Hypomanic Edge

Washington Post Op-Ed

noreply@blogger.com (John Gartner) — Fri, 14 Apr 2006 03:04:00 +0000

A Nation Built on Immigrant Genes

By John D. Gartner
Tuesday, April 11, 2006; Page A21

If you've been following the big immigration debate, you might get the impression that the primary economic advantage of liberal economic immigration policies is that they supply America with low-wage workers willing to do grueling, unskilled jobs that native-born Americans won't touch. Not true: They are the source of America's success.

The secret to America's wealth is that we were settled by restless, driven, overconfident, risk-taking dreamers. As I have explained in a book on the subject, these traits are all signs of a genetically based, mildly manic temperament, which is not a mental illness, called hypomania.

Hypomanic traits have been part of the American character since the country's beginning. In the 1830s, Tocqueville noted that Americans were "restless in the midst of abundance," always moving, always working and perpetually hurling themselves into one new business venture after another. Not coincidentally, in my research, I found that entrepreneurs have these same traits.

America is an amazing natural experiment -- a continent populated largely by self-selected immigrants. All these people had the get-up-and-go to pull up stakes and come here, a temperament that made them different from their friends and relatives who stayed home. Immigrants are the original venture capitalists, risking their human capital -- their lives -- on a dangerous and arduous voyage into the unknown.

Not surprisingly, given this entrepreneurial spirit, immigrants are self-employed at much higher rates than native-born people, regardless of what nation they emigrate to or from. And the rate of entrepreneurial activity in a nation is correlated with the number of immigrants it absorbs. According to a cross-national study, "The Global Entrepreneurship Monitor," conducted jointly by Babson College and the London School of Economics, the four nations with the highest per capita creation of new companies are the United States, Canada, Israel and Australia -- all nations of immigrants. New company creation per capita is a strong predictor of gross domestic product, and so the conclusion is simple: Immigrants equal national wealth.

Andrew Carnegie, a 19th century Scottish immigrant and, quite a manic personality, who started working in a factory for pennies a day and became the richest man in the world by mass-producing steel, made the same argument. Immigrants, he wrote, were unusually "capable, energetic and ambitious" people. They had to be. "The old and the destitute, the idle and the contented do not brave the waves of the stormy Atlantic, but sit helplessly at home." He called the flow of people into America the "golden stream" that contributed more to America's wealth than "all the gold mines in the world." It's as true today as it was then. The Scottish, Irish, Italians, Japanese and Eastern Europeans were last century's Mexicans -- unwashed hordes, thought to be good only for cheap labor.

Let's get the lesson of Sept. 11 right. We need to screen who gets into the United States, to keep out the suicide bombers. But if they're not here to kill us, chances are they will inject new life into our economy. In my book, I predicted that future historians will be able to date the beginning of the decline of the American empire to the day we stop being the destination of choice for immigrants. Ominously, U.S. immigration peaked in 2000. Is this the beginning of the end? I hope Osama bin Laden will not end the great American experiment.

The writer is an assistant professor of psychiatry at Johns Hopkins University Medical School and author of "The Hypomanic Edge: The Link Between (a Little) Craziness and (a Lot of) Success in America."

John D. Gartner Speaks at the Princeton Club of NY

noreply@blogger.com (John Gartner) — Sat, 25 Jun 2005 15:29:00 +0000

John D. Gartner Ph.D, Assistant Professor of Psychiatry Johns Hopkins University Medical School, speaks at the Princeton Club of NY

Tuesday, June 28th at 6:30 P.M.
Princeton Club of New York
15 W. 43rd St.

Call (410) 337-8207 to reserve a space.

What is Hypomania?

noreply@blogger.com (John Gartner) — Sat, 25 Jun 2005 14:46:00 +0000

The following is an excerpt of material cut from The Hypomanic Edge:

“Highly intoxicating, powerful, productive and desirable,” is how hypomanics experience their elevated mood, according to Goodwin and Jamison, authors of the nine hundred page authoritative book Manic Depressive Illness. [i] A patient’s description helps illustrate why:

I feel good–about the world and everything in it. There’s a faster beat; a sense of expectation that my life will be full and exciting. It’s a very infectious kind of thing. We all have an appreciation for someone who’s positive and upbeat. Others respond to the energy...It’s just very easy to make friends...I become particularly aware of women...All of a sudden I have the confidence I can do what I set out to do. I take on more projects largely because I’m not worried about running out of energy...I feel vigorous and active; accelerated, willing to take more risk. People give me compliments about my vision, my insight. Suddenly I seem to fit the stereotype of the successful, highly intelligent male. 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... [ii]

According to DSM-IV diagnostic criteria, the following behaviors need to be observed to diagnose hypomania. These are the same criteria used for mania. As mentioned earlier, the only guideline we have in distinguishing between the two is that they differ in “degree of severity.”

