What is Mania?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

How is mania related to Manic Depressive Disorder?

Manic Episode or mania, as it is commonly known, is a mood episode, not a diagnosis. Mood episodes are used to decide which Mood Disorder a person has. For all practical purposes mania and its milder cousin hypomania are only associated with one of the forms of Bipolar Disorder.

Having an episode of mania or hypomania is the defining symptom that distinguishes Bipolar Disorders from Depressive Disorders. The connection is so strong that for a long time what we now know as Bipolar Disorder was known as Manic-Depressive Disorder. Changing the name has confused a lot of people. I still see clients who say they have been diagnosed with Bipolar Disorder and Manic Depressive Disorder. Sometimes they also tell me they have Depression.

Once you have Mania or Hypomania we forget the Major Depressive Disorder diagnosis and use the Bipolar label only.

A Manic Episode is marked by a period of time of at least a week, or less if you get so bad you end up in the hospital before the week is out, where you have a really high, expansive or elevated mood. This is not just a little happy or full of energy but a way “off the hook” period of time. Mania is not a good time. A little may feel like fun in the beginning. People with Bipolar Disorder may like a little mania but full-fledged mania is frightening.

Typically people who are manic have grand schemes to do things. These ideas make sense to them but they sound impossible to most other people. This is not the person who thinks they can sail around the world or invent an internet program. There have always been visionaries who plan to do great things and don’t get appreciated. These are people who try to run for president, cure cancer and beat the house in Vegas – all in one week.

They have decreased need for sleep, sometimes getting by on three hours of sleep a night and they try to do everything until they crash. This looks like a person on Methamphetamine but they don’t need drugs to be like this. Most people who get only a few hours of sleep may be able to function, but they will be tired and drag all day until they can sleep again. The person with mania can go days on little or no sleep and they feel fine. But the longer they are manic the crazier they act and sound.

Fully manic people talk a lot, pressured speech, the sort that erupts rather than is said. This is not normal conversation. They know what they are talking about by not many other people can follow them. Because their mind is racing they become angry and irritable when other people cannot keep up.

In full on mania they become very goal oriented, taking on lots of projects, rushing to do many things, but not always finishing anything. They have difficulty staying on one project, jump from task to task and sometimes get stuck on something that to others looks meaningless or insignificant.

Since they know what they have in mind they think of themselves as brilliant and important, they become full of self-importance until the manic episode ends at which point they may become depressed and regret all they have done or said. This differs from narcissism in that the episodes of grandiosity go away leaving them ashamed or embarrassed.

A common characteristic of a manic episode is getting over involved in things that are pleasurable. They may gamble, do drugs or drink to excess. There is a huge overlap between alcoholism and manic or hypomanic episodes. During manic episodes, they may have excessive, unsatisfiable urges for sex and engage in sex with partners they don’t know.

Someone who is experiencing a manic episode may become so impaired that they have hallucinations. These hallucinations will go away when the mania ends, unlike psychotic hallucinations that are more long-term. It is also possible to have a “mixed episode” where the person is both manic and depressed at the same time.

If someone has these kinds of symptoms we reserve judgment as long as they are able to work, have friends and are not upset about the episode. If it starts to affect functioning then the diagnosis is given. If someone is doing drugs or has a medical problem that is causing these symptoms then we don’t think that is mania and recommend they stop the drugs or get the medical problem treated.

If you have ever had a Manic Episode I would recommend you talk with a doctor, psychiatrist or other mental health professional. Treated early you still can have a productive life. The longer you wait to go for treatment the more the risks that while manic you will do something you can’t take back and the mania will likely get worse each time you have an episode.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Sleep Paralysis – What causes it? Is it related to PTSD or demons?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Sleep paralysis.
Photo courtesy of Pixabay.com

Is Sleep Paralysis related to PTSD or the supernatural?

Imagine awakening suddenly in the middle of the night. Sitting on your chest is a demon; there are ghosts, dead people or spirits standing around your bed. You try to scream but nothing comes from your throat. You would run if you could but your legs won’t work. You are awake and paralyzed. Looking up at the demons you are helpless to do anything beyond saying a silent prayer inside your head. You are experiencing Sleep Paralysis.

Sleep Paralysis is one of those unusual problems. This condition is especially terrifying to someone who has the disorder.  If you have a belief in the supernatural you may dread falling asleep.

Sleep Paralysis has long been more the province of legends and the supernatural than included in the area of mental health. This experience has been connected to many other worldly phenomena. Similar experiences were described during the Salem witchcraft trials.

Today we have a scientific explanation that satisfies some, some of the time, but are we sure?

In Sleep Paralysis you can see, move your eyes and breathe, but the rest of your body is unable to move.  Some episodes of Sleep Paralysis last seconds. The average is six minutes. Occasional an episode of sleep paralysis will last longer than 6 minutes or on rare occasion’s hours.

Many people with Sleep Paralysis, up to 30% also have a history of Panic Attacks. It is more common among those with PTSD or anxiety disorders. Sleep Paralysis is also most common among those with minority status, especially African-Americans (Sharpless et al 2010.)

Other researchers have suggested that dissociation may be related to the old or “Lizard brains” freeze response to threat or danger. The same mechanism might explain the inability to move despite overwhelming terror found in Sleep Paralysis. Fear and anxiety may both cause and be the consequence of Sleep Paralysis.

