We met a few days ago with one of our favorite people. She’s a writer and an artist and she has been gradually reducing some of her medications to see whether the combination of more diligent self-care and a lower dose of medications can lead to better quality of life and a return of some of her creative capacities.
This is, however, a little bit risky. In fact, in our last visit, I saw some evidence that not only was her thinking improving but perhaps, her sleeping was becoming more disrupted.
What to think about the sudden emergence of a fantasy (or was it a fantasy?) of flying across the country overnight to spend a day with a boyfriend? Is that the creative re-emergence of self or is it perhaps hypomania?
There is, unfortunately, no real way of measuring how “high” you are. We don’t have an altimeter that measures hypomania or mania. There are some scales that we use, but in our experiences, the very best approach is to create a custom scale.
We sat down with her and using a self-rating scale that we think has a pretty comprehensive list of possible experiences when hypomanic (the HCL-32). we identified which of those symptoms she is experiencing right now, as well as a list of other symptoms that she has experienced in the past that she doesn’t have now, which might be a sign that she is getting too energized.
The 32 in HCL-32 refers to a checklist of experiences that may happen when you become energized. If you want to make your own “altimeter” begin by looking over this list and choosing experiences that you have had in the past when you become more energized:
- I need less sleep
- I feel more energetic and more active
- I am more self-confident
- I enjoy my work more
- I am more sociable (make more phone calls, go out more)
- I want to travel and/or do travel more
- I tend to drive faster or take more risks when driving
- I spend more money/too much money
- I take more risks in my daily life (in my work and/or other activities)
- I am physically more active (sport etc.)
- I plan more activities or projects.
- I have more ideas, I am more creative
- I am less shy or inhibited
- I wear more colourful and more extravagant clothes/make-up
- I want to meet or actually do meet more people
- I am more interested in sex, and/or have increased sexual desire
- I am more flirtatious and/or am more sexually active
- I talk more
- I think faster
- I make more jokes or puns when I am talking
- I am more easily distracted
- I engage in lots of new things
- My thoughts jump from topic to topic
- I do things more quickly and/or more easily
- I am more impatient and/or get irritable more easily
- I can be exhausting or irritating for others
- I get into more quarrels
- My mood is higher, more optimistic
- I drink more coffee
- I smoke more cigarettes
- I drink more alcohol
- I take more drugs (sedatives, anti-anxiety pills, stimulants)
Now think about which ones occurred early in the process (early warning signs) and which ones took place as you started to get into difficulty – started to become hypomanic or manic (signs of impending crisis).
You may have a list like this….
Early Warning Signs
- I talk more
- I am physically more active (sport etc.)
- I enjoy my work more
- I sleep a little bit less (30 minutes to an hour less per day)
Crisis Warning Signs
- I am more impatient and/or get irritable more easily
- I drink more alcohol
- My thoughts jump from topic to topic
- I tend to drive faster or take more risks when driving
- I spend more money/too much money
- I sleep quite a bit less (two hours a night less per day or more)
The best time to do this is before you start to get energized because, unfortunately, as your mood elevates, your capacity to see the risks of your behavior diminishes in a sometimes startling fashion. And this all happens unconsciously without awareness on your part. Your brain shuts down the part of itself that monitors for risk.
This custom measure (or altimeter) can be life saving and we encourage all of you to consider making one for yourself. It is to some extent, embedded in something called a Wellness Recovery Plan or a crisis plan about which we have written elsewhere.
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