Struggling With My Voices in a Mixed State

I’m writing my thesis right now and controlling my mind is getting rough. I’ve had to take a long break from it due to my meltdown in January, so I’m starting it up again. And now the little voices are coming back. They’re the ones that tell me I’m going to be a failure, that I’m not living up to people’s expectations, that everyone is waiting on me, that what I’m writing is complete garbage (though that’s just being a writer in general). But the voices are getting worse. Now I’m starting to get paranoid. I’m slipping into conspiratorial theories where I believe that people are talking about me behind my back. I think that everyone in the philosophy program hates me and is only faking it when they see me. And this is while I’m relatively up, I’m not depressed, just paranoid. It’ll get worse too, for about 2 months I struggled with the belief that my doctor didn’t perform surgery on me but just knocked me out and injected saline so I wouldn’t know the difference.

Every set back that happens while I’m like this is met with incredible frustration. It’s hard to keep going when even little things go wrong. Being paranoid makes me sensitive to every little possible criticism or even question. It doesn’t take much pressure at all to just crumble.

But I’ve been able to reassert a small part of myself. I managed to coax myself into writing about 6 pages today and reading through an article. I did it by giving myself lots of rewards for every step along the way, behavioral activation works really well in getting myself back to a productive level. It’s almost unconscious now how I set up small rewards for every productive thing that I do. Yet, lots of cigarettes were smoked today to calm myself down. And now I’m experiencing a degree of sundowning. The day’s wearing on and I can barely keep going. The only thing that works now is xanax and talking back to my voices. Since I’m in a mixed state, I do have some degree of mania that I can tap into. So I talk back to my voices and try to bring out the manic side to fight them off. It succeeds a little bit, and that edge is nice to have back, but even as I write this they’re still talking to me.

I hope they go away soon, I’m tired of having more than one person in my head at any given time.

My First Suicide Attempt

So I’ll get a little more personal today. I write a lot about little things on this blog, but I ignore the big stuff that over half of everyone with bipolar goes through, attempting to kill themselves. I’m going to change that up a bit and relay a little more of myself.

My first suicide attempt occurred 4 years ago in August. It was before school started and I was under some stress but not too much. Thinking back on it, I wasn’t stressed that much at all, I was enjoying the prospect of my classes and was with some friends. At the time, I was not diagnosed with bipolar, and to the best of my memory, never had a full manic state yet, only depressions. And for a week or so at the time, I had been a little depressed, but not too badly. General anhedonia and lethargy. I felt fake around other people, but it wasn’t a crippling depression that most people associate with suicide.

What I was at the time of the attempt, was mixed. I began to have plenty of energy and went out with my friends. We had a good time, I enjoyed it to some extent, but being mixed, I have this sort of long stare attitude toward the world. I’m not entirely there and I don’t really like being in the world any more. I just want things to black out and cease in a very trivial sense. Suicidal thoughts abound not because I despair, but they come casually, without plans and simply acting on impulse I can go ahead and do it. It’s the mania that drives this. The complete impulsivity of it all. I don’t formulate anything specific, I just see an opportunity and decide to take it.

And an opportunity arose that night.

We decided to go for a swim at night. It was around midnight and I had sundowned very hard. I wasn’t talking very much, and just wanted to escape. In the water, I found such an escape. The water was warm for august and the waves just rocked me back and forth. Instead of playing, I said that I’d go for a swim. And so I swam. I’m not a strong swimmer, but I had that manic energy. I felt strong yet calm, I wanted to swim to the other shore yet I knew I couldn’t make it. And I didn’t want to make it. As I swam further away, the waves rocked me more and more. It was, and still is, the most peaceful moment of my life, swimming in the waves waiting to die of exhaustion and drown. I just kept swimming away and it was perfect.

I didn’t evince any signs to anyone. I didn’t even know I was suicidal. It was just an impulse to leave and the best way to leave was to kill myself. Nobody around me knew what I was doing either. I got really far out and the waves were fairly large, nearly 2 feet. And it was after they couldn’t see me anymore that they started to panic. They started yelling for me to come back and to find where I was. It just broke me. I couldn’t do it with them watching me. I had forgotten about them up till that point. But I couldn’t hurt them by having someone kill themselves while they were right near by and couldn’t stop it. Thinking of this I couldn’t help but stop and start crying. My peace was broken and with it went any ability to kill myself at that point.

I’m still unsure how long I floated there until I treaded back. To this day, they all still think that I just went a little too far out. But I was just silent after that. I went back and didn’t talk much. I covered by saying that I was tired. But really, all I wanted was that peace back.

At the time, I had these thoughts before. I thought they were normal for people to have. This mild need of escape every now and then. Surprisingly, and I’m surprised at myself, I didn’t think twice about it. My mood picked up the next day and I never really thought of it as something that was wrong about me. It wasn’t even until a year later that I thought I might be bipolar. I think that the reason that I didn’t take it seriously is that it didn’t fit with my archetype of a suicidal person. I wasn’t depressed (I thought that meant crying all the time) and it wasn’t a cry for help, which I had been told suicide was. Neither of these fit me. I felt perfectly fine and just decided to kill myself. Like taking a walk on a nice day. Having this experience has shaped my idea of suicide completely. Suicide doesn’t need to be a cry for help. It may just be the impulse of a disease.

