When a person is ‘high’ they are likely to behave in ways that are quite out of character. They may become very active, talk nonstop, feel superconfident and be filled with a feeling of wellbeing. The need for sleep decreases and concentration becomes difficult. The person constantly seeks out company and may become involved in spending sprees, reckless driving, unwise business ventures and inappropriate sexual behaviour. Mania may start suddenly or be preceded by hypomania and can last from days to months.

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Characteristics of mania: Mania can often begin in quite a pleasant way in that the person experiences a feeling of wellbeing, may be full of energy, drive, initiative and enthusiasm, and generally finds everything and everyone pleasant and agreeable. For many people the first indication of their mood level rising is that they require less sleep or in fact none at all. Sometimes, however, they feel irritable and argue and disagree with those around them. Others are likely to notice this increased pressure and enthusiasm because it is out of character or inappropriate to the situation. People experiencing mania often do not see a need to change or modify this behaviour which they may find exciting and enjoyable. Some people experience an increase in creativity or insight, or may become very enterprising.

A common experience that friends and relatives report is that the person with mania won’t stop talking and talks over the top of others, interrupts or contradicts everything they say in a very off-hand, sometimes hurtful, manner.

As the episode progresses people with mania tend to become more excited and more restless. This may be seen in their speech where they are inclined to talk quickly and jump from one topic to another, and/or in their level of physical activity as they have trouble standing or sitting still and fidget continually. For some people there is an increase in religious/spiritual feelings.

Sometimes mania and depression may be present simultaneously and this is known as a mixed state. It is not always easy to recognise and may include feeling depressed during mania, racing thoughts during depression, and other combinations of mood, thought and behaviour. Probably the most striking feature of mixed states is the variability and changeability of mood. When an individual demonstrates such a wide array of varying and contrasting emotions their underlying condition may prove harder to diagnose. A proportion of all those diagnosed with bipolar disorder may also develop some kind of rapid cycling. Rapid cycling tends to occur predominantly in females and a person experiencing this is defined as someone who has at least four episodes of mania or depression per year.

Problems that may arise:

As the level of mood elevation increases, with the person becoming more excited and less in control, their judgement usually decreases and they are likely to do risky or reckless things such as driving cars at high speed, full of confidence that they are expert drivers. There is also a tendency to do whatever feels good at the time with little regard for the future consequences. People may therefore buy things they cannot afford, or go on long trips without making any prior arrangements.

Sometimes when a person is high their thoughts may be speeded up so much that they become jumbled and unclear. At this stage people may also believe that they have special powers, or are in some way different from, or better than, everyone else. Some may believe they are in fact some famous person or deity, such as the Virgin Mary or Jesus Christ. By the time they have reached this level of disturbance they are likely to be quite conspicuous and tend to be hospitalised either by friends, relatives, or the police, often under the Mental Health Act. The progression from normal mood to a level of mania sufficient to interfere with someone’s everyday functioning can take anything from hours to months. Usually a few days are required before the mood reaches this extent, but there is no guarantee of this. Early diagnosis is important so that treatment may be started promptly.

People describe mania:
‘…if I’m ill, this is the most wonderful illness I have ever had.’

Mood
‘…first and foremost comes a general sense of wellbeing. I know of course that this sense is illusory and transient…Although, however, the restrictions…are apt at times to produce extreme irritation and even paroxysms of anger, the general sense of wellbeing, the pleasurable and sometimes ecstatic feeling-tone, remains as a sort of permanent background of all experience during the manic period.’

Changes in thinking

‘…the memory is complete. One idea calls up a host of related ideas without effort. I cannot but consider every question of judgment or conduct in all its aspects simultaneously, and I see the right answer at once.’

Racing thoughts

‘My thoughts ran with lightning-like rapidity from one subject to another. I had an exaggerated feeling of self-importance. All the problems of the universe came crowding into my mind, demanding instant discussion and solution.’

Too much energy

‘I wanted desperately to slow down but could not. Nothing helped – not running around a parking lot for hours on end or swimming for miles. My energy level was untouched by anything I did. Sex became too intense for pleasure, and during it I would feel my mind encased by black lines of light that were terrifying to me. ’

Perception and sensation

‘Almost always when I start to get manic I notice the change in the way I experience music. Gradually I am aware of an incredible intensity of feelings. Each note…becomes unbearably poignant. I hear each note alone, all notes together, each and all with piercing beauty and clarity.’

Behaviour

‘When I am high I couldn’t worry about money if I tried. So I don’t. The money will come from somewhere, I am entitled, God will provide.’