As someone living with bipolar affective disorder (BP), my immediate thought turned to hypomania and how much it seems to conform (with certain caveats) with Pearce’s aims.
In his introduction to the Hedonistic Imperative, Pearce introduces hypomania and its cousin: full-blown mania. As someone who has direct experience of both, I’d like to expand on Pearce’s thoughts around bipolarity as a potential source of future unalloyed euphoria. I’ll also provide a critique of Pearce’s claims.
First, a little about hypomania itself. Pearce offers a relatively detailed expose in his introduction, and the history of BP can be found in a short article written by Neil Burton for Psychology Today which I’ve appropriated here. [2]
Over the years great changes have occurred in our understanding and subsequent definitions of bipolarism. The terms used for BP - ‘melancholy’ and ‘mania’ - have their origins in the Ancient Greek. The idea of a relationship between the two can likewise be attributed to the Ancient Greeks and particularly Aretaeus of Cappadocia in the century BCE. Although he suggested that both patterns of behaviour resulted from the same disorder, it was not until the modern era that this idea gained currency.
In 1854 Jules Baillarger and Jean-Pierre Falret independently presented descriptions of the disorder to the Académie de Médicine in Paris. Baillarger called the illness ‘dual-form insanity’ whereas Falret described it as ‘circular insanity’ and observed that it seemed to cluster in families, correctly postulating that it had a strong genetic basis. In the early 1900’s the psychiatrist Emil Kraeplin studied the course of the illness and found that alongside the extremes of mood could be periods of relative stability. It was he who coined the term ‘manic-depressive psychosis’ to describe it and it wasn’t until the 1950’s that the term ‘manic-depressive illness’ was used more accurately as a description, and not until the 1980’s that the term ‘bipolar affective disorder’ came to be used. This was primarily done as the latter was thought to be less stigmatizing than the former.
There are those, however, both among the psychiatric community and those with BD who prefer the original term as they feel it more accurately reflects the symptoms of the disorder. Nonetheless there are, in my opinion, good reasons for the latter term as it allows for a broader description of the spectrum of the illness, most notably those of hypomania and cyclothymic versions of the disorder.
A Brief Summary of Types of Bipolarism (from the Royal College of Psychiatrists’ website [3]) :
1. Bipolar I - generally typified by manic episodes and extremely high elation, happiness and euphoria coupled with the intense feelings of depression and despair (although a small minority of those with type I bipolar may only have manic episodes).
2. Bipolar II - periods of extreme depression coupled with hypomania, milder manic episodes.
3. Rapid Cycling - more than four mood swings in a 12 month period.
4. Cyclothymia - milder mood swings than with BD but can last longer.
5. Mixed States - where mania/hypomania occur together with depression. These derided periods can be particularly dangerous as along with suicidal ideation (if one reaches this stage) you also have the drive and energy to carry it through.
It’s worth pointing out that mania/hypomania can also be dysphoric, i.e. distressing and morose.
Causes:
• Believed to be genetic.
• May be due to physical problems with the brain which is why medication is the first port of call.
• Stressful life experiences or other physical illness.
Treatments:
Mood stabilisers such as lithium are often the first medications prescribed. It has a long history to treat both mania and depression and has been used for the past 50 years, although how it works is still not clear. The main difficulty with lithium treatment is getting the dosage right as there is a small gap between the therapeutic level and lithium toxicity. Nonetheless, lithium is extremely successful at controlling mood swings. Incidentally, Native Americans used to take those who exhibited psychotic symptoms to bathe in pools of lithium-rich water. Indeed there have been studies which suggest that trace elements of lithium added to water lower rates of suicide, homicide and rape in the population. Prof. Allen Young from Imperial College has called for more investigation into this, arguing that, ‘the eventual benefits for community mental health may be considerable.’ [4]
Other mood stabilisers include anti-epileptics such as sodium valproate, carbamazepine, and lamotrigine, as well as anti-psychotics such as quetiapine and olanzapine. Psychological methods are often employed together with self-monitoring of lifestyle choices such as stable sleep patterns, exercise and diet.
