal and I had no instinct to die. It went down warm and satisfying. I went out to the back balcony and felt the first pull of the downward thrust that would then settle into something unholy in a matter of minutes.
Sitting on a chair, flicking a flame and lighting my cigarette I stared out on our backyard that was returning to its green state. I wanted to leap. I thought of what I was going to do that day, maybe go out on State St with Rachel. In my mind I could see the visual of me running and jumping and sliding over the railing to dive head first into the ground while my cigarette slowly floated down. I saw my body crush on the ground and everything would stop. Rachel would probably want to go to Noodle’s and Company again and order Mac and Cheese with Meatballs. I loved the feeling of being weightless. I can’t understand how she liked any meat served at Noodle’s. I needed to stand. I couldn’t sit. I needed to stand. And move forward. But I knew I shouldn’t. I knew where that was going and I didn’t want to go there. But it felt like the greatest thing ever. Rachel would want to walk hand in hand like she always does. If I positioned my body right when leaping I could land head first. Over and over it repeated in my head in various forms while I retreated to the safety of nicotine. Minutes passed like hours as I sat, visualizing my death and being pulled toward it. By the time the coal touched the filter I was catatonic from resisting the urge. I forgot about Rachel in the process. She danced in my thoughts from time to time but was lost in the push and pull of my mind.
My energy was growing disproportionately to the coffee but it wasn’t the clean energy of mania that wraps me in a warm blanket of delusion of success and superiority. It was a frenetic energy that devoured my mind. I staggered inside as carefully as possible feeling that a slip in my concentration would be disastrous. My mind would leap from subject to subject, not with the usual aplomb of feeling like I was having the most original ideas about it that anyone could think of — I was simply scattered and jumping to and fro within my mind without organization or sense or plot. I needed to do something, anything, I forgot about everything else and settled into dashing around trying to preoccupy a mind that spiraled downwards into deadly static. That day I accomplished a lot, so I thought, it was just a cleaning expedition up the mountain of papers and coffee mugs that had become piled up in my little nook which led to me sorting them into smaller piles that in the end made no sense to anyone including my disorganized mind. It only made sense in a tangential way, like when misusing a turn of phrase or attempting a pun that went nowhere and the mind knows it but can’t for the life of it know why it failed. When the switches are flicked so quickly, I often miss the change that came on like a rush. Whatever normal was was lost in the confusing blur.
I forgot about Rachel who watched the frenzy and was disturbed.
I couldn’t sleep that night. Every three hours I woke from my dreams that were filled with terror and violence that seeped into my conscious brain holding reality hostage. There’s never been a dream that wasn’t disturbing and lamictal made them real. It isn’t like a nightmare where it fades into obscurity and you’re left unsettled and reality’s coherence overwhelms the twisted logic of the dream. The dreams I have become real and I have to struggle against the false beliefs that the dream implanted in my brain after I wake into a semi-conscious state believing I was still struggling against demons in 42 Mae Street that I always return to but never fully understand or want to understand for fear of finally comprehending its estranged logic. That night was filled with hours of returning to reality and pushing down the unreal.
The next day passed as I grew more frenetic during the day and in the evening it overwhelmed me as I dreaded the coming horror of sleep. It kept coming toward me, another night of horror that I didn’t want to endure but I dared not share with anyone, not Rachel, not Grace, they didn’t want to know what I thought. They didn’t want to know that I would spend that night constantly seeing them die. I downed my antipsychotic to pass out earlier in an attempt to escape the bizarre overwhelming feeling of drowning in an abyss of irrelevant energy. It wasn’t unpleasant in the normal sense of the word in that I felt a prick or a throbbing pain or a wound that I couldn’t stand, it was unpleasant in that my mind was sucked down and pulled apart and left to rot in a cesspool. Escape was all I could think about, a fresh air that would save me.
The impulses came back.
The next day, when Harold returned from classes I stole Rachel away, I wanted to walk without aim. Standing on State’s sidewalk waiting for the speeding cars on Johnson St to pass and the light to change so I could march ahead and then the pull to take a step forward yanked me closer to the cars to the point where I could swear that if I leaned forward I would be struck. The impulse felt like a man standing behind me with his hands on my back slowly pushing me ever forward, the physicality of the experience seemed irresistible and my mind was torn with the terror of what would happen next if I lost a single precious second of concentration as impulses pushed faster than I could react. I squeezed Rachel’s hand hard and then I lost track of my thoughts. And I took a step and then another and let go of her hand. It happened before my conscious mind could catch it. The speed of the movement forward was faster than anyone else to notice what I was doing. The step felt like a fall from a collapsing railing on our balcony, a sudden weightlessness that shocked the mind but overwhelmed it with an irresistible freedom of the fall surrounded by broken fragments of wood or swimming in the warm waves of a dark lake as muscles tire and the lapping soft waves wash over my face lulling me to stop or slipping into warm unconsciousness drawn darkly downward by half a bottle of pills that promised a final relief however it might come. My mind gave up. It lost its focus and fell. No one around me knew. No one in the house knew. I just took a step forward and fell.
