Hypomania

HYPOMANIA (from Greek hypo - under, below and mania - madness), a mild form of manic state. From the more severe forms of the latter, H. differs in that with it to a greater or lesser degree, clarity of consciousness, mental coherence, and the ability to orient oneself are preserved. The general excitement characteristic of manic patients in H. usually only causes increased mobility of mental processes, which sometimes makes the patient, especially at first glance, brighter, more interesting, and more original than he was before. What particularly strikes one in such cases is the speed and ease of the associative process: patients become excessively talkative, sparkle with witty turns of phrase and wordplay, grasp even distant degrees of similarity in things, readily joke, noting various minor shortcomings in those around them, make puns, compose poems, etc. Excessive talkativeness, however, represents only one manifestation of general motor excitement and increased striving for activity: the patient is in continuous motion day and night, knows no fatigue, and becomes extraordinarily enterprising. He feels a lively need for communication with people, takes part in all kinds of meetings, entertainments, and excursions, often becoming the soul of such gatherings, easily mastering any situation and impressing those around him with his resourcefulness and initiative. The mood of the patients is usually elevated, cheerful, colored by a feeling of heightened joy in life. Some of them say that only in such states do they fully understand how beautiful life is. For them, a day is not enough to exhaust its joys, people seem to them dear, good, and well-disposed, only the good and cheerful is remembered from the past, there are no worries in the present, and the future shines with rainbow hopes. Jokes, laughter, cheerful conversations do not cease from morning till evening. New people, upon first acquaintance, patients often charm with their cheerfulness and expansiveness. Only approaching the patient more closely does one succeed in detecting the pathological peculiarities of his condition: lack of unity in thoughts and actions and the resulting inconsistency, thoughtlessness, superficiality, and inconstancy. Even in the mildest degrees of the disorder, one is struck by the inability to think through one definite thought consistently, the variability of interests, jumping from one subject to another. Patients fall into exaggerations, take on tasks far exceeding their actual strength, make unnecessary acquaintances, write long letters to people whom they barely know. Every object that catches their eye arouses their greed; they enter into disadvantageous transactions, make unnecessary purchases, give generous gifts. The mental equilibrium of patients is easily disturbed; they completely submit to the impressions and emotional movements of the moment, and sometimes the most insignificant external causes on their part cause extreme irritation and acute outbursts of anger. In some, irritability generally comes to the forefront: they are impatient, demanding, inclined to argue and find fault, cannot tolerate contradictions. Almost always there is increased sexual excitability. Understanding of the pathological nature of their condition is usually absent. At first, and sometimes throughout the entire attack, patients can by greater or lesser effort of will suppress mental excitement and maintain control over their actions. Often they do not interrupt their usual activities for a single day, although their productivity, despite the increased striving for activity, objectively turns out to be reduced. In such states, they do not consult doctors, and therefore mild attacks of H. often go unnoticed. From typical manic attacks, the conditions described differ only quantitatively—in the strength and degree of the disorders presented; in some cases they proceed as independent phases of cyclothymia (see), and in others they represent only the introductory (or concluding) segment of a typical attack of manic-depressive psychosis (see). Hypomanic temperament (hypomaniacal). This term is used when elevated mood, excessive mental mobility, and striving for activity represent characteristics that do not describe individual moments in a person's life, but his constant mental makeup. Mostly in such cases, one is dealing with psychopathic personalities (they are also called 'constitutionally excited,' 'hypertimics,' etc.). But Kretschmer uses this term also to denote normal people with the so-called 'sunny' character and increased mental tempo—cheerful, mobile, and responsive people. It is precisely in them that the physical as well as mental peculiarities, which Kretschmer considers characteristic of 'cycloid' personalities, are best expressed. These are picnics (see Constitution), with rounded, natural, abundant and rapid movements—people 'in harmony with their environment': simple, sociable, open, understandable and easily adaptable to any situation, though not very consistent. They grasp any new thought easily, have many-sided, though usually not very deep, interests, are very energetic and show much warm love for work, to which they devote themselves with passion and enthusiasm, not always, however, enduring prolonged and systematic strain. Besides such a characterological understanding of the hypomanic temperament, Kretschmer also speaks of hypomanic psychopaths and of H. as a psychotic form. For him, however, there is no sharp boundary between these three groups, since they differ from each other not qualitatively, but only quantitatively: all this is different degrees of expression of the same variant of cycloid (or cyclothymic) constitution. Therefore, persons with a hypomanic temperament lying within the limits of normalcy represent precisely the most favorable soil for the development in them of attacks of manic-depressive psychosis.