If you’ve never experienced a delusional thought or hallucination, it might be hard to imagine having and believing them. But that’s exactly what happens to people like me. In fact, these delusions and hallucinations seem more real than reality!But many people who will never have a hallucination experience warped perceptions of reality from time to time, especially if they are prone to depression, hypomania, or mania.
The key to preventing a full blown episode is recognizing the earliest signs of your mind getting out of balance. Once you are far out of balance, it will take extreme measures to get you back to normal. But if you catch it early, small steps are often enough to bring you back in balance.
This means we need to be aware of even slight changes in our perceptions of reality, and dedicate ourselves to getting help and taking action when our thought patterns deviate from that.
Making the Commitment
As we’ll see when I get to writing more about what mania feels like, the commitment to changing your mood can be very difficult to make.
Somewhere along the line, though, I decided to live in the reality that most people in my society accept, and which works best for my family. This perspective gives me the freedom to feel and believe what I am experiencing when my mood is unstable without letting it control me.
It doesn’t matter to me how real it is when I hear voices or see the future. It doesn’t matter if I really should die because I haven’t mopped the kitchen floor in a month. So what if the 500 new ideas I had last week really could make me a billionaire overnight?
These are not the thoughts to act on if I want a stable mood and a life that works for me and my family members in the long run. They may be just as real as normal people’s reality (or more real), but that doesn’t mean I can’t choose differently.
As we fall into depressed states or spin up into manic ones, key thought patterns emerge. Recognizing them allows us to say that’s the bipolar talking, and choose to give those thoughts less weight as we take steps to stabilize our moods.
It’s normal to have these kinds of thoughts sometimes. But if they start to happen frequently, or in clusters, you may be headed for trouble.
Many people who experience these kinds of thoughts find they come in specific phrases. For example, one of my pre-depressed “I’m Bad” thoughts is “We are trash heap people.” A common “Nobody Cares” thought I have is “You wish I would die.” One of my pre-manic thoughts is “This idea (or 15 ideas) can’t fail.”
Recognizing these key phrases while we still have a grasp on reality allows us to take steps to regulate our mood before the thoughts become powerful delusions we can’t let go of.
These types of thoughts are characteristic of depression coming on.
- Never/Always – Thinking often becomes more absolute. Whatever is the case right now starts to feel like the only way anything ever has been or will be. Black and white thinking.
- Hopeless – Feeling that there is nothing you can do to impact an outcome, or that it’s not worth trying for anything in life.
- Suicidal – Wishes that you would die, thinking up plans of how to kill yourself, that others would be better off without you.
- I’m Bad – Negative judgments about yourself. Thinking you are ugly, fat, skinny, mean, lazy, stupid, messy, unlovable, useless.
- Nobody Cares – Thinking no one cares about you. Ascribing negative motives to other people.
These types of thoughts are typical of mania coming on.
- Flight of Ideas – You start to make brilliant connections and get idea after idea, both interlocking and seemingly unrelated. They may fall far outside your actual knowledge and skill base, but be fully formed in the grandest sense.
- Not Enough Time – You don’t have time to explain things or do projects. You may feel you don’t have time to take a break to eat, sleep, or slow down because there is so much to do.
- Extreme Confidence – You feel infinitely smart and capable. You feel you deserve promotions or could take on major projects without a challenge.
- Feeling Sexy – You feel desirable, attractive, and are more interested in sex.
- Feeling Lucky – Risks don’t feel risky to you. Things like gambling, unprotected sex, reckless driving, or outspending your means don’t scare you. You feel sure it will all come out ok because you are lucky.
- I’m Fascinating – You think everyone is hanging on your every word and is interested in your approval.
- I’m Special – Your perspective seems unique and more valid than anyone else’s. The regular rules don’t seem to apply to you.
- They’re out to get me – You feel persecuted, attacked, thwarted, or are very quick to anger or frustration. (This can be part of depression, too.)
Hallucinations & Other Delusions
These are common hallucinations and delusions.
- Seeing things other people don’t see – This can range from slight changes in your vision like blank spots or wavy lines all the way to seeing people who look 100% real. A person who is not real may know things they shouldn’t be able to know, may have an unusual appearance, or tell you to do things in a way that someone normal would not. Other people will not react as though the person or other apparition is present.
- Hearing sounds that others don’t hear – Ringing in the ears, music, voices, commanding voices, distant conversations, your name being called, or other sounds such as sirens or animal sounds are some of the possibilities. Look for a source of the sound. If there isn’t an obvious one, it may be a hallucination.
