But Hypomania is Great!

hypomaniaSometimes I feel like the Grinch. This past week I found myself in the uncomfortable position of suggesting that it might be good to moderate the hypomania one of my patients was experiencing.

I also got a somewhat frantic call from the therapist of another mutual patient, the therapist was asking, “how does this end… he really doesn’t want to stop feeling this way, it is too appealing.”

The way I try to get out of my Grinch role is by focusing on what is the best way of minimizing current, or future, impairments.

As we have talked about on a number of occasions in this blog, the trouble with hypomania is that it usually involves not just relief from the constant self-criticism that we would all want to avoid, it means that the person with hypomania is missing real and potentially important warnings in his or her social environment. The man whose girlfriend of many years is saying that she is at her wit’s end, who is not hearing that message because he is feeling so good that nothing negative is registering. The woman whose closest friend has equally “had enough.”

The other problem, that may be an even more compelling reason for moderation, is that for many people what drives their mood instability is in fact gradual shifts into hypomania. For these people, the more hypomanic they get, the closer they get to an Icarus-like fall from the heights right into a deep depression.

Another way of reframing the issue is by saying that, really, I have no interest in raining on someone’s parade. The best way of sustaining a good mood is usually to moderate it. The more extreme it gets, the more fragile it is. So, actually, what I am arguing for is getting as close as possible to a constant, very, very mild hypomania. That may not be possible, but it is also true that you don’t usually get there by flirting with disaster at the upper end of the spectrum of hypomania.