Hypomania, Upswings, and Lithium

I was in a slump for a while, then I was swingin upwards only to get sick. So I’ve been a bit down. But yesterday, I saw the first glimpse of another upswing. It happened really quickly and I could see the wheels turning in my head as it happened. In the space of about an hour and a half, I went through two full cycles. That’s a good indication that a mood is breaking in my world and it did break. Thankfully, it was trending upwards. And today, the trend continues in a good way. I feel a little more motivated and physical. There’s a raw energy that’s in my muscles which indicates that I might go hypomanic in the next week or so. I’m rather pleased.

But I’ve also been wary of it because lithium has now seen to it that I have really three possible elevated moods. There’s what I just standardly call up, where I feel good about everything and get things done, then there’s hypomania which is a notch above that, and finally a full blown mania. Between the lithium and the klonopin, I’m probably not going to reach the heights of mania unless I go off the klonopin and really push the limits of my moods with alcohol. And that’s not a bad thing. Manias feel wonderful, but their consequences rarely are that nice. That just leaves an up mood and a hypomania in my future.

While talking with my psychologist yesterday, he and I really tacked down the difference between my up moods and my hypomanias. Both have a great deal of creative potential. I have strong aesthetic experiences in both. I love to write, to read, to listen to music. I’m also very adventurous and highly opinionated. Yet, in the output and mentality, there exists a difference. Writing is the best clue for detecting the difference. In a hypomania and a mania, I’ll write at nearly a stream of consciousness. And along with that is a bunch of jumbled nonsense that has no bearing on the subject at hand. I could literally cut out large portions of what I write and string together about a third into something really interesting. That’s something I love about hypomanias, there are so many ideas and I can pick and choose later on what I want to work with. It’s creativity at its best. But in my up moods, I’ve noticed a similar creativity and out of the box thinking habits, but my writing doesn’t suffer. While it requires some elaboration and goes by at the speed of light, it’s always on point. With just a little organization, it’s possible to get very good writing and creative solutions. And it’s all coherently put together.

The difference between my new up phases, created by the lithium, is that the noise is removed from my thoughts. The extraneous tangents and ideas no longer surface in my thoughts. While I think rapidly, almost too rapidly at times, it’s directed and controlled. It’s almost as if my hypomania is distilled into rapid thought on a single subject; rather than bouncing between a thousand and one subjects.

And I’ve noticed this in my behavior as well. I’m better at staying on track with a single task. I can clean and finish the dishes instead of starting it, getting side tracked, then side tracked again, then realizing that I have dishes to do and finishing only about half of what remains before getting side tracked again. Now it’s possible to have the energy to do something and finish the task, which is a whole new realm of wonderfulness when in a low mania.

Why do I bring this up? Well, part of me just wants to show that there is another form of constrained hypomania. One where you feel good and are still impulsive, but in a more refined and less destructive manner. I still start projects, but not a dozen at the same time. In many ways, I actually like this more than I like the hypomania, which borders on out of control in its impulsivity. But I also wanted to bring it up because not many people sing the praises of lithium. Before going on it, the web abounds with how it causes brain fog and memory issues (which are not founded in research). It also targets one of the best parts of being bipolar, our up phases. I didn’t want to have a condition where I only got depressed and never had another hypomania again. So I was reluctant to try it. Yet, here I am singing the praises of it. It’s refined hypomanias into a new breed of mood that sticks around and lets you function while also being fun and kooky (and heavily opinionated). It’s definitely worth the blood tests and the constant hydration to get a higher degree of functionality out of feeling on top of the world.

 

Existential Moments and Popping My Morning Pills

I guess you wouldn’t call it an existential moment in the fullest extent. It’s more of a “what the fuck am I really doing” kind of moment. Taking my meds has become very routine. It’s so routine that in the midst of a psychotic episode I still try to take them. It’s just second nature to roll out of bed, grab coffee, and then at 11 I take my lithium and klonopin. I just shake them out, and down them with some water. It’s just about as close to natural as one can get in a routine. Same thing goes for the night. I don’t even haphazardly forget anymore, where I lay down to go to sleep and then I suddenly remember to take my pills. I just wander into the kitchen at the appropriate hour and take half a dozen pills. It’s like a midnight snack.

Last night, I had one of those above moments where I got out the pills and just stared at them for a little while. I don’t know if you all have done it, but it’s a peculiar thing. It’s so routine that I take these pills that I don’t even think about them anymore. I know the side effects and work around them and they’ve just become integrated into my life. They are a benign to benevolent force in my life. But it really hit me last night that I’m taking some serious pills here. I’m radically altering my brain chemistry to make me function at a high level. Half a dozen pills is all that it takes. They’re small, some are pinkish others yellow, one is split in half because I don’t like the higher doses. And it keeps my moods from going too high, too low, or completely losing grip on reality. One would think that the pills should be more dramatic. Like bright neon red and primary colors, not pastels. And the bright colors would go along with the fact that I can’t take two of them twice without risking some very unpleasant and potentially life threatening side effects. But instead, I gobble them down like chalky bad tasting jelly beans.