A) A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week.

B) And at least three of the following:

1.inflated self-esteem or grandiosity
2.decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3.more talkative than usual or pressure to keep talking
4.flight of ideas or subjective experience that thoughts are racing
5.distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6.increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
7.excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying spree, sexual indiscretions, or foolish business investments) [iii]

In this section, I hope to offer a slightly fuller picture of the signs of hypomania, in contrast to mania, borrowing freely from classical texts, most especially Emil Kraepelin’s Manic-Depressive Insanity and Paranoia. Kraepelin, dubbed the “father of psychiatry,” published his classic work in 1921. Yet many would agree that, “there has been little improvement in the description of the symptoms of manic depressive disease since Kraepelin’s work.” [iv]

Accelerated psychomotor activity

“Accelerated psychomotor activity is the hallmark of mania,” reads Kaplan and Saddock’s classic Comprehensive Textbook of Psychiatry. [v] You think fast, talk fast, make decisions fast and act fast. Your mind spins from idea to idea. You blurt out whatever comes to mind. You leap before looking. (“Ready, shoot, aim,” is how one businessman described it to me.) Driving this speed is a powerful psychic and physical engine, whirling at five thousand revolutions per minute. “The Energizer Bunny on steroids,” is how legendary Internet venture capitalist John Doerr (no type B personality himself) described Scott McNealy, CEO of Sun Microsystems. [vi] Manics and hypomanics have energy to burn. They don’t need much sleep. They work extraordinary hours. If they’re not moving, they’re painfully restless. If their forward motion is impeded, they’re irritable. They must act immediately, decisively and forcefully on everything, even if it just occurred to them five minutes ago.

In small doses, speed is exhilarating and empowering. From an evolutionary perspective, being mentally and physically faster than your rival, your prey or your predator could not fail to be an asset in the contest to survive and reproduce. But if you go too fast, it can be like those movie scenes where the hero is hurtling down a mountain in a car whose breaks have been cut, trying not to spin off the curves. Indeed, Nigel Nicholson wrote about his manic-depressive friend Virginia Wolf, “her imagination was furnished with an accelerator but no brakes.” [vii]

Hypomanics charge ahead. In war, they might be the first soldiers over the hill, a good way to get decorated or obliterated. In business, we often heard during the high tech bubble about the “first mover advantage.” The trumpeted idea was that the first entrepreneurs to enter a new market could stake their claim. Whether or not it was truly an advantage is debatable. Most of those first movers are bankrupt now, though a few —the Jobs, Gates, Ellisons and Clarks—are fabulously wealthy.

Move Fast

Kraepelin called it “pressure of activity.” The manic “is a stranger to fatigue, his activity goes on day and night; work becomes very easy to him.” [viii] He displays “pronounced restlessness,” “increased busyness” and “an agitated desire for hurried enterprise.” [ix] This increased activity is not simple random hyperactivity. It is directed by an urgent sense of purpose toward some mission. DSM- IV calls this an “increase in goal-directed activity.” [x]

Increased activity is also driven by a heightened sense of restlessness. Manics sometimes feeling as if they were “jumping out of their skin.” On the ward, they are often a management problem because they simply can’t t keep still. If you see a patient pacing the floor frenetically, without examining their chart, you can guess their diagnosis. In the most acute mania, Kraepelin noted, “the patient sings, chatters, dances, romps about, does gymnastics, beats time, claps his hands, and makes a disturbance.” [xi]

Hypomanic restlessness is not quite so dramatic, but it is nonetheless unmistakable. When I asked business correspondent Michael Rubin if he thought entrepreneurs were restless, he laughed. “I have what I like to call my elevator test. Ride in an elevator with one of these guys and watch them go nuts. They get itchy, tense, tap their feet, press the buttons again and again, and reach for a cell phone. They can’t take 90 seconds of inactivity. It feels almost cruel, but it’s funny to watch them.” [xii] Fieve observed that, “manic businesspeople have an almost pathological fear of vacations. Why shouldn’t they? Hyperactive, they find enforced leisure a form of torture.” [xiii]

In Business Week, Jim Barksdale, Netscape's CEO, described Jim Clark as "a maniac who has his mania only partly under control." [xiv] Barksdale should know, Jim Clark is most well known as the co-founder of his company Netscape. In The New New Thing, Michael Lewis profiles Clark as a perpetual motion machine with a short attention span. He is forever hurtling impulsively at unsafe speeds on helicopters, planes, boats and cars. When his forward motion is impeded, Clark becomes irritable, bored and depressed. In his search for the stimulation of the "new new thing," he quickly loses interest in the companies he founds, and tosses them into the laps of his bewildered employees.

