HYPOMANIA — IS IT A BENEFICIAL CREATIVE ENERGY OR A PRECURSOR TO BIPOLAR DISEASE?
The prevailing theory on why the 19th-century Dutch postimpressionist painter Vincent van Gogh cut off his ear is that the source of his genius is also what drove him mad. His paintings suggest a frenzy — he produced 2,000 paintings and drawings, most in the last few years of his short life. He might have had hypomania, an elevated mood state that enables a high degree of productivity. For some who have it, the mood largely sustains itself to productive outcomes. But for others, it precipitates an emotional drop to a depressive state, not unlike, but a modified version of, the swings that are characteristic of bipolar disease (manic depression).
Van Gogh’s diagnosis is incomplete and based on analyses that came decades after he died. So no one can be certain of what specific illness or illnesses guided his paintbrush and the gun with which he committed suicide at age 37. But the painter is hardly alone; the arts are filled with personalities who by all accounts suffered some degree of mental illness in one respect or another: Mozart, Edvard Munch, Sylvia Plath, Jim Morrison, perhaps even Beethoven, Winston Churchill and Michaelangelo.
So the study of hypomania — a more moderate, sublevel variation of mania, on the “up” side of manic depression — tends to look at highly productive people who are by nature creative. Note that the condition is reportedly not limited to the arts. In his book The Hypomanic Edge, the Link Between (a Little) Craziness and (a Lot of) Success in America(Simon & Schuster, 2005), author and psychiatrist Dr. John Gartner claims to recognize symptoms of hypomania in Henry Ford, Christopher Columbus, David O. Selznick and genome entrepreneur J. Craig Venter.
Not too shabby a club. Even if it involves the voluntary loss of an ear from time to time.
Researchers say that in the spectrum of bipolar disease, there are some people who never or rarely experience the depression end of it. A 2005 review of Gartner’s book in The New York Times includes an interview with Dr. Ronald C. Kessler, a professor at Harvard Medical School, who comments on hypomania: “When you look across the entire bipolar spectrum, you find that maybe 10 percent to 15 percent of these people never get depressed: they’re just up.”
It could be considered an enviable state. Kessler quotes another psychiatrist who said, “The goal in life is constant hypomania: you never sleep too much; you’re on; you keep going,” touching on the apparently lesser need for sleep and an increased productive output among hypomanic individuals.
Real people, real hypomania
To learn more about hypomania, I had an e-mail exchange with author Rick Singer, a psychotherapist and social scientist. Singer is the author of Your Daily Walk with the Great Minds: Wisdom and Enlightenment in the Past and Present (Loving Healing Press, 2006) and the upcoming Now, Embracing the Present Moment (O-Books, 2011). Singer believes he has hypomania himself. Here are parts of our conversation.
Russ Klettke: How do you define hypomania?
Rick Singer: [It is] a period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
Features of mania reflect a marked elevation of mood, characterized by euphoria, overactivity and disinhibition. Hypomania is a mild form of mania.
Yes, it can exist without depression; however, it is more common to have a period of moderate depression after a state of hypomania. Hypomania can lead to a full manic episode and is often what precedes a full manic episode in those suffering from bipolar disorder.
RK: What are some of the better “outcomes” or conditions for a person with hypomania? In other words, it can be a productive time for some people, yes?
Singer: It can be a time of extreme productivity; however, it can also lead to irrational and destructive behavior. When I experience hypomanic episodes, I can write very effectively and actually wrote a majority of my books when in this state.
RK: Might hypomania be characteristic of a more creative personality, or is there no correlation?
Singer: There is certainly a correlation with creative [output]. Manic depression and depression are very common in genius.
RK: Tell us about the downsides of hypomania — both from your study and perhaps clinical observations.
Singer: Hypomania can lead to irrational and often destructive thinking and behavior. Bipolar disorder is among the most dangerous of psychological disorders and creates great suffering. Many individuals stop taking or refuse to take medications because mania can be very enjoyable compared with intense depression. This state of going from one extreme to another creates incredible turmoil in human beings’ lives.
