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Guest Essays

Two Decades with Bipolar Mania and Psychosis

A Guest Essay by Bob Yamtich
This essay was originally published
on Bob’s blog.
Intro
(I wrote this in October 2019, I have since restarted my coaching practice and this website.)
At age 24 I published my memoirs, where I claimed my battle was against “walking death, death while living,” the zombie stuckness of depression. Little did I know that I was battling bipolar depression. I was sporadically successful at that battle from ages 18–33, when the stress of having a child hospitalized me.

I thought all work was for The Cause, a battle that sounded like social justice but was more existential. My early writing was stream of consciousness and storytelling without a pause to declare lessons learned, perhaps because I didn’t learn. I certainly didn’t pause. I framed all fights in terms of what I wanted — a “yes”- clean drinking water, engaging education, celebration of diversity.

I now attempt to build and maintain emotional and mental wellness. I've lost a lot personally and professionally: I was California Marriage and Family Therapist #81075 before I washed dishes in Arkansas and cashiered at Kroger in Atlanta. In between these minimum wage jobs, I was a counselor at a school for gifted kids and an engineering teacher at a school for urban kids. I lost both of the school jobs due to mania. I also lost my second marriage and later the chance to live with my son.

Nonetheless, with 15 years without an accurate diagnosis or adequate treatment, I developed some useful coping strategies. Some aspect(s) of my approach to life helped me hold it together for so long, right up to the moment I couldn't.

I thought depression was the lay of the land and not just the lay of my land. If offered a diagnosis earlier, I would likely have spouted off Camus, Kafka, and Kierkegaard to show myself as part of a broader, though individual, struggle that had more to do with radical self-responsibility than mental health.

I will try, in a long blog, to help you see or feel at least one thing differently about managing bipolar mania, depression, or psychosis. I’d be honored if my experiences enhanced your self-connection and self-advocacy. If something doesn't land for you or apply to your circumstance, please let it blow past you like the wind.

How I See Bipolar
Most bipolar authors describe a two part sequence — a manic episode followed by a depressive period. A spree of sex, shopping, and substances followed by a time where you can’t get out of bed and perhaps don’t want to live. Still, it isn’t a urinary tract infection, penury, or a hangover that leaves one down — the depression, or at least the threat of the depression, was always there.

Mania is an attempt to gather resources and change the world to pre-empt threatened depression. We will look later at what lessons we can take from mania, which has a non-zero success rate at temporarily lifting mood. Hence, shopping therapy.

So, I see depression as a hellish lake of lava that can be temporarily escaped but never forgotten. Mania is a mountain building effort to rise above the lava. Depression may be omnipresent, but it isn’t omnipotent. The challenge is developing habits of thought and life skills that are stable and sustainable.

These skills are intended to supplement, not replace, work with a psychiatrist and a talk therapist. Although I’m about to share perspectives and approaches to manage mania, the best attack may be taking medication as prescribed. The clear mind I have to write comes from medicine; my coping over 15 years was imperfect with many lost loves and jobs.

I’m just trying to offer a little extra and hopefully new insight, yet I defer to the well established best practices of mindfulness and psychiatry with therapy.

Lessons from Mania
A yelling child usually has at least a partial point; so do manic impulses. Staying stuck in depression may be unbearable, which leads to ever increasing efforts to escape the lava. Would the lights and sounds of Vegas help? If I post enough on social media, will my business increase?

Empathize with the impulse to find the gem of beautiful longing. Vegas may be for fun; marketing may be to gain work. To manage mania is not to close every door, a sure path back to depression.

Talk to your therapist. Write in your journal. When in doubt, get in shape.

For me, mania extended my existing interests. My love of coins led to giving away thousands of dollars of coins attempting to run for President, which I became old enough to do in 2016. I made quicksand. I buried sand my son played with when he was two. My longing was for permanence. Because depression loomed. I just picked up rocks with my now four year old in a joyful but moderate way, and I’m delighted he lovingly shares in my hobbies.

Many numbers make me smile. Music too. I join philosopher Walter Kaufmann (author of Without Guilt and Justice: From Decidophobia to Autonomy) in saying human decisions matter. Even if you allow some divination or take guidance from the radio to help push you out of ambivalence, you are making a choice.

Do something memorable; manic brainstorms can help with this but temper them with checks for safety, expense, and permission. Find an excuse to go outside. Kiss a rock. You can’t say you’ve tried everything until you do.

Mania can give ideas to overcome depression. If you treat the depression, the mania will be manageable because that part of your brain won’t be in a panicked survival mode trying to avoid the depression. You can maintain your self-connection and develop strategies to meet needs in an empowered, coherent way.

Psychiatry
My psychiatrist reflected that depression was my consistent struggle and mania my intermittent struggle. I thought I was the opposite for 15 years, flying high and nowhere near the depth of despair. Only recently do I see that consistent threat of depression as a source of motivation for mania. With elevated, stable mood largely due to medication, med compliance is newly easy for me. Because I feel good.

