Dr Jonathan Haverkampf
In this article I will focus on bipolar disorder, which means that episodes of hypomania or mania occur, mostly in sequence with episodes of depression. If you are looking primarily for depression as a topic, please look at my articles on depression.
Hypomania and mania are phases of elevated mood on a spectrum, with hypomania as the less intense form. During mania an individual behaves or feels abnormally energetic, happy or irritable.  The need for sleep is usually reduced during manic phases.  Depending on whether the state is one pf hypomania or mania, the activities and thoughts can still be goal-directed and useful to the individual in the former or increasingly chaotic and mostly harmful in the latter. In a full-fledged manic phase patients describe feeling of “embracing the world” and having the sense that everything is possible in the moment. This often means that the future and the past become subjectively more remote. Often individuals buy expensive goods and services they cannot afford, such as luxury cars (mostly men) or around the world trips, begin ‘great’ art or business ventures or throw themselves into risky sexual adventures
Bipolar disorder leads to more pronounced swings in mood and activity, which may be linked the fact that the risk for anxieties and, as a result, substance abuse is higher in bipolar disorders. Patients try to self-regulate with the help of a psychotropic substance, which can then lead to addiction if the bipolar condition remains untreated. In these cases, it is important to also treat the bipolar condition rather than just the addiction to remove the crucial factor that maintains the addiction.
While individuals can still have partial insight in hypomanic states, and as a result often function well on their job for a while, insight and coherent planning for the future collapse in manic states. However, in both states people often lack the insight and self-reflection to enter therap. Characteristically, even if problems in relationships and in one’s finances become apparent, the elevated mood supports the belief that one can solve these problems by oneself. Problematic is often also a reduced self-esteem which lies below the heightened mood, because the individual knows, at least subconsciously, that life feels more difficult than it should. This makes it difficult to accept help, if it is seen as a confirmation of one’s deficits. Convincing someone who experience hypomania or mania of the benefit of therapy thus involves two aspects, suggesting that the client not only has the present but also a past and a future and that the achievements and successes of therapy will come through the client’s abilities and are his or hers to claim.
Psychotherapy and medication are usually used. Mood stabilizers, such as lithium and substances from the groups of anticonvulsants and antipsychotics, are often prescribed if the bipolar disorder is at least of moderate strength, and also in a number of milder cases, depending on the impact of the condition on the patient’s life. As antidepressants can induce manic states in people with a predisposition for bipolar disorder, for the episodes of depression they should be used with care and usually under the protection of a mood stabilizer.
On the psychotherapeutic side, the main part is to establish a stable working relationship with the patient. This requires to meet the patient where he or she is emotionally. As meaningful communication with oneself and the environment is often reduced in manic states, this requires often an extra effort of empathy and alertness for the messages coming from the client.
Gradually and carefully bringing in the past and the future as important issues helps the client better reconnect with the own timeline, which can add stability if the client is open to it. In some cases, it might be necessary to first work out why the client’s entire time line has meaning and not just the moment. In episodes of depression an emphasis on the future rather than the past can be helpful, while trying to establish a more balanced view of the client’s past. Bipolar disorder is an up and down, and seeing these movements in the context of a larger picture rather than in the spur of the moment is to many clients extremely helpful.
The patient should be aware that meaningful communication in a manic, and also hypomanic phase, can be less efficient as when he or she is emotionally in a normal state. Feeling ‘bad’ or ‘too good’ filters out information that may be of significance to the client. Information associated with positive emotions tends to be filtered out in the ‘bad’ states, while the reverse is true for information associated with negative emotions. This also reflects on the communication with oneself, leading to a distorted image of oneself. This is what significantly contributes to the suffering, which in the manic phase also comes from overconfident decisions, such as borrowing large sums to start a business because the client believes about her customers that ‘if she builds it they will come’ in multitudes.
There are indications memory might be affected in manic states. But what happens is people seem to follow their derivative or superficial values, such as buying a car they do not need and might even not want in a more ‘normal’ state. It never fails to surprise, how much people in a manic or hypomanic state leave a sense of direction in life, which is often later in the depressive episode for the pronounced feelings of failure and self-blame. Bipolar disorder has affected many very creative people, but they usually were successful in their work because it followed a certain direction, which added stability amidst uncertainty. This underlines the importance of identifying one’s fundamental values, interests and aspirations if one suffers from pronounced mood swings, because they remain very stable and help chart a course and make decisions even when the world around seems different.
© Dr Christian Jonathan Haverkampf. All rights reserved.
This article is solely a basis for academic discussion and no medical advice can be given in this article, nor should anything herein be construed as advice. Always consult a professional if you believe you might suffer from a physical or mental health condition.
 American Psychiatry Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington: American Psychiatric Publishing. pp. 123–154. ISBN 0-89042-555-8.