Life has ups and downs, that’s a given. But when the highs and lows are evidently more extreme than those of others, it becomes a problem.

I was 20 years old when I was diagnosed with bipolar disorder type 1. I had completely lost my grip on reality and ended up in Mount Carmel Hospital with a psychotic episode. I could no longer distinguish what was real and what was imagination.

Psychosis is just one of the many symptoms of bipolar disorder. The psychiatric condition, also known as manic depression, causes unusual mood shifts and changes in energy and activity levels. It means my moods cycle between deep depression and high mania.

Deep, dark depression

I had my first experience with depression in my teens. I remember the feeling all too well. Depression is a dark disorder. It leaves you feeling empty, longing for anything but life. Reality seems black and everything feels hopeless. Things you used to enjoy no longer make you sparkle, people you used to love seeing no longer make you laugh.

I personally get extremely tired on both a mental and physical level and every step I take seems too much. Simple things like taking a shower become a challenge. And when you lose all joy in life, you begin to wonder what the point is. As bipolar psychiatrist Kay Redfield Jamison wrote in An unquiet mind: “If I can’t feel, if I can’t move, if I can’t think and I can’t care, then what conceivable point is there in living?”

A psychiatrist once asked me how often I thought about suicide.

“Just the normal amount,” I said. “The normal amount is never.”

I teared up as I told him I thought about ending my life on a daily basis. Depression overshadows all the light in your life. It gives you the illusion that there are no other solutions. I now know that there are – always – better solutions.

Manic euphoria

Mania is the opposite. It turns you into a superhuman. Everything has meaning. Your energy level rises and your mood is exceptionally great. You are euphoric for weeks or even months on end, as if you are on drugs 24/7. You are confident, usually overconfident.

I was 18 when I first experienced mania and people around me would tell me to slow down. The only response I could think of was: why don’t you speed up?

It also comes with rushing thoughts, heightened irritability and recklessness. You spend money you don’t have and become promiscuous. You seek thrill and sensation, no matter the cost. You tend to mess up relationships with those who genuinely care about you. Yet, it feels like being on top of the world.

Hypomania is a lighter form of mania and, just like mania, it means to be in a high mood for an extended period of time. In both hypomania and mania, I felt no need to sleep or eat. I effortlessly started playing Mozart on the piano and reading Einstein’s papers without a problem. I was out five nights a week and always surrounded myself with people. I started travelling without limits, spending money without thinking and trying a lot of drugs.

Living with bipolar is about finding balance

Mania makes you cross your limits. It makes you do so much that you forget most of it, leaving black holes in your memory. You make decisions that you will regret later on. And your mind starts rushing. Your thoughts are flying through your head and you can’t talk or write fast enough to keep up with them.

In my worst mania, I started seeing signs and patterns all around me, everything seemed to be connected. I felt like I was totally in sync with the universe. And then I turned paranoid.

I hadn’t slept in a month and my mind was driving me crazy. I thought everyone was looking at me and talking about me wherever I went. When I read the news, I thought it was all about me. When I watched disasters on television, I thought I had caused all of them. Mania never comes without a crash. It sends you into depression, or worse, psychosis. The weeks I spent in a psychotic state of mind have been the scariest of my life and I wouldn’t wish that upon my worst enemy.

Recovery

It has now been over a year since the psychosis and it took me that whole year to fully recover. At first, I would go back to Mount Carmel Hospital every two weeks to speak to my psychiatrist and doctors. We would have brief chats and they would decide whether or not to lower my medication dosage.

The first few months were rough. I tried to go out and do sports within two months after my hospitalisation and immediately realised that I could not expose myself to so many impulses yet. Big groups freaked me out and my psychotic symptoms would reappear in loud and crowded restaurants.

I was testing the grounds, figuring out what I could and could not do. The main challenge was to learn to trust myself again. Because how can you rely on your perceptions when they were once so messed up? How can you believe the way you perceive reality when you ended up in a psych ward for believing your mind? How can you get back to confidently living life again when you experienced such an intense attack on your sanity?

Coping mechanisms

It took time... and medication and therapy and reflection. It took lots of writing, tracking my progress and talking to friends. And, even today, these are the things that keep me sane. I track my moods and write about my experiences. I practice yoga and diving, two things that allow you to actively focus on your breath, your body and your surroundings.

Recovery taught me to find coping mechanisms. At first, I taught myself little tricks for when I was feeling anxious. I had never experienced fear like this before and the trauma of the psychosis manifested itself in little anxiety attacks.

If I would feel myself getting paranoid about my surroundings, I would touch all of my fingers with my thumb, one by one, to ground myself again. I would sit down and look around to prove to my brain that no one is in fact spying on me or following me around.

I stuck to a strict sleeping schedule, so that I would have eight hours of sleep per night – not more, not less. I made sure to eat three meals a day, even if I didn’t feel the need. I found people I could openly talk about mental health with. I started doing activities that helped me feel present. And I learnt to use my experiences for the better, instead of being at the mercy of them.

I learnt to accept my limitations and the fact that I need rest. Where I was once stuck in the idea that my worth was based on what I achieved and ever-focused on being great, I know now that I am worthy in simply being alive and getting through the day.

It has been a year of being actively alert on how I am doing. I check in with myself several times a day: are you just having a bad moment or a bad day?

How bad will you allow things to get before you act? What is an acceptable amount of sadness and what is bordering depression?

Are you doing well or are you great? When are you simply appreciative and grateful and when are things getting out of hand? Are you genuinely happy or starting to be reckless?

Living with bipolar is about finding balance. More than anyone else, we need to find the liveable middle ground. It’s a matter of life and death and it will be a battle for life. There is no magic pill and, though my medication helps me a great deal in staying alive, I need to deal with this myself.

Bipolar can be exhausting to live with and it’s annoying to be dependent on moods. It is almost like you are divided into two different people and they make appearances whenever they want. It’s up to me to handle that as well as I can.

But, all in all, it has been a process of learning and growing. To accept that you have had bad luck and that you can’t change the facts but that the rest of your life is still up to you. That you can still explore the depths of who you are and talk to strangers and make something beautiful out something not-so-pretty.

The amount of lessons I’ve learnt in the past year are worth years of living. I wouldn’t have it any other way.

Belle de Jong is a mental health advocate for the Mental Health Association Malta.