[Paleopsych] NYT: Hypomanic? Absolutely. But Oh So Productive!

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Health > Mental Health & Behavior > Hypomanic? Absolutely. But Oh So Productive!
http://www.nytimes.com/2005/03/22/health/psychology/22hypo.html
March 22, 2005

    By BENEDICT CAREY

    "S ometimes when talking to people, I'll tell them that I've just had
    a lot of coffee, even though it's not true, because I know I fire off
    in all directions, and I can talk to you about anything - literature,
    string theory, rock guitar - I once worked for Leo Fender - and one
    thing I say to people is that, of course, I live near the edge; the
    view is better."

    Laurence McKinney, 60, who lives near the edge of Boston, is a
    business consultant, a Harvard graduate and self-described polymath
    who has had a career that is every bit as frenzied as his
    conversational style.

    Among other ventures, he said, he has started pharmaceutical
    companies, played in rock bands and helped design electric guitars,
    and written a book about the neuroscience of spirituality. This month,
    for the first time, he helped start a Web site for people like
    himself. They are known as hypomanics.

    At some point, almost everyone encounters them - restless, eager
    people, consumed with confident curiosity. Researchers suspect that
    their mental fever shares some genetic basis with that of bipolar
    disorder, known colloquially as manic depression, a psychiatric
    disorder characterized by effusive emotional highs and bouts of
    paralyzing despair.

    In recent decades, scientists have found that bipolar disorder is
    widely variable, and that its milder forms are marked by hypomanias,
    currents of mental energy and concentration that are less reckless
    than full-blown manic frenzies, and unspoiled, in many cases, by
    subsequent gloom.

    New research helps explain how people with manic or hypomanic
    tendencies navigate the small triumphs and humiliations of daily life,
    and provides clues to how some of them quickly shake off the emotional
    troughs that their ambitious natures should make inevitable.

    "It kind of goes against the common assumption, but many people who
    are inclined to hypomanic or manic symptoms have an underlying
    resilience," said Dr. Kay Redfield Jamison, a professor of psychiatry
    at Johns Hopkins University. "They may get trashed by their peers,
    laid low, but they respond very strongly."

    In a new book, "Exuberance," Dr. Jamison argues that flights of joyous
    energy similar to hypomanic states frequently accompany scientific and
    literary inspiration.Psychiatrists have known for more than a century
    that bipolar disorder, unlike any other mental illness, is often
    associated with some financial and professional accomplishment. Mania
    can inspire destructive shopping or gambling sprees, but it can also
    generate bursts of creative and focused work.

    Psychiatrists and psychologists have found ample evidence for bipolar
    tendencies in the life histories of many famous writers and painters.
    The composer Robert Schumann, for example, experienced extreme mood
    swings; so, some now argue, did the poet Emily Dickinson.

    Some studies suggest that first-degree relatives of people with
    bipolar illness, who are likely to inherit some genetic basis for
    bipolar disorder, are particularly likely to enjoy high socioeconomic
    status.

    Most recently, researchers have turned their attention to the mild end
    of the bipolar spectrum, and sliced it into many permutations. Bipolar
    II, III and IV, for example, each include depressive episodes and
    varieties of hypomania, or exuberant moods. Cyclothymic disorder
    involves rapid cycling from moderate depressive to manic symptoms, and
    hyperthymia is a state of elevated mood.

    "When you look across the entire bipolar spectrum, you find that maybe
    10 percent to 15 percent of these people never get depressed: they're
    just up," said Dr. Ronald C. Kessler, a professor of health care
    policy at Harvard Medical School.

    As one psychiatrist put it, Dr. Kessler said, "The goal in life is
    constant hypomania: you never sleep too much; you're on; you keep
    going."

    With the exception of Bipolar II and cyclothymic disorder, which are
    accepted as standard psychiatric diagnoses, these permutations of
    low-level bipolar disorder overlap with each other and with normal
    ranges of mental function so much that some scientists question how
    distinct they are.

    "For some of us, there is a lot of wariness about this tendency to see
    bipolar disorder everywhere," said Dr. William Coryell, a professor of
    psychiatry at the University of Iowa School of Medicine, adding that
    "it's very difficult to determine reliable boundaries between one
    diagnosis and another" and document the true prevalence of the
    conditions.