RK: Is there a known cause or causes?
Singer: There are tons of theories, but it certainly is not specifically known. Of course, it’s a biochemical abnormality in the brain; however, the exact cause is not known.
RK: Are there prescriptive pharmaceutical and nonprescriptive therapies that work?
Singer: Mood stabilizers such as lithium are the most common treatment. It is a highly biological disorder; thus medication is almost always needed, especially in the more extreme and dangerous cases.
A few nontherapists also shared with me their experiences with hypomania. One woman’s hypomania progressed to full-out bipolar disease:
“When I was manic, which happened after attending a three-day ‘energizing’ seminar on creating wealth, I charged a lot of their upcoming (expensive) seminars to my credit card. When I went to cancel them the following week, I racked up a very high long-distance bill on the phone, not cognizant of where I was calling and its consequences. For the week or so I was manic; I was unable to perform my daily functions at my job, nor get to any business-related meetings … I no longer knew how to arrive at locations or which subways to take (I had been using the subway system for over a decade).
Among many other things, I proposed outlandish ideas to my boss about how to make her company better, and decided my top floor city apartment was now a penthouse. Of course insomnia was completely a part of it all, where I was unable to sleep for a week (it didn’t matter how many Benadryls I took or how many soothing teas or hot milks I ingested, per therapist’s suggestions. I also forgot how to boil water for tea, and needed my boyfriend to do it for me). If anything, I did accomplish some things I had been putting off, like writing a letter to an author who had completely misquoted me months earlier in a book. I was not shy about telling her how I felt. Other than that, several people thought I was ‘really funny.’ But for the people closest to me, it really was not that funny. Soon after I was put on medications, and stabilized on lithium carbonate. Normally, I’m a very competent and reliable person. I have a BA and MA (4.0 GPA).”
Another person, the wife of a man whom she describes as hypomanic, shares, “He is currently building a large closet in my bathroom while hypomanic. Most of his projects get done in that state. It’s great that he has all that energy, but he does tend to get injured because he doesn’t think things through and can be really impulsive. He also spends a lot of money on tools and equipment for his projects without thinking about the bills.”
Beneficial hypomanic energy — or clinical bipolar disease?
The condition of hypomania is considered a disorder by the reference manual of record to the psychological sciences, the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). The manual states that the diagnostic criteria for hypomania require at least three of the following symptoms for at least four days:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- Increased talkativeness
- Racing thoughts or ideas
- Marked distractibility
- Agitation or increased activity
- Excessive participation in activities that are pleasurable but invite personal or fiscal harm (shopping sprees, sexual indiscretions, impulsive business investments)
How does one know if he or she has crossed the line from hypomania to manic depression? Hypomania can occur on its own, whereas mania by definition occurs only in conjunction with bipolar disorder. The more “advanced” mania symptoms are quite similar, except that the DSM-IV specifies they must last at least seven days, and the manifestations are so severe they lead to hospitalization, often as a result of psychotic symptoms — “a break with reality,” as it is sometimes called.
For the person with true hypomania, things aren’t nearly as bad. “It kind of goes against the common assumption, but many people who are inclined to hypomanic or manic symptoms have an underlying resilience,” according to Dr. Kay Redfield Jamison, who described her observations to The New York Times when discussing her book on the disorder, Exuberance: The Passion for Life (Knopf, 2004). Jamison, a professor of psychiatry at Johns Hopkins University, says her research shows that individuals with hypomania “may get trashed by their peers, laid low, but they respond very strongly.”
So whether your outlet is painting, exploring, inventing or building closets, you might be among the rare individuals blessed with that “up,” hypomanic ability to barrel into things with great creativity and productivity. But if your mood and the ways in which those moods manifest themselves fall with a thunderous crash, it may be something more serious and destructive. That would be a time to seek professional help.
Nevertheless, as Publishers Weekly describes in a review of Jamison’s Exuberance, the Peanuts character Snoopy might have had a handle on the relationship between hypomania and creative output all along.
“To those of us with real understanding, dancing is the only pure art form,” said the beagle. “To live is to dance, to dance is to live.”