It also made me think about just how acclimated I have become to these pills. I was terrified of nearly every one of them when I first went on them. I tried to see taking them as an experiment, but it’s rather scary going on such powerful drugs. Especially antipsychotics. That’s a class of drugs that you never want to mess around with. Though, I knew that I needed medication, there was that distant part of me that really didn’t want to take anything that would radically alter me. Because that’s basically what they’ve done. I’m not the same person that I was a year and a half ago. I’m much different now. With lithium, I think about hydration constantly; not something I foresaw happening ever in my life. As such, I was kind of afraid of just what would become of me after taking these drugs. They were new, special, and powerful. Now, they’re calming, useful, and at times a necessary evil.

It interests me still, my relationship to my drugs. Where on the one hand I don’t like everything about them, but I cling to them and freak out if I can’t find them. They’re about as important in my life as my laptop, which is saying something. But, every now and then, it just seems to strike me how common place these life altering chemicals have become. This isn’t about how comfortable we’ve become with medicating everything, it’s just that after a while, medication becomes less than medication and more just part of daily life.

Spring, Hypomania, And a Shopping Spree

Spring is in the air. Actually, 80 degree heat is in the air and it’s more like summer around here. It still shocks me that our lakes were covered in ice a week ago. Wisconsin is usually pretty weird when it comes to weather, but this is a new freak show. But enough about weather, the biggest thing is that the weather has changed dramatically. And apparently it’s not uncommon for moods to either.

My psychiatrist relayed this information to me the last time I saw her. Apparently, mood instability often occurs at two times in the year, the spring and the fall. I don’t mean it in terms of becoming hypomanic in the spring and depressed in the fall. That’s more likely to coincide with summer and winter. Instead, spring and fall are often where moods just fluctuate. And it explains my current ups and downs. But it also made my entire college and even high school.

Falls would start out strong, riding on the coattails of my summer up phase, then half way through I would start becoming erratic and things would go to hell after that. Similarly, I would rally in late January and then in spring time I’d start to go up and down and classes would become difficult again. Learning the periodicity of these moments of instability illuminated a frightening amount of my life.

But with my own up phase swinging into place, I’m becoming quite hypomanic. I hit one of my key signs yesterday, which is not doing anything immediately productive, but laying the groundwork to be productive. I got new notebooks to write in for my book. My thought processes were also very fast, flighting from one idea to another. I was well dressed, as I usually am when hypomanic (I take a lot more pride in how I look when up). And along with that I was hyper sexual. All warning signs that something was up.

But I kept it under control, I just kept walking and wandered about in order to let the energy dissipate. I also let my spending spree run wild with used books. Madison has some wonderful bookstores. We have one used bookstore, Avol’s, which is the size of a Barnes and Nobel, but instead of 5 foot book stacks, these go floor to ceiling. It’s glorious. And then there’s Paul’s, which is a small boutique store, but with 25 foot ceilings, which also has floor to ceiling bookshelves with narrow hallways that you barely fit down. The entire place smells of books, I love that smell. There is also Browzers, that has more contemporary fiction as well as some great antique books. I love antique books. I found a suede covered first edition collection of Yeats’ poetry hidden in a stack of books to be given away by my old high school. I liberated it. And lastly, there’s University Bookstore’s basement, which has half priced books on everything that was used for classes. It’s filled with major fiction authors as well as some non-fiction.

But long story short, I hit all of them. Usually, I’d buy books that I had no previous interest in and probably wouldn’t read. Honestly, in a hypomanic state, I would buy books that I thought I should read. Ones that would make me more cultured and increase my self image just by having them. By having something so vague as that means that I could buy anything without restraint. But this time I was on a hunt for books by Albert Camus. This limited my buying prejudices and turned it all into a hunt. In the end, I bought 7 books, spending $18 total (I love used books).

The last little tid bit that I noticed above all else was my writing as a signifier of my hypomania. While I think that what I wrote about being joyful is good. Any decent psychiatrist or someone with bipolar will not see me as writing about being joyful, but completely manic. In fact, the entire thing reeks of bipolar experiences, but I’m ok with that. I’m pretty sure that most of the authors in the early continental tradition had mental illness of some sort. Plus, the impassioned rhetoric makes it more interesting to read than a dry philosophical text.

