We care about depression and anxiety. Where’s the empathy when it comes to manic episodes?

Like many people, Joscelyn Guzman knew what it was like to be depressed. For much of her life, she had been shown compassion and empathy whenever she spoke about her struggles with depression — that is, until, she experienced a bipolar manic episode.

For one month, Guzman was riddled with uncontrollable euphoria. She channeled her energy into impulsive hobbies and could not sleep or eat for days. If she wanted a T-shirt, she wound up spending hundreds of dollars on a shopping spree. If she wanted to make a YouTube video, she’d record hours of footage in the middle of the night.

In one of the worst moments of her manic episode, Guzman convinced herself that her confidence was super-human. That her lack of sleep or food made her immortal.

She believed she was God.

“I haven’t shared this very much,” says Guzman, 26. “People would probably look down on me for saying that, but in my mind, I really couldn’t control it.”

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But one day, her high was replaced with a newfound wave of paranoia, depression and suicidal thoughts — a low that was so sudden and overwhelming, it prompted a hospital visit. And shortly after, Guzman was officially diagnosed with bipolar disorder. More specifically, bipolar I, which causes manic episodes that last at least 7 days and depressive episodes that last at least two weeks, according to the National Institute of Mental Health.

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It’s a complex and misunderstood diagnosis that, despite growing awareness, is still stigmatized.

The pandemic accelerated a positive movement toward mental health prioritization, but experts and those who have dealt with more severe mental health issues, like mania, say the empathy and understanding doesn’t always extend to conditions like bipolar disorder..

“I think everybody who reads this story will have mental health problems,” says Patrick Corrigan, a professor of psychology at Illinois Institute of Technology. “Everyone knows what it means to be depressed or (have) anxiety, but the fundamental thing about stigma is difference. While one may get depressed occasionally or a bit euphoric once in a while, most people don’t know what it’s like to be in the throes of a manic episode.”

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What is bipolar disorder? Manic episodes, explained.

Like depression, bipolar disorder is a mood disorder characterized by shifts in energy,  activity levels and concentration. The difference, however, is those with bipolar disorder experience alternating periods of depression and mania.

A manic episode typically lasts from a few weeks to a few months, according toKay Redfield Jamison, a professor of psychiatry at the John Hopkins School of Medicine. Common signs can include “extreme irritability and paranoia, grandiosity and euphoria, changing in thinking (and) speaking a lot, very rapidly.”

“People get highly sociable and disruptive. People sleep much less, are much more activated in general. It’s a very high-energy state.” Jamison, who specializes in mood disorders, also has firsthand experience with bipolar disorder, writing about it in her book, “An Unquiet Mind: A Memoir of Moods and Madness.”

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In some cases, manic episodes can also include elements of psychosis, such as delusions, which Corrigan explains are false, grandiose beliefs (“like ‘I’m a man on the moon'”) as well as visual or auditory hallucinations..

The dangers of misunderstanding a manic episode

At first, no one helped Guzman during her month-long manic episode. It wasn’t because they didn’t care. It’s because they didn’t know.

On the outside, her energy seemed uncharacteristic but not eyebrow-raising. Friends and family didn’t recognize that she was plagued by powerful delusions while getting little-to-no sleep each night.

But this nuance, experts warn, is part of the complexity of bipolar disorder.

Often times, the media depicts mania (or even “maniacs”) in an extreme way. Characters experiencing psychosis, like DC Comic’s Harley Quinn, are often stereotyped with “crazy behavior. Hearing things, seeing things, talking to yourself and making no sense,” Corrigan says.

The reality is that mania can manifest in subtle and positive ways at first, making it harder to spot. Singer Bebe Rexha said, in a tweet announcing her diagnosis, the “highs” initially contributed to her strong work ethic. And Kanye West, who has rapped about his bipolar disorder, is often glamorized by some fans.

“Sometimes, the mania seems positive, but I know it can get really dark. That’s why it’s important we don’t make it seem like this amazing thing, because it’s not: It’s your mind not being OK, and the real-life consequence is death,” Guzman says.

Jamison adds, “It is a very interesting illness and certainly associated with creativity, which runs the risk of romanticizing a very potentially lethal illness.” The rate of suicide among people who deal with bipolar disorder is approximately 10 to 30 times higher than the general population, research has shown, with 20–60% of them attempting suicide at least once in their lifetime.

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In recent years, more people have been spreading awareness about the importance of de-stigmatizing bipolar disorder — including celebrities.

In 2018, Mariah Carey revealed her bipolar diagnosis, encouraging others to seek treatment after “the hardest couple of years I’ve been through.” Selena Gomez has shared her personal experiences in an effort to rid the shame often associated with it, and West has challenged the “crazy” label that is often slapped onto mental illness. Even Halsey, also diagnosed with bipolar disorder, responded to the lack of compassion toward West during his public mental health struggle.

“I’m so disturbed by what I’m seeing,” Halsey tweeted. “A manic episode isn’t a joke. If you can’t offer understanding or sympathy, offer your silence.”

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Open, judgement-free conversations about mental health that go beyond sadness and anxiety are the first step to de-stigmatization and compassion.

“Know about mania. Know about your illness. Know about the treatments for it. Always ask questions,” says Jamison.

Beyond awareness, however, Corrigan emphasizes the importance of learning about these diagnoses by listening to people’s real-life experiences. It’s what inspired Guzman to share her story with us.

“There’s so much stigma around mental illness in general and then especially bipolar disorder,” she says. “But I’m going to keep talking about being diagnosed bipolar. I’m going to talk about being in therapy. I’m going to talk about mental illness.”

If you or someone you know is experiencing a mental health crisis, call the 988 Suicide and Crisis Lifeline which provides confidential 24/7 support by dialing 9-8-8.

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