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.
Tags:
afflictions,
anhedonia,
depression,
emotion,
everyday experience,
everyday speech,
exhilaration,
friends and lovers,
gloom,
illnesses,
lifetime,
mania,
melodies,
mood disorders,
personal world,
social situations
