How Bad Is a Bipolar Episode? You Only Know After It’s Over

It's hard to know how bad a bipolar episode is when you're living it. That's because it's your brain that is sick. It is your perception that is skewed. Other people may look at you and think it's clear how sick you are and how truly bad a bipolar episode is, but these people are fundamentally missing the problem: you're so sick that you can't see how sick you are. 

How Bad Can a Bipolar Episode Be?

Bipolar episodes are, by definition, life-altering. They fundamentally harm a person's life -- they have to in order to meet the diagnostic criteria. A mood episode without impairment and/or distress is just that, a mood, not an illness.

A bipolar episode might be a depressive episode where a person experiences dramatically diminished pleasure, profound sadness, an extreme inability to make decisions, appetite suppression, excessive guilt, and insomnia. All of these symptoms may contribute to an inability to maintain social relationships, attend events, and more. A person may become a jobless hermit as a result of this type of bipolar mood episode.

A bipolar episode could, instead, be a manic episode. This type of episode can cause one to think they are a god, one may experience elation for no reason, one may seek out pleasurable experiences in spite of negative consequences, and one may even lose touch with reality entirely (become psychotic). In this type of bipolar episode, a person can easily destroy their entire life, credit, employment, schooling, and more.

Why Can't We Tell How Bad a Bipolar Episode Is?

As I've said, a bipolar episode can be very bad indeed, and it's worth remembering that about 11 percent of people with bipolar disorder die of suicide.¹ This shows very clearly that these 11 percent of people literally couldn't understand the severity of their own bipolar episode or what to do about it, or they would still be with us today.

In the case of a depressive bipolar episode, such as the one outlined above, the person in the center of the storm is working so hard; they may not recognize all effects the episode is having on their life. Losing a job, for example, is an obvious possible consequence of extreme depression and may be quite noticeable by the person in the episode, but they may be so resigned to the suffering of depression that they feel helpless to do anything to stop it. Moreover, all the niggly changes to one's life, one's home, one's relationships, and one's actions may not be comprehensible by the person with bipolar disorder at the time they are happening because they are simply too wrapped up in sadness, suffering, pain, and a desire to die. It's really easy to forget you ever had friends when death seems like your next and only move. Depression puts goggles on you, and much of the world is blacked out with those goggles on.

In the case of how bad a manic bipolar episode, such as the one outlined above, can be, it goes without saying that if you truly believe you are a god, you may not recognize the reality of what you are doing to your life. People who are manic typically don't worry about credit card payments. People who are manic typically don't worry about having sex with seven men in three days in spite of being in a previously monogamous relationship (and, in fact, may not care about any type of protection during those encounters). And people who are psychotic lose touch with even the basics of reality, perhaps thinking that billboards are speaking to them or that they are being tailed by the police everywhere they go. These manic goggles are more like looking through a kaleidoscope of glowing colors.

Knowing How Bad a Bipolar Episode Is -- Afterwards

Fortunately (although it feels very unfortunate), after a bipolar episode is over, we can see things as clearly as anyone else. Once euthymia (a stable period) has set in, we can see that we were acting harmfully, or irrationally, or unusually to the point where we did lose our jobs, kids, financial security, friends, and so on. We can see how we destroyed things. We can see how we harmed others. We can see how we harmed ourselves. Everything becomes painfully clear once the goggles are taken off. We can now see exactly how bad our bipolar episode was, and sometimes we're shocked by it. That's right, we sometimes sit there, staring at the rubble, unable to recognize what our lives have become. And worse yet, sometimes we can't even remember how it got that way.

But one thing I know for sure is no matter how bad our bipolar episode was and no matter the ruins now around us, we can work to make our lives better. It may feel impossible to do that at this point, but it isn't. People with bipolar disorder have come back, their lives have come back, after the worst bipolar episodes imaginable. You can do it too. No matter what. Yup, the shock after a bipolar episode can knock you back, but you can make a plan to get back up again with help, treatment, and persistence.

Source

1. Medscape, Bipolar Disorder. Updated July 2021.