Hypomania

By Tim Kuss, LFMT, LADC

Hypomania is sometimes hard to distinguish from true mania. Rather than clear lines between mild mania(hypomania) and “full-blown mania, it seems that there is a continuum of symptoms, thinking and behavior that stretches across from euthymia (normal) to psychosis. I think of psychosis and milder delusional states as belonging to mania. Having said this, some degree of delusional thought seems to exist across such a continuum of mood states. Because of such a spectrum of dysfunction, hypomania although certainly enjoyable to sa person with bipolar disorder, has definitely resulted in self-defeating behavior for me.

I cannot be sure when hypomania first appeared in my life, but it was there before any of my psychotic episodes. Following the start of my recovery from chemicals, I did not have psychotic episodes for almost 10 years. I managed to stay out of psych wards, but experienced other negative consequences from my mood disorder.

Some of the symptom of hypomania can be grandiosity, irritability, rapid thinking, insomnia, loss of appetite, and hyper sexuality. On the positive side I tend to be very motivated and energetic and can get a lot of work done when I get hypomanic. Like many others with bipolar disorder, I frequently can use these positive mood swings while filtering out the negatives.

Hypomania, or mild mania is one of at least 6 mood states of bipolar disorder. By my own personal experience and through observation, I have learned that hypomania can last for months and perhaps years. Hypomania is very seductive, as it feels so damn good! It tends to have benefits such as perceived clarity of thought and decision-making. I have more creativity and psychic energy and use that creativity in an artistic form, which for me is writing and expansiveness which promotes relationships and connections with others. In hypomania, there is unfortunately also a high risk that a person may get into self-defeating behavior that is self-destructive. Three aspects of hypomania have been particularly self-defeating for me.

The first is grandiosity. I have made poor decisions when hypomanic, since I have not had the necessary mental filter to consider that I may be wrong. I have not had the necessary humility to ask others for feedback (or to hear their feedback). Grandiosity combined with expansiveness went into the equation of deciding to use drugs in my early 20’s, which precipitated deeper and deeper mania until I became psychotic and had to be institutionalized. I now have a firm rule about not using any amount of alcohol or other drugs and also limit my caffeine intake. This rule helps my mood to stay more stable.

Irritability is the second aspect of hypomania that has caused me a lot of trouble. I had role-models in my life that were irritable and became aggressive with others. I learned to blame others for “making” me angry and to act out my anger by yelling, throwing things, and, I must admit, on occasion hitting or hurting others. I have been fortunate in restraining my physical acting out to a few isolated incidents that did not hurt others excessively, but I did break valuable things early in my first marriage and I did scream at the top of my lungs at several partners and my oldest daughter. This behavior scared others and most likely created more distance in our relationships. I may have “won the battle, but lost the war”. Sometimes, my earlier behavior sometimes colors my present efforts to connect with those I have always loved.

I have had a long struggle sharing the third aspect of hypomania that caused me a lot of problems. It makes it easier that I speak of it from the perspective of a man in an 18 year committed relationship, with zero acting out with others during that time.

Some of my earlier partners had to deal with a series of affairs I had with other women. I have now learned that hyper sexuality can be a warning sign of growing mania that can lead to psychosis. I used to think that guilt was the main factor in contributing to psychosis after the first of these affairs, Later, I learned that my alcohol use was contributing to a kindling effect to increasing mania, Now, I know that hyper sexuality is a symptom of increasing mania, which could end in psychosis with or without chemical use.

Today, my perspective is that hyper sexuality does not need to be a negative thing as long as one makes positive choices about one’s behavior. These choices could include more sexual activity with my partner or simply pleasuring myself.

Wild thoughts can continue like adrenaline that doesn’t go away. I can’t sleep, have enhancement of my senses, feel irritable and euphoric, am incapable of continuing attention, neglect employment, have accelerated thoughts and speech, flight of ideas, unrealistic self-esteem with grandiosity, delusions, and increased activity. This all can lead to exhaustion, spending sprees, increased sexual activity, increased alcohol and drug use, and, for the unfortunate, death. These are notes from readings on hypomania. As I write many of these words, I am experiencing them. I have so much mental activity that I have been unable to sleep for hours. Luckily, I slept for at least 4 hours before this wakefulness. Fortunately, I was teaching my group about sleep management last night.

