My previous article covered the controversy about why people think it is not possible to be hypomanic without losing control. It is a good backdrop for this article.
There are four steps that lead to hypomanic success:
Determine the starting point.
Assemble the tools necessary for the task and become proficient at using them.
Create a realistic plan.
Do the work.
Most assessment tools for bipolar disorder are only for making a diagnosis. Rarely does one assess where someone is in terms of their ability to actually handle elevated states. If we are going to succeed at being hypomanic without losing control, we need to assess a number of factors, including intensity, awareness, understanding, functionality, comfort, and what value the person sees in the experience. These criteria need to be gauged at different levels of intensity until you find the one where they are all optimized.
We also need to determine the critical role time plays in the escalation from hypomania to out-of-control. We often find that the person is not aware of the level of intensity until it is too late. By the time he/she recognizes the hypomania, there is too little time to get it under control before it begins to escalate. People often find, for example, that once they get to an intense mania they only have a few hours before they end up hospitalized, but at the hypomanic level they often have a week or more before it starts to spiral out-of-control. It is critical to find the level of intensity that will allow a big enough window of time. That window needs to be a month or more, which for most beginners is at a 10% - 20% intensity.
There is a plethora of tools that have proven effective in helping to reduce the intensity of mania. Many of them can be modified to work in maintaining a certain level of intensity, but are also critical in lowering the intensity if it begins to increase. Such tools are an important part of any toolkit. One important thing to keep in mind is that mania affects all aspects of our lives: physical, mental, emotional, spiritual, social, and career/financial. We need to make sure that our toolkit will address all of them.
To master the ability to maintain certain levels of intensity, though, we must use more advanced tools. Several of them have already been developed and have proven effective for a variety of people. Many more will undoubtedly be developed as more and more people discover tools that work for them.
There are many advanced tools specifically designed for controlling mania. Here are just a few of them:
Failure to recognize what state you are in is one of the central causes of bipolar being in disorder. It is critical that one is aware of what the level of intensity is at all times. Sadly, far too many people are completely unaware not only of their current state, but what each level of intensity is. We must learn to recognize the difference between a 10%, 20%, 30%, etc. before we can start trying to control them.
Learning to separate what the experience of mania feels like from how we behave as a reaction to it is another critical tool for getting mania under control. Since even the DSM confuses the two it is understandable that this is a difficult task. If you do not realize your behavior is a reaction to and not part of being manic, you will not realize that you actually have a choice to behave differently.
Separating feelings from reactions is not a reference to simply emotional feelings that we may have. It means separating what it feels like to be at a particular level of intensity from our usual reaction to it. This is the central point of cognitive therapies, but taken to another level from how they are normally practiced. This is a prime example of how existing tools can be adapted for different outcomes.
Let's face it, behavior is why bipolars get in trouble when they are in an out-of-control mania. A thorough inventory of the behaviors that adversely affect others is helpful in becoming more aware of them. Of course, this awareness alone will not prevent bad behaviors, but will present the opportunity to choose better ones.
The above tools are just the beginning and a complete toolkit should be built before beginning. No one would attempt to fly a plane after merely reading about a few of its features. Classroom lessons, studying and learning from a trained professional are not only required but simple common sense. It would be foolish and dangerous to do otherwise. Please treat hypomania with the same wisdom with step by step study and practice.
Unfortunately, crisis and bipolar seem synonymous for far too many people. It would be wise to plan for the next crisis with concrete actions to be taken to recover from it. But, It is important to remember that the focus of a crisis plan is on making symptoms go away, not learning how to be hypomanic and in control.
A success plan needs to include who is going to help, how to recognize it immediately when it starts, the estimated time before losing control, what steps are necessary at each time frame, and more. There also needs to be failsafes built in to recognize and mitigate any escalation in intensity.
Please understand that the process will take time, perhaps as much as a year or more. A success plan should not start out with trying a 40% intensity. It is important to master a 10% intensity and progress in 10% increments.
All the plans in the world will do no good if if the work is not done to make them a reality. This is the most important step of all.
Besides the fact that bipolar people want it, there are major benefits to getting hypomania under control for all involved. Greatest among them are increased stability and lowered risk of crisis, but removing the behavioral issues is most appreciated by those who have had to tolerate them for too long.
Please remember that this article is just an introduction and should not be used as a guide to follow. For more complete lessons, please visit the Bipolar Advantage Website.
Part Three of this hypomanic series explores how to find the line between hypomania and out of control.
Please share your thoughts in the discussion below. This is an important topic that needs to be talked about instead of kept in the closet.