A manic episode is a sustained period of abnormally elevated mood. This can range from a glowing sense of euphoria to a pressured and agitated state, in which people feel as though they could jump out of their skin. When someone is manic he has seemingly boundless energy, and in the early phases may be quite productive. His speech becomes too rapid and the normal give-and-take of conversation is lost, you can’t get a word in edgewise. The person with mania may become easily distracted and will describe his thoughts as having a racing quality. When listening to a person who is manic, the ideas that fly from his mouth seem to blossom one on top of the other (flight of ideas). Elaborate, and sometimes unrealistic and grandiose, plans are laid out. These take many forms, such as getrich-quick schemes or religious revelations that he, and he alone, has discovered. If you attempt to reason with a person who is manic, he may become agitated, condescending, and openly hostile.
Psychotic symptoms, which include delusions, thought disorganization, and even hallucinations, can occur during a manic episode. The hallmark of a delusion is the belief in something unrealistic that cannot be shaken. People may believe that they have been chosen for a special mission, or that they have been imbued with magical abilities. If a person believes God is speaking to him, or that he makes all of the shampoo in North America, or that he has been chosen to save the universe, nothing you can say will alter his mindset.
Sleep becomes markedly diminished, or the person stops sleeping altogether. They typically will not complain of being tired, although as the sleeping pattern worsens, agitation and irritability often increase.
Problem behaviors develop. Generally these are pleasure-seeking in nature, and they may include:
• Out-of-control spending. This can take the form of draining bank accounts, maxing out credit cards, spending retirement accounts, and buying anything and everything in a highly impulsive manner.
• Risky sexual behaviors. These are common, and include multiple partners, unprotected sex, and random and impulsive encounters with strangers. Someone in a committed relationship might start an affair, or have a sexual encounter that is otherwise not typical for him, such as a heterosexual having a homosexual liaison.
• Substance Abuse
• Impulsivity. This can include breaking off close relationships, leaving jobs, getting on a plane with no clear plan, and so forth.
Other types of behavior commonly seen in mania may center on specific goal-directed activities. Examples run the gamut from writing a novel or a symphony over the course of a few days to becoming involved in mystical or spiritual activities such as reading tarot cards for hours on end or saying thousands of rosaries. Still other people will turn to cleaning activities, often vacuuming through the night and getting down on all fours to pull lint from a rug.
For an episode to meet DSM-IV criteria for mania it must last at least one week, but this duration criteria goes away if the severity is such that hospitalization is required. Additionally, at least three of the previously mentioned symptoms (pressured or rapid speech, grandiosity, high-risk behaviors, etc.) should be present.
Finally, for the episode to be considered a true mania, it must cause severe impairment at work, at home, or in relationships. Likewise, mania is diagnosed if the symptoms rise to the level where the person is at imminent risk of harming themselves or others and requires inpatient hospitalization.
The following is an excerpt from “Chad,” a short story about a mother and her recently diagnosed son, which illustrates many symptoms of mania.
She opens the door and looks at her twenty-one year old son, red hair spilling over his shoulders, naked behind his drum set. “Listen to this. Listen to this,” beating a lightening-fast cadence. “The world came out to play. I said I’d had enough. The man came down from Frito-Lay. I had to call his bluff. And so we sang and dance and played. The music man had run away. It gave me something to perceive, when all the others would not believe.” Mrs. Greene stands in the doorway, at a loss once again. What did Dr. Adams tell her? Where is she supposed to draw the line? Is he getting any better? She’s scared to look him in the eye, their beautiful son. She shouts over the drums, “Chad, could you please get dressed, you’re going to be late for your appointment.”
His words shout out too fast and too loud, “I don’t know if I want to go. You know you should wear more white, Mom. White is the color of purity, all the people in the world wearing white are joined by bonds of purity. I can see the rays connecting us. When I wear white we know each other. The only way they can know me is to be naked or wear white. That would be such a pretty song. I’m really making progress with the music, everything is so beautiful, check this out, check this out.” The drumsticks fly over the skins. “Chad! Look you promised,” she’s shouting to be heard as she wades through piles of dirty laundry. “You promised you’d keep your appointment with Dr. Adams.”
He pivots abruptly, “Promise? Did I make a promise? Can’t break a promise. One more song,” beating down on the drums, eyes closed, his body fused to the music.
“CHAD!” she grabs a drum stick.
A rapid flash of anger crosses his face. She feels a different fear, the pulse of adrenalin and the single thought, don’t set him off. She glances at the blank space over his dresser, the hook that held a mirror, his night of breaking glass.