The car stopped and I came back to reality.
It took all of a second for me to attempt.
That’s how fast it can happen.
Rachel screamed in horror.
Mixed states will one day finish me off once my luck runs out.
It is the most dangerous condition to have — a mixture of mania and depression that blends the impulsiveness of the manic mind with the need to escape from a diseased brain. I caught it almost in time before it was too late to take another step and for the briefest of moments contemplated walking back to the house with it dashing through my mind at dream speed. Instead I walked back with a chill hanging over me and Rachel pale from what she had just observed. She didn’t talk. She didn’t know what to do. I wasn’t depressed like she was and this was incomprehensible as I was just talking to her before though it was filled with disorganized thoughts and bizarre logic that leapt to and fro between subjects leaving off the ends of sentences to begin a new one only to resume the previous sentence as though the conversation never had a pause. Frightened is too subtle, to weak a word for someone who nearly lost someone while holding their hand. I never wanted her to know, I didn’t want Grace to know because she would just worry and in my mind that was worse than letting her into my life like she would want. In my room I curled up in the corner staring at my pills hoping to god that I wouldn’t move toward them while Rachel wordlessly held me not knowing what to make of the day. Knives and falling and drinking and speeding cars filled my mind with possibilities that I never wanted while my normal self or manic self struggled to save me from my depression. The fixation on death between suicide and living without knowing which would win and desperately not wanting to die while I was hurled through unconscious impulses to end it while my mind tears itself apart not looking for answers but in a desperate attempt to survive is the singularly most disturbing thing that I have experienced or could imagine. For me, mixed states are the product of a diseased subconscious that acts on its own impulses driving me toward killing myself while my conscious mind revolts splits of seconds later in fear that it was too late and that it might not exist in just a few seconds from the point of its sudden awareness of the impulse to die. I once spent months like this, perpetually confronted with death every minute without knowing what to do or how to get help or how to think let alone move forward with my life and instead I was left paralyzed on a couch existing. It is a feat to exist in a mixed state, one I never experienced with depression or experienced the perpetual horror in any other walk of life. I should have called my psychiatrist then and there when I realized that something was off. I should have told Grace. Instead I sat, curled up, in the corner, hoping it would go away.
It did for a moment and I slept.
The next day I sat in the corner in a ball Rachel crawled in with me and the touch of another human who would be damaged by the reality that I could die at any moment bristled through my body. But I would try to stay alive for her. So I called my psychiatrist. We increased my antipsychotic. I became a zombie.
Antipsychotics have the most peculiar ability to remove all emotion from the mind. One would think that this is not a bad thing but emotions are necessary for cognition, they are necessary for any sort of will to do things whether it is a positive voice or a negative one. Instead, I sat around and did nothing. It is what I believe people think of when they say that someone was neutered, an absence of any recognizable humanity that just sits and stares and digests and excretes and existing is just about the only thing that happens because living is too animated a word to use. Time compresses and stretches as hours pass by in mere minutes in the zombie brain but days stretch on in unbearable ways as the day never seems to end and even though sleep sounds like a great idea you’re not tired in any way, just fuzzed out which leads to laying in bed waiting for the inevitable to happen as the mind finally releases melatonin and falls asleep. They are the reason we think of people as drooling in psych wards. They have not advanced in any appreciable way since then. Lower doses might be good, but when they have to be jacked up, an absence grows.
In an attempt to erase a portion of my mind I took all of it hostage and returned to the couch to sit day after day joylessly watching The Daily Show on repeat in an attempt to bring some sort of reaction to my life. But nothing happened and all I did was sit next to Rachel as she watched me grow into a lifeless being like I would do with her when she would cycle down some day in the future. Two weeks of my life erased to protect me from myself. I didn’t miss them because they didn’t happen to me, they were just gone, like before, when I lost six months of my life without knowing it to leaving the drug up too high in dosage. Before I went all the way down the hole I heard Rachel tell me that she would always be there. She knew what she was getting herself into before all of this happened, she knew I was more fucked up than she was. But she didn’t care.
It made the two weeks a little more bearable.
