recently that discuss the advantages of hypomania. The Hypomanic Edge by John Gardner and Finding Your Bipolar Muse by Lana Castle both discuss how one can safely harness hypomania to increase one's productivity, creative output, and potential to become a railway tycoon, dominatrix, or Zamboni driver. (OK, I made up the last three, but if I wrote a book about hypomania, those would get at least a chapter each.) Hypomania can imbue you with wonderful feelings of confidence, talent, creativity, self-esteem, charm, and intelligence, all of which can help you achieve great things. It can also feel distinctly uncomfortable and irritating—sometimes both at once. When I'm hypomanic, I love to go running because the pleasure of flying over the pavement is enhanced a million percent. But sometimes underneath the pleasure there's the churning of this desperate engine that wants to go ever faster, and I can't always keep up.
HOW MIGHT MY FRIENDS REACT TO MANIA OR HYPOMANIA?
A good way to gauge whether or not you're acting abnormally is to pay attention to your friends' and family's reactions. Sometimes, nobody will realize you're manic until it's too late. But people who know you can usually sense when something is a little off. From a friend's perspective, your “perfectly reasonable” obsession with the pattern in the IBM call database is not perfectly reasonable. A friend can have good insight even when you've lost it. Here are some comments friends might make if you're acting unusually, even if they don't know you have bipolar disorder.
“You're acting really intense.”
“You've been working on that project nonstop for a week. Don't you ever sleep?”
“Are you high?”
“What are you talking about? You're not the CEO of Microsoft!”
“Slow down, you're not making sense.”
“Are you drunk?”
If friends know you have bipolar disorder, they might give feedback like:
“You're getting a bit speedy.”
“Have you been sleeping?”
“This is really out of character for you.”
It can be really annoying to hear these comments, especially if you feel strongly that you're not manic or hypomanic. But it's worth being patient with them, because a trusted friend's insight can help you stop an episode before it gets out of hand.
DEPRESSION AND SADNESS: WHAT'S THE DIFF?
A bunch of nerds had a conference in Las Vegas. After enjoying steak and strippers, they defined clinical depression as having a handful of symptoms that persist for at least two weeks and represent a change from your regular functioning. If you've experienced depression, you can probably list the symptoms yourself: a sad, depressed mood for most of the day; a loss of pleasure in activities you normally like; changes in eating and sleeping; crying a lot; fatigue; recurring thoughts of death. At the extreme, people can become catatonically depressed: too depressed to move or speak. The symptoms of depression overlap with conditions such as vitamin deficiencies and chronic fatigue. So it's important for doctors to rule out other factors when making a diagnosis. Unfortunately, many people with bipolar disorder experience more depressive episodes than manic or hypomanic episodes in their lifetime. How do doctors differentiate between depression and normal sadness or grief? Back to the DSM-IV!
1 Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful) You feel sad, down, and empty. Maybe you cry a lot. This feeling persists from day to day.
2 Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others) You don't feel like going out with friends, doing your laundry, calling your girlfriend, or going to the gym. Activities you normally enjoy feel sad or painful to you.
3 Significant weight loss when not dieting or weight gain (e.g., a change of more than 5 percent of body weight in a month), or a decrease or increase in appetite nearly every day You find it hard to eat, or you eat a whole box of ice cream just to distract yourself from the sadness. Your body feels strange and makes different hunger demands than usual.
4 Insomnia or hypersomnia nearly every day You have a terrible time getting or staying asleep at night. Or all you want to do is sleep—you start sleeping twelve hours a day, every day.
5 Psychomotor agitation or retardation nearly every day (observable by others, no merely subjective feelings of restlessness or being slowed down) You look and feel like you're moving through molasses. It takes you thirty seconds to take your bowl of oatmeal out of the microwave. Your friends get impatient because it takes you forever to put on your jacket. Or you feel agitated and move around like an angry old man.
6 Fatigue or loss of energy nearly every day You dread the time between periods when you have to walk from one lecture hall to the other. You feel really tired—too tired to do the things you normally do.
7 Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) You feel extremely guilty about being a terrible friend or being a bad person, for no apparent reason. You feel like you have no worth as a person.
8 Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) You can't make decisions or prioritize tasks. Thinking about whether to go to the bank or the library first nearly kills you. You can't concentrate on a dinner menu, let alone your thesis.
9 Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide You can't stop thinking about all things death related. Even if you don't want to commit suicide, you can't stop thinking about how you would do it.
The DSM-IV goes on to note the same “ruling-out” clauses as for mania and hypomania: that your symptoms aren't better accounted for by drug abuse, a medical condition like hyperthyroidism or chronic fatigue, or bereavement following the death of a loved one. The depressive symptoms must represent a marked change from your regular functioning and persist over at least two weeks.
The key words are “change from your regular functioning” and “persistent.” If you feel like the world has become inherently more depressing and your prospects in life fundamentally bleaker—and these feelings last for a long time and deplete your functioning—it might be depression. If you're just having a bad day and temporarily feel down on yourself, it's probably run-of-the-mill sadness. If you're just not hungry one day, it's probably nothing. But if you lose all desire to eat, have sex, or go outside for two weeks, that's depression. Sometimes you might have a couple days of real depressive symptoms, but manage to pull yourself up before they develop into full-blown depression (tips on doing that later!). In some ways, depression is like the common cold: You can feel it coming on and try to stop it from developing if you catch the symptoms early enough. But once it sinks its teeth in, it can stick around for a long time.
Just like mania, depression can make you do stupid things. On one end of the spectrum, there's suicide, which we'll talk about later. Way on the other end of the spectrum are the stupid thoughts you have when you're depressed. During my last depressive episode, I burst into tears at the sight of a normal white fence and insisted to my boyfriend that it was the saddest fence I'd ever seen in my life. (If you want to see the world's saddest fence for yourself, it's located at 2761 West Seventh Avenue in Vancouver, British Columbia.)
Like hypomania, depression can be harnessed for good. Maybe you take advantage of your reduced energy to spend time reading, or maybe your experiences with depression lead you to write great poetry. Or maybe you embark on a mission to catalogue the world's saddest fences. Who knows?
TRIPPING THE LIGHT PSYCHOTIC
When I first told one of my friends I was taking