I do notice that it is hard to focus and concentrate. I have learned over time to keep redirecting myself to a task. No delusions today. I have my wife, friends, and co-workers to validate or challenge my perception of reality. I am over the buying sprees, the increased sexual activity, the my impulses of increased drug or alcohol use. I’m, planning on not going there again and am practicing my recovery program with help of my support network. Learning and writing about bipolar disorder is part of my recovery ­with not from bipolar disorder.

I am expecting soon to enter into my daily routine, which helps me stay grounded. It is 5:48 AM and I only need to survive until 6:15 when my wife wakes up. Meanwhile I am using this journaling as a grounding force. Later, I have 3 friends with bipolar disorder to talk with about my hypomania. They will “get it”. They will support me to continue with my routine, attend my support group tomorrow, keep taking my meds, and keep practicing my coping skills. I’m taking a break now to practice progressive muscle relaxation.

So I’m through another episode. My wife is up and we talk. I leave for work. Work keeps me grounded in reality. For 8 hours I will be held responsible by more objective measurements utilizing coherent thoughts and behavior. It is a place where I can apply my mental energy in a positive way. If I have too many days of continued hypomania I know I will need to talk to my doctor about adjusting my meds, as one of my supportive friends has suggested.

Jail Cells

By Tim Kuss, LMFT, LADC

I’ve had several experiences with arrest and incarceration. With two of them I showed manic behavior. The first of these happened when I was about 21 years old. I had been using hallucinogens like LSD and mescaline experiencing hallucinations and delusions when high. I also had a series of what I considered to be “flashbacks” in which I experienced mostly pleasant delusions when not using. I understand now that my chemical use had triggered my bipolar disorder, serving as “kindling” contributing to increased symptoms.

I had been thinking that billboards and other signs were sending me personal messages and was ”following” these messages to a special place. I believed that my “true love” and good friends would be waiting for me at the end of the message trail, where we would be together. I began thinking that they had arranged a surprise party for me.

At one point my delusions led me to being hospitalized in a psychiatric ward. Later, I was following yet another “sign trail” which included barging through the back yards of some expensive homes on Summit avenue in St Paul. I imagine someone must have called the police. When they caught up with me, I had taken my shirt off and discarded it because I believed that I was supposed to do that. The police arrested me on Vagrancy charges, and put me in a jail cell.

They had taken my belt and shoes, asked me where I lived and my phone number. I began to think of myself as an oppressed man suffering from discrimination. I had been an anti-war protester in college and had spent a month marching with Father Grappi’s people in Milwaukee. i started singing the songs we had sung while marching:

“Oh Freedom, oh freedom over me...and before I’ll be a slave, I’ll be buried in my grave...and go home to my lord and be free” then on with several verses, including a few that I made up to go with the situation.

Then “We shall overcome” and several other songs. I had attended Buddhist temples while out in California, I went next to chanting “Nam myoho rengae kyo” and “Om” for my second hour of vocal renditions. The police did not attempt to put others in my cell. I spent some time attempting to lie on the spring on the lower bunk, as they had not provided a mattress. I think I was into my third hour of singing and chanting when my father showed up. He had gathered the few belongings taken from me and had paid my bail. We drove home quietly.

A similar occurrence happened about 19 years later. I had 15 years of sobriety and had been functioning as a chemical dependency counselor for 11 of those years. I was working the evening shift at a halfway house and went over the center line while making a left turn. It was a difficult turn and I imagine that I was tired. It was July 2nd, just before a three day weekend. One officer followed me into the parking lot behind my apartment building. For some reason, I commented that he had taken quite a risk by following me into this dark, isolated spot. He ran my driver’s license and found that I had a warrant, which turned out to be for a parking ticket I had forgotten about.

I wound up cuffed and put in the back of a squad car, despite protesting that my two daughters, ages 1fourteen and ten, were waiting for me to come home. In the jail cell, I had a deja vu experience of thinking that I had been discriminated against and began my routine of singing freedom songs alternating with chanting. This time I heard fellow prisoners yelling at me to shut up. It was a long 2 hours before my girlfriend arrived to pay the parking ticket and court fees.