In his book David Hillman provides strategies, hints and tips that he has found useful to manage his condition over the years. As part of our #life hacks series we’ve been featuring key chapters from his book. This week we are sharing his advice on navigating life triggers.

"We know that if someone has a susceptibility to bipolar disorder, then big life events can trigger episodes of either depression or hypomania/mania. In the past my triggers have included being suspended from school, seasonal variations in light levels, jet lag from long-haul flights, losing a job, moving house, poor living environment, caring for my dad when he has had a manic episode, and grief. The strong emotions generated by the start or end of a relationship are also capable of inducing a manic high or depressive episode. It is important to understand the effect that these triggers can have and to counteract their impact in the case of planned events, or minimise the effect in the case of unexpected events. A manic episode may or may not follow directly after these types of events. In the case of jet lag, I will tend to have a manic week or two as soon as I arrive in the new country, but other events may take weeks or months to have their impact.

It does not necessarily follow that a stressful event will always cause an episode. Life is stressful and some degree of stress is both inevitable and even desirable to encourage us to grow and develop. A bipolar episode is more likely to occur, however, as a result of a combination of more than one trigger, mixed in perhaps with poor diet or lack of exercise over a period of time. If several potential triggers occur within a short space of each other, there would be a high risk of a manic episode occurring for me.

I therefore plan life events carefully and make sure I don’t schedule several big events for the same time. For example, when I got married, my wife and I moved in together several months before so that these two potential triggers didn’t happen at the same time.

Happy events can be triggers just as much as sad ones. Success in a project at work could generate elation and become a potential trigger. It’s therefore important to be aware of both positive and negative life events and mitigate their risk as much as possible.

Early warning symptoms

I have a fairly classic set of symptoms for bipolar disorder, type I. This means that I can go for long periods showing no signs of the illness and then suffer an episode of mania, usually followed by a brief period of normality, and lastly a period of depression. There can be a number of peaks within one episode and I can show signs of remission only to go “high” again.

During the onset of the manic phase there is a period where symptoms are mild. This is the time to nip the episode in the bud before it escalates.

During the mild, hypomanic phase my symptoms will start with a lack of sufficient sleep. Other symptoms include the following: 

• Taking on extra responsibilities.
  
  
• Talking more quickly and intensely than usual, not listening to someone in a conversation and trying to impose my opinions.
  
  
• Forming over-ambitious ideas about the future.
  
  
• Showing a more than healthy interest in religion.
  
  
• Being more emotional than normal.
  
  
• Restlessness.
  
  
• Inability to finish a task before moving on to the next one.
  
  
• Disordered room/flat.
  
  
• Less care than usual over domestic chores.
  
  
• Heightened libido, sociability and charm.
  
  
• Starting to smoke.
  
  
• Walking a lot, often at night when unable to sleep.
  
  
• Extravagant spending, being over-generous.

In the recent past, I have generally recognised the onset of mania and have tried, sometimes successfully, to stave it off by reducing commitments, visiting my doctor, taking extra medication and taking time off work. I have also been careful to eat well, exercise and rest. However, there have been a number of “breakthrough” episodes where these precautions have not been sufficient and my mood has continued to rise to a more intense mania.

During the intense, manic phase my thoughts start racing extremely quickly and I seem capable of very creative thinking. However, the thought process begins to spiral out of control after a while. My thinking becomes jumbled and I start to interpret the world around me in an abnormal way. The thoughts and “themes” during this stage may include the following:

Symptoms of mania

• Delusions of grandeur. I may believe that I am more important, more special or more gifted than I am in reality.
  
  
• The feeling of being chosen for a mission. This might be that I am the Second Coming and am going to be crucified to save the human race, or that I am the reincarnation of a Buddhist Lama, for example.
  
  
• Paranoia. I may believe that I am being followed and that I am on a mission as a secret agent, or being hunted down by the police or the Chinese army, for example. I will frequently change clothes in shops or restrooms and dump my old clothes to ‘evade’ my pursuers. This is a costly activity and I have lost a lot of coats and bags through this process.
  
  
• Time travel. I may believe that I have the ability to travel forward in time. I may believe that I am unable to find a way back to the present, which is extremely distressing when I realise I will not see any of my friends or family again.
  
  
• I may send emails that appear strange and indicate irrational though.
  
  
• Often I will become very angry with anyone who disagrees with my opinion and may become aggressive if people start to intervene and make demands on me to take medication.
  
  
• Since I am prone to confrontation in this state of mind, and can appear aggressive to strangers who are confused by my behaviour, I can get into fights and may even get arrested or detained by the police.
  
  
• I will often go walking all night, maybe going to bars drinking large quantities of whisky. My feet can get covered in blisters from all the walking.
  
  
• I will often decide that I do not need sleep and may go as much as a week with barely a wink of sleep at all.
  
  
• I will often become fixated on a political issue such as the struggle to free Tibet.
  
  
• I get extremely agitated and unable to stay still anywhere for long or to concentrate for even short periods.
  
  
• Finally, I may decide to escape from my living environment in the belief that the police or the Chinese army is catching up with me. I may also be fleeing from a friend or relative who I feel is trying to restrict my activities against my will. 
  
  

When I am in this state, it is very difficult to reason with me. If I can be persuaded to take extra medication, it is possible to bring me down from the high. Otherwise, some sort of intervention from the medical profession is necessary.

Like the triggers, each of the symptoms in the mild phase does not suggest an impending manic episode. Everyone can lose sleep from time-to-time and I am no different. I also like a whisky from time to time. Often I leave my room in a mess because I am too tired to sort it out. However, if there are a number of these symptoms and a pattern is emerging, together with a change in normal mood, then it would be reasonable to conclude that I was having a manic episode. Close friends can tell I'm at risk of a manic episode by simply detecting a change in the tone of my voice."

 

*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. 

 

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# Life Hack 1 Advice on preventing mania

# Life Hack 2 Advice on food and the importance of nutrition

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