While it is true that patients who experience hypomania as a side effect of Clonazepam may prove to have a form of bipolar disorder that has previously gone unrecognized, drug-induced hypomania is not invariably indicative of bipolar affective disorders.
It’s frustrating because suddenly I’m facing the woes I wrote about in college regarding labeling mental illness, and the impact of the use of labels, such as “creative” or “over-achiever”.
- I am hyperthymic, literally, “over spirited”.
- It’s not a diagnosis, because being “consistently happy” is not recognized as a mood disorder.
- I became hypomanic, but that wasn’t exhibiting hidden underlying bipolar or schizophrenic disorder.
- It’s not bipolar… it’s drug induced paradoxical side effects.
Label it or Leave it?
Some people would include in the Bipolar Disorder category a consistently elevated mood called hyperthymia. Being constantly upbeat and always enthusiastic is not unheard of, but it is not the norm in the general population. It is more common to experience a fairly steady, neither-too-high-nor-too-low mood characterized by some contentment, some discontentment, some happiness, and some sadness — usually associated with external events such as receiving good news, problems with personal relationships, etc.
Does a long-lasting, exuberant mood that causes no problem need to be placed on the spectrum of mood disorders? In a clinical sense, no. If it poses no threat to anyone’s health, it is not a concern for psychiatrists. Cataloging and understanding a mental state like this, however, may help us better understand the full spectrum of emotional states related to mood disorders and provide clues about what can go wrong when moods become extreme.
Some people always seem to be upbeat and energetic, trying new things and initiating new projects. This trait, which is sometimes called hyperthymia, is not unlike being on a “permanent high.” Some people argue that hyperthymia is a type of mood disorder that results in high activity and inflated sense of self-esteem — something like living with constant hypomania but with the crucial difference that it is not as clearly episodic. Instead, it seems to last and is without any associated depression.
While observations of many people indicate some of them have this mood trait, hyperthymic disorder is not recognized as a mood disorder by either of the two mainstream authorities, the American Psychiatric Association and the World Health Organization. It appears in neither of their diagnostic manuals, the DSM IV and the ICD-10.
On the surface, people with hyperthymia seem optimistic and full of energy. They radiate self-confidence and self-reliance; they seem to believe they can do whatever needs to be done. They thrive on new experiences that promise variety, intrigue, and novelty. Usually, they have a great many personal interests, as well as plans for the future. They also can be articulate and witty.
It might be most accurate to think of hyperthymia as a temperament or personality trait rather than as a marker of a mental disorder. Of course, if this trait causes problems, then it becomes a legitimate subject for psychological or psychiatric care.
In fact, criticism of mainstream psychiatry is often directed at its alleged predisposition to label people with problems that don’t exist. The inclusion of homosexuality in earlier editions of the DSM IV — an error since corrected — is a frequently cited example. The reality is if someone is not unhappy, suffering, or a threat to themselves or others, psychiatrists have no reason to intervene. They are busy enough treating people with serious mental problems. It is only when complaints or serious problems appear that the labels of the DSM IV are applied as part of the process for providing effective treatment. A hyperthymic personality can be satisfying, productive, and creative. But if for some individuals it is a manifestation of a part of a spectrum of mood disorders, it could be problematic. For example, some people later diagnosed with bipolar disorder first seek help with depression after they have experienced a set-back in their lives. A close look back over their lives may reveal that they have been hyperthymic. Rather than having easily recognizable mood swings, these people may have been experiencing years of constant emotional elevation and enthusiasm along with a long history of uncompleted endeavors.
Also, the lack of a healthy response to the full range of life experience might cause problems for some people who always seem to have elevated spirits. A full, healthy life for most people includes periods of elation and introspection, action and reflection. If only one pole of our emotional lives is present, we may miss the benefits of the counterbalancing half of our responses to events. Consequently, we may lack understanding and empathy in the way we interact with people and respond to events in our lives.
I write with a weary head—last night made my heart tired, and I carried that heavy heart to bed, as I finally got home sometime after three in the morning.
My friend, he’s 37, a former Army man. We only met this summer, but we’ve hung out quite a bit since that chance meeting in August.
He invited me to his friend’s karaoke night. She’s a friend, a co-worker I think, young, something like 26, and single. I met her earlier that night as I learn he’s procured the “goodies” for his friends and we’re going to drop hers by her place in Ocean Beach before her dinner… karaoke isn’t until later. I learn that it’s something like $60 bucks worth of white powder.
As I see her, I already feel underdressed for her party to come… She’s in a short shirt (or shirt dress?) covered in sequins, black fishnet leggings, and applying false lashes with very dramatic, artfully applied eye makeup. I had chosen a striped knit shirt that shows of my curves, but isn’t much more interesting than that, and a pair of jeans with boots.
