THE HYPOMANIC PERSONALITY 57As David ’ s case shows, however, there is a caveat to taking medica-
tion. When hypomanics are on lithium, they discover that they are just
like everyone else — a goal that is desirable only when the going is rough.
To b e m i d d l e - of - the - road is not attractive to a person who has been on
the mountaintop. Life in a medicated emotional state may seem fl atter,
less colorful, and less fun. Hypomanics with this reaction may continu-
ally compare their present state with the former in its best moments —
those times when they were at their liveliest, most creative, and most
outgoing. Missing the highs of hypomania (and the lively people they
themselves were under its spell) may lead them to stop taking medica-
tion. In other words, there is an addictive quality to the hypomanic state.
Treatment is complicated because once lithium is effective, people taking
it often believe that they are able to handle things without it and refuse
further treatment. It is no easy task to make people who do not want to
take medication do so. After all, there are no pills for people who do
not want to take pills.
The hope is, of course, that taking drugs for the regulation of moods
will not limit the creative abilities of people with bipolar disorders. With
the fl ood of new medications being developed for bipolar disorders, we
are a long way from hearing the last word about the extent to which
creativity and productivity are affected (if at all). At present, research
shows confl icting fi ndings on the effects of medication on creative
achievement.
However, although there are real problems in giving pharmacologi-
cal treatment to people with mood disorders the consequences of not
doing so are far worse. If nothing is done about bipolar illness, it will
progress, the mood swings becoming increasingly frequent and severe.
Depression may intensify, increasing the risk of suicide. Modern medi-
cine permits relief from the extremes of despair and chaotic behavior,
allowing choices that were not previously available.
Psychotherapy in combination with medication can be a very effec-
tive means of treatment. Medication frees the person from the devasta-
tion caused by extreme depressive and manic episodes. Psychotherapy,
for its part, helps the person deal with the disorder, assisting him or her
to understand the psychological implications of mood swings and their
aftermath and persuading him or her of the need to take medication to
prevent a recurrence. Therapy can also be seen as a form of preventive
maintenance: the hypomanic client, as a life strategy, takes steps to
mitigate the expected fl uctuations.
Of course, suggesting therapy is easier than initiating it, because
hypomanics are not always the best listeners. While in a hypomanic
state, they rarely have genuine insight into their condition. Furthermore,
whether high or low, they may not have a good sense of how they are