Outcomes:
Around 1% of the population will experience BD at some point in their lives. Medication regimes can last anywhere from a few months to lifelong. Median age of onset is 25 years. An equal number of men and women develop BD and it found across all ages, races, ethnic groups and social classes. BD results in approximately 9.2 years reduction in life expectancy and as many as 1 in 5 people with the condition complete suicide. [5]
Which brings me back to Pearce’s Hedonistic Imperative. Taking into account all of the above, might not research into mania/hypomania be a useful starting point? Indeed, is any pertinent research being undertaken given that Pearce states, ‘Toxic ‘medication’ can depress elevated mood to duller but ‘normal’ levels. Such flatter and supposedly healthier levels of emotion enable otherwise euphoric people to function within contemporary society [but] by the norms genetically enriched posterity, however, it is the rest of us who are chronically unwell - if not more so. Contemporary standards of mental health are just pathologically low.’ [6]
Optimistic words indeed. But is there actual research to back them up. Well, yes and no. Pearce owns BLTC Research, a series of websites to publish online texts support paradise engineering and abolishing sentient suffering for future generations. The websites promote high-tech anti-ageing as well as information about pharmacology, biopsychiatry, molecular genetics and genomic medicine. There is a huge amount of data spread across these websites but I bravely ploughed ahead and read as many of the papers concerning research into mania - sorry, mostly abstracts - as I could. There was a lot of it, from areas such as investigations into the Self-Report Manic Inventory to ‘Manic Mouse’ where mice missing the GluR6 gene were observed with control mice who had the gene. GluR6 is a glutamate receptor that resides in a genetic linkage region associated with BD. Mice missing the gene exhibited many of the symptoms of mania as well as being more aggressive. Treatment with lithium reduced hyperactivity, aggression and risk-taking type of behaviour, with biomedical tests suggesting that GluR6 may play a unique role in regulating some of the symptoms of mania. [7]
There were several papers describing either types of mania or the treatments used to control them.
[8] A paper entitled ‘Emotional hyper-reactivity as the fundamental mood characteristic of manic and mixed states,’ suggested that mixed states were about intensity of emotions and not tonality of mood. [9] Another paper suggested that BD ought to be regarded as a broad spectrum of symptoms as opposed to the more formal categories listed in DSM-IV (since updated to DSM-V). [10]
Surprisingly, what I couldn’t find were studies directed from the perspective of mania as a positive human condition. Given the relatively poor understanding of the underlying causes of BD this is perhaps to be expected - we will not be able to challenge the view that mania is something to be controlled and promoted until we fully understand its mechanisms.
So from a contemporary real-world perspective? If you asked me if I would be able to discard my depressive episodes, the answer would be an unequivocal yes. If the same were asked about my hypomanic episodes the answer would be more nuanced. The ability to control the duration, intensity and dysphoria of these episodes would be welcome. Yet it has its positives - a certain level of creativity, risk-taking behaviour and periods of euphoria. It has, however, also been an extremely destructive force in my life - 3 marriages behind me, 10 suicide attempts (one earlier this year landing me in ICU on life-support for a week), loss of employment and extended periods of desolation and despair.
Pearce argues that we can, ‘eradicate suffering in all sentient life.’ The Buddha proclaimed, ‘All life is suffering,’ although ‘unsatisfactory’ would be better translation. Philosophically, can we lead lives of continued happiness without dissatisfaction to give it meaning? Is it even possible? (Pearce and the Buddha are in agreement here that it is). And is hypomania a good place to start? Speaking for myself, I agree with Pearce that we should start to see research being undertaken on the ‘positives’ of BD and not just about control and the reduction of symptoms.
As a technoprogressive, I would like to end with one further quote from the Buddha: ‘Thousands of candles can be lighted from a single candle and its life will not be shortened. Happiness never decreases by being shared.’
Notes
1. http://www.hedweb.com
2. https://www.psychologytoday.com/node/98951
3. http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/bipolardisorder.aspx
4. http://www.theguardian.com/environment/shortcuts/2011/dec/05/should-we-put-lithium-in-water
See also http://www.irishtimes.com/news/psychiatrist-calls-for-lithium-to-be-added-to-water-1.6272
5. http://www.dbsalliance.org/site/PageServer?pagename=education_statistics_depression
6. http://www.hedweb.com
7. http://www.sciencedaily.com/releases/2008/03/080312081256.htm
8. http://www.biopsychiatry.com/manvar.htm, http://www.biopsychiatry.com/bitreat.htm, http://www.biopsychiatry.com/mood-stabilisers.htm
9. http://www.biopsychiatry.com/manicintensity.htm
10. http://www.biopsychiatry.com/mandep.htm
