Interview with Len Ramsay On Hypomania

len ramsay life coaching

Interviewer:       

Hypomania is one half of a Bipolar 2 Mood Disorder diagnosis.... That part where the patient is "Manic but not out of touch with reality or psychotic"... "Excessively Happy"... What do patients talk about when they talk about hypomania?

 

Response from Len:        

Patients generally don't talk about hypomania. They don't often use DSM terms. As far as talking about how they feel when they are hypomanic... Why talk about that? What's the problem? "Life is flowing, man, and I'm a big success."  ... more likely the talk to bring to therapy is about depressive symptoms. And this results in a couple of big problems.

            Many clinical depression diagnoses end up as bipolar diagnoses because clients show their hypomanic symptoms later than they show their depressive symptoms, if they indeed show or report them at all.  Sometimes a client who is diagnosed with depression shows up relieved and happy... and when faced with this, I  might find myself feeling somewhat relieved and happy as well. 

            This can be a red flag. Is this excessive happiness I see, an indicator for hypomania? A goal-directed mood, something that goes along with hypomania, makes suicide more achievable.         Being the master of the universe puts otherwise impossible tasks within your grasp. Suicide is a risk in a depressed or bipolar client who shows up happy whether you've got the right diagnosis or not.

 

Interviewer:       

So suicide is connected with hypomania?

 

Response from Len:        

Yes, in the way I've just spoken about. And there is a way in which the misdiagnosis of Bipolar 2 might directly contribute to suicidal behavior. A diagnosis of depression may indicate the prescription of antidepressants. These may be prescribed when they are not the best thing - they can be dangerous to someone who also suffers from hypomania, increasing the risk of suicide.

            The fact that hypomania does not present as clearly or as often as depression in Biopolar2 makes this an important area of concern.

            For some, the crash never comes - death comes first. Or sometimes for the luckiest, the crash DOES come, and it is survived and even worked through, offering up a richness in life not before imagined.

            Something like this happened to me and that's why I love my job.

 

Interviewer:       

What then do patients actually talk about when they show hypomania? Do they like hypomania?

 

Response from Len:        

What's not to like? The direct feelings are pleasurable. You're not slipping into chaos or losing contact with reality in any conventional sense. You get a terrific amount of stuff done. Your creativity is high. You won the contest.

            You're euphoric and elated. You have a sense of accomplishment and a heightened level of happiness.... And then there is irritability.  Maybe to you, "people are stupid". Or maybe too often, others just don't "get it". And when irritability comes In, this is usually someone else's fault. Some frustration comes in.

            It is more disconnection - a consequence - that doesn't feel good. It's lonely to be faster and smarter, more effective than the people around you. That loneliness hurts. And sometimes that hurt is available in the psychotherapy office to offer a way in to access awareness of some of the feelings of hypomania, and to accomplish some integration of that side of the polarity.

Interviewer:       

What advice do you give as far as helping patients make sure not to cross the line into destructive behavior when in a hypomanic state?

Response from Len:        

I'll take that in two parts.  First, when the patient has some awareness of their hypomania and knows the risk of stepping out over some line in to overtly destructive action... gambling in to bankruptcy, "Superman" crashes while taking physical risks, random unprotected sex, and all of that, or even to move toward that awareness, the mindfulness stuff works.

            Even here there are a couple of steps: psychoeducation and mindfulness training. For me, this part is about body awareness, feeling the emotions and sensations, finding a centre that is not chaotic.

            Truth be told, something like mindfulness is important in a lot of my work, although I usually don't call it that.

            So this is the second part, moving clearly past harm reduction and illness into the generation of wellness.

            Affect regulation within a range that excludes both chaos and rigidity is important in my view and my approach to work.  In Bipolar2 many of the features like restlessness, rapid speech, and intensity of goal direction are issues mainly because they disconnect the client from contact with others. Even overtly destructive actions that bring risks to physical health also include this key issue of disconnection from real or meaningful interpersonal or relational contact with others. While disconnection is a consequence, contact, connection and relationship comprise the therapeutic intervention.

            While mood stabilization is the first line of treatment, I want just enough of that so that I can make personal contact and have a human relationship with the client.  I usually take a Relational Gestalt perspective. Others use different frameworks, and in every case, at least as I believe it to be true, somehow the relationship is what makes a difference in the effectiveness of therapy. cloud.."

            For some, the crash never comes - death comes first. Or sometimes for the luckiest, the crash DOES come, and it is survived and even worked through, offering up a richness in life not before imagined.

            Something like this happened to me and that's why I love my job.

 

Interviewer:       

I recently read (and have not yet interviewed anyone about it) that the longer you’re in a hypomanic state, the harder the crash. What are your thoughts on this?

 

Response from Len:        

Sure. The more grandiose is the castle you build, the higher will the walls be, and the louder the crash when they tumble down. Hypomania is not something that emerged in the 20th century - only the terminology did,  " The bigger they are, the harder they fall" ...It's everywhere in popular culture.

            The issue for me is losing touch with reality in ways that are not so severe or blatant as the stuff of mania. Hypomania still isolates the person who suffers and creates a kind of recursive loop of elevating grandiosity that serves to defend until it doesn't work anymore.

            Along the way, social supports weaken, love fades, the animosity of some who have been "othered" increases and the ultimate crash can be tragic and sometimes deadly.

            I am thinking of Mick Jagger singing 'Hey, You, Get off of my cloud. Don't hang around me, two's a crowd... Get offa MY cloud.."

            For some, the crash never comes - death comes first. Or sometimes for the luckiest, the crash DOES come, and it is survived and even worked through, offering up a richness in life not before imagined.

            Something like this happened to me and that's why I love my job.

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