When all the meds did was “manage mania”, I was tempted to avoid my mood stabilizing element to rely on coping strategies that I had learned. Specifically, I was a trainer of Nonviolent Communication, which one of my therapy supervisors described as a branch of Cognitive Behavioral Therapy, the gold standard to gain freedom from the mental traps of depression. I was surrounded by skills. In hindsight, my work as a therapist did not pay much attention to medication compliance- I thought that with or without psychiatry, my job was to teach skills.

All meta-analyses of psychiatry and talk therapy conclude that a combination of the two leads to making and maintaining gains.

I was ambivalent about the treatment of my mania, so I was ambivalent about psychiatry. Like an external force, psychiatry was a “treatment of me” by outsiders and not “my treatment” with valued consultants. My engagement with a slow and steady talk therapy, discussed next, increased my buy-in. I was also heartened to have a competent, witty, and caring treatment team. I wasn’t alone in competence, wit, or care.

The conventional wisdom makes sense to me now- the treatment of bipolar depression and/or mania, certainly when it goes as far as psychosis as it had with me, requires a medical component. Psychiatrists have become some of my favorite professionals partly because they can accomplish so much empathy and insight in a brief session.

Join your own treatment team as an active participant. Then all efforts will be with you, not done to you.

Talk Therapy
For years, I have received more therapy than I have offered. My second to last therapist, Aimee, gently suggested I was still manic when I admitted I thought our sessions were broadcast over a podcast. She moved states and referred me to my current therapist, Kyle, who does improv and references ancient myths like a college professor. I don’t think we’re on TV, but we are often funny.

My end of delusion happened on his watch, but thanks also go to the patient Aimee who was often the only person I spoke to in a week and prevented a deeper dive into lonely lunacy as my mom watched me take ever more prescribed meds, while I still thought it was “treatment of me.” I had been food tampering on a broad but hard to detect level- I dumped lithium pills in aquifers that sourced Coca-Cola and Fair Oaks Farms. Elements aren’t eaten by microbes; they are the most stable form of those atoms and elements don’t degrade. So, when I took lithium, my pee contained eternity. My grandiosity wanted lasting impact. I still have civil engineering crimes I’ve never admitted. I move rocks, I bury sand, and I throw my two cents towards a “Penny Lane” in every community I visit.

Aimee kept me sane; Kyle will see what I do next. I’ve spent so long being unemployed, and only recently grounded in the shared reality, that I wonder if and how I will rise. Kyle reminds me that a job isn’t an identity as parenthood or even writer may be. I’m spoiled by the 1:1 attention; I attended a bipolar support group last night and didn’t have a huge sense of shared experience. With grandiosity gone, what remains? A guy in group said that after his manic episodes, he frequently experiences depression, then rebuilds.

I can tell how much therapy provides an outer (and lower) limit to how I may fall. I faced a weekend without any scheduled activity before a Monday at noon appointment. I rely on my sessions for accepting empathy and encouraging insight. Part of me suspects twice a week would be justifiable; we always want the least intense successful treatment on a continuum from weekly therapy to twice weekly to partial hospitalization outpatient to an in-hospital stay. I journal to remind myself of my resilience. I remind myself that in some ways I’m an experienced adventurer, yet in others I am very young.

How much do I value reality? As far as I can tell, shared reality is the only prize for growing past delusions. This shared ground can be the foundation for attending to needs for community, inclusion, and participation. I will discuss this in therapy, a place where I bring my current level of well-being to a person with both empathy and perspective. I’m engaged with my therapy, which advances in step with my own progress. I suggest “talking about what matters” is the mark of therapy going well, although I join Carl Rogers in believing we all have an internal drive for wellness so unconditional positive regard and patience may trump perceived relevance. People, when free and able, use their time well. Be honest in therapy, and grow.

Friends
I heard from an old friend that a therapeutic tool I gave her, decks of feelings and needs cards, had been servicing her and her clients well for years. She has extended and updated the tool for deeper work, and I was delighted to hear from her and to engage as colleagues since I was not currently seeing clients. Her blessing bears repeating:

“I hope you can find a stability to keep you oriented, and connected to this 3D world, a care and humor to keep your ego in check, and reflections that honor your empathy skills, your creativity, and your beautiful brilliance.”

I wish I had asked what reflections are, but I love it so much.

Other friends have arranged visits for our children to meet. They are happy to see me as well. I owe many apologies for pushing away some friends, sometimes from grandiosity (“They aren’t helping my career enough”) and sometimes to protect them from my silliness, and over-relying on other friends (which I am sure happened, although my parents have been my primary support team).

One of my bipolar cycles is from self-obsessed to self-forgetting. One moment of self-obsession I’m sure people have selected stones to carve into statues of me, and the next moment I am so despondent that nothing matters and I’m lucky to harness the energy to walk around a grocery store. Mania is grandiosity meaning I matter tons; depression is meaninglessness, even whether or not I get out of bed, or, as I heard at the self-help group, hit by a bus.

Interestingly and tempted to call this a sign, my oldest friend called while I write this. We talked for 50 minutes and she reminded me who I am and how I can be happy without a statue. As soon as it’s not a choking hazard, I’ll give her youngest daughter a fossil.

Thank God for friends. Thank you Universe for friends, family, food, and fun.

Also, spread out your pain and delusion: nobody wants to digest it all. If you don’t have enough friends, increase therapy sessions.
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