Monday, June 18, 2007

Mania vs Psychosis

Originally uploaded by versionz.
psychosis (sike-oh-sis) - a severe mental disorder in which the sufferer's contact with reality becomes highly distorted.
- Collin's English Dictionary

As promised, here is my response to JungleTart's (a fellow BiPolar Type 1) observation the other day.

" are the first and only to discuss psychosis as compared to other bipolars only talking about mania. There's a huge difference..."

Yip, BiPolar communities often talk about mania and psychosis like they're interchangable. They're not.

(please note that what follows is based on my personal opinion and experience, and no greater authority)

To some degree they lie on the same spectrum, starting with hypomania on the mild end, with mania in the middle, and psychosis at the extreme end of mania. But even though it is a spectrum there is a definite "cross over point" between mania and full-blown psychosis, which this post will attempt to define.

BiPolar Type 2's will unlikely have experienced psychosis - if they had, they would've been diagnosed as BiPolar Type 1 s. In fact, I reckon that the percentage of all BiPolars that have been psychotic is probably in single figures.

It's not that easy pinpointing where the difference between severe mania and psychosis lies. Both conditions could, I suppose, be described as irrational. Where I think they differ is in the nature of the irrationality. Mania, to my mind, is more of a rash, impulsive, over-confident irrationality. Psychosis on the other hand, involves the whole belief system. Which would explain why so many psychotic episodes are experienced (erroneously?) as spiritual or religious. (Me - I thought I was God the first psychotic episode, A mantic the second, and a Seer the third)

If you know anything about drugz, I suppose that Mania is to Psychosis, as a Cocaine buzz is to an LSD trip (but how would I know these things?)

The best way I could describe my own psychotic experience is for you to put yourself into Truman's (of the "Truman Show" movie - one of BPG's all time favs) shoes. At the point that you (Truman) start realising that all is not as it seems, that strange occurances and coincidences keep happening, and that somehow you, yourself, are at the centre of it all - THAT's how psychosis feels.

Here are some other manai/psychosis differences (according to Garp BPG):
  • Psychosis often involves Paranoias. Like convincing beliefs that evil agents are plotting against you, and you're been spied upon. I've gone through this, and it's terrifying. A gazillion times worse than any horror movie. I know for a fact that I will NEVER, EVER shit myself as much as I did my first episode (something I tell myself when real-world scary situations arise)
  • Before being diagnosed as BiPolar, your first psychotic episode often earns you the label of "Schizophrenia" - Paranoid Schizo in my case. Only a year or so later, when you are living a "normal" life again (something which Schizos can apparently never get fully back to) can the dear doctors deduce that, no, you're actually BiPolar Type 1, not Schizo.
  • It's harder to get a psychotic "back to earth" than a manic. One of the scarier things about psychosis is that there is no guarantee that it will end - sometimes when you slip gravity you never get completely back to earth. (in which case the dear docs will deduce that, no, they were wrong, you were actually Schizophrenic all along). Seriously though, mania has relative comfort in that you know it will blow over (probably into full-blown depression, but that's another topic). With psychosis there's no knowing, which is pretty terrifying, especially to your loved ones. The only way i came back was through ECT.
  • The primary way of diagnosing psychosis (in my experience anyways) is by a method called "reality testing". This is a particularly interesting topic for the philosophically minded, but i won't even go there. Basically it's a conversation with a PDoc and if they ask you (as in my case), whether you really are the third Messiah, and you answer yes without a shadow of doubt on your excited face, well then you're psychotic.
There are probably loadsa other differences I haven't touched on. But I'll finish up with Hunter S. Thompson's wonderful quote (which seems pretty relevant right about now):

“The Edge... there is no honest way to explain it because the only people who really know where it is are the ones who have gone over.”


  1. psychosis really really really really suck, it's worse and remotely alike to an out-of-body experience, i fear every so often i'll go psychotic again.

    hey i changed my address to http://a

  2. Anonymous18 June, 2007

    In these manic/psychotic moments how many of your friends stood by you? What efect on your family? What about the strain on your marriage?

    1. Family stood by me but friends...none of them!

    2. my friends stood by me. my family did not.

  3. Anonymous18 June, 2007

    I'm BP but the only psychotic episodes I've ever had were drug-induced recreationally as a kid and post open-heart surgery later.

    There was no part of heart-surgery pain or debility that could compare with the horror of psychosis. Truly the worst experience(s) of my life: free-floating, abject TERROR like nothing to be believed.

    I simply can't imagine surviving days on end of it.

