IN HIS 1921 classic, Manic-Depressive Insanity, Kraepelin characterized some of his patients as “cyclothymic.” These were people who experienced mild ups and downs as a natural part of their personality. Hagop Akiskal of UCSD also uses the term in this fashion.
The DSM, however, views cyclothymia as an illness, a form of bipolar lite. These patients experience a chronic condition of fluctuating mood disturbances without breaking into full-blown episodes. The cumulative effect, though, is likely to cause great personal distress and interfere with normal functioning.
There is no right or wrong interpretation of cyclothymia, here. At this level, where illness bleeds into personality, it is virtually impossible to separate the two. This also applies with regard to hypomania (mania lite) vis-a-vis exuberance and how dysthymia (low grade chronic depression) relates to a depressive temperament. For right now, however, let’s simply acknowledge the cycling presence and the effect that even its slightest expressions may have on our overall well-being.
Imagine if You Will
The following was originaly published on BipolarWorld by Colleen Sullivan, and is used here with her permission:
This is a fictional story about Mark and Diane. Mark has cyclothymia.
Mark and Diane met at a time when Mark was in a hypomanic mood. He was charming and attentive, constantly surprising Diane with small gifts and tokens of his love. His courtship of her was a whirlwind of phone calls, dates and promises of love everlasting. Diane found him irresistible and soon found herself deeply in love with him. Both were working at good jobs making decent money and in a short few weeks decided to marry, and a honeymoon cruise was planned. During this time Mark's mood had shifted to normal, but he loved Diane and the marriage took place.
Though Mark struggled hard to hide it, he became depressed while on the cruise ship, withdrawn and indifferent not only to the events taking place on the cruise, but to Diane. It seemed all he wanted to do was sleep, and made excuses to her that he was exhausted after the events of the past two months. Diane tried to understand, but she was hurt, especially when he would say things like "Please just leave me alone. Go have some fun."
The morning before the cruise was to end Mark woke up a totally different person. Exuberant and full of excitement about making their last days special and memorable ones. Diane was thrilled - she had "her Mark" back (or did she?)
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Diane would soon learn that this was just a taste of things to come. Twice in the next months Mark lost excellent jobs, once because he was unable to get out of bed for several days and failed to call in and once because he decided he knew better than his boss. When he was depressed he was disinterested in working and gave no thought to finances. Diane worried about the bills and he would be angry if she tried to talk to him. Then before she knew it he was on top of the world. At such times he was wonderful with her, but Diane felt she was a ship at sea without an anchor. She never knew what to expect.
Neither did Mark. He was as much at mercy to his moods as Diane was. Yet, he couldn't truly understand why she was so upset. Mark didn't see anything aberrant about his moodswings - he had had them for years and thought it was normal for people to go through them.
Things came to a head one night when Mark arrived home, escorted by two police officers and charged with DUI. Diane gave him an ultimatum. Either they seek help or she was leaving him.
At the first appointment with the doctor Mark informed him that he was there at the insistence of his wife - that there was nothing wrong with him - and that he needed no help. The doctor disagreed.
I wonder if this story has a happy ending?
Revised July 8, 2016
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