Whenever I tell a new doctor that I’m hypomanic they ask me to describe what I mean when I use that word. I hate the question, because it’s glaringly obvious that they’re assessing my answers against criteria they have in their heads, probably derived from the big diagnostic manuals (DSM-5 or ICD-10). Obviously when hypo I do display classic indicators like decreased sleep, increased energy, increased libido, increased productivity and so on. And of course I understand there are core set of experiences people in a hypomanic state may share which is why they they tend to appear on mood monitoring charts or apps and in self-help books.
The problem with being measured against a general checklist is that accepted symptoms are not usually what I find herald hypomania. There are a whole a range of deeply personal things that I consider much more important in making my own assessment. So the risk of giving an honest answer is that I won’t match the checklist. I will not fit in the prepared box, so the clinician will conclude is that I don’t really know what I am talking about when I explicitly state that I’m hypomanic. This causes me huge frustration; I have worked and worked to be acutely aware of my mood states and to have that expertise dismissed because it’s unorthodox is upsets me every time it happens.
So I think I’ve decided I’m giving up on truthfulness with new professionals because I’m sick of my consistent, reliable signs of hypomania being seen as irrelevant. So I think I’ll share them here instead, and if I get up enough courage I might even pop a copy in the post to the psychiatrist ;)
Funny fingers. Whenever I’m going high I get this thing where I have to scratch or rub my fingers, especially the outsides of my little fingers. I have never successfully conveyed this experience to anyone. I tried to explain to the team registrar recently that it is something that I do it because my need to feel something there. He misinterpreted that and it’s written on my discharge letter that my fingers are numb. Not a bit of it. My fingers feel and function normally, but they need more sensation. I have to do it, I have to meet that need and give them more, otherwise the agitation builds.
Swagger. I’m hardly the sort of person that swaggers around the streets of London. In fact I’m often quite timid, scared of people when I’m depressed, ashamed of my body size and dreading the next time I’m asked me if I’m pregnant (no, just a quetiapine baby). Throw a little hypomania into the mix and I couldn’t be more different. Suddenly I walk in a completely new way. I stride. I sashay. I swagger. It’s a mixture of confidence, the certainty I am sexy, a touch of arrogance and a readiness to engage in confrontation. The best I can describe it is to suggest that you walk along to the track Battle Without Honour or Humanity and see how that feels.
Necklaces. When high, I dress differently – or as the registrar recorded, with more panache. It’s not just that I think more about my clothes than I would when I am depressed. It’s not that I go out and buy new clothes. It’s that apparently great outfits I hadn’t noticed now leap out of my wardrobe. Because my self-confidence is high I am also certain of my own attractiveness so it never occurs to me that I might not be able to “work it”. Most noticeably, the necklaces come out to play. Now, I will readily admit that I am a necklace fiend, if not a hoarder. I have about 50, all of them beautiful, and yet days or weeks can go by without me wearing a single one. In comes hypomania and suddenly the biggest and boldest, the “statement” necklaces, are also leaping out at me (and the compliments I receive of course reinforce my belief that I have great taste in jewellery and should hang on to every necklace I own, so yay).
Pointy teeth. For me one of the earliest indicators of a high is having pointy teeth. Of course my teeth aren’t really any pointier than usual; a quick check in the mirror proves that, as does the knowledge that this isn’t Bon Temps. But they feel much more pointy and I can’t stop running my tongue over them. This is part of a broader package of enhanced senses; my feet are more conscious of the interior of my shoes; things sound louder; colours seem brighter. But it’s always the teeth thing that tips me off.
Asinging and adancing. Based on my Twitter connections, this is a pretty common indicator but I’ve definitely never seen it on any mood chart. On an upswing I find myself travelling from room to room via the medium of Zumba-ish dance moves. When I would normally stand still – washing up, hanging the washing out, cleaning my teeth – I am side stepping or bum kicking or scooping (sorry, that probably make much sense if you’ve never done aerobics!). I chair dance while writing. I get up and start dancing when I should be working. I’m also very into singing, loudly and confidently, loud enough for my son to complain that he can hear me through two walls and a pair of headphones. At least he says I’m good.
Comely commuters. Often I will sit on the Tube and be oblivious to my fellow passengers, buried in my phone or my Kindle. Sometimes I will plug myself into my headphones and do a little people watching. But sometimes, hypomanic times, I find that the carriage is filled with unfeasibly attractive strangers. Everywhere I look there’ll be someone hot. I know I’m staring and that some people have noticed that I am staring and look puzzled and uncomfortable but I can’t help myself. They are literally mouth-watering and my breathing gets shallow, my pupils dilating. Luckily I am never quite manic enough to proposition anyone.
Sunsets. On an upswing, sunsets become almost unbearably beautiful. On long summer evenings when the pressure is high and the sky changes from blue to lemon to streaks of intense pink, I almost cry at so much splendour and the elation spikes and pulsate.
Tweet rate. I do type pretty fast – I learned in the fast-paced chat rooms of the very early noughties – and I do tweet a lot. But hypomanic I tweet a lot more, bam, bam, bam, one tweet after another and another. Online friends sometimes (with good reason) check in with me when they see how fast I am getting my tweets out there, but of course if I feel great I’m unlikely to want to tone things down. But I will probably note what they’re saying somewhere in the back of my mind.
Head music. Head music is another one I’ve frequently heard from other with bipolar but have never seen “officially” acknowledged. It is, I guess, a pseudohallucination – something that is “heard” within the head, but not as an actual sound as someone might experience if they hear voices. For me, it’s usually a loop of a particular song or piece, a particular musical phrase, a snatch of melody or, at its most annoying, a single word over and over again. It can easily be linked with a switch to mixed mood as I become very agitated by being unable to stop the music.
In the loop. Strangely the head music often has no connection at all to what I have been listening to. Which is a good thing, as despite the fact that I have 219 Spotify starred songs when I’m high I will play just one over and over, all day long (hoping the neighbours are at work). When Tom gets home and opens the door there is sometimes a very audible “Uh-oh!” as he clocks what I’m listening to. Again.
I’m not asking anyone to change any diagnostic criteria or mood apps on my account. In fact, I’m asking clinicians to do less work. I want them to sit back and trust that I know something about my condition and remember that I’m monitoring myself for the 23.5 hours a day while they get a 30-minute window. Now, I’m willing to bet that pretty much anyone who experiences hypomania has something weird and quirky that they know they need to watch that’s outside the diagnostic box. This is the stuff that professionals should value; they should be learning from our quirks. Don’t fence us in.