What a Bipolar Mixed State Really Feels Like

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Yesterday, I couldn’t stand being inside my skin. It felt like a prison, this body of mine that didn’t know what it wanted or why it was here.

I squirmed through the day, fussing and eating and eating and fussing. One bowl of frozen yogurt wasn’t enough. Two left me hungry. Three made me depressed that I’d eaten so much.

I flicked through the cable channels, but nothing appealed. Faces looked indescribably ugly to me. Voices sounded screech-owl shrill. This was the entertainment I was paying so much money for every month. This was dreck. All at once, I started to cry.

You should go out, I told myself, and find some pleasant distraction. But although an intense nervous energy seized me, I couldn’t imagine getting dressed. That would mean I’d have to face my body in the mirror, and like the gargoyles inhabiting my TV screen, I was too hideous to contemplate.

I had no idea why I felt so rotten until I realized that what I wanted to do was throw my empty bowl at that accusatory mirror and see it shatter into a thousand tiny pieces. Aha, my brain finally said: a mixed state.

When you say “bipolar disorder,” most people think of mania and depression. They don’t realize that there’s another place on the bipolar spectrum, which is so difficult to describe it’s known by several different names: a mixed-features episode, agitated depression, a mixed state. Whatever you choose to call it, it’s hell.

A mixed state combines all the irritability of dysphoric mania with the doom-and-gloom outlook of major depression. It’s tough to recognize, even when you’re smack in it.

It’s also tough to treat such a raging blend of symptoms. Is an antidepressant to combat the malaise and hopelessness? Or should you target the restless agitation instead? Which direction is better: up or down?

There’s no easy answer to this dilemma—which is more than just a damn shame. It’s also hazardous. Individuals in a mixed state are at a significantly higher risk of suicidal behavior.

Not only do they feel they’re not worthy of living, they have the relentless energy required to plan and execute an attempt. That isn’t always the case with “simple” depression, which can paralyze the will and the body.

After years of not knowing what’s going on, I’ve come to recognize I’m in a mixed state by the ferocity of my desire to smash things up. That doesn’t just mean dishes or mirrors—it also includes relationships. In a mixed state, I turn sharp and nasty and feel nothing but contempt for people who don’t understand why, all of a sudden, I’m so mean. I can’t explain it, and that only fuels my anger, which simmers at a low boil until it finally explodes.

It’s not surprising, therefore, that the mixed state requires tremendous compassion and patience from friends, family, and loved ones. It’s not an easy state to be around. Rest assured that however hard it may be for others to witness, it’s even harder to inhabit.

So, what can one do to ease one’s suffering? Or to avoid being smashed to smithereens by someone in a mixed state? The best answer I can offer is simply this: get to know the symptoms.

Now that I’ve come to understand that this unsettling melange of emotions is part of my bipolar disorder, it’s become somewhat easier to bear—because I know that, like every other mood in the bipolar spectrum, this one, too, will eventually pass.

As it did. When I woke up this morning, the storm had disappeared from my brain. I felt perfectly fine, except I knew there would be consequences. There always are.

So I spent the next half-hour calling the people I had spoken to yesterday to apologize for how rude I’d been. “It wasn’t me. It was the mixed state talking,” I explained, and they were good enough friends to let me make amends. In the end, that’s what really helps the most: having people in my life who recognize the beast, and can tell me it’s come back again, and will just as surely go away.