For those with bipolar disorder life would be a lot easier if hypomania (mild manic symptoms) were more like a stomach ache. You'd begin to hurt or feel nauseous and the experience would signal that something is wrong. You might take an antacid, you might refrain from eating until your pain subsides, or if you do eat, you'll go for something bland and soothing. The point is your stomach ache signals that something "not good" is occurring with your digestion.
But the experience of hypomania is more complicated. First, it's important to recognize that the majority of people with bipolar disorder spend about 75% of their time in the depressed end of the bipolar spectrum (see previous blog dated 2/7/10 to understand hypomania in the context of the broader bipolar spectrum). And even if hypomania occurs while you're experiencing normal midrange mood, it comes along and seductively beckons with the promise of pleasure.
Imagine you've been feeling down for a while. The cold, gray, dreary months of November through March haven't offered much to support positive mood. Then along comes springtime with more daylight hours, a trend towards warming, bright wonderful sunshine and an entire natural environment that seems to be "waking up" from its winter dormancy. Before you know it, you too feel the same sense of invigorating aliveness. You're waking up earlier in the morning and your energy is readily available - no more desire to pull the blankets over your head and return to the soothing cocoon of sleep. Your thoughts are moving faster, you're connected to your creativity and you're experiencing the desire to open up and blossom, just like everything else around you. You breeze through your day with a fair amount of energy and when evening comes along you don't really want to wind down. There is so much more still to do and sleep feels like interference.
The problem is, this is no stomach ache! There's nothing that intuitively feels bad about the early aspects of hypomania; in fact your experience is just the opposite. Hypomania comes along and says "Hey, let's go play!" Why would you not say, "Sure, I'm in!" And then it's a slippery slope from there, only your trajectory is upward (at least initially). What creates double trouble is when the elevated energy and accompanying behaviors aren't inhibited and when your need for sleep continues to decline, hypomania can spawn further intensification. In other words, the pleasurable impulses which feel like heightened productivity or innocuous play can easily progress towards something more dangerous and turbulent. Gentle springtime turns into a summer tornado.
Some with bipolar disorder are able to utilize healthy adaptation where appropriate measures are taken to keep from being swept up in the storm, but usually we see this in those who have lived with their disorder for several many years. They've become keenly attuned to the more subtle nuances of hypomanic mood. When elevated mood arrives a mild warning alarm sounds instead of the more natural response of setting restraint aside and going with the flow. This healthy inhibition or even the recognition that a medication adjustment may become necessary requires excellent self-observing skills plus an appreciation of the potential negative consequences of hypomania.
Unfortunately, it's difficult to be successful with this when you're relatively new to the disorder because there's not much in your experience that teaches this lesson. However, the more you come to know what your hypomania feels like, the better you'll become at identifying its influence and taking appropriate corrective actions. The good news is that there is usually a positive progression of adaptive learning in those living with bipolar disorder.
What I've just laid out may be one of the most difficult challenges of having bipolar disorder. If you're bipolar, you can't necessarily trust the natural ebb and flow of mood and emotion. Thinking, self-observing and applying good judgment must become the transformative mantra of the bipolar young adult. And once you get it that just because your experience "feels good" it doesn't always mean "it's good for you," you're more than halfway towards figuring out how to remain stable.
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Russ Federman is co-author of Facing Bipolar: The Young Adult's Guide to Dealing with Bipolar (New Harbinger Publications), see www.BipolarYoungAdult.com