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Mania and Bipolar Disorder

Mania is a state of extreme activation or irritability. Hypomania is the same syndrome with less severe symptoms: "mania-light" as some have called it. Healthline.com provides a typical checklist of signs of mania:

When mania or hypomania alternates with depressive episodes, the resulting syndrome is called bipolar disorder. But mania can occur by itself.

To be considered mania, rather than hypomania, symptoms must be extreme. In such cases there is little doubt about the diagnosis (except to rule out the use of methamphetamine and similar drugs) because clinical-strength mania is so distinctive.

A person experiencing a manic episode is usually not filled with joy. The manic person's emotions are intense and the person may be very irritable. A flight of ideas is common in mania: the thought process wanders or takes off on wild tangents.

What are symptoms of mania?

Hypomania is defined as a less extreme version of mania that does not involve obvious self-harm. Healthline comments, "People who have hypomania, the milder form of the manic side, may feel more energized than usual, more confident and full of ideas, and able to get by on less sleep. Hardly anyone complains about that."

For others, hypomania is not so pleasant. Symptoms can include insomnia, irritability, agitation/­anxiety, and difficulty concentrating.

Unlike with mania, people with hypo­mania typically do not endanger them­selves. Mania, by contrast, often re­quires hospitalization for self-protection.

People who recognize themselves as hypomanic sometimes say they enjoy that state, or this is when they are most productive. Drugs like lithium can damp the excessive emotionality of a manic state, but they also reduce the creative edge that people value.

Alexander Hamilton did productive work during manic states, but Hamilton also did many impulsive and self-dstructive things in his short political and social life. He shows both the pros and cons of hypomania.

Bipolar Disorder

Mania and depression alternate in the disorder once known as manic-depression. Psychologists call this the bipolar (two-sided) disorder.

DSM-5, the Diagnostic and Statistical Manual of the American Psychiatric Association, version 5, recognizes several variants: Bipolar I includes depression alternating with episodes of severe mania. Bipolar II includes only hypomania and some depression.

What is the bipolar disorder?

Others prefer to see bipolar disorder on a spectrum. Dr. James Phelps (2017) approvingly cites the approach of Dr. Gary Sachs of Harvard. Phelps writes:

First of all, let's get this straight: the Harvard-associated Bipolar pro­gram has been using a spectrum approach to diagnosis since 2004. They say "Do you have bipolar disorder, or not?" is the wrong question. The right question is "how bipolar are you?"

The spectrum approach defines a continuum that has severe depression on one end (with no manic symptoms) and severe bipolar disorder on the other end (with full blown manic episodes). In between is a range of depressive states.

On the far left end of the depression spectrum, conventional anti-depres­sants (mostly SSRIs) do not work. Ketamine or ECS might work. Moving to the right, toward milder forms of depression, still without manic symptoms, one enters a zone where antidepressants work quite well.

Moving a little further toward the manic side on the right of the spectrum, but still with no overt manic symptoms, the effective drugs change. SSRIs become ineffective or make things worse, but a different set of drugs called mood stabilizers is effective.

Moving a little further toward the manic/depressive side of the spectrum, signs of mania start to appear, alternating with depression. Depressed days are usually being about three times as common as hypomanic days. Mood stabilizers work.

Finally, on the most extreme right end of the spectrum, depression alternates severe manic episodes. With this extreme of the disorder, hospitalization is required during manic episodes for the patient's self-protection.

A student describes his manic-depressive father:

One day he was planning to make another bathroom in the house. So he had to bust out a spot on the floor for the toilet. He did. But he wasn't satisfied.

Soon the little hole that was meant to be a passage for the sewer pipe ended up being a trap door for a cellar that he and his boys spent digging out for days. And it was hard for all four of us to keep up with him when he was in the mood for working.

Dad would often get started on projects that would usually run into money that we didn't have. He'd drop that project and go on to another, then leave that one unfinished and go on to another.

Then for some reason he would become depressed and have to go into the hospital for some time. [Author's files]

What did researchers discover when studying the possible connection between artistic creativity and mental illness?

The bipolar disorder is associated with artistic creativity. Many famous figures in history suffered from bipolar disorder. Jamison (1995) lists (among others) Edgar Allen Poe, Sylvia Plath, Paul Gauguin, Cole Porter, Vincent van Gogh, Gustav Mahler, Virginia Woolf, Mark Twain, Tennessee Williams, Charles Mingus, Ernest Hemingway, Georgia O'Keefe, and Ezra Pound.

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References:

Jamison, K. (1995) An Unquiet Mind. New York: Knopf.

Phelps, J.R. (2017, January 28) Bipolar Diagnosis: Spectrum or Yes/No? PsychEducation.org. Retrieved from: http://psycheducation.org/diagnosis/bipolar-diagnosis-spectrum-or-yesno/ .


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