Her apartment is typical of that in Ocean Beach. Her front door opens to her parking space immediately adjacent to the alley and the busy street. Incense of some sort is burning, and it’s adorned in an eclectic mix of items collected, the quantity and quality expected of a just-out-of-college girl, as I assume she is.
We leave and make our way back north along I-5 and into a neighborhood where, coming from my beach life perspective, I’m pleased to see real houses. You know, the kind that some kids are lucky enough to grow up with. This one a split level, enough bedrooms for the parents and kids, a small yard, garage, lined up on a street of all the same and a culdasac or two for good measure.
Here I’m to meet the friends he grew up with. He considers these friends his “family”, inasmuch as he considers the friends in his Mission Beach ‘hood and co-workers just “friends”.
They have two little girls, about 5 and 6 years old, one a red head and the other a blonde, otherwise difficult to tell apart. We bring the count of couples up to three, and we’re there to hang out a bit before taking his pal, Pete, with us to the party. He grew up with the boys too, and is in from out-of-state. He seems quiet, though it’s hard to tell, as he’s sort of stuck back behind me in the corner in a seat a little apart from the circle.
Sitting in the living room with these friends, I quickly felt welcome and included. Much like eager parents, they are happy to welcome a girl into his life. They tell stories about childhood in their suburb of San Diego. Playing football, warrior like battles of throwing sticks, then graduating to swiping liquor from the uncle’s cabinet and replacing the vodka with water.
As I relax in my rocking chair it’s easy to see myself hanging out with these guys again. Easy going and warm, and when we have to go, a round of hugs to go with their hopes that we’ll do it again soon.
I go to grab his car, he borrows a cooler to stock for the party. I’m the designated driver. Pete climbs in the backseat.
I’d been hanging with my pal all day, and I wonder at how it is he’s not simply starving. No breakfast, at about three in the afternoon we’d had a half of a Rubicon deli half sandwich each. Plenty for that moment, but long since forgotten and long in needing. As we approach Muzen, the Vientamese karaoke join, I ask if I can drive through Wendy’s real quick for a burger. He doesn’t eat anything.
Earlier he had explained a bit of the in’s and out’s of cocaine to me. How it just amplifies whatever it is someone is… crazy people become crazier. Normal people just seem to have much more energy. He said he’d had a “bump”, “testing out the goods” earlier. I think maybe he’d had two or three lines thus far. I have no idea how much that is, I have no idea about using cocaine, and just a little more about living with it in your world. I think maybe it’s the cocaine that keeps him from being hungry. In this moment, I feel like I should apologize for being hungry, for the quick drive thru detour…
We arrive, and turns out this isn’t the same place as they’d been before. It’s not BYOB, but he hustles the guy at the desk, passing him two bills, a twenty on the outside, as I help him carry the cooler past into the room.
The room is much larger than times I’ve gone to Asian karaoke. I’m relieved to see that the people inside are dressed like me, I fit in. Peter was ahead of me and grabbed a seat on the corner of the couch. My pal seems to now been in performance mode, assuring his presence is noted among his friends. I take the small corner of the couch next to Peter, happy that there’s someone else here with us. It’s not feeling much like an us. As far as us goes, I guess you’d say he didn’t introduce us—Peter and I, to his friends.
He fixes me a drink—it’s three or more hours before I’ll be driving us home. I’m okay with that, though I know to some of my more conservative friends being the DD means respectfully no drinking at all. Meanwhile, it the party girl is smashed, and he is keen to catch up quickly adding two more beers to the three or so he had at our last stop.
Peter and I talk a bit, left to each other alone in this group of commrades. He doesn’t know anyone here either—maybe he’d met two of the girls once before. I learn he’s single, and as quite an attractive guy, I comment on the single girls. Turns out it’s just the belle of the ball who’s solo, and so far her performance isn’t attractive to his eye.
The contrast deepening between these two men, I become ever more thankful that Peter was along for the ride.
Meanwhile, the shirt dress outfit struggles with boundaries, especially as she starts performing dramatic drops to the floor in a half split. Obviously intentional, but I’m not so certain about the intent of her friend who routinely comes from the couch to stand from behind, hoisting her back to her feet lifting from her under her pits. It makes for interesting people watching, but I wonder if she’s aware of how it looks to us. It appears to be no easy task for her friend.
Our pal is quick to ensure everyone has a drink, and with assistance his bounty is gone. He’d taken $20 from Peter in the purchase, but I notice he’s had only a couple beers, turning down new ones from our ever eager host of sorts. Some are dispatched to the store nearby to procure more. I don’t know if our pal went or not, while the room was open, I had long given up on his movements. He hadn’t even spoken to me more than once or twice since entering.
