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C H A P T E R 1 6 Life’s Roller Coaster Mania A doctor told me during a counseling session early in my diagnosis that [bipolar disorder] was a garbage-can like diagnosis. I thought to myself: if it’s a garbage can diagnosis, I don’t want to be bothered with it. I’m not taking medications for a garbage can diagnosis. . . . The best thing about mania is the confidence it gives you—a little bit is great, too much is disastrous. —ANONYMOUS PATIENT 1. He was thin, a bit too thin for health. He looked bedraggled by life, pulled from Kansas to Washington, D.C., leaving his wife and children behind. “I left it all because I was manic,” he said, with an air of disgust. Who was he disgusted with? “I wish someone would have just grabbed me by the scruff of the neck and said, Hey, don’t make any life decisions; you’ve lost your judgment.” Life decisions—making too many and/or making them too easily is as dangerous as not making them at all. How clearly mania and depression outline the extremes of the dilemma of us all before the terrible fact of choice: indecisiveness in depression—nothing can be done; overdecisiveness in mania—everything is to be done and nothing gets done. We are doomed to choose, Sartre said, yet we don’t know when to choose and when not to choose. “I denied the illness until I discovered that my biological mother was hospitalized for a mental illness; then, I finally realized that it could be true.” He was adopted, a perfect setup for ignoring biology. Why did he not accept it despite those facts? Many people know of a family history of mental illness but still won’t accept it. For all his disgust at himself, he was an aware man, an unhappy, depressed, dejected man, but an aware man. He fulfilled Socrates’ dictum—Know thyself—yet his knowledge gave him neither joy nor power to change things, at least not without taking the step of allowing medicine and science to intervene. He was a podiatrist; now he is a temporary worker. He shook my hands firmly when he left, looking into my eyes as if trying to drain some of my confidence in his recovery into himself. I hoped I was right. 2. If the nuances of depression seem confusing, one might hope that the opposite mood state, the condition called mania, would be more straightforward. However, mania, too, is a complicated phenomenon. Here the mood is classically elated, although usually one alternates between elation and irritability, and sometimes one is purely irritable and not euphoric at all. There often is a sense of giddiness. Time seems to be sped up; the world is slowed down. One does not need to sleep much; everything is going twice as fast. Four hours can do it. While the rest of the world is sleeping, one’s energy is running as if it were eleven A.M. on a Wednesday: why not clean the entire house at three A.M.? Things need to get done, even if they don’t. Redecorate the house; do it again; buy a third car. Work two hours longer daily: the boss loves it. One’s thoughts pour forth; the brain seems to be a many times more efficient organ than the mouth. Trying to keep up with those rapid thoughts, one speaks quickly, interrupting others, running a conversation from only one end. Friends and coworkers get annoyed that they cannot get a word in edgewise. This may produce more irritability; why can’t everyone else get up to speed? “Depression is a curse to oneself,” Robert Lowell remarked; “mania, to one’s friends.” Sex becomes even more appealing; one’s spouse may like it, or might tire of it. The urge is so strong that one might look to satisfy it elsewhere; affairs are common ; divorce is the rule; HIV rates are high. Self-esteem rises; sometimes, it leads to great successes, where one’s skills are up to the task; too frequently, it leads to equally grand failures, where circumstances overwhelm one. But there is no past; there is hardly today; only the future counts, and there, anything is possible. Decisions become easy to make; no guilt, no doubt, just do it. The trouble is not in starting things, but in ending them; so much to do, so little time...

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