Over the past month, I have witnessed two episodes of bipolar-related mania unfold on social media platforms. The response from those witnessing was a swirl of mixed jokes, empathy, and taunting. As a psychiatrist, my heart always breaks for the person in the throes of a mania, and for their family members. So today, I wanted to share a brief blog post to help those interested understand what mania is, how it presents, and how you can help when it does.
I would like to say that it is unethical to diagnose a person whom I have never met or examined. I am not diagnosing Kanye West, as he has already disclosed to the public that he has been diagnosed with bipolar disorder.
It's Just Like Fire
Last night, around 11 pm, a concerned patient contacted me to let me know Kanye West was tweeting strange messages in rapid succession and seemed manic. This patient, very compassionately, was worried this Twitter storm may culminate in Kanye West harming himself. Though there was not much I could do in the moment, I thanked my patient for their empathy and expressed concern and hope that Kanye would be better soon - that hopefully his psychiatrist or family would get him help right away.
Mania is a gradual or sudden onset of a mood change accompanied by a huge increase in energy. This mood change can be a shift to extreme happiness, euphoria, or even extreme irritability and agitation. It can begin in a matter of hours, days or weeks, but typically is thought of as a kindling episode of excessive neuronal activity, like a fire starting in the brain. This is possibly similar to what happens in seizure disorders.
Over the years, I have truly enjoyed my work with patients diagnosed with bipolar disorder. Although it may seem cliche at this point, it is true that many people with bipolar-spectrum diagnoses are extremely intelligent and creative.
Photo Credit: Jimmy Kimmel Live/YouTube
I have been a fan of Kanye West since I was about 20. During some of his more controversial rants or statements, I've always felt a twinge of pain when would people would dismiss him as being "crazy" or "a sell-out" or now, being a thorn in the collective side of those planning to vote for Biden in November. Often elevated in intensity, the level and type of thinking for those with bipolar disorder is beautiful in its inability to be restrained and its true desire to piece together all the meanings and messages of our human existence. The key to maximizing that beauty is in caring for it, and the owner of it, so that it does not spill over to a place that is self-destructive.
When to Call it Mania
In order to meet criteria for bipolar disorder, a person has to have had at least one full manic episode in their lives. Bipolar disorder is also characterized by periods of depression. There is a spectrum of symptom intensity, so some people have milder forms and also milder mood swings. For those with a brand new diagnosis, these episodes typically are triggered by:
Extreme stress
Sleep deprivation
Misusing chemicals, especially certain drugs/alcohol
For those with an established diagnosis, who have been willing to accept pharmacological intervention, episodes can also be brought on by stopping medications prescribed for mood-stability.
After an episode begins, a person may start to exhibit the following changes in their thinking and behavior:
Staying up being productive at night (doing projects, creating things, cleaning, writing letters/emails, etc)
Speaking very rapidly
Having thoughts jump from one topic to another - in a way that is related, but not clearly so
Severe irritability and agitation
Sleep interruption (either a decreased need, or inability to fall asleep)
Thinking they are suddenly better than everyone else (grandiosity)
Feeling "on top of the world"
Impulsivity
Untreated, an episode like this can last for months. Unfortunately, episodes of mania can land a person in all sorts of trouble because of the reckless things they may do or say when in that mental state. It's often very embarrassing to have to come back and clear up those actions once the mania fades, and they're left in the dust of public mimicry and humiliation.
Throwing a Lifeline: How to Help
The convention in psychiatry is to diagnose a person with bipolar disorder if they ever have a manic episode - even if they have not experienced a depression. If you suspect that a family member, friend, or you yourself may be experiencing major mood swings or mania with or without depression, there are things you can do to help. It's important that you help, not just spectate. This is a difference in brain function that can be very serious and lead to deadly consequences if left to run rampant.
If you know your loved one does have manic episodes or has an established diagnosis of bipolar disorder, establish a medication and treatment plan with them and their doctor. But also establish a crisis plan. This may include being given permission to speak to their psychiatrist, being given some permission to help with their medication administration, helping them get adequate sleep, or knowing when to call in a crisis unit (many states have mobile crisis units you can call to your home for emergency psychiatric evaluations). Remember, there are privacy laws that prohibit doctors from speaking to family members without written permission. Please discuss these issues with your loved one BEFORE you need it - like during a time when they are not having mood episodes. Trying to convince a manic person to give you rights to speak to their doctor will typically get you nowhere at all. As with anything else with health-related consequences, prevention is best. Encouraging self-care, good sleep and ongoing mental health care is going to be invaluable in a situation like this. If your loved one shows signs of an impending mania, like talking excessively or not sleeping, you need to take action immediately. If your loved one does not have a diagnosis or a doctor, call a mobile crisis unit in an urgent episode or 911 in an emergency.
Likewise, if you begin to notice your own thoughts moving rapidly, or feeling like you just don't need to sleep, or that you can't stop talking, you may be going into a manic episode. Reach out to a psychiatrist or your Primary Care Physician to get help stopping the mania with things that balance your mood and help you get lots of sleep (which at times can stop an emerging mania in its tracks).
Social Media Crisis Etiquette
If you are in a position where you can witness but not necessarily provide direct help to a person having a mental health crisis in public (including on social media), just BE KIND. Treat others the way you would want to be treated in the event you or your loved one were in a crisis. If you can privately message a family member to alert them that their relative seems to be having some issues, please do, with respect and privacy if possible.
For more information, please contact the National Alliance on Mental Illness or the Depression and Bipolar Support Alliance, or visit their websites here: