Making Sense of Mania and Depression - My Story of Bipolar Disorder

Written by Peter C. Whybrow

He lowered his voice. "As time rolls on, my head speeds up; ideas move so fast they stumble over each other. I begin to think of myself as having special insight, understanding things that others do not. I recognize now that these are warning signs. But typically, at this stage people still seem to enjoy listening to me, as if I have some special wisdom.

"Then at some point I start to believe that because I feel special, maybe I am special. I have never actually thought I was God, but a prophet, yes, that has occurred to me. Later--probably as I cross into psychosis--I sense that I am losing my own will, that others are trying to control me. It's at this stage that I first feel twinges of fear. I become suspicious; there's a vague feeling that I am the victim of some outside force. After that everything becomes a terrifying, confusing slide that is impossible to describe. It's a crescendo--a terrible tornado--that I wish never to experience again."

I asked at what point in the process he considered himself ill.

Stephan smiled. "It's a tough question to answer. I think the `illness' is there, in muted form, in some of the most successful among us--those leaders and captains of industry who sleep only four hours a night. My father was like that, and so was I in medical school. It's a feeling that you have the ability to live life fully in the present. What's different about mania is that it goes higher until it blows away your judgment. So it is not simple to determine when I go from being normal to being abnormal. Indeed, I'm not sure I know what a `normal' mood is."

EXHILARATION AND DANGER

I believe there is much truth in Stephan's musing. The experience of hypomania--of early mania--is described by many as comparable to the exhilaration of falling in love. When the extraordinary energy and self-confidence of the condition are harnessed with a natural talent--for leadership or the arts--such states can become the engine of achievement. Cromwell, Napoleon, Lincoln, and Churchill, to name a few, appear to have experienced periods of hypomania and discovered the ability to lead in times when lesser mortals failed. And many artists--Poe, Byron, Van Gogh, Schumann--had periods of hypomania in which they were extraordinarily productive. Handel, for example, is said to have written The Messiah in just three weeks, during an episode of exhilaration and inspiration.

But where early mania may be exciting, mania in full flower is confusing and dangerous, seeding violence and even self-destruction. In the United States, a suicide occurs every 20 minutes--some 30,000 people a year. Probably two-thirds are depressed at the time, and of those half will have suffered manic-depression. Indeed, it's been estimated that of every 100 people who suffer manic-depressive illness, at least 15 will eventually take their own lives--a sobering reminder that mood disorders are comparable to many other serious diseases in shortening the life span.

The crush of revelers in the Lamb and Flag had diminished. Stephan had changed little with the years. True, he had less hair, but there before me was the same nodding head, the long neck and square shoulders, the dissecting intellect. Stephan had been lucky. Over the past decade, since he had decided to accept his manic depression as an illness--something he had to control lest it control him--he had done well. Lithium Carbonate, a mood stabilizer, had smoothed his path, reducing the malignant manias to manageable form. The rest he had achieved for himself.

While we may aspire to the vivacity of early mania, at the other end of the continuum depression is still commonly considered evidence of failure and a lack of moral fiber. This will not change until we can speak openly about these illnesses and recognize them for what they are: human suffering driven by dysregulation of the emotional brain.

I reflected this to Stephan. He readily agreed. "Look at it this way," he said as we got up from the bar, "things are improving. Twenty years ago neither of us would have dreamed about meeting in a public place to discuss these things. People are interested now because they recognize that mood swings, in one form or another, touch everybody every day. Times really are changing."

I smiled to myself. Here was the Stephan I remembered. He was still in the saddle, still playing chess, and still optimistic. It was a good feeling.

THE MEANING OF MOODS

During a recent interview, I was asked what hope I could give those who suffer the "blues." "In the future," my interviewer asked, "will antidepressants eliminate sadness, just as fluoride has eradicated cavities in our teeth?" The answer is no--antidepressants are not mood elevators in those without depression--but the question is provocative for its cultural framing. In many countries, the pursuit of pleasure has become the socially accepted norm.

Behavioral evolutionists would argue that our increasing intolerance of negative moods perverts the function of emotion. Transient episodes of anxiety, sadness, or elation are part of normal experience, barometers of experience that have been essential to our successful evolution. Emotion is an instrument of social self-correction--when we are happy or sad, it has meaning. Seeking ways to blot out variation in mood is equivalent to the airline pilot ignoring his navigational devices.

Perhaps mania and melancholia endure because they have had survival value. The generative energy of hypomania, it can be argued, is good for the individual and social groups. And perhaps depression is the built-in braking system required to return the behavioral pendulum to its set point after a period of acceleration. Evolutionists have also suggested that depression helps maintain a stable social hierarchy. After the fight for dominance is over, the vanquished withdraws, no longer challenging the leader's authority. Such withdrawal provides a respite for recovery and an opportunity to consider alternatives to further bruising battles.

Thus the swings that mark mania and melancholia are musical variations upon a winning theme, variations that play easily but with a tendency to become progressively off-key. For a vulnerable few the adaptive behaviors of social engagement and withdrawal unravel under stress into mania and melancholic depression. These disorders are maladaptive for the individuals who suffer them, but their roots draw upon the same genetic reservoir that has enabled us to be successful social animals.

Several research groups are now searching for genes that increase vulnerability to manic depression or recurrent depression. Will neuroscience and genetics bring wisdom to our understanding of the disorders of mood and spur new treatments for those who suffer these painful afflictions? Or will some members of our society harness genetic insights to sharpen discrimination and drain compassion, to deprive and stigmatize? We must remain vigilant, but I am confident that humanity will prevail, for all of us have been touched by these disorders of the emotional self. Mania and melancholia are illnesses with a uniquely human face.

From A Mood Apart by Peter C. Whybrow, M.D. Copyright 1997 by Peter C. Whybrow. Reprinted by permission of BasicBooks, a division of HarperCollins Publishers, Inc.

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