Adventures in Zyprexa – Day 3

So it’s the third day on zyprexa. Already I’ve noticed that I’m agitated, just like I was when going on abilify. This time it’s not nearly as extreme because I have klonopin on hand, but I’m very bouncy and fidgety. I’ve also noticed that I do not need to take klonopin as much as before. Before zyprexa, I literally craved to have it in my system to give me some temporary control back, now that feeling is gone. Hurray antipsychotics! As for brain fog, maybe I’m unique in this regard, but I don’t feel like I have it. I don’t feel slow or off balance mentally. In fact, I feel sharper and things seem easier than before. But that might just be residual mania creeping in. Perhaps it’s switched my paranoid mania into a regular mania. Let’s hope so, because I like those.

Hunger. That’s something that I did not experience on abilify. Quite the opposite, I couldn’t stand food and I would dry heave in the morning from nausea. Now, everything seems delicious and I want more of it. I have to fight off the snack attacks by reminding myself that it’s the drug talking and not my stomach. I’m resolved not only to stay at the same weight that I’m at now, but to start exercising more and losing weight while going on this medication. If I do that, I’m going to give myself a good pat on the back for dodging that bullet.

Paranoia. Not quite gone yet. The klonopin/zyprexa combo has really reduced my suspicious thinking. Even on a lower dose of klonopin, I can feel my brain wanting to think that way, but it’s not delusional. It doesn’t transform itself into a belief. So I don’t have to fight it, it just flits in and then out of my head. I can live with that. It makes me more delightfully eccentric than before. So far the effect from the drug is mild, but it’s only the third day. I can feel it acting in my system, but hurrah for it having a mild impact. I’ll keep tabs on it for the next few days and see how it performs in the long run. I’ll have to make sure that I get back to mood journalling soon to keep track of all of these changes.

Taking the Psychopath Test as a Manic Depressive

I recently took the psychopath test, otherwise known as the Hare Psychopathy Checklist. I scored fairly high on it. Which leads me to question the substance of psychopathology and bipolar disorder. There is a caveat, this is a self test and not one administered by a professional, so it has to be taken with a grain of salt. But I’m approaching the test as though I don’t know that I’m bipolar. And what I find is that most of the questions fit bipolar mania really well. Even just accepting that I have bipolar and filling in the blanks with 1s to say that they partially fit (as in half of my life is spent in some manic state right now) gets me very close to saying that I have “criminal tendencies.” Which, I guess I do. I’ve done a few things in the past that I won’t reveal here for self incrimination purposes. But the point remains, I score fairly high compared to normals.

But does that really mean that I’m a psychopath? I don’t think so. I think it means that I’m bipolar. In fact, most of these questions were similar to the ones asked by my psychiatrist in diagnosing me with bipolar. Take for instance some of the diagnostic criteria: Impulsivity, Juvenile Delinquency, Irresponsibility, Lack of Realistic Long Term Goals, Poor Behavioral Control, Promiscuity, Proneness to Boredom, Grandiose Self Worth, Superficial Charm, Early Behavioral Problems. All of these fit mania and bipolar disorder! Throw in a dash of mild violent behavior associated with mania and voila, apparently I’m a psychopath. Well, I’m not that high on the list, but I’m getting there. But I’m not a psychopath, I’m bipolar!

In reality, I see this as having a lot of false positives for people who have more mania oriented bipolar disorder. But that’s beside the point, what I’m also concerned with is how this impacts people’s understanding of mental illness and psychopathology. I have a sense that an appreciable amount of people with bipolar are scoring above 20 on the list. Talking with other people, they all score relatively low, below 20. One of my friends scored about 12, and she was worried about how high that was. But if people take this in any was as a definitive test of psychopathology, then it appears to me that lay people will be misdiagnosing people who have bipolar as psychopaths. And this worries me because it just adds to the stigma of being bipolar. No longer are we just mentally ill, we’re all crazy dangerous psychopaths (though, in fairness, it is not the case that all psychopaths are violent individuals who are a menace to society, despite the common perception that they are all serial killers and CEOs).

The whole point of this is that it worries me on two fronts, the misdiagnosis by lay people and the stigma of psychopathy. Even reading through some quick forum posts, I saw people confusing psychopathy with schizophrenia. And given that mental illness is already so poorly understood by the general public, I feel that exposure to simplified tests such as this only makes it more difficult to have a mental illness. I don’t have any grand ideas about how to solve this, the only thing that I can think of is that this highlights the need to be even more outspoken about mental illness.

A First Rate Madness – Synopsis and Review

Can mental illness be a recipe for leadership? Contrary to common perceptions, Nassir Ghaemi contends that in times of crisis, falling along the spectrum of manic depression might provide just the qualities that are needed to survive the turmoil. In a historical analysis, Ghaemi identifies in multiple leaders, from Sherman and Lincoln, to Ghandi and Roosevelt, four characteristics that arise from manic depression: Creativity, Realism, Empathy, and Resilience.