Peter was a back up singer from the couch, but I took on a couple of songs. The other single guys interacted with me, seemingly uncertain of who I was and why I was there. Sitting besides Peter the entire time, I don’t blame them, who knows who I am, and if I’m game. The volume prevented conversation to distill the truth.
I watched him encourage dancing on the couches, the leader of the pack. Not that they needed too much encouragement, but I suppose it was something of the age difference, made more apparent by the two of us—Peter and I—as the seeming wall flowers. He called for the party girl to get up on the table and dance, suggesting Coyote Ugly. I fear for her, as she’s already kicked over my cup, spilled a few drinks, and besides the table being strewn with drinks, it’s also covered in liquid. I don’t know if she ever made it up there, I just recall seeing her making an attempt, lifting her foot to the table, but teetering backwards. I wonder if she realized that her top wouldn’t allow her to make it up there… though since I’d seen everything between her legs several times already, I’m not sure that’d really be something that would matter to her. I wonder how much of her goodies she’d consumed already. She talks to one of her friends about how the guy running the place has singled her out, I couldn’t hear the descriptive she used, but the point was clear. She thought herself undeserving.
All in all it wasn’t so bad. Tame really. I compare to my experiences with my friends in San Francsico, and frankly with them I’ve had far more fun. Packed in, having to share laps as seats, hot and smelly. We too have plenty of sequins and short dresses. And we’ve definitely danced on the tables.
The unsettled difference isn’t quite apparent to me yet.
I’m surprised to find it’s after 1am, as I had known the reservation to have gone until midnight. Frankly, it pleased me that time passed so fast. Hanging out with my pal has made me feel a little bit lame. Not quite able to hang as long, as strong, and no desire to waste my days away in hang over.
My self-prescribed lameness returned as Peter and I hear our pal working making plans to move the party to his place. I think Peter had hoped for some time with his pal, being as he’d driven 8 hours to visit, and was just here for the weekend. I know I had hoped to return to a scene more like the house of friends earlier. Several people had left already, it was the singles who were raring for a plan, and he was all too happy to promote his, to our dismay.
I was going to drive Peter “home” on the way back, but our pal applied multiple aspects of peer pressure, I think it sealed the deal when it came down to the other car following us. Meanwhile, I could hear the negotitations of the other car. Party girl wanted to carry her open bottle of champagne, and I heard someone suggest putting it our car, as I was the sober driver. Geez. I saw that bottle set aside atop a trash can.
In the car, our pal became an animated conveyor of plans, repeating himself again, and again. As he addressed Peter—his wanting to go home, his not singing a song, etc, I found myself wanting to defend him. What? Our pal didn’t get up and sing a song either… he was just a clown on the microphone, using it to instigate, notsomuch sing. And hey, not being introduced didn’t leave either of us much impetus to converse, let alone that the volume that accompanies Asian karaoke.
Peter relented. I just knew he’d regret the decision.
Our pal urged me on—faster—to the liquor store, worrying we’d not get there in time. The shop was closed. I’m aware of being careful of those following behind, and negotiating where I was going with my drunk (and I assume, still high) navigator who urged me again to go faster, even though we’d exited the highway and were now on the closing time, people strewn streets of Mission Beach. I was relieved to hear Peter pipe up from the back seat trying to settle him down a bit. The next liquor store was also closed. Darkened so that we didn’t even notice it was there as we passed. Now, onwards to the grocery store—it’s 24 hours. I park in the underground lot, and the other car pulls up aside. He runs into the store, Peter in tow. Peter arrives back at the car to announce that they aren’t actually open and that our pal has moved on to CVS.
A security guard comes over to tell us that we can’t be parked there.
If I hadn’t already, this is the moment that I realized my position as the “adult”. The driver, the local, the one in the lead. I decided to stay put. Who knows where the pal that joined all of us together in this night was?
Turns out it was a smart move. When he returned to the car it was from 7/11, as it turns out that CVS was also closed. He proudly proclaimed his feat of aquiring 32 cans of cheap beer, and a bag of ice, which somehow had something to do with cutting the line.
I drove us, leading the car behind, to his place.
As he took my place to park his car in the garage, he told me that he wasn’t sure what they’d do with out him. When I replied that I wasn’t sure what he’d do without him, it was just a reply. He gave me the key to the door with quick instructions—open the door, put on music… anxiety isn’t quite the right descriptive. I don’t know what you’d call it. There were mere moments between my opening the door, and he coming in behind me.
