It can be useful to think of bipolar mood and behaviour along two axes: depressed vs. elated mood and low vs. high energy levels. Sometimes people with bipolar can be both depressed and energetic, a so called mixed state. Some manic episodes will be energetic and accompanied by an elevated mood of optimism, joy and even ecstasy.
I agree that full blown mania needs to be treated.
> I agree that full blown mania needs to be treated.
Curious - is it your view that hypomanic symptoms don't need to be treated then? If so, why?
Edit: formatting
Mania on the other hand is basically like, you can't control the shit that comes out of your mouth. You act on every fucking thing that pops into your head, even when you recognize that it's hurting the people around you. You just can't stop yourself; its compulsive and incredibly distressing. People are uncomfortable around you and you can tell. Your judgment is impaired and you don't understand the grey area between right and wrong. You have like 15 thoughts flying through your head and you can't keep any of them straight for more than a few seconds at a time. It really, really sucks.
I generally agree with this to my experience, with the caveat that their depressive swings are managed well - via medication or other means.
It's easy to idealize a hypomanic phase for the creativity that often comes with it. However, it is important to not confuse creativity with hypomanic behavior.
With proper medication, the creativity is not actually dulled, but rather, the overexertion that comes with the hypomanic phase is reduced, thus minimizing the depressive swing. This enables the patient to be creative in a sustainable way.
This is a good educational site with a lot of info about bipolar II and hypomania: https://psycheducation.org/
To what I've personally witnessed, even hypomania needs to be treated too, or at the very least vigilantly managed because even if it's not immediately destructive, the depressive phase inevitably arrives and can be quite destructive.
So whom does the “treatment” benefit? ;P
No, real mania is dangerous and the patient surely benefits from treatment. But there is a rather wide gray zone where I sometimes get a feeling it’s not the patient that benefits from the “treatment”, but rather his or her social surroundings. Not entirely unproblematic from an ethical perspective... depending on the reasonableness of those in the social surroundings of course.
Patients who are hypomanic by definition aren't having marked impairments in social or occupational functioning and won't need to be hospitalized. There's nothing forcing someone who isn't currently on a psychiatric hold to take medication, so if they're taking it it's likely because they believe they're benefitting from it.
For example the Swedish journalist Ola Wong recently shared his story on national radio about going hypomanic and then full on manic during the Swedish "refugee crisis" in 2015. It was quite interesting to hear him describe how he just felt that his social surroundings of journalists and opinion makers had gone mad when they refused to acknowledge there were potential problems associated with accepting 160k refugees in a single year (relative to population that's like if the US accepted 5.2 million refugees in one year). After "banging his head against the social wall" for a few months he became more and more agitated and restless, and finally needed hospitalisation. Just weeks after his hospitalisation the debate climate turned around 180 degrees to agree with Wong. That probably helped his recovery. He seems to have had no psychiatric trouble before then, or after.
Now, was the problem entirely with Mr Wong? :P
Great and thought provoking example. I think you could argue there could be some genetic susceptibility to having a manic episode when placed under stressors like that, meaning potentially there's a relative with bipolar disorder or pretty severe major depressive disorder. I don't think most people would fall into a manic episode when placed in situations like that, but it is impossible to know. In my time rotating in the psych emergency department I saw someone with a similar presentation to Ola. No psychiatric history, stressful event happened, didn't sleep for a few days, came in in frank psychosis, treated with Seroquel, left the next day totally fine. Diagnosis given was brief reactive psychosis. Maybe the same happened for Ola Wong.
I agree that most would probably not have had the same reaction to the same circumstances. But after listening to Ola’s story I wonder if you couldn’t produce some instability in most people if you take something they care deeply about (in Wong’s case Sweden’s future and the role of his profession in it) and have their social surroundings deny obvious truths and thereby jeopardize it...
I'm not sure what you're basing this statement on, but it's actually anything but "fun" for the person experiencing the manic phase.