- Having a conversation with other species or entities – If you have an actual conversation with an animal, spirit, or deity, you can be pretty sure that’s an experience regular people wouldn’t consider normal.
- Believing that you are a deity, or directly connected to one – If you feel you are a god or otherwise receiving direct divine information, this is not a normal experience.
- Seeing or feeling things happen that should be physically impossible – Test your experiences against accepted scientific hypothesis. If they should be impossible, they probably are.
- Reading other people’s minds – You may be very in tune with cues people and situations are giving you, but reading other people’s minds is not something that fits with a normal reality.
- Knowing what is happening in another place/world/dimension/the future – Again, this is not a normal experience. While it makes sense to heed intuition about potential danger, don’t go out of your way to act on this sort of “knowledge.”
- Feeling obsessively compelled to do something – It is not physically necessary to check a lock 100 times or wash your hands for 3 minutes every time you touch a doorknob.
What to Do?
So you recognize some of these thoughts… what are you going to do about them? Sometimes it’s murky. For a while I would hear sirens. Well, when you are driving and you hear a siren, you are supposed to slow down and get out of the way. If you’ve hallucinated the siren, that could cause a lot of trouble in traffic! Then again, if the siren is real you certainly want to heed it.
I use questions to help me determine if the way I feel or the things I’m experiencing are real or not. If a thought falls into the general categories above, I don’t automatically assume I’m just crazy. But I do check it against these questions and make a guess as to whether the thought or experience is a part of the reality I have committed to living in.
Ask Yourself These Questions
- Am I experiencing any physical signs of an altered mood? I’ll talk about these next week. If “yes” I don’t assume my perception is correct.
- In my “normal” mindset, would I have this perception? If “no,” I don’t assume my perception is correct.
- What would other people see as the consequence to the action I’m about to take? If very different from mine, I don’t assume my perception is correct.
- Do others see/hear/feel/understand what I’m experiencing? If others around me can’t see/hear what I think is going on, I don’t assume my perception is correct.
- Does the thing I am seeing/hearing make sense in context of what else is going on? Sirens but no lights, and everyone else speeding along? They’re probably imagined.
- Could acting on what I’m sensing put myself or others in danger? If I’m compelled to do something or take a risk that would be widely recognized as dangerous, this is not the time for following impulses.
It’s ideal if you have already told someone in your life about the possibility of this happening and how you would like them to respond. They can then help you monitor the situation. If you start to show signs of coming unhinged from the reality you have chosen to live in – the “normal” one, they will be prepared to notice and to intervene.
I have an advance directive as part of the power of attourney I filed with the county. This allows me to specify what types of medical decisions I authorize and to give TinyHands the ability to make decisions for me if I am not able. You can do an advance directive that does not specify another person who can made decisions for you if you wish.
Even if you have not already set up an advance directive and relationship with someone who is willing to help, telling someone about your hallucinations or delusional thoughts is important. It helps you identify and clarify your thoughts and recognize the At the very least, use a crisis line!
Find a Safe Space
If you are being told to hurt yourself, find the company of others and remove your access to weapons.
If you are not seeing and hearing normally, don’t drive.
If you feel compelled to embark on a shopping spree, lock up the credit cards and bank account.
If you are easily enraged and feeling on the defensive, take a few days off work and warn your loved ones.
Basically, replace acting on the feeling with another action: one of protecting yourself from the harmful effects the bipolar episode threatens you with.
Keep a Record
It’s a good idea to keep a journal or notes on a calendar so that you can track your moods, the thoughts that come with them, and find the things that have triggered them. Here is a check list of things to track.
- Changes to medications and whether you took them or not.
- New foods or foods you suddenly quit eating or eat a lot more of.
- Sleep patterns and quality.
- Specific thoughts of the types listed above.
- Major shifts in mood
Dietary, Lifestyle, and Medical Intervention
Now is a good time to take really good care of yourself.
- Reach out to a therapist, doctor, friend, crisis line, or online group, and tell them you may be at the beginning of a new episode.
- If you are on medications, call your psychiatrist and tell them about your new thoughts and moods.
- Try to follow a regular sleep pattern. If you can not sleep, practice down time without judgement about not sleeping. (More on this later). If you can not wake, try using a light-based “sunrise” alarm rather than a jarring alarm, and move your bedtime forward.
- Avoid caffeine, sugar, alcohol, and other recreational drugs.
- Eat regular meals, made up of mostly simple foods such as organic meats and vegetables.
Next up: Recognizing Behaviors