Subject: [LONG] Dealing with Hypomanias

From: Shlomi Fish <[email-masked]>
Date: Tue, 20 May 2008 15:06:30 +0300

Hi all!

This is an essay I started writing, currently in email format, in which I am 
giving my experience of dealing with hypomanias, and to a lesser extent 
clinical depressions, clinical anxities, and unipolar and bipolar disorders 
in general.

It's still very rough on the edges, so any commentary will be welcome 
(including corrections of errors). It's also incomplete, and I still need to 
convert it to DocBook/XML.

If you're responding to the list, please trim the text.

(Oh, and Chen, please allow Elizabeth to reply.).

The permanent version is currently on:

http://www.shlomifish.org/dealing-with-hypomania-email1.txt

But here goes nothing.

Regards,

	Shlomi Fish

--------------------------------------------------------------------------

First of all - a note:

In a previous email someone complained that I should write my emails more
carefully, cite sources, research the subject, etc. and not just write them
offhand. In response, I'd like to note that xkcd explained very well
what happens if you take it to extremes: http://xkcd.com/406/ .

I have different levels of discipline for different levels of documentation
(SMS, Email, IM, IRC, Blog posts, blog comments, essays on my sites, stories
I'm writing, etc.). I haven't yet written a scientific paper, but this will
require a whole new level of discipline. I don't expect any original post
to a mailing list to be fully researched and 100% correct (from the many
aspects of correctness), much less a reply. 

So you won't be able to cite what I write in a scientific paper, but I feel
I have to pay this price if I want to actually write it faster and write more.
(See http://www.paulgraham.com/hp.html for more about this.)

It doesn't mean that I completely lack any discipline when writing an email. 
It's just that I'm taking it into proportion depending on the context.

-----------------

Now onwards. This email is kind-of a brain dump of mine for a topic I've 
wanted to write about for a long time. I plan to eventually convert it to 
DocBook/XML and research it some more.

The topic in question are Hypomanias 
( http://en.wikipedia.org/wiki/Hypomania ), which while containing the word
"mania" are actually below mania, and the person is still in control to
some extent, and, with some awareness, may realise he's in a bad condition
and should improve. 

Hypomanias are a variation on Clinical Depressions (
http://en.wikipedia.org/wiki/Clinical_depression ). The latter are not 
everyday
"I am depressed." depressions, but rather a feeling that one is bad, being
consumed with guilt, with a tendency of being less communicative and less able
to perform your responsibilities.

Now I probably have Mania-Depressia ( 
http://en.wikipedia.org/wiki/Bipolar_disorder ) because I had a single
"Grand Mania" and a few smaller manias, and have frequent Hypomanias, and have
been clinically depressed or clinically anxious at the time. So I'm writing
about this from experience.

------------------------------------------------

Quoting from the Wikipedia ( 
http://en.wikipedia.org/wiki/Clinical_depression ),
the symptoms of depression are:

{{{{{{{{{{{{{{{{{{{{{
* Persistent sad, anxious or "empty" mood 
* Loss of appetite and/or weight loss or conversely overeating and weight gain 
* [[Insomnia]], early morning awakening, or oversleeping 
* Restlessness or irritability
* [[Psychomotor agitation]] or [[psychomotor retardation]]
* Feelings of worthlessness, inappropriate guilt, helplessness
* Feelings of hopelessness, pessimism 
* Difficulty thinking, concentrating, remembering or making decisions
* Thoughts of [[death]] or suicide or attempts at suicide
* Loss of interest or pleasure in hobbies and activities that were once 
enjoyed
* Withdrawal from social situations, family and friends
* Decreased energy, fatigue, feeling "slowed down" or sluggish
* Persistent physical symptoms that do not respond to treatment, such as 
[[headache]]s, [[digestion|digestive]] problems, and [[chronic pain]]
* Decrease/Feeling in motor-speed (time seems to slow down)
}}}}}}}}}}}}}}}}}}}}}

These are mostly the external symptoms. While the exact thoughts differ from
person to person, here is how I felt:

* I felt I was bad and evil. That I was a bad person, having a bad influence
on the world, that "God hated me".

* I felt this was my true state, and that my happy, capable, intelligent and
active state was due to "a pact with the devil" or something along these 
lines.

* I found that the thoughts haunted me, that I couldn't really sleep, and
was afraid of thinking.

* I believed the entire world was bad and kept perceiving everything as bad.

* I had trouble communicating with others, and was afraid to tell them how
I felt.

* I found it harder to do things that I found easy to do. For example,
I spent hours on end solving a single math problem. I kept convincing myself
that it should be easy which made me feel much worse.

* I was consumed and overwhelmed with guilt. I felt guilty for many things
that I perceived as wrong.

--------

In regards to hypomania, Wikipedia says 
(http://en.wikipedia.org/wiki/Hypomania) : 

{{{{{{{{{{{{{{
* '''[[pressured speech]]; rapid talking'''
* inflated [[self-esteem]] or grandiosity;
* decreased need for sleep;
* flight of ideas or the subjective experience that thoughts are racing; 
* easy distractibility and attention-deficit (superficially similar to 
[[attention deficit hyperactivity disorder]]);
* increase in [[psychomotor agitation]]; and
* steep involvement in pleasurable activities that may have a high potential 
for negative psycho-social or physical consequences.
}}}}}}}}}}}}}}

It's a pretty good description of me when I'm hypomanic.