To give one example, Clark got the notion that he could sail a large boat across the Atlantic without sailors, relying exclusively on computers guided by his software. To demonstrate this bold claim, Clark built an impossibly grand fifty-million-dollar sailboat: the Hyperion. He insisted at the time of the ship’s construction, that it have the world’s largest mast, and was later enraged when a newer boat bested his seventeen‑story mast by a few feet. The interior was decorated with the finest woods, gadgets and millions worth of Monets. On the Hyperion’s heralded maiden voyage, she left from the Canary Islands to retrace Christopher Columbus voyage of discovery. Even during this dramatic journey, Clark became restless. Only two hours and forty minutes into the ten-day trip he complained: "I don't know why the fuck I came on this. It's going to be boring as hell." [xv]

Decreased need for sleep

Decreased need for sleep is one of the most clearly biological symptoms of mania found in 81% of manic patients. Where a manic patient might stay up for three days straight in a frenzy, the hypoamanic might be a workaholic who get by on four to six hours a night for years, punctuated by periods of intense work where they routinely pull “all-nighters.”

Talk Fast

Ninety-eight percent of manic patients evidence “pressured speech,” which is rapid, loud and difficult to interrupt. [xvi] If you do interrupt a pressured speaker, perhaps to get a word in edgewise, he or she will become irritated and talk over you. Pressured speech also puts pressure on the listener. Anyone who has ever encountered a hypomanic salesman, who wouldn’t stop talking until you bought his product, knows what I mean.

While manic speech is clearly crazy, hypomanic speech rarely strikes the listener as insane. In fact, the hypomanic’s moderately accelerated thinking often gives him the appearance of being “a live wire,” according to Henderson and Gillespie, authors of the Oxford Medical Association’s Textbook of Psychiatry. The hypomanic is “a witty man with ideas” who “tends to monopolize conversations, expresses his views dogmatically and drifts from one topic to another.” When challenged, he “becomes sarcastic or rude, changes the subject, thinks that the person who does not see eye to eye with him is a fool, and does not hesitate to say so.” [xvii] Goodwin and Jamison note that the hypomanic is “firmly opinionated and interpersonally aggressive.” [xviii] There is always an aggressive quality to pressured speech, as well as an exhibitionistic one. The conversation is simultaneously a competition and a performance, as the hypomanic speaker is driven to command attention and dominate others through his or her speech.

Politics is one field full of opinionated fast talkers, especially the kind who like attention and competition. Marveling over his father’s dominance of any room, Theodore Roosevelt’s son declared, “He was the bride at every wedding and the corpse at every funeral.” John Hay once estimated that Theodore Roosevelt’s dinner guests at the White House were responsible for only four minutes of conversation. TR--who didn’t so much talk as shout, did the rest of the talking. His words “reverberated like a bombshell” as he spat out consonants with projectile-like force that “lodged in your brain like shrapnel.” [xix]

It was an explosive force he knew how to use. As a 21-year-old freshman New York Assemblyman, TR took on the whole political machine of his own party. They tried to show him who was boss in Albany using a simple procedural rule. The Speaker of the House simply refused to call on him. TR marched down the aisle, banged on the Speaker’s desk, ranting “Mr. Spee-kar!..Mr Spee-kar!” for forty minutes, until they recognized him. [xx]

It would have been a physical impossibility to have not heard TR. He was as one contemporary journalist noted “an irresistible force.” One British diplomat said the two most impressive natural phenomena in America were Niagara Falls and TR. At a political rally, a would-be assassin shot him point blank in the chest. His massive chest muscles, which he had built through years of relentless exercise, in an effort to overcome his childhood asthma, stopped the bullet. But before he went to the hospital, he finished his speech!

Businessmen are also notorious talkers. One obvious manifestation is the cliché of the businessman who perpetually has a phone glued to his ear with several lines lit up at once. “They don’t feel right unless they have six or seven overseas calls coming in, ” wrote Ronald Fieve in Moodswings. He recalled the case of a hypomanic entrepreneur who grabbed the phone off his desk to make international calls in the middle of therapy sessions. [xxi] The wife of William Zeckendorf Jr. wrote: “From the time he gets up in the morning he’s on the telephone—while he’s dressing, at breakfast, in the car, in the office, as soon as he gets home, right up until he goes to bed.” [xxii]

When I read my profile of hypomanic behavior to Craig Winn’s former employee, he began laughing when I said that hypomanics “aggressively dominate conversations.” “He didn’t want anyone else to talk. I’m serious. One of our senior vice presidents made some comment in a meeting, and he went both to him and his boss and said, ‘Usually, I’m the only one who speaks in meetings.’”

