The rate of suicide for bipolars is somewhere between 15-20%, which is extremely high. I believe that one of the reasons it's that high is that we bipolar folks get to see and be somewhere most people will never go. During the highs (mania), great projects are completed, great artistic endeavors become real, and charm is our password to any realm. Unless...unless the manic muse of happiness becomes the Gorgon of manic rage or manic psychosis.
Why is it called rage and not anger? Imagine somebody igniting a barrel of magnesium versus a spitting little sparkler and you'll have a visual analogy. The best example of manic rage I can offer is my own experience. It starts with a hot rush in the center of my being, working it's way from the pit of the stomach like lava rising to the lip of overflow on a volcano. At some point my brain switches from rational mode to psychotic maniac. Under the influence of the gorgon, I've destroyed petrol/gas station restrooms, attacked a friend, strangling her till several football players pulled me off her. She bears the throat scars still 25 years later. I tried to jump from a car traveling 70 mph and severely bit the person who tried to stop me . Her injuries required medical attention. I've swung at someone by punching through a glass window several times, thus ending up in the hospital for extensive surgery to reconstruct a destroyed arm. This injury required months of physical therapy and left me with only partial use of the hand due to the severe nerve and tendon damage. And that, my friend, is manic rage.
Manic psychosis is the most extreme form of mania and almost always requires hospitalisation. A person this whacked out needs some quick, professional help for they are generally completely out of touch with reality. Left to their own devices they often end up on the streets unable to take care of themselves and are easy prey for unsavory types. It's crucial that a well-informed physician diagnose a person in this condition for it is often the case that bipolars experiencing severe mania are misdiagnosed as schizophrenic. Some of the symptoms of this form of mania are auditory and visual hallucinations along with paranoia.
At any rate, it's important that you analyze the substances you are using and why. If you find yourself using drugs to accelerate an already elevated euphoria, or using another drug like alcohol or pot to "take the edge off," try to see if you can determine a pattern in your use. Do you go for periods of time without using anything? Do you binge? Do you drink to calm down? Do you use a drug to pull you from depression or to hide it? Are you an extremist in your use, never moderating it? In any case, if you find yourself drawn to mostly alcohol and an "up" drug such as coke or speed (cocaine and amphetamines), and you have many of the other symptoms of bipolar illness then ask yourself the following: Does my substance use interfere with my life? If the answer is yes, then it's quite possible the two are related and you are a candidate for treatment on both counts. The conjunction of substance abuse and bipolar illness is not accidental by a long shot and there is ample research to support this contention. In any case, the first step toward understanding your illness is to name your chemical conspirators. Conspiring with you (and against you) are the various legal and illegal mood-altering substances, from alcohol, nicotine, cafeine and chocolate to the full spectrum of illegal or illegally-gotten drugs.
I tend to think that: 1) If BPD is biochemically based, and 2) If we are genetically predisposed to it as is accepted, then 3) Once the predisposition becomes a reality, there's no way any part of our personality can said to be uncontaminated by the disorder. Given that, 4) It's not surprising that such a potent cocktail often produces some rather unusual personality types.
In any case, a significant number of bipolar types can be forces to contend with because of their keen, sharpened senses and wit, and an exaggerated ego equipped with an excess of bravado. If you add substance abuse to this already volatile mixture, I can almost guarantee you'll end up with either a renegade or a corpse--sometimes both, in that order. So, if you find you're often the charismatic leader of the pack, perhaps it's a combination of your genetic birthright and an abundance of legal and illegal chemicals that made you so. Beware the bravado doesn't land you in jail or the hospital--it's done both for me...but I always had my fans cheering me on. And you know what? Sometimes it was awful goddamn fun too! And that's why we bipolar types grieve--because there's a part of us the drugs rob us of. I won't lie to you; I've had a helluva run in my time, and I miss the frenzied peaks--but they nearly killed me. So now I take the drugs that keep me semi-sane and make the best of it. Learning to deal with bipolar grief means learning to say goodbye.
So what does it mean to say the help a bipolar substance abuser needs most must come from him/herself? It can mean one of two things actually: 1. If the abuse is primary to the bipolar disorder (meaning it appears to be a clear case of self-medicating as a way to deal with the symptoms of the illness), then chances are pretty good that with the right cocktail of psychotropic drugs the person will feel less compelled to continue to abuse. 2. If, on the other hand, the drug of choice is secondary i.e., pursued for reasons unrelated to the bipolar disorder, the person may continue a pattern of abuse even with drugs for the illness. Thus, their addictive behavior becomes an interfering factor with both the efficacy of the drug therapy itself and with the ability to remain drug-compliant. It is the latter that perhaps is most often the culprit when the dually-diagnosed hit the skids and fall out of the safety-web of family, friends and physicians.
You will find an extensive tutorial on this site which will teach you in detail how to think through dealing with this illness. The information is essential for both you (the person who has a bipolar diagnosis) and the caregivers (private and professional) who surround you. For the complete tutorial that will help you to cope with your condition and get out of the quagmire of thinking with your emotions rather than your brain, see Thinking Through Bipolar Illness ©.