To capture a mood: Mania

Mental Illness. It’s always been here. It always will be. Why are we still afraid to talk about it?

Perhaps this is a lofty goal for my simple blog, but I hope to raise awareness of mental illness and increase understanding.

I don’t claim to be an artist but I have made some collages and I think they’re pretty neat. First, I will tell you a bit about my “process.” I am always scanning printed materials for images that strike me. Usually I cannot readily explain why a particular image touches me, but if I feel something when I look at it I cut it out and tuck it away for later. I always have a shoebox of clippings in my closet.

Then, when I feel inspired, I empty my box and attempt to create a mood. My hope is, that when one looks at the collage, they are made to feel the mood I was attempting to capture. I do not claim success. Until now the only people who have seen my collages have been my husband and my sister, and I know they would tell me they’re great no matter what. So I must admit I feel quite exposed and vulnerable posting them on the internet. I’d like to reiterate that I do not label my collages as “art.” Rather, the process of making them is a therapeutic activity for myself.

Okay, enough preamble. Here is “Manic.”

Manic 2011/2012

As you may have guessed from the title, I was trying to capture the feeling of being trapped in a manic episode. Physicians use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose mental illness. I will be quoting from the Text-Revised Fourth Edition (2000, American Psychiatric Association).


The DSM criteria for diagnosis of a manic episode is as follows:


A) A distinct period of abnormally and persistently elevated, expansive or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary)

B) During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

1) inflated self-esteem or grandiosity
2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3) more talkative than usual or pressure to keep talking
4) flight of ideas or subjective experience that thoughts are racing
5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6) increase in goal-directed activity (at work, at school, or sexually) or psychomotor agitation
7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C) The symptoms do not meet criteria for a Mixed Episode

D) The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

E) The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication or other treatment) or a general medical condition (e.g., hyperthyroidism)

Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I disorder.

Let's focus on the seven symptoms listed in criterion B, keeping in mind that all of them need not be present for the diagnosis of a manic episode.   I will use photos of different parts of the collage to discuss each symptom.

1) "inflated self-esteem or grandiosity"

The woman with the cigarette- doesn't she ooze confidence? When manic one may feel as if he or she is the most interesting and attractive person around. As you may guess, it feels good. However, this inflated sense of self-worth can be dangerous. One may feel invincible and take unnecessary risks. Grandiose delusions may develop. One may alienate oneself from his or her social network. 

In the manic state it feels as if anything is possible. Nothing is unreachable because you are so awesome and capable. The text here reads "NOT HOW OR WHEN OR WHY BUT YES." I want it and it will happen because I'm great.

Next symptom:

2) "decreased need for sleep"

This one is self-explanatory but very important because it is an objective measure. Diagnosing mental illness is extremely difficult because it is so subjective and often relies on the self-report of the individual, which may be unreliable. Exploring sleep patterns is therefore very useful in the diagnostic process. 

This image illustrates the next three symptoms I will discuss. 

Mania doesn't always feel good. You can feel threatened by your own thoughts. They come too fast and too hard and there is no respite. 

3) "more talkative than usual or pressure to keep talking"

Interacting with someone in the throes of mania is exhausting. They never shut up. They talk too fast. They don't make sense. The "pressure to keep talking" is a little more difficult to understand. A manic person may KNOW they are talking too much but feel incapable of stopping. When quiet a feeling of inner tension rises, only to be relieved when talking again. 

4) "flight of ideas or subjective experience that thoughts are racing"

5) "distractibility" 

As an observer you see a person jump from one topic to another, as a sufferer you feel out of control. 

Next symptom:

6) "increase in goal-directed activity or psychomotor agitation"

Mania can be a time of great productivity. Sleeping less leaves more time for action and increased self-esteem results in more ambitious goals. Of course there may be positive consequences of such behavior, but more often one takes on more than one can manage, resulting in feelings of defeat, failure and regret when the mania passes. 

Similar to the "pressure to keep talking" one may feel pressure to keep moving (psychomotor agitation). Examples include: pacing, fidgeting and picking at one's skin or nails. It is unpleasant. You wish you could sit still.

And now the final symptom listed in the DSM:

7) "excessive involvement in pleasurable activities that have a high potential for painful consequences" 

Most prominently featured in my collage are unsafe/impulsive/promiscuous sex and substance abuse. Others include excessive spending and impulsive investments. 

Mania is a very dangerous condition, complicated by the fact that it often feels good (at least at first). Despite severe and painful consequences from a manic episode a person with bipolar disorder may long for the feeling of happy confidence experienced while manic. This longing may lead to medication noncompliance, which then causes additional manic episodes, resulting in more damage to one's life and the lives of others. I therefore urge you to screen for mania in the people around you. I am NOT asking you to diagnose anyone, simply be aware of the symptoms and seek help if you believe someone is ill. 

And finally, talk about mental illness. I don't want it to be a secret anymore. People need help and they will not receive it if they are shamed and hidden. 

Later I will post photos of more of my collages to illustrate other forms of mental illness. In the meantime I would love to hear your thoughts and questions. I hope that you have never experienced mania yourself, but if you have suffered know that you are not alone. 

Spread the word!

Thank you for reading!