--------------------------------------------------

Many people (mostly computer developers) I've talked with admitted to have
been clinically depressed:

* One of my best friends has admitted that she used to have many depressions.
Whenever I met her in real life, or talked with her (on the phone, on IM,
etc) she seemed very cheerful, fun loving, intelligent, and rational.

She claimed that when she is depressed she tends not to communicate a lot
and also cannot achieve too much at work, which she said only makes her
feel worse. I can relate to both of these, as I recall that that was the case
for me on both accounts when I was depressed.

* I talked with a programmer, well into his 50's (and still active) who
admitted to having got into depressions several times in the past. He again
seemed normal (if somewhat eccentric to me).

* One time on irc.oftc.net someone joined and spoke in l33t-speak, asking
how he can be a "haxor". People thought he was a troll, but I ended up PMing
him and it turned out he was depressed. I spent the afternoon trying to
help him. Eventually, at evening, he claimed that he was feeling better and
parted. (It is known that often depressed individuals feel better in the
evening and at night.)

* A fellow programmer I talked with admitted to having got into depressions
in the past, and that she tried to function despite that.

* A fellow Perl monger I talked with said that he sometimes exhibited some
of the symptoms of hypomania. He seemed very hyperactive to me, so I wasn't
really surprised, but it may also be plain excitement and not a medical
condition.

----------------------

Here is a list of some famous people who have had Mania-Depressia:

http://www.mental-health-today.com/bp/famous_people.htm

Bipolar disorder is relatively uncommon and many more people are 
Unipolar and only have depressions and anxieties. Depressions and anxieties
are considered the "common cold" of mental illnesses, and are exhibited
in a large amount of the populace.

Someone told me that he read a study that said that roughly 50% of the
authors in the English language today have Mania-Depressia. I haven't been
able to find it online and would appreciate any references.

----------------------

Dealing with Clinical Depressions:
---------------------------------

There is a lot of mis-information and dis-information about depressions in
the public. When I was depressed and hypomanic as a teenager I didn't know
how to call these "conditions", or how to effectively deal with them. If,
after reading the description on the Wikipedia, you feel that you have been
depressed in the past, read on.

The best advice I can give on dealing with clinical depressions (and possibly
also as a preventitive measure or just to understand what people think) is
to buy the excellent book "Feeling Good":

http://www.amazon.com/Feeling-Good-Therapy-Revised-Updated/dp/0380810336

It is a self-help guide for cognitive-behavioural therapy[CogBeh], that was
originally written in English and was recommended to me by my therapist.
Just reading it helped me understand the source of my hypomanias, and I found
the exercises recommended there to be helpful as well.

{{{{{{
[CogBeh] - http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy
}}}}}}

Note that if you are depressed, and even more if you're feeling suicidal,
you need to consult a cognitive-behavioural therapist for a session, as
soon as possible. I am not a mental health professional and am not qualified 
to give professional therapy, and this essay is not a substitute for it.

A few things that should be realised:
-------------------------------------

    1. Mentally Ill is not Eccentric
    --------------------------------

When people say that someone is "crazy", "insane", "out of his mind" etc. they
usually mean that he or she is eccentric or behaving irrationaly, not that 
they 
are mentally unsound. I know and have heard about many people who are 
eccentric
or very eccentric and yet are perfectly sane, and lead perfectly happy lives.

There's a difference between conformism or "being normal" and mental health. 

    2. Not every bad mood is bad:
    -----------------------------

Some bad moods are normal and are a healthy part of living and would not
lead to depression. For example, if someone you cared about died, it's
perfectly OK to feel sad. Rational fear is also normal and healthy. (but one 
should avoid irrational fear). My point is that one cannot or should not be 
happy all the time. Sometimes it is also OK to be a little "down". 

    3. Drugs are not the most Effective Way to Treat Depressions
    ------------------------------------------------------------

Depressions have a cause. According to "Feeling Good" it's usually a
thought or a group of thoughts that is bothering someone, and caused someone
to feel depressed. Psychoactive medication aims to deal with the symptom
that is a chemical problem in the functioning of the brain. However, it
does not deal with the actual cause that is the mental problem.

So you still need cognitive-behavioural therapy and to read "Feeling Good".

That put aside I should note that I am taking medication, prescribed
to me by a Psychiatrist. It does not prevent me from becoming anxious, but
it may make the anxieties less severe (I'm not entirely sure about that).

Computer Developers and Anxieties:
----------------------------------

Computer Developers are probably likely to become anxious more than people
of most other professions. With the irrational working hours (see 
http://www.igda.org/articles/erobinson_crunch.php ), tight schedules,
tactless or unfriendly co-workers, bad software management practices,
bad code and lack of craftsmanship, irrational management that
"demands-the-impossible", too few vacations, and other factors - it is
probable that they will feel trapped, resentful, unhappy and as a likely
result anxious or depressed.

