A Day in the Life of a Manic Person

27 August 1999 – Diary
Finished work at 10:30 pm Thursday night. Came home and worked on my web site until 3:30 am. I had gotten e-mail from a friend who said to be careful that the web site does not take over my work. Well, it hasn’t. Unfortunately it has taken over my sleep instead. Got up at 5:30 am on Friday to go to work. Since I only had 3 hours sleep the night before, today is going to be very interesting as no sleep pushes me towards mania.

It is drizzling slightly, the sky is a clear light grey, it is cool outside and the streets are empty. Feels like Christmas.

Had two cups of coffee between when I arrived to work at 6:30 am and 8:15 am. Strong coffee. Am now jumpy and wandering about the office waiting to visit a client. I have started being garrulous and I have to watch what I am saying to the office staff.

Dropped staff at the client to work and returning to office. I am now definitely showing signs of being manic. I’ve gotten slightly twitchy and driving is now difficult as I react to every single little distraction on the highway. This includes cars on both sides of me, trying to read signs on the sides of the road, admiring the hills shrouded in rain. I also try to change a CD when driving on the highway in high speed congested traffic. I know this is stupid but I do it any way. Don’t actually play the CD, turn on the radio instead and spend the remainder of the time switching between two radio stations. Every 20 or so seconds.

Stop off by a friend to pick up two books. Although I am clearly saying the correct things (I hope) and properly admiring her new car, I have the funny sensation that I am not actually handling this conversation well. I feel as if I am not able to read her manner to indicate if I am being polite or relevant. Leave without being sure whether she was pleased to see me. Perhaps I should have waited until later to do this.

Return to office to find the electricity bills not sorted out. Quarrel with messenger. Spend the next three hours getting work done but in a very erratic and ad hoc way. Wandering back and forth in the office. Must have climbed the stairs in the office at least 10-12 times in the three hours. All the work is being done at once, not one task at a time. I have about six folders and pieces of paper open on my desk all the while making and fielding phone calls.

I keep on forgetting and remembering what I was doing, which is partially why I have so many tasks being handled simultaneously. Thank god I still have presence of mind to write things down, but everything is being written down on little scraps of paper instead of my standard note list. One system failing here. I hope I can find the pieces of paper later and I hope I can understand what I wrote.

What the heck. Decide to have more coffee.

Time is now eleven o’clock and I still haven’t had breakfast. Don’t even feel hungry, and even though I know I am a little jittery, am still mostly in control. Feeling quite good. Still have some presence of mind to call psychologist. Can’t get an appointment for another twelve days. Ask receptionist to make appointment with another psychologist for tomorrow.

Call the electricity company to sort out the electricity bills. Shout to my office assistant to bring me the information while on the phone with the electricity company’s service rep. Office assistant brings only part of the information. Shout very loudly to her to bring the rest. Am not very polite. Service rep is hearing all this. Put on nice voice and sort out problem with the service rep – he is unusually cooperative I find.

Psychologist’s receptionist calls back. My psych has agreed to see me at 1:00 pm today. Apparently the receptionist has told my psych about the desperation that was apparent in my tone and my psych is making a special appointment to see me. Thank god for wonderful caring psychs!

Call office assistant into my office and fire her. I’ve wanted to do this for a while now, but I have the feeling that if I was not feeling so irritable, she would have gotten off with a slap on the wrist and a warning for being inefficient instead of being fired. I’m now am feeling guilty as well as irritable and stressed out.

Deal with problems happening in office for the hour until the appointment with the psych. All done competently but with an overlay of impatience as if I was working too slow. Am now very physically twitchy.

Drive to psych. This is now definitely a hazardous thing to do. I cannot concentrate on any one thing and one of the effects is that I cannot watch the rear view mirror long enough to make sure that I actually see what is in it. Cannot hold a mental picture of the vehicles moving in front of, behind, or at the side of my car. The overreacting to stimuli has reached the point that I physically swerve my car to many of the things that I see, even if they are not near to my vehicle or a threat. The twitchiness isn’t helping in controlling the car. Am expending a lot of effort damping these reactions.

Realise that now that I am out of the office I feel really great. Reconsider just not going to the psych. Intellectually I want to see her, but I don’t care, I don’t care, I don’t care – I feel great and I don’t want this to stop. I’ll do all the things to stay high and remain like this.

Sit in the psych’s office for about an hour as she is late in arriving from her other office just to meet me. Spend the first part of the time fidgeting – I am as twitchy as I have ever been and this may be one of the worse days of mania that I remember. Can’t keep my feet in one place.

I have a book in my hands but I can’t concentrate to read. Every time the five year old boy in the corridor skips past, my concentration is broken and I stare at him as if for the first time, even though he passes by the door about once every 30-40 seconds back and forth. Every time he skips past the door my body initiates a fight/flight reaction and I pull away and cringe.

The sound from the TV in the waiting room adds yet another source of stimuli to overreact to. Every change in the tone or volume causes my shoulders to twitch. After about five minutes, I turn it off.

My hands and feet are now living their own life. I feel like a parent with unruly children. Give up on reading and divert my energy to calming myself.

The waiting room is very quiet and no one else is there. The time spent waiting allows me to calm down somewhat. The little boy wanders into the room. I don’t perceive him as any threat and he comes across and asks to see my cellular phone.

