Readers following Wayne County Circuit Judge Wade McCree's Judicial Tenure Commission hearing might be wondering about hypomania, the condition that Judge McCree's lawyer reportedly offered as an explanation for some of the conduct at issue in the hearing. The British Journal of Psychiatry is skeptical that it can be defined, as explained in Hypomania: what's in a Name?:
‘When I use a word,’ Humpty Dumpty said, in a rather scornful tone, ‘It means just what I choose it to mean — neither more nor less.’(Lewis Carroll, Through the Looking Glass and what Alice found there, 1871)
The use of the term hypomania in this and other countries impressively follows the Humpty Dumpty principle. Indeed, in the UK many, perhaps a majority of, inpatients are diagnosed to be ‘hypomanic’, perhaps partly out of a sense of politeness. The term manic does, after all, have a pejorative flavour to some ears (paceJamison, 1996). The original Greek sense of the word is that hypomania is hierarchically below or beneath mania. It fills a gap between the full syndrome and more everyday states of elation. The issue is simply where to draw the line with mania, on the one hand, and with normality, on the other. If we actually use them, operationalised diagnostic criteria should permit us to do this reliably.
The 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10), the World Health Organization medical classification list, says:
The terms "mania" and "severe depression" are used in this classification to denote the opposite ends of the affective spectrum; "hypomania" is used to denote an intermediate state without delusions, hallucinations, or complete disruption of normal activities, which is often (but not exclusively) seen as patients develop or recover from mania. ... here is a persistent mild elevation of mood (for at least several days on end), increased energy and activity, and usually marked feelings of well-being and both physical and mental efficiency. Increased sociability, talkativeness, overfamiliarity, increased sexual energy, and a decreased need for sleep are often present but not to the extent that they lead to severe disruption of work or result in social rejection. Irritability, conceit, and boorish behaviour may take the place of the more usual euphoric sociability.
The controversial new DSM-5 officially coronated this week apparently doesn't offer much more assistance. It basically sticks to the script of DSM-4, except that it refines and adds more emphasis to symptoms of heightened activity or energy. DSM-4 defined a hypomanic episode as:
A) A distinct period of persistently elevated, expansive or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
B) During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
- inflated self-esteem or grandiosity
- decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
- more talkative than usual or pressure to keep talking
- flight of ideas or subjective experience that thoughts are racing
- distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
- increase in goal-directed activity (at work, at school, or sexually) or psychomotor agitation
- excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
C) The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
D) The disturbance in mood and the change in functioning are observable by others.
E) The mood disturbance not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
F) The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication or other treatment) or a general medical condition (e.g., hyperthyroidism)