What Having A Bipolar Mixed Episode Feels Like

I woke up alone in the car I live in to a flat tire. My immediate resolution for the day was to decide how best to kill myself. It sounds extreme, I know; but that's exactly what living with bipolar disorder is like for me.

I was diagnosed with depression at 19 years old, which must have made sense from the outside. Being bookish and nervous around people, I probably appeared depressed more often than manic: my "ups" were often spent in seclusion, hammering away at some novel or art project. It wasn't until I was 28 and going through a divorce that I was diagnosed with bipolar disorder by two different doctors, a diagnosis that felt more dire than depression but made worlds more sense to me.

Throughout my twenties, it seemed like my mood swings got worse every year. Like hurling a sword at a hydra, every time I shed an unhealthy coping mechanism (cutting was an early one; smoking cigarettes came later), my moods kept coming back in increased severity over the years.

By the time I reached that diagnosis at 28, I realized I had spent all of my life so far doing everything in my power to manage my mind without medication — largely because it wasn't available to me, since my parents didn't believe in mental illness, but also because it was my "normal." I figured I was just overemotional, painfully shy, randomly impulsive. So I took to treadmills and weight machines, cut way back on drinking, built up my support system, and started practicing mindfulness and meditation. I had made it this long without meds, I thought, so why start now?

Now, two years after this diagnosis, I'm 30 years old and still treading in these rising waters. When the flat tire made me suicidal, it was my first hint that maybe I shouldn't be trying to manage this illness by myself. Especially not in my current situation, when simply staying warm or dry enough is difficult some days.

Three days before the flat, my partner and I were woken up at 6 a.m. by a police officer knocking on the window, asking to see our IDs. As we scrambled to reach the glove box, he asked if we were doing anything wrong. The officer wouldn’t answer the question. After running our IDs, they told my partner to open the door and step out immediately. He began putting shoes and a coat on, but they responded with “Open the door, or we’ll break the window.”

He stepped into the cold, shoeless, wearing pants and a tank top. “Am I being arrested?”

One of the three cops said yes, explaining that Nebraska was asking for his extradition. I knew what it must be for: he had gotten a citation last year on a cross-country road trip that he had forgotten to pay. Somehow, it had escalated to an arrest warrant.

The next few days were spent rushing. I had to figure out how to get money into a phone account so I could receive his collect calls from jail. I had to tell his job what was going on, while also trying to squeeze in my own work in the meantime and worrying about leaving the dog alone in the car. I started drinking nightly to feel OK with my aloneness. I had been keeping it together for the most part. But the morning I woke up with a flat tire, something broke in me.

I had been in the midst of a mixed episode for weeks. A mixed episode is a toxic combination of the manic highs and depressive lows that can occur in bipolar disorder. It is the kind of perfect storm that puts people like me at a high risk of suicide. I hadn't started actively identifying these episodes until recently, but I can trace them back to my childhood. In second grade, I got in trouble for whispering to a friend during reading time. I resolved to run away from home, despite having two of the most loving parents there waiting for me. I wrote my resolution in all caps on the inside of a Lisa Frank folder and held it up so my friend could read it. My teacher confiscated the folder. This is how these moments feel to me: they come on sudden and strong, even from a baseline of feeling neutral or happy.

Another time in grade school I thought I ate a bug and came into class crying. My friend had to tell my teacher what was "wrong" with me because I couldn't speak. I remember feeling like I actually wanted to die, if the bug wouldn't kill me first. Senior year of high school, I had nearly a 4.0 GPA and perfect attendance. But one morning, I was nervous about a test in my first period class so I took a turn and drove my car into downtown Chicago. I'd never been into the city alone, and I'd certainly never skipped class or failed a test. It just felt, truly, like the only way to solve the problem at hand.

In my adulthood, here’s what one of these mixed episodes feels like for me. First, I forget that I’ve ever been happy. That low moment becomes my entire lived experience, past and future. It’s akin to falling into a deep, dark well in the middle of nowhere, completely naked and cold. My brain short-circuits in these moments to one of two conclusions: I can either wait to die naturally and suffer immensely, or stop the hurt on my own terms. When my "highs" figure in, metaphorically speaking, I'm likely to believe I can build an airplane to get out of that well, or dig through the stone with just my fingernails. It is a terrifying, toxic combination of believing I can do anything and not caring if my actions result in my getting hurt or humiliated.

During these episodes in the past, I have suffered delusions that make me act irrationally. I have maxed out credit cards on things I can’t remember buying. I have believed wholeheartedly that I was someone else for weeks at a time and acted on her self-destructive impulses. I have physically hurt myself with whatever I have on hand. I have done things that could be spun in a positive light, too — like the weekend I wrote and published a 30,000-word memoir (and withdrew it days later, mortified), or the time I drove two hours to Denver to interview for a professional job I was completely unqualified for. Rarely do these impulses hurt anyone but me.

On the occasion that they do hurt others — like the time I adopted a dog and had to give her up months later — I feel like I deserve the ensuing feeling of being stuck down in that well.

To some, it seems like a character flaw, like I have no impulse control. I have wondered about this, especially when some tout the opinion that mental illness isn't real, that it's just a manifestation of a personality type.

But everything about the symptoms I experience from bipolar disorder goes against my core identity: I do have impulse control; I've committed to an exercise regimen for years; I'm not a hedonist, and prefer being in committed relationships. And I'm certainly not an intrinsically violent, raging, suicidal, or hopeless person. I'm almost always smiling. I'm almost always kind. It feels like my personality exists in an entirely different compartment than my illness. Like a sugar rush or an alcohol buzz, the effects of bipolar seem to strike me out of nowhere. It's not like a phobia or flaw I can anticipate, like avoiding playgrounds for fear of children or ordering "no mayo" because of an allergy. I could be having the best day of my life and suddenly want to crawl in a hole.

I have survived this long without medication, but that morning with the flat tire, it seemed to sink in for the first time: if I had addressed my own health sooner and given medication an honest try, I may not have come to this place emotionally.

I held this realization tight, like a pebble in my hand, and addressed the flat tire one step at a time. I loaded up my backpack. Because my phone was dead, I left a note on my friend’s door about the flat. Then, I walked about a mile to a gym downtown, the only place I knew was open that early where there would be familiar faces. The whole walk, I breathed through tears, muttering a Buddhist mantra I’d memorized years earlier. I imagined, to passing cars, that I looked no different than the other scruffy, mumbling vagrants wandering in the morning light.

When I arrived at the gym, Matt at the front desk was welcoming and sympathetic, agreeing to help with the flat as soon as his shift ended. I called my partner’s grandma and she was encouraging, too. Slowly, I revived myself, drank water, had some coffee. I rested. I came back to myself.

It has been over a week since this event, and this mixed episode is subsiding a little bit, but my realization about my own health and medication remains. I have no dogmatic conviction that pills will suddenly “fix” me. I have lived in my own head long enough to know that mental illness is a raggedly woven quilt of genetics, history, physical fitness, and environmental stressors. Knowing this, I commend myself for coping quietly with this alone my whole life.

But I also remember that flat tires aren’t always going to happen in a safe neighborhood where I have helping hands nearby. Life will do worse, inevitably, and this illness isn’t going anywhere. I am finally on a waitlist to obtain medication. My hope is that the next time I’m faced with a struggle, I won’t have to fight to exhaustion just to continue to survive. I'm beginning to see medication as a necessary something extra, like training wheels, to help me round the corner into a life that feels a bit more manageable.