Hypomania and Exuberance - Which is Which?

Patient Expert

Hypomania in and of itself is not a pathology. According to the DSM:

The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

Fine, so why worry? Well, here's the catch:

The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

Okay, a little quiz: Two women are dancing on tables. One of them is the reincarnation of Marilyn Monroe. The other is someone whose idea of a wild night on the town is coupon night at the Olive Garden. Which one is experiencing hypomania? Which one is in more danger?

In 2004, Kay Jamison published "Exuberance: The Passion for Life." Her poster boy was Teddy Roosevelt, whose life, according to a friend, was the "unpacking of endless Christmas stockings." A journalist said that after you went home from a meeting with the President you had to "wring the personality out of your clothes."

You can make a strong case that TR lived with bipolar, but life on the "up" side of "down" clearly was not a problem to him. In her book, Dr Jamison makes it clear that exuberance is a temperament, a legitimate and beneficial part of one's personality, not part of a disease state. TR literally lived in "up." Up was no stranger to him.

As for Marilyn, yes, she too may have lived with bipolar, but in the context of her larger-than-life personality, who would even notice her hypomanias? Check out her hilarious banjo scene in "Some Like It Hot." Clearly, like TR, Marilyn was a natural exuberant. But, unlike TR, Marilyn did not die a natural death.

Dr Jamison cautions that there is the danger of crossing the line into being too exuberant for one's own good. Moreover, as much as society benefits from exuberant people, the world is also wary of them.

Hagop Akiskal of UCSD favors the term "hyperthymic." Thus, upbeat may be your baseline personality "trait", which is a very different proposition than being in a temporarily hypomanic "state." But Dr Akiskal sees personality traits and mood states as occupying the same spectrum, in effect bleeding into one another. Thus hyperthymic may morph into hypomanic.

Think of Marilyn - again. This time, recall her famous "Happy Birthday, Mr President" tribute to JFK. Vintage Marilyn, fully exuberant. But at the same time, she was completely out-of-control on the set of "Something's Got to Give."   When she called in sick for the 17th time, Fox fired her. Something had to give. Something, eventually, did.

To return to the two women dancing on tables: Same behavior, but two very different women. One is in her natural element, fully at home in "up." The other? Who knows were up will lead? To mania? To a crash into depression?

None of us want our personalities medicated out of us, and our doctors too often are insensitive to this concern. Too often, exuberance and hypomania look the same to them. Too often, we are conned into thinking it is the same. Alas, there is no easy way of knowing.

This is the tenth article in my series on "Up" that investigates mania, hypomania, hyperthymia, and any state that can be regarded as higher than "down." Previous pieces:

First Up: Mania
Does Anyone Truly Understand Up?
Dysphoric Mania
Mania and Hypomania's Dark Side
Mania, Hypomania, and the Dark Side of Bipolar
Mixed Bipolar States, Dysphoric Mania and Hypomania
Treating Mania

Recognizing Hypomania

Is There a Hypomanic Advantage?