David Hillman has lived with bipolar disorder for over 30 years and in that time, he has experienced nearly all that bipolar has to offer, the public and private health systems, detention under the mental health act, unemployment, broken relationships, difficulties with family members, grandiose ideas and exorbitant spending. 

In his book ‘Bipolar Life Hacks, A Personal Guide to the Self-Management of Bipolar Disorder’ he provides strategies, hints and tips that he has found useful to manage his condition over the years.

Over the coming weeks we will be featuring key chapters from his book. This week we are sharing his advice on how to prevent mania:
  

Giving advice to prevent mania

If my support network notice that I am doing a lot and taking on a lot of responsibility or becoming over-anxious about a problem, it is useful to have a little reminder that maybe I ought to take it easy and perhaps give up one or two commitments. This does not mean getting very serious and worried. It is just telling a friend that maybe they need to take the pressure off a bit, as we all need to from time to time.

If I am beginning to show some mild signs of approaching mania, then I suggest they tell me what they have observed, backed up with examples. Useful advice in this sort of situation might be:

“David, I have noticed that you have not been sleeping very well over the past few days and you seem to be quite stressed. Yesterday evening you seemed very restless and were talking very intensely. Do you think you need to take some extra medication?”

Gentle suggestion like this will be much more effective than a confrontational approach:

“David, I think you are going down ill again. If you do not take more pills I’m going to call your doctor.”

The second approach is likely to make me defensive, especially if I am already a bit manic, and is less likely to persuade me to take more medication. If I am slightly manic and get inundated with a lot of calls from panicking friends who do not know me well, then that only aggravates the problem. 

When I am suffering from intense mania, I am likely to be quite paranoid. When talking about me to others and discussing what to do, I suggest my support network do this out of my earshot. Otherwise, they will confirm my paranoia. The worst thing for someone who fears that everyone is plotting against them is to discover that everyone is indeed talking about them behind their back! 

During intense mania it is vital that I take risperidone, an anti-psychotic drug. As mentioned previously, this book will not seek to describe all the different treatments available, and there are many. Any changes to medication should be made in consultation with a psychiatrist or other health professional and I have an agreement to adjust my dose of Risperidone to meet the needs of the situation. But almost everyone I've met is on a different combination of drugs and dosages. I am just lucky to have found a regime that works for me and this can be a trial and error exercise taking several years.

It is important to be sensitive when suggesting I take risperidone. Demanding that I take the medicine will more than likely result in an argument and I may well then think that the person trying to help is one of ‘the enemy’ and I will not trust them. It is better for them to explain their concerns and why they think it would be a good idea for me to increase my medication. If they can steer the conversation so that they allow me to make the final decision on medication, it will not leave me feeling disempowered and angry.

The kind of language that might be effective would be:

“David, you seem very stressed at the moment. You have been talking a lot about saving the world and you seem unable to concentrate on anything. I think it might be a good idea if you thought about starting to take some risperidone this evening. What do you think?”

By contrast, a less effective approach would be:

“You’ve gone high again. Take some risperidone or I’m calling the police!” In fact, I would more likely to try to escape abroad, feeling that a net of conspiracy was closing around me and taking my choices away.

In a manic episode, I am in a state of high nervous anxiety, paranoia and exhaustion. Consequently, any kind of dispute is likely to antagonise me. If people around me can keep calm and speak in a soothing way, this is a great help. I understand that I can be extremely hard to live with when manic and this is a ‘Big Ask’, but panicking and confronting me because of strange things I have said will have a negative effect. 

This does not mean I am suggesting that people agree with everything I say and confirm my deluded thoughts. If I think I can hear voices and people around me say that they can hear the voices too, that will not help. Gentle challenge is a better approach and the best tone for dealing with someone in mania. 

David has kindly made his book available free of charge in the hope that if you find something useful in its pages, you will make a donation or regular giving to Bipolar UK to help other people affected by the condition. Please send an email to [email protected] requesting a copy of the book.