As a software manager, it is your job to keep your software developers happy.
This means doing the exact opposite of the above-mentioned points. Refer to
this essay which I started writing:

http://www.shlomifish.org/philosophy/computers/software-management/perfect-workplace/

(Work in progress)

As opposed to common belief, treating your software developers with superb
conditions, will make them much more productive, not less. So make sure
you read my article above (and the links pointed to from it), and integrate
its recommendations into your workplace.

Naturally, this is more difficult to do if you're a grunt programmer. However,
you can still refer your boss to what I wrote if you feel he's reasonable
enough. If not, it may be a good idea to quit or even to relocate to somewhere
with more job opportunities. Some jobs are worse than being unemployed.

-------------

Obviously, from reading "Feeling Good", it is evident that depressions,
anxieties and hypomanias are not limited to programmers, and actually predate
programming by a long time. Many retired people also find themselves the 
sudden victims of these mental ailments. However, I feel that due to bad
state-of-the-art of software management in the world today, it is especially 
common there, than in most other jobs.

Some Advice from my Experience:
-------------------------------

Like I said, I still haven't fully recovered from my Mania-Depressia and
am still getting into hypomanias. However, here is some advice I can give
from my experience:

    #. Do Cognitive Exercises:
    --------------------------

This is probably the best advice one can give. Read "Feeling Good" and do the 
exercises given there. They are very helpful.

    #. Exercise:
    ------------

Exercising and especially doing aerobic exercise is very useful for preventing
or lessening anxieties.

    #. Diet:
    --------

I don't consume alcoholic beverages, don't consume caffeine, have never
smoked, and have never consumed any of the currently illegal drugs. While
it does not prevent hypomanias, I find that it makes me less moody, more
energetic throughout the day, and allows me to sleep better at nights. (I 
had also tried to refrain from eating sugary foods, but I didn't persist
in it very well.)

I also take multi-vitamin pills, and some people take many more individual
minerals than I do, and while I'm not sure it helps with anxieties, it's
very good for health and longevity.

    #. Relaxation:
    --------------

I also find that relaxing or doing things you love to do is helpful for
keeping a good self-esteem. It's especially important during anxieties.
Listening to music, sitting, thinking and doing nothing, taking a time
for leisure at the computer, are useful for relief from troubling thought.

    #. Write Down Your Thoughts:
    ----------------------------

When I'm hypomanic, I'm getting lots of good ideas: for stories, for essays,
random useful thoughts, etc. While a lot of them had seemed silly in the
past, some of them proved to be very useful and rational.[ManiaStories]

It would be a good idea to write the ideas down, or even work on realising
the essays or articles, because it makes one less excited and calmer. It
would be a good idea not to publicise them in public until you're well out of
a hypomania, because they may prove to be immature or silly in the
short-run.

I personally may have sometimes been rejected from jobs because of my many
things I've written online, and are easily accessible using a Google Search.
I don't mind that because I feel that expressing and publicising my
creativity is more important than making myself a better job candidate to
some "attractive" jobs. And some employers seemed to be very impressed by
some of what I wrote online, or at least did not mind that, and these seem
like jobs I prefer.

{{{{{{{{{{{{
[ManiaStories] - I even ended up finding many really crazy stories I had
during my "great mania" as fodder for the following stories:

* http://www.shlomifish.org/humour/humanity/

* http://www.shlomifish.org/humour/Star-Trek/We-the-Living-Dead/

And naturally my hypomanias have been catalysts for most of my other
stories.
}}}}}}}}}}}}

It is naturally a good idea to receive as much commentary as possible about
one's articles or writings in private before publicising them for all the
Internet to see.

    #. Be Honest:
    -------------

It is a good idea to admit that you're "stressed" - anxious, etc. My therapist
said that the word "hypomania" is intimidating because it contains the word
"mania", so one should rephrase it in case the other party is not that 
knowledgable about Psychology. Sometimes you may find some of your
friends or family (but not all) good candidates for consulting with your 
thoughts or feelings. I once spent an hour or so on an IRC conversation 
listening to a 19-years-old whom I knew, talking about her problems.
I also consulted people on IRC or IM about my own issues and often found
creative solutions or empathy.

This is doubly correct for talking with my family members.

    #. Maintain a low online profile:
    ---------------------------------

During a hypomania, it is a good idea to maintain a low online profile.
Namely, don't post too much to mailing lists or other forums, don't chat on
the IRC too much (and try to focus on technical problems or your psychological 
situation), and in general try to maintain a low-profile.

However, I feel that real-life meetings with people and talking to
them face to face is actually very good for one's well-being during a 
hypomania.

So if you can get a friend or a few to meet with you in a café , or go to a
club meeting, it will be a good idea.

-----------------------------------------------------------------
Shlomi Fish       http://www.shlomifish.org/
"The Human Hacking Field Guide" - http://xrl.us/bjn8q

The bad thing about hardware is that it sometimes work and sometimes doesn't.
The good thing about software is that it's consistent: it always does not
work, and it always does not work in exactly the same way.