Harold buzzed in and out of the house forming a blur in my mind as though he was moving in fast forward. It didn’t make sense how fast he was going, it didn’t make sense how the colors of his shirt changed from day to day. It didn’t make sense. He was just a blur. Rachel would not leave my side. Most of my memory is gone but I remember her being there, she was there holding me for endless periods of time. I also remember Cliff being there when Rachel was gone. I don’t know if we talked. We probably didn’t. But I remember his sitting on the couch across from me clicking through episodes on Netflix when the autoplay would stop 118 seconds into next episode. He moved before I did because I don’t remember moving. I don’t remember if Grace was there. I know she was. It’s not a belief in the tentative sense of the word, I knew it as though the belief had a probability of 1 despite a lack of memory. Food always appeared and was too salty. That was definitely Grace. It had to be Grace.
I don’t remember much at all. That’s all I can get back.
I let it happen because it’s the only thing to do.
And it worked.
I was exhausted.
The return to reality is a surfacing of sorts as a swimming metaphor is the only appropriate one because the physical sensation is not unlike the unmedicated return to reality. One day I’m gone and the next morning I feel like I can breathe but am insanely exhausted from being held down. That’s the miracle of short half lifes, one day and I’m back in business. It felt good to be back to normal. It felt very good to feel safe. Rachel was there. She always would be there. Not like Grace though, Rachel would become more entrenched. Neither would understand what I went though, not in the way that I understood what she went through. It’s impossible to describe the fracturing of the mind into consciousness and subconsciousness where the two no longer communicate and one is diseased and the other frightened and exhausted.
April was half over, the damage was done. In the weeks that would follow I remained frightened of ledges where I still saw myself floating over them in a PTSD sort of way rather than an impulse and I relived the experience of falling or of stepping in front of a car or taking too many pills or plunging a knife into my chest. April was hell. All I remember of that month is surviving it.
Rachel made it better.
Like I did with her, she led me by the hand back to the norms of reality. For the first few days I stayed inside and recovered the remnants of my brain and reacquainted myself with what it felt like to be alive. She was there and held me while I fell asleep and curled up with me on the living room couch while I drank my second cup of coffee. Grace didn’t know anything beyond the fact that I had a bad reaction to my meds. For all I have been through, for all we had together, I wouldn’t put her through another attempt if I could avoid it. With Rachel, I could avoid it. Harold drove me and Rachel to Woodmans since I wouldn’t drive still out of the fear that I might plunge us into oncoming traffic and he sensed that something was amiss but couldn’t put a finger on it. The bustle of humanity and food was pleasant. It felt normal, something I could latch onto, something concrete to direct my mind back into functioning. Something with a horizon.
A week after the attempt Rachel took me walking. We went to the park and I told her my second attempt with overdosing on Seroquel (pills are my thing). I’ve had several in my life. I’ll probably have more. One of these days my illness will kill me. One can only survive so long with these impulses, one can only survive so many fleet footed drivers. I wasn’t sure how Rachel would respond, I just had to let her know. If she was going to be with me she had to know what she was getting herself into, that if she remained with me she could very well lose me at any moment without warning without a word. Just gone. If that meant the end of whatever we had, that was it. No one had known or seen what she had seen. She accepted it. She kissed me passionately like I had proposed to her.
The lake had thawed and I remembered too much looking out on it, but it felt good in a new way though I didn’t tell her why.
We walked home holding hands.
It was slow.
It was comforting.
The last week saw the full return of normality. The obliteration of my mind was receding as the memories faded and the past was forgotten in certain ways that made it seem unreal and tangential to my life so that I could resume normal functioning. Rachel and I went out on our first date. We had not really been out together yet, it was something that we skipped over and forgotten about and it was lost in the bustle of breaking up a relationship and sneaking around that preceded it. Chicago was not a date. It was an escape. We went to Forequarter. It’s a small slightly hipster place to eat on east Johnson (where Audio Depot used to be which was a place that I frequented for audio supplies that the Lodge lacked and served in a pinch the necessary equipment) and was run by the people who used to have Underground Kitchen before a grease fire destroyed it. It’s one of the few places in Madison where you can find goat and rabbit. And that’s the whole thing of the place. It is Wisconsin rustic food at its finest complete with fantastic cheese and meat platters that satiate the soul. There are no reservations, there are only a few tables as it is quite small for a popular restaurant, and the drinks there are to die for because of Dave. Rachel and I walked there in the warm spring heat that really amounted to being just 50 degrees.
It was the most awkward first date I have ever been on.