To this day, I still dream about those waters and that peaceful feeling. Whenever I’m suicidal I start to have the physical sensation of floating in the water at night. The slightly cool air and warm water going up and down. And I never feel scared of it. I’m just reminded that at any given point, I’m just a hair’s width away from doing it again. Every time I have suicidal thoughts, I get to my psychiatrist immediately because the slightest amount of a mixed state will mean that it will happen suddenly. No plans, no suicide hotline, just some opportunity will strike and I’ll decide that I’d rather not live. So while I’m still in control, I stop it dead in its tracks before I lose control again and there’s no one around to call out to me because to this day, I still can’t do it with someone watching me.

Inside a mixed state and what helps

So I’ve been inactive for the past few days. I had a small depression after 2 weeks of mania and now my brain is working its way out of it. In the mean time, I get mixed states. Mixed states are poorly described as a mixture of manic elements and depression. That’s so vague and doesn’t really describe the hell that mixed states are. They’re worse than depression.

Each person is different, so this is not generalizable, but it might be interesting for other people to know. When I’m mixed, my mind races at a manic clip. If you’ve ever been a dumb undergrad like me and had a whole pot of coffee, it’s similar. Your thoughts go at a thousand miles an hour and you’re filled with anxiety about nothing in particular. While mixed, my thoughts act like they would in mania, short, fast, constant stream, and vivid. I’ll find dozens of things to do, but unlike mania, there’s no “let’s do it” motivation behind it, just an “it should be done” thought. That’s where the depression kicks in, the executive function.

When depressed, thoughts of doing things go dead. I can acknowledge that something needs to be done, but there’s no impetus behind it to actually begin to act. It’s like the exact opposite of mania, where everything has the need to be acted upon RIGHT NOW! In a mixed state, I have all these thoughts racing at me, telling me that things should be done, but the depressive side prevents any of that from being acted upon. What I’m left with is a pile of thoughts about things I could be doing without any ability to act on them, and the pile just gets higher and higher every minute.

If I stay like that for even 30 minutes, my anxiety kicks into overdrive. I feel like the world requires everything and I can’t manage to do any of it. Time passes and I’m usually sitting, not able to stand at all, and stare as my thoughts begin to jump quicker and quicker from one thought to the next. Next, my memory goes as time wears on.

As my thoughts race from thought to thought, there’s little time for my mind to settle any of the information in it. A surprising amount of what I remember is due to my doing something. It’s similar to how you never really understand a paper you read without writing on it. The process of doing something forces analysis and categorization of things in memory to be stored for later. The chaff gets sorted out and what remains is what is vital to a task. But, if I’m jumping from thought to thought without action, there’s not even enough time for me to dissect the information and label it as important.

After about 90 minutes, I begin to lose my identity. I can’t pick out what thoughts are actually mine and the only way to describe how it feels is to say that there are people living in my head. It reminds me of Locke’s theory of personhood, where memory defines the individual, regardless of the body. Where a prince and a cobbler both fall asleep, and when they wake up, the cobbler’s brain/body has all of the prince’s thoughts and memories, and vice versa. The intuition is that the body is not what is important for identity, but the thoughts and memories. He’s got a really good point, after my memory begins to fade, I cannot lock onto who I am and connect which thought I need to go with. Instead, I’m pulled in every direction at once without a history to give it context. However, I disagree with this intuition based upon my own experiences in other contexts, and I’ll write very soon on how this can be remedied by Harry Frankfurt’s wholeheartedness.

Catching these states is of the utmost importance. It takes less than 60 minutes to render me nearly catatonic and then unable to even decide whether take drugs for it. It’s even harder to decide to medicate before hand, since somedays I just feel a little weird which does not develop into a full state and then the medication would be worse. But when I feel like this, what I usually start with a mindfulness exercise that I was taught which I think can be helpful to many people who have days where they are being pulled everywhere.

I start off by sitting, closing my eyes at first just to shut out some of the visual noise. I take a few deep breaths and focus on the air moving. Then I slowly focus just in on how my feet are feeling. Then slowly attempt to capture how my feet and legs feel, proceeding up my entire body until I can focus on how my entire body feels at a give instance. Then I add in other senses, from touch I proceed to sound, then sight, then smell and taste. All the while keeping slow breaths, but not worrying if I have to breathe quickly here and there. After I hold this in my mind for a minute or so (nobody’s perfect and can hold all five senses in their mind at the same time, but I still try), I imagine my brain as a stage where I control the lights where actors are the thoughts. I do not try to control them at all. They come in, they say their piece, they go out. I focus the lights on them to see them more clearly. My job here is to observe them and describe them to myself. The point is not to fight any of the thoughts, but to categorize it. Fighting makes it worse. Think of telling someone to breathe through the pain. Grunting and screaming against the pain just makes your body tense up and does little to help. Breathing through it and letting your muscles relax in the face of pain usually helps keep the pain down. This is similar, not the same of course, but in the same category of breathing through the pain.

By describing and categorizing the thoughts, I distance myself from them. My brain thinks at a second-order level, above the first-order thoughts telling me that I should do things. This puts distance between myself and the “you should do this” tag attached to every thought. After I feel more stable, not necessarily calm, I can often gain a foothold on my thoughts and let them pass.

This is obviously no substitute for medication. Also, I have to do this really early in my mixed states or I cannot do it at all. It also is not strong enough to overcome really powerful states. But when my brain starts to get fuzzy on somedays, this 5-10 minute break can do wonders for my focus by helping rise out of the white noise, or to stop the cascade of white noise from developing into a mixed state. I also find this helpful for that 2pm period where all I want to do is nap.