  4. Anonymous19 June, 2007

    Another mania vs. psychosis thing is that you can be psychotic without being manic at all if you're experiencing a psychotic depression. Even when I'm manic, though, I don't tend to have psychotic episodes where I think I'm the messiah or stuff like that; I get the mood-incongruent ones where I hear all these voices talking about me and think everyone's trying to kill me.

  5. For some of us, psychosis accompanies our mania. For example, when I am running hot, I see things on the periphery of my vision. This causes me to think creatures or people are jumping in front of my car. Very annoying.

  6. very interesting topic here.

    i'm a BP1 and have never experienced psychosis. to be honest, i'm not sure as to how i would deal with it if the situation came about.

    now you've got me interested in researching this. LOL.

  7. Taken in four point restraint to a dual diagnosis ward across state,
    I was told the next morning I had bipolar 1 and was possibly an alcoholic. I was pretty sure they were mistaken because I was after all the virgin Mary. (I've never been Catholic and the virgin part, well....) After a few days I told them what I thought they wanted to hear, That was 2.5 years ago. I lost my home,marriage,dog,job and more. Ilive a clean and sober life now but still can't understand how I lived a fully productive life until the age of 52 with no sign of mental illness. I did do LSD in the day and yes there were similarities.

  8. Psychosis is hell. In the middle of it, I called on God to prove he existed in our lives and to heal the state and keep his promises to me. I believed he promised that I was healed of bipolar disorder becuase I was off any medication for 7 years. That fixed belief became tested. Strangely, as the psychosis misted in and absoloute terror crept in, who can say one calling for God's mercy is delusional? Where is the line? Yes, I also believed that God was sending me messages through signs and events about my life. I beleived I had a special relationship with him. But reread that sentence: how many people who are unafflicted believe this? I have many friends who talk about these experiences all the time of God working in their lives through events and directly through people. Why is one man a madman with this disorder, and another Moses? Why doesn't God speak about this? We ARE all his children.

  9. I was sectioned for 6 months with psychosis and thought I was Jesus. 2 years on they diagnosed me with bi polar after I was sectioned again. I always start out manic then it develops into full blown psychosis. Long depressions follow and during that time I try to figure out if all the coincidences were actually real etc. There were things I cannot explain and things deffinately were real at times. Mania is psychosis but your still in the world, with full onset psychosis you leave this planet.

  10. iam bipolar1 with psychosis .I need anti- psychotic for life.I got my psychosis through excessive meditation.It is out of world experience seeing light,darkness etc.There is good evil souls and iam the one woman chosen by God to fight anti-christ .Oh...its also end of the world.classic bipolar1

  11. Anonymous21 June, 2011

    i was taken 2 hospital with phsychosis and told the doctors i had came through the water from the pharoas i also felt like i was in the trueman show and everyone was watching every move i made then the paranoia sets in and u get worse i was hospitalized for 2 months and am on antipsychotics and diazepam but still havent been given a diagnosis

  12. You didn't mention schizoaffective disorder!
    I have been psychotic and manic but I was hallucinating floridly and not really delusional. I had some "paranoid ideation" and some grandiosity (I felt like I was turning into an angel). I also thought people wanted to kidnap me. Most of the psychotic features were a lot of fun ~ something like LSD actually (which I do NOT take nowadays, though I have been known to dabble in years past...) At the very peak I had symptoms I later found out were "catatonic" (as in catatonic excitement, not stupor). I ended up yelling incoherently, like a wild animal. It was the nearest I had ever come to truly losing my mind.
    In my diagnosis you have to meet full criteria for mania and schizophrenia simultaneously. Being as I'm in London the ICD10 criteria predominate and there is no "hallucinations/delusions for 2 weeks in the absence of prominent mood symptoms" stipulation. I think of myself as type 1 bipolar because nearly all my symptoms and experiences fit with that. The only difference I get is occasional psychotic panic without mania or depression. And I can get very low grade voices again without full-blown mania or depression. I usually have some degree of "elevated" or depressed mood at most times and I've just got used to it.

    Hey don't bipolar I's also get psychosis in depression? I know it's rarer, but hardly unknown. Mixed states can be floridly psychotic. I first went severely psychotic in a mixed episode.

    I also heard BTW that type 2 bipolars can get psychotic depression (though obviously not psychotic mania). This does stand to reason, as lots of unipolar depressives get psychosis also.

    Come to think of it, I can think of a couple of unipolar depressives I know who get far more depressed than any bipolar person I know... which kind of goes against stereotyping; but tre you go...


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