How a Potential Career Can Be Derailed by Mania

My intention in writing these posts is to share the experiences that I went through with my son, starting with the first manifestation of his illness and our journey through numerous subsequent episodes. It's also to provide commentary as a parent and psychiatrist on issues that these experiences bring up, such as how the diagnostic process works in mental health, and how to work with treatment providers and medication issues. My hope is that reading this may be helpful for people with mental health issues and also their families and friends.

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Source: A.I. Generated Image via DALL-E

After his decision to pursue physical therapy, enrolling in a local community college in Madison, Wisconsin, Bill settled into his new apartment, close to downtown. We bought books for his physical therapy courses and reconnected with friends. I left him in good spirits and drove back to St Louis. He reported that his courses in physiology and anatomy were interesting but that he felt that the chemistry course covered the same material as his high school class. He joined a martial-arts group that practiced capoeira, a Brazilian combination of dance, acrobatics, music, and spirituality—the elements that intrigued him the most and connected with new friends. The term seemed to go well for him but later in the spring he started to get manic. People with bipolar disorder often experience a higher rate of manic episodes during the spring season, likely due to the increased daylight hours and changes in circadian rhythms caused by the shift from winter to spring.

Bill was briefly hospitalized at the university hospital; unfortunately, this coincided with his final exams and his inability to focus sabotaged him. He returned home to St Louis for the summer, to have a chance to finish recovering, as he put it. He got his old job back and spent time with his friends. He seemed stable but that turned out to be an illusion, as detailed in his journals. He was gradually escalating in his symptoms despite an increase in his medication dose.

Religious Issues

A common occurrence in the manic phase of bipolar disorder is intensifying or changing religious beliefs. For example, Bill changed between Christian, Buddhist, Taoist, and Toltec religious beliefs and practices. Common to all of them was a heightened spirituality. As a Unitarian, these changes in religious belief, per se, didn’t present a problem for me; Unitarians believe that all religions have a core of spirituality that embrace God and enhance the life of the believer. For Bill, there was an intensified belief that a particular creed at a particular time in his life was an important new belief to follow. The worrisome aspects in terms of his illness were the switching to a new and different religion and the intensity of the religious fervor, a core feature of mania. Even more worrisome was the combination with other manic symptoms, including decreased need for sleep and grandiose thinking. As Bill journaled:

“While doing my thing at home, my elevated mood again demanded a grandiose explanation. And I would think and think and feel joy at the marvels my mind unraveled. The explanation for my expansive feelings was that I was a full-blooded Saint, in Christian terms. And that I had achieved the full manifestation of my dreamer upon the physical plane, in Toltec terms. To truly have this belief in myself tied in with my self-image and the implications of being a Saint was uplifting beyond anything I can recall."

A Return to the Hospital

Bill had become too ill to be at his job; he now developed a new symptom, catatonia, in which he would stand motionless for long periods, sometimes even with his arms suspended out to the side in a karate pose. Catatonia originally was thought to be a hallmark of schizophrenia but more recent evidence suggests that catatonia is more common in bipolar illness than in schizophrenia; in either instance, it occurs in people who are very ill. Bill needed to be hospitalized.

We set out from St. Louis to make the five-and-a-half-hour journey to Madison. Bill, to my surprise, had no objections about going back to the hospital. I had explained that because he now lived in Madison it made more sense for him to be hospitalized there and to have his doctors there determine his treatment plan. We drove along the highway stopping at rest stops to stretch our legs. He didn’t talk much and my sense was that he was deliberately shutting down his talking in order not to say too much. I told him that we had already agreed that he was going to the hospital and so he didn’t need to be so guarded. He opened up slightly about how fast his thoughts were moving and the intensity of his feelings. I was anxious about his being far from home but I also knew that the illusion that I had any control about how things would go was just that: an illusion.

After Bill was in the hospital, I talked frequently with his inpatient team to hear about their medication plan and then their longer-term plan. They felt that given how severely ill Bill was that he could benefit from a stay at a longer-term facility, namely Mendota State Psychiatric Hospital, which was the public mental health facility for Dane County. Bill was treated there by a skilled psychiatrist who understood the struggles to find the right dose of a neuroleptic. I was grateful for their competence and knowledge of the Dane County mental-health system and its resources. Bill was on the UW inpatient ward for less than a week before being transferred to Mendota. He absolutely needed a longer-term hospital stay for the medicines to take effect. Because Mendota is a longer-term-stay facility, they are used to the idea that someone like Bill requires more time to reach stability. He even explained to me what it felt like to be catatonic. I was surprised to learn that the motoric appearance of being frozen wasn’t experienced that way cognitively but rather that in the midst of what looked like a state of suspended animation his thoughts were roaring along at incredibly high speed.