I put the music on, and moved into the bedroom. Exhausted from his interupting my sleep the night prior in the wee hours in the morning, setting this day into play, I crawled on top of the covers to rest. Knowing that I would, earlier he’d said he’d change the sheets—the bed being given over to his guy friend and some girl he hoped to score with the night prior—but that wasn’t a priority now, and frankly, it wasn’t for me either. It’s not like I was going to be getting any sleep in this setting.
I got up after just a few minutes. I stepped into the living room to see him leaning over the stereo. He didn’t hear me. I warmed my hands at the heater, and when he turned he came over. Nearly the same moment, Peter came in from outside. He was going to catch a cab—go home. I quickly considered offering to drive him, borrowing the car, and perhaps even taking myself home while I was at it… No, at this point I was there to observe from a separated distance.
I felt for Peter. $20 funding drinks for people he’d never met, and now a cab ride that couldn’t be any less than $60 or $70, just minutes after arriving at the party he’d never wanted to be apart of any way.
Peter left, and he turned back to me. I snapped. I pulled my arm away, as he said I could just take a cab home too. No, I was going to wait until it was all over. I was appalled. How had I missed how little respect he’d shown his friend he considered “family”, and the girl he considered his “girlfriend”.
He might offer words of affection regarding those friends he’d known since grade school, but his actions showed no concern for the relationship. I counted myself the same. He didn’t care what I did—he’d pay for my cab—as long as it wasn’t an interruption.
In the moment my heart sank with sadness as I realized that the way I yanked my arm back from his touch showed more than any words could. My eyes must have too. And that I knew that from his perspective, it was all my problem.
I gestured that he should just join his friends, the party in progress, and return to his intent of getting wasted. I stepped away and back went back into the bedroom, this time pulling the blanket over my head to block a little of the noise, and the lights, leaving room to breath and see.
Party girl entered the bedroom, and a plate with more of the white powder was had. He stepped out of the room trying to prevent others from joining and having to share, and in that moment she took all there was left. Three swipes I believe, from the sound of the snorting. I’m pretty sure he was offering just one, but then again he didn’t intend to give away the $60 worth earlier, but I was starting to see why it was that he was so confused about the night before and all the money he thought he’d spent. He’d muttered something about $400 bucks. Yeah, I’d be concerned too, as it seemed that that was just another of his typical Thursday nights.
He came back in the room, and drawn with him with another of his co-workers. He saw the plate too, apparently he would have partook, but there wasn’t any left, but he’s offering to call his guy.
In the course of the next hour, while I attempt to rest in the dark room, waiting out the chaos, I hear conversations… someone pushing him to get more “goodies”, though the his guy hadn’t responded. Other voices join the mix, distinct in that they carried foriegn accents, Irish maybe. More hopes that they might score. Even from my distance, separated, observing by ear only in the bedroom, I could hear things growing out of the scope of his intent. He had come in early on to bring in my iPad, so it wouldn’t be swiped, and that left me thinking of my iPhone, sitting there playing the part of Rdio DJ. People came in and out of the room, to get to the bathroom. Party girl came in numerous times, her words were slurred to begin with, I don’t know how to describe the progression from there. She dropped something loud to the floor, in the darkness, and I wondered why she was spending so much time apart from her party people. Earlier she’d been alone in the house, on the couch, looking over a book. I’d gone to check out what was up, as she’d dropped something to the floor then too, and that sound alerted me to something amiss. My pal had been robbed apparently a few times before, people in and out of his open house while partying… oh, it’s just her. I didn’t address her, just moved to get some water before returning to the room.
It was near 3:30am. They are deciding to go to the bay. Chaos, commotion.
I’m not ashamed, I suppose purely for the fact that I think there shouldn’t have been enough shame left for me to take a part of it.
I got up and pulled on my boots, and grabbed my bag. She was huddled near him in the doorway to the room, a sad gesture to see. She thought she wasn’t visible, and the look that passed was obvious. Yes, I’m lame. Oh, wait. No, I’m not.
He stepped from the doorway into the living room, to clear way for me and that left her lingering oddly in the room. She stepped uncertain to the door, and I gave a firm hand to her back to guide her out the door, closing the door partially to make sure my intent was clear.
He had wide eyes, hard lined pupils.
I told him I was taking his car to go home, and conveyed my judgement.
He didn’t respond, except when I asked if Peter was still here, to say “No, he can take care of himself”.
For a moment I thought when he stepped to the door with his keys, that he was leaving me to take a cab, the only means by which it seems he’s ever able to travel or to convey me. No, he was going to pull the car out for me.
This guy, really, he’s a great guy.
But it was just that day that he had told me that he’d been mean to me to see how I’d react.
He opens doors, and he always pays for dinner.
He always pays for my cab.
I want a guy who can pick me up.
I left knowing he’s not that guy—he’d rather a beer in his hand.