    Yet even if bipolar disorders can be reliably diagnosed in only 2
    percent of the population, some now believe that hypomania or similar
    charged states are more prevalent than previously imagined. About 6
    percent of college students score high on personality tests that
    measure hypomanic tendencies, some studies find, and about 10 percent
    of children rate as temperamentally "exuberant," a related quality.

    Outsized delight in small successes may be central to what kindles
    hypomanic natures and sustains them. In an effort to learn how the
    joys and sorrows of daily life affect mania and depression, Dr. Sheri
    Johnson, a professor of psychology at the University of Miami, began
    surveying men and women in whom bipolar disorder had been diagnosed.

    Originally, Dr. Johnson was interested in the effect of negative
    events, like struggles at work or arguments at home. "But the people
    in the study told us we were getting it wrong, that it was when good
    things happened that they felt they had their manias," Dr. Johnson
    said.

    In two studies involving 149 people, one completed in 2000 and the
    other a continuing project, Dr. Johnson has found that personal
    victories like a promotion oran award very often precede or coincide
    with manic symptoms, though the person may be feeling neither manic
    nor depressed when life takes a good turn.

    Even when small successes do not arouse manic symptoms, they appear to
    prompt exaggerated surges of confidence. In one study, scheduled for
    publication later this year, Dr. Johnson led a team of psychologists
    who rated a group of 153 college students on a hypomanic scale, which
    included items like: "There have often been times when I had such an
    excess of energy that I felt little need to sleep at night," "I often
    feel excited and happy for no apparent reason," and "I often feel I
    could outperform almost anyone at anything."

    The scale was intended to identify people at risk for developing
    bipolar disorders.

    The researchers gave the students a hand-eye coordination test, then
    told them that they had scored very well, regardless of their true
    scores. Offered a choice of which test to take next, the hypomanic
    group selected a significantly more challenging exam than their peers
    did. These students not only expected to do very well, Dr. Johnson
    reports, they were more willing than peers to pursue difficult goals
    after an initial success.

    Researchers do not know whether this surging confidence and hunger for
    challenge persists, or for how long, but it is a familiar pattern to
    some psychiatrists who treat mild forms of bipolar disorder.

    Dr. John Gartner, a psychiatrist in Baltimore who specializes in
    treating hypomania, recently published "The Hypomanic Edge," a book
    that identifies hypomanic symptoms in the lives of American historical
    figures from Christopher Columbus to the biotech entrepreneur J. Craig
    Venter.

    "These are people who are always moving the goal posts," Dr. Gartner
    said in an interview. "If they do well at one thing, they shoot for
    the moon."

    In a footnote in his book, Dr. Gartner recounts the story of how Henry
    Ford sailed off on a luxury steamer on a whim in 1915 to personally
    end World War I and bring world peace. "I'll bet this ship against a
    penny," Ford boasted to the reporters, "that we'll have the boys out
    of the trenches by Christmas."

    This grandiosity practically begs for a tragic fall. Difficult goals
    are by definition less likely to be achieved, even by those with
    mental power packs, and there is little question that people with
    hypomanic tendencies feel disappointment deeply. For some, their
    fevered, scavenging curiosity may overwhelm any excess rumination: new
    projects beckon before the old ones can be mourned.

    "I'm not so much smarter than other people as faster," said Mr.
    McKinney, the polymath near Boston, who contacted Dr. Gartner after
    hearing of his book. "I swing more often, I make errors, but I make
    them faster. That's how I sometimes describe it. If you can focus this
    energy, you can do great things with it. If not, well, I think it can
    be difficult."

    And that is one catch. Dr. Peter Whybrow, director of the University
    of California's Neuropsychiatric Institute in Los Angeles, said that
    he considered true hypomanic types to be rare and that some of them
    crashed at midlife, or later.

    "Usually what happens in the clinical domain," Dr. Whybrow said, "is
    that these people come in when they've had a business reversal and
    they're very depressed. They look back on their lives and realize that
    they were hyperactive, hypomanic, that they started a lot of projects
    but finished very few of them."

    The view may be better, but it is easy to lose your balance.