Creativity is identified not with finding solutions to problems, but with finding new problems to solve. It’s the out of the box thinking that Ghaemi contends is indicative of manias found in people along the bipolar spectrum. It also does not occur as often in hyperthymic individuals, but only with hypomanias and manias. He contends that it is an asset that leads to innovations no one would have thought of, and it is this inventiveness that makes for a leader in times of crisis who will provide the unique solutions that are necessary.

The first creative leader identified with full symptoms of bipolar disorder is General Sherman of the American Civil War. Sherman is the man credited for revolutionizing warfare from the Napoleonic style of en masse warfare to total warfare, where civilian infrastructure is targeted. It set the stage for warfare that would rule the 20th century and is credited for its extensive role in ending the American Civil War. Sherman displayed everything from failure due to mania in his previous life before taking over as General in the war where he failed to hold down any sort of job and constantly moved; while also appearing to have severe depression, even psychosis. He constantly paced, had intense energy levels, and also had his depressions that threatened his life and terrified his closest friends. But through the mania, he became creative and saw a new form of warfare that could end the war. It was risky, he cut off his supply chain, marched toward Atlanta with no back up. He was considered mad for taking such a risk, but it is this riskiness that led him to carry out a plan that defined a new breed of warfare.

Realism is the next quality. Realism is the quality of knowing how much control one has over one’s environment. And it is a quality honed by depression and backed up by science. In a 1979 study, Ellen Langer and Jane Roth found that “mentally healthy” individuals overestimated their control of a situation, while depressive individuals were able to detect the difference between luck and success.

Individuals with this quality are leaders like Churchill and Lincoln, both with periods of hypomania and depression. Churchill was able to see through the bluffs of Hitler despite the marginalization that occurred from his gruff exterior. Lincoln was able to find compromise up until it was no longer possible and then take the needed and bold steps to accomplish the unification of the states. Ghaemi contends that their realistic assessment of situations stemmed from their depressive symptoms. Both had them, and both proved to fall into the realistic assessments that Langer and Roth identified.

Third is Empathy. Again, Ghaemi provides a neurobiological assessment of how depression leads to being more empathetic with other individuals. Individuals who experienced severe depression had more oxytocin receptors, leading to hardwired empathy. It is not something gained from reading a book, it is learned through tragedy and depression.

The great leaders who experienced depression on a large scale were MLK and Ghandi. Both practiced a radical form of empathy that led to their practice of nonviolence. Ghaemi contends that their ability to empathize with other individuals led them away from violent resistence and toward the peaceable consilience of conflict. Without the hardwired empathy, they might never have reached their conclusions

Fourth is Resilience. What is meant by this is “good outcome in spite of serious threats to adaptation or development.” Resilience is a trait marked by hyperthymic personalities, those who display a higher level of energy marked by its proximity to mania. The added energy caused by falling along this spectrum of bipolarity causes one to remain strong and creative in the face of adversity. A needed quality in times of crisis. It is the philosophy of “what doesn’t kill you makes you stronger” and it is hard to permanently wound someone who has manic symptoms.

The great leaders who had bipolar symptoms that marked resiliency were FDR and JFK. Both took charge in times of great strife and learned quickly from their mistakes. JFK was an important case study of a properly medicated individual with bipolar disorder. He learned quickly from his failure at the Bay of Pigs incident to the creative solution during the Cuban Missile Crisis. Both withstood great periods of strife and problems, but both over came great physical ailments and presidential failures to continue on when others might have crumbled.

There are other leaders in the book. A quick comparative in terms of proper medication and poor medication is provided as a comparison between JFK and Hitler (who also had bipolar disorder). Toward the end, Ghaemi provides a quick study of crisis leaders who were mentally healthy and failed to live up to the crisis. Instead, the leaders reacted in predictable ways without creativity, empathy, realism, or resilience. The leaders examined were Bush Jr. and Tony Blair.

A final suggestion is provided. One hinted at on the Colbert Report. That we should look for mentally ill leaders in times of crisis. That being too normal might be a hindrance in crisis time despite being a benefit in times of peace.

In the end, Ghaemi provides a fascinating and convincing story concerning the role that bipolar symptoms might provide in times of crisis leadership. It is uplifting to me to see that what is traditionally seen as a reason against achievement may actually provide the character traits that produce great individuals. Where if one was not afflicted by abnormal moods, one wouldn’t be hardwired to survive. This message combined with case studies of great individuals provides a unique historical narrative that is refreshing in its message as well as thorough in its historical analysis. As a small history buff myself, I hope to find more scientifically based psychological analysis of historical individuals. A First Rate Madness is a pleasure to read, takes about a day’s worth of effort, and provides unique and uplifting messages about the greatest leaders in history.