Hi franz kafka. Do you have a psychiatrist that you can talk about this topic with that would be aware of your situation during your two hospitalizations? They may have insight into this that is not obvious to you.

When my mania is very severe, I do tend to have psychosis, but I've sure been full blown without the psychosis a number of times. The edge between "very hypomanic" and "full blown manic" is probably a curious one for some people. From my reading of others' experiences, how one person experiences full blown mania is not always the same as an other's. A person's "norm of conduct" can also make one person's full blown mania seem different, milder, or more severe than another's. One person's multiple piercings, tattoos, and mohawk could be stable behavior, while it wouldn't be for another.

In my case, I believe it is clear that I'm full blown manic when my behavior becomes scary to people, or attracts so much of an attention that people are shocked by my behavior. I think it's one thing for a person to observe an elated hypomanic and "laugh with them", "shake their heads", or think "Wow, she's REALLY in a good mood, exceptionally productive, loud/fast talking, or acting a little strange today!" It's another for them to see a full blown manic and say/think "What on earth is wrong with that person! OMG! Whoa, Nellie!"

Or if a hypomanic person is irritable, a person may say "Damn that person is an a**ho*e!" or "Cut the road rage!", "Shut the heck up!" or "Stop the tirade!" It's another to see a person with full blown mania that's in a fury basically looking like a psychopath killer, inspiring people to call the police, run away in fear, or have hospital security guys drag you in an isolation room for a nurse to give you an injection. In some of the latter cases, people get strapped to beds. I've also had a hospital guard assigned to sit outside my room and then follow me around the ward.

Definitely adding psychosis to either of the above full blown manic scenarios can be extra disconcerting or frightening. I know that psychosis even without bipolar is surely scary and can look similar.

I know that strangers saw me manic in the past, but maybe weren't immediately clued in that I was totally unwell. That's where knowing baseline can come in. Riding the border of the very hypomanic/manic is likely quite common. Or, there are just times when people don't see/hear everything, and definitely don't know what's all going on in your mind. I believe I was not really aware of the reality of my situation on many occasions. Insight is difficult. Mine has improved since I learned about my disorder, but isn't always perfect.