All my nephews and nieces play with my cell phone, so I let him do it too. He is very trusting in his actions and speech and having to talk with him acts as a calmative. I know I don’t make much sense in my speech, but he is too interested in pushing the buttons on the phone, watching the lights and pretending to talk with his brother and sister to care.

He sits down next to me me and leans against me and his being there relaxes me. The ten minutes he spends with me forcing me to respond to his questions erases much of the remaining stress and hyperactivity I am exhibiting and my twitching all but disappears. By the time my psych arrives I am sufficiently back in control that she cannot recognise that I am hypomanic bordering on full mania (or did I pass into the manic stage somewhere?).

Once in my psych’s office I cannot control my thoughts for the first minute or so to respond to her question on how I feel. Each of the ideas wants to come out first. But once I start, I am able to talk properly and coherently with her. Discuss all that happened from June to now, which was easy since I had already written it.

She asks if I am on medications. Asks why I stopped and I say that I had a fixed amount of energy to focus on myself, my daily life and my work, and due to the extreme situation in office in July I had to divert all my energy there. And in the process I lost the ability to take care of myself.

She berates me for being silly (in a nice way), and insists that my priority must be taking my medication first, and work on anything else second. She says it quite a few times. I nod yes, but somehow I feel it hasn’t sunk into me. I suspect that I am going to have to repeat the mistakes of the last month a few more times before it does sink in.

How is it that I can know first hand what she says is true and not really believe it?

She says that my very rapid cycling in late July and early August was probably caused by stopping the medication abruptly. It is a relief to know that there is probably no real change in my pattern of mood swings.

I think the combination of Sodium Valproate / Lithium had worked well to stabilise me in June and my destabilisation was caused by the combination of mild depression and high work load at office rather than the medicine stopping working. (Personally I don’t think the Lithium does anything, but I am not going to try changing my medications and seeing what happens. I refuse to lose three to six months of my life to experimentation.)

I tell her that I would love to start back the medication but I have to survive the one or two week period while the effect of the drugs kick in. That has been the problem over the last few weeks – the best I could do had been to take the medication when I could, not consistently. She suggests that I get someone to make me take them – and then casually mentions that she could hospitalise me to ensure that I take them.

I am taken aback. The thought of hospitalisation and loss of control fills me with horror. But it also adds a dose of reality on how serious she thinks the problem is. I agree to get my mother, who lives down the lane from me, to pass by on mornings and afternoons to make me take the medication.

I know that if I ask my mother to ensure I take my medication, she will, and as a bonus will bring me breakfast and dinner too. But I know it will be an enormous irritant to me, that it will seem to me that she is imposing on my independence and my life. I am going to have to tell my mum that I want her to help me but that I will be annoyed every morning and every afternoon when she appears. I hope she can deal with the combination of my need for her and the anger that I will show her.

Personally, I think the mere fear of hospitalisation will be quite sufficient for me to take my medication on my own.

My psych and I agree to leave the Lithium dose as is at 600 mg daily and to increase the Sodium Valproate from 400 mg daily to 600 mg daily. I request an antidepressant in case I become depressed and stay depressed like this month and my psych categorically refuses to prescribe me one. She says that given my experience with St. John’s Wort, an antidepressant is likely to make me manic or affect my rapid cycling in unpredictable ways. I am to aim for becoming stable, not for ways of managing my depression or mania.

I grudgingly accept her suggestion, if for no other reason than my experience has borne her out. But I feel vulnerable. How am I going to survive the next two weeks?

My psych asks me if I can’t take the next two weeks off. I tell her that since the beginning of June I have spent five of twelve weeks being absent from work or effectively non-functional. It is not a very good ratio at all. Taking two more weeks off is not really an option if I want to think to myself that I can handle a job. And I think that my parents’ and my brother’s patience in dealing with me is wearing thin.

We discuss the office work. I say that the trigger for destabilising me in July was exceptional, but it is a trigger that could and is likely to happen again. Then I tell her that I really should have another job. She thinks so too and suggests that I talk with my therapist about how to gracefully tell my parents I cannot work in their business. I know this is right, but it is not going to be easy. Especially since I need a well paying job to service my loans.

28 August 1999 – Diary
One of my very close cousins spent last night by me. I had been delighted to have her over, since her presence acted to stabilise me. When she arrived I was still hypomanic, but her presence reminded me to take the first dose of medication.

I haven’t seen her in ages and we spent the whole night chatting. I mean the whole night. We went to bed at 5:00 am. I was out of bed at 7:45 am to go to work. The time is now 3:15 on Saturday afternoon. Have had 8 hours sleep since Wednesday morning and I am going partying tonight.

I am sleepy, but I don’t feel like sleeping or want to sleep. I would bet that my underlying symptom is hypomania, but I don’t feel it because my body is exhausted. I am going to regret all this. I wonder if my body will fail before my mind or vice versa. I wonder how many days I can stay up with less than 20 hours of sleep.

Vive le café!

addendum
One of my friends (and guardians) just called about going out tonight. She asked how I was feeling and I told her I was manic and I haven’t been sleeping. She wants me to cancel plans for tonight, and come by her and get some sleep. I told her it was good advice and I wasn’t planning to take any of it.

So partying is on for tonight. But she will have my car keys and she will be entitled to drag me home and put me to bed .

Hopefully with silk restraints.

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