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These recurring symptoms turned out to be bipolar psychosis linked to depression, stress, and major life changes.
Sensitivity Note: Please know that this blog includes a vivid discussion of psychotic hallucinations. I describe what I experience in some detail, and I don’t want anyone to feel caught off guard while reading. I hope you’ll keep going, though, because the hallucinations I describe didn’t harm me, and this story ends on a hopeful note. I share these experiences openly to help others who may be struggling with undiagnosed bipolar psychosis.
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I experienced my first bipolar depression hallucination at age 19. It was so vivid, it felt real. My then-boyfriend broke up with me, and I had to move back in with my parents because I had nowhere to live. I had flunked out of school the year before. I now know bipolar disorder caused my academic struggles, but I was truly confused at the time. My parents had no idea what was going on.
I was despondent over the breakup to the point that I had trouble functioning. When I took walks near traffic, I saw images of myself being hit by a car as I stepped off the curb. It felt as if a very vibrant movie were playing, with me as the star. These images often accompanied suicidal thoughts. I got over the breakup by going into yet another euphoric manic episode, but that’s another story.
Recognizing Repeated Bipolar Hallucinations
Over the years, the “movies” continued. I called them “death images” and assumed everyone dealt with them. My death images showed up in busy places with a lot of people and vehicles. Standing and waiting for the light to change at an intersection seemed to be the main location. I always “saw” my body getting hit by a bus or car, flipping up into the air, and landing at my feet. I was not disfigured, and it wasn’t gory at all.
I can distinctly remember being on street corners around the world, waiting for lights to change, and “seeing” myself struck by a mighty large array of international vehicles! I talked to my friends about the images, but no one understood. I’m sure they thought I was describing a thought or a worry. Truthfully, these had nothing to do with thoughts or specific worries. They simply happened in vivid and colorful detail.
I wasn’t scared per se, but the experiences seemed to coincide with life changes, such as a breakup with a boyfriend, a move, or other stressful events. It’s hard to believe that I once thought these vivid death images were normal experiences!
When Bipolar Psychosis Becomes Severe
As my bipolar disorder became more severe over the years, the “death images” changed. I saw myself chased and bitten by pit bulls, or I saw things on the ground, such as a leaf that looked like a severed hand. I will not go into details about what it was like when the psychosis was really raging, but for the most part, I had to live with these hallucinations.
I visited more doctors, therapists, bodyworkers, and healers than you can imagine to find help for my moods and these visions, but no one ever caught on to what was happening. I look back at the kind but often incompetent healthcare I received for so long, and it makes me sad. A few intelligent questions would have spotted my bipolar disorder and this depression psychosis easily.
When I finally saw a competent psychiatrist, I was diagnosed with bipolar disorder in 20 minutes. That was years ago, when I was 31. Unfortunately, I wasn’t taught much about psychosis in my first few years of treatment, and I certainly wasn’t taught how to manage the psychotic symptoms. My treatment was medication-based and rarely focused on how I could manage the illness myself. I knew this had to change, so I took over my own treatment three years after my diagnosis, and my life changed for the better.
What Psychosis Looks Like for Me
On a basic level, there are two types of psychosis: hallucinations and delusions. Hallucinations always involve the senses (visual, auditory, olfactory, etc.), while delusions are false beliefs. Seeing something that isn’t there, such as seeing myself getting killed by a bus, is a hallucination. Believing that someone has planted a recording device in your living room to frame you is a delusion. I should point out that psychosis in bipolar disorder is always connected to either a depressive or manic mood swing.
Identifying Visual Hallucinations in Bipolar 2 Disorder
It’s said that my type of bipolar disorder (bipolar 2 disorder) rarely includes psychosis. I now know this is balderdash. These psychotic visual hallucinations do happen in bipolar 2 disorder, but people don’t know what they are, so they don’t mention them during doctor visits.
I wanted to get better. I went into detective mode and figured out that my “death image” hallucinations were always part of my anxious and overwhelmed depression and not a part of my euphoric hypomania. (I likely had them with dysphoric mania, but that type of mania was rare for me when I was younger.)
How Stress Triggers My Psychotic Symptoms
I set out to categorize the specific images and figure out if there was a trigger I could stop. I realized that just as I was teaching myself to manage depression, mania, and anxiety, I could do the same with psychotic hallucinations.
Listing out my hallucinations gave me the information needed to do something about them. I realized that literally standing on an overwhelmingly busy street could conjure up the hallucinations, but it took me some time to figure this out.
I concluded the hallucinations happened when I was in a new and stimulating place, especially a new country, and when my life was going through a change, such as:
- A relationship problem
- Success or stress at work
- Meeting new people
- Having new adventures
Isn’t it amazing that good stress could make me depressed and psychotic in the same way that bad stress did? I also identified what caused my paranoid delusions and vowed to prevent them as well.
Managing Psychosis as Part of Daily Life
Taming psychosis became a large part of my management plan. I learned to see the “death image” hallucinations as a sign that I needed to examine where I was in life. It was as though my brain was giving me a wake-up call to be more present in my life so I could take care of my mental health.
This made the hallucinations less worrisome and helped me make the changes needed to get them to go away. This isn’t a post on management — I talk about how I manage my bipolar disorder in my books — but I do want to encourage anyone with bipolar disorder or anyone who cares about someone with the condition to learn about psychotic hallucinations and how they can manifest when someone with bipolar is simply under stress.
Psychosis is a disruptive and often destructive symptom that we must manage along with mania and depression. I still experience some psychosis. It’s so rare for me now that I know that when it shows up, it means I’ve had a reaction to a drug, or I must change something in my life immediately. My last “death image” was quite a gift, as it made me realize a project I thought I loved was slowly making me ill, so I quit!
I hope this description of psychotic hallucinations in bipolar disorder helps others see if they have a touch of unexpected psychosis in their symptoms. Recognizing psychotic hallucinations is the first step toward a psychosis-free life! I’m much, much happier now that my psychosis is rare. I hope the same for all of us living with bipolar disorder.
If you or a loved one is experiencing significant distress or having thoughts about suicide and need support, call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24-7. If you need immediate help, call 911.
UPDATED: Originally posted March 5, 2015