With most first dates there is prep work involved. There are conversation starters that you run over and over again to try and find middle ground while also revealing more of yourself. Whether or not you actually succeed in doing so is another matter but the thought is there none the less. Nerves are wrecked and sweat pools and the world feels like its spinning but at least you can concentrate on the girl in front of you and wonder how you could ever do this to yourself yet know exactly why you are doing it. Most first dates for me are hell from anxiety that is slowly overcome. Ours was hell because it was bizarre.
At this point we had been through each other’s hells and nearly lost the other to illness. We bonded over nearly half a year of tribulations and intimacy and casual conversation punctuated by the extremes. We no longer had much to talk about. We didn’t want to revisit the last parts of our lives. They had to remain buried. It had to remain in the past. Only Chicago held anything for us. So we had our first date. Both of us fumbled for words because we knew what the other was doing, we talked about it every day. I mentioned that she looked nice in her black cocktail dress but I helped her pick it out. She said the same for me but she has seen me in the entirety of my wardrobe before. We talked about music, that we had already shared with one another. We tried to talk about class that we both went to and discussed over breakfast that day. We had nothing new. It took us all of about five minutes to discover that there was little to be said.
So we talked about food.
Neither of our palates are that great.
I’ve never struggled so hard for adjectives in conversation.
It wasn’t anxious. It was bizarre. It was how marriage must feel but marriage seemed to be free of this strange lacking.
And that was when we discovered it.
We practically were married.
We were living together, we slept together, we spent our days together, we spent our nights together, we spent our ups together we spent our hells together we were inseparable and did not lead lives outside of one another because we were so close. The realization of this fact is an interesting one. It isn’t a blow to the relationship, it’s a third person view of how close we were. And we both discovered this at the same time. But we weren’t married. Relationships are not simply intimacy like I had with Rachel, it is not simply hormones like me and April, it is not just good times or bad times like her and Harold but a collection of these things slowly forming a web in the mind of neurons that alter behavior, thoughts, and feelings. It is a web with vertices chaotically scattered and randomly connected paths giving rise to emergent thoughts of love and feeling. Rachel and I both had the same central thought with one another. The other will die. She knew that I had nearly died three times and would probably try it again some day. She would have died if I hadn’t stepped in. There was no web that grew organically around dates and phrases building up to form the supervening structure of love, the web is a central node or vertex that all paths connect to. It was intimate and a tested bond, but it lacked everything else.
We stared at each other wondering what to say next.
The meat was cooling on the platter.
And then we discovered that we hadn’t said everything.
I’ve only told someone that I loved them once in my life. And that was Grace. And that wasn’t romantic. So it came as a shock to me that I said it first. Some people would say that it’s like breaking the sound barrier where the tension builds and builds and then is finally released when the other replies with the same words. That everything is building up to a singular moment that both people were waiting for and the words hang in the air only to be accepted and internalized and recognized as the only thing that could be said at that particular moment of awkward tension.
She replied the same way.
We both felt the soul crushing weight of our delusional relationship.
Most people would find relief in it but it’s the realization that our relationship was not born out of casual first dates and slowly growing more intimate and learning about one another’s hobbies and interests and finding things in common and this leading to sex and then more dates and then more sex which in turn would develop a bond that would migrate into one day living with one another to test drive marriage even though no one would really say so which then would either lead to a parting of ways once the realization that you are no longer in love with the other person and made a mistake or would wind up with each other finally married forever and ever until divorce. Ours was born out of desperation and selfishness and loss and a history that we never wanted to revisit but by saying I love you that meant that everything we had was built on, things we desperately wished to forget, formed the sad foundation of our relationship and nothing joyful without the tinge of sadness or rejection or despair or hurting someone, just a single trip to a museum was free of these things, and that our future together was bleak at best. And death was at the center of it all. It was too soon. It was like saying I love you on a first date but worse. The words did not break the sound barrier but were hollow and never should have been said though we did love one another it was not the love intended by those words. We were never in love with one another, we teased, we danced, we flirted, but we never went through the phase of thinking about one another in a way that didn’t revolve around moving out of depression in some way. Our lives were focused on that, our lives were focused on my attempt, in between were scraps of movies and class. And it weighed us down with the simultaneous realization that if it ever ended the other would could die without the other keeping guard. Not as a direct result, but they would, because the other would be gone, the other would slip, and no one would catch them and their luck would run out.
I should have waited for at least the second date.
But we did have each other.
We ate silently.
We finished and I paid the bill.
It was a mile back home and we walked in silence.
And then she held my hand and it all made sense again.
None of it mattered.
Now was our time to start building something.
Regardless of whether it went anywhere.
We would be there together.
That’s what it finally meant.
Till the end came for one of us.