Sleep paralysis is more common with overtired or sleep deprived individuals. It is also associated with taking Antidepressants, Benzodiazepines and some other medications. Ohayon et al., 1999 (Cited by Sharpless) also suggested a relationship between SSRI’s and Sleep Paralysis but Sharpless did not find a connection.

Sleep paralysis can occur when falling asleep or when awakening from sleep. Its main characteristic is not being able to move for an extended period of time. This condition occurs naturally during REM sleep but we don’t know we are becoming paralyzed when we are asleep.

The episodes of paralysis while awake are most often accompanied by very vivid hallucinations. The more vivid the hallucinations the more terrifying the Sleep Paralysis. Sometimes the person will experience hearing sounds. Even when experiencing the full symptoms of Sleep Paralysis, both the visions and the inability to move, many people describe the experience as a “dream” (Fukuda et al, 2000.)

If the hallucinations occur when falling asleep they are called Hypnogogic. Hallucinations that occur when awakening are called Hypnopompic.

Sleep paralysis may be connected with a physical disorder such as Narcolepsy. Reports suggest that those who hear sounds are most likely to also have narcolepsy. Sleep paralysis has also been associated with Migraines. If this occurs more than once or causes significant distress it is wise to seek medical attention.

Sleep paralysis is more likely to occur when someone has moved to a new location, is under stress or has consumed an excessive amount of alcohol.

Mental health practitioners, therapists, and counselors are mostly concerned with two relationships between sleep and mental health. Is the problem with sleep caused by a mental illness? Symptoms of depression include changes in sleep and appetite. Depression can be seen as the cause of a sleep problem.

Sometimes sleep issues can create symptoms that are diagnosed as mental illness. Nightmares play a role in maintaining depression and PTSD.

Beyond those two alternatives, most other sleep issues are in the providence of medical doctors. There are plenty of sleep problems that are in the International classification of sleep disorders that are not directly included in the DSM.

The following are past posts on connections between sleep and mental health issues.

Getting Rid of Nightmares that Maintain Depression and PTSD

Trauma Steals Your Sleep 

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Not everyone who hears voices is psychotic

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

All radios

Not everyone who hears voices is psychotic.
Photo courtesy of Pixabay.com

Did you hear that?

People in our society tend to think that hearing voices means you are crazy. We tell stories about this and we laugh at jokes, sometimes not too nice stories and jokes. It makes some of us feel safer to think that those who hear voices are not like us. We say that, even when we have heard the voices.

The truth is that most people hear voices. Sometimes we count the voices towards a mental illness and sometimes we don’t. The counting makes something a problem and other things, not so much.

The majority of all teenagers hear and have heard voices. One author says as many as 70% of all teens hear voices. Don’t be so quick here.

Have you ever thought you heard someone calling your name, looked over your shoulder and saw no one there? Did you shrug it off? Did you pretend it didn’t happen? Some people think if they don’t admit they have symptoms then they are all right.

Truth is our brains sometimes try to help us out and sometimes they are wrong when they do it. You hear a sound. You can’t make it out. Your brain turns it into the closest thing to something it recognizes, tells you someone is calling your name. Sometimes it may only be your own thoughts but if you are concentrating on something you forget which is in your head and which is in your ear. Your brain makes up a story to help you out. Sometimes the brain is wrong.

Sometimes we get thoughts in our head. It is like someone is telling us to do this – no don’t. Some people interpret this as an angel on one shoulder and the devil on the other or maybe it was your conscience. For a moment the voices sound real. But when you try to get them to stop can you make them shut up? People with a psychosis like schizophrenia can’t make the voices stop when they try.

Ever see or hear a dead relative come back to talk with you? How about an angel or religious figure? One rule psychologists follow is if this thing you see or hear is religious in nature or if you are grieving then we tend to disregard that experience. It happens a lot, you should get over it on your own. If not seek help.

If the thing you see or hear is all good and encourages you to do well, we are not so worried here. Unless it bothers you or the voices get too loud for you to think. But if the voice in your head tells you to kill people or break laws, we think this may be a big problem.

Ever been lying in bed and thought you saw or heard something in the room? When you are about to fall asleep or if you are asleep and start to wake up, images and experiences from your dream world can get dragged into the conscious world. We have special names for this, hypnogogic and hypnopompic hallucinations. We don’t count those experiences as a mental illness either, not most of the time because most normal people have these.

I should also mention that most hallucinations involve hearing things. Most of the times when people see things it is drug or alcohol induced. People with mental illness usually hear things, at least in the early stages.

We should also mention here that auditory hallucinations caused by mental illness are about the rarest kind of mental illness. There is much more depression and anxiety out there than schizophrenia. Not all people with schizophrenia are paranoid and not all people with paranoia have schizophrenia. Not by a long shot.

So aren’t people with schizophrenia violent and scary. No, not really. People with a mental illness are no more likely to get violent than anyone else. If someone is hearing voices give them some room, don’t crowd them and for sure call for some professional help.

So don’t people who hear voices scare me? Not half as much as the person who just found out their spouse was cheating on them and now they have brought their gun to work to fix this situation.

There is a great training on what to do if you encounter someone with a mental health crisis.  That program is called Mental Health First Aid. Have I mentioned that before? Check my other posts for more info. This was just a quick look at the whole area of hallucinations and mental illness. If you or someone you know has a problem in these areas please seek out professional care.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.