Think Fast

“Racing thoughts” is found in 71% of manic patients. [xxiii] To those in the grips of manic madness, it’s terrifying. The acceleration is so extreme it tears the fabric of thought apart. Ideas whir past too fast to form coherent mental structures. Kraepelin’s patients repeatedly complained that an uncontrollable cascade of thoughts “imposed themselves.” It was “stormy,” in their heads and “thoughts chased each other.” They “have so many thoughts in their head that they cannot pray, cannot work.” [xxiv]

The patient, who writes below, was found franticly running in circles in a parking lot. He was trying to tire himself out in a vain attempt to slow his thoughts down:

Although I had been building up to this for weeks, and certainly knew something was seriously wrong, there still was a definite point where I knew I was insane. My thoughts were so fast I couldn’t remember the beginning of a sentence half way through. Fragments of ideas, images, sentences raced around and around in my mind like the tigers in Little Black Sambo. Finally, like those tigers, they became meaningless melted pools. Nothing once familiar to me was familiar. I wanted desperately to slow down but could not. My energy level was untouched by anything I did. [xxv]

Hypomanics also think very quickly, but not so quickly that their thoughts are disordered. For them, this can be an advantageous trait. I spoke with one former executive who worked closely with Craig Winn, founder of Value America and the man profiled in the exposé Dot.Bomb. Speaking on the condition of anonymity, he described his former boss: “I’ve never seen anything like this guy. He processes information faster than anyone I’ve ever seen.” He recalled that a team of executives from another company made a presentation to Winn: “the 7 reasons Value America should partner with us.” “They gave the first two, and Craig finished their presentation for them: ‘Here are your other five, ’ he said. They were dumbfounded. He was right. I’ve never seen anything like it.”

Flight of ideas

“Flight of ideas,” is a rapid generation of ideas, jumping from topic to topic, across relatively loose chains of association. Saul Bellow gives an excellent example in his novel Humboldt’s Gift, a fictionalized account of his real life relationship with manic-depressive poet Delmore Schwartz. When he was merely hypomanic, Humboldt was a great orator--“the Mozart of conversation.” But his thinking started to fly apart, driven by its own centripetal force. “His monologue was an oratorio in which he sang and played all parts…before your eyes the man recited and sang himself in and out of madness:”

He was off. His spiel took in Freud, Heine, Wagner, Goethe in Italy, Lenin’s dead brother, Wild Bill Hickock’s costumes, the New York Giants, Ring Lardner on grand opera, Swinburne on flagellation, and John D. Rockefeller on religion. ...Soaring still higher he began to speak about Spinoza and how the mind was fed with joy by things eternal and infinite. [xxvi]

Hypomanics also evidence flight of ideas in an attenuated form. French psychiatrist Falret, one of the first to ever write about hypomania, wrote in 1854: “The profusion of ideas is prodigious.” [xxvii] In his memoir, Leap: A tale of love and madness in the Internet Gold Rush, Tom Ashbrook explained how he got swept up in Internet mania. One day, on a street corner in Boston, he ran into Rolly, an old college friend who eventually convinced him to join an Internet start-up. Ashbrook resisted at first, but Rolly started calling him, and calling him, and calling him, with “a stream of wild ideas:”

His rate of idea production per second seemed almost crazed. Rolly Rouse was the only person I knew who stopped breathing when he talked. His brain was like a great furnace that sucked up all the oxygen in his body. Rolly was a blazing idea factory... [xxviii]

Consider a similar description, from a cover story in Fortune magazine about Bill Gross, founder and CEO of Idealab, an Internet incubator company. Next to a picture of a smiling Bill Gross was the caption: “I lost 800 million in eight months. Why am I still smiling?” The author, Joseph Nocera, a respected business correspondent, begins his article with an unusual mea culpa. He apologizes to his readers for his previous Fortune article that hyped Gross, before the Nasdaq crash. He confesses Gross converted him into a believer:

I believed him because I was dazzled by him. A small wiry man, Gross had an infectious boyish enthusiasm that was charming and irresistible. He spoke so rapidly—jumping from topic to topic as if he were hyperlinking—that it was hard to keep up with him, and had so much energy he seemed constantly on the verge of jumping out of his skin. He bubbled over with irrepressible optimism.

And his brain! That’s what really set him apart. You could practically see the ideas bursting out of it, one after another, each more offbeat, more original, more promising than the last. The sheer profusion of ideas—and the way he got excited as he described them—was a large part of his charisma. [xxix]

The reason Bill Gross was still smiling, in case you were wondering, was that his latest idea du jour (or should we say du nanosecond?) was “going to be unbelievably huge,” and “revolutionize the Internet.” Eight hundred million, eight hundred shmillion, nothing could diminish Gross’ confidence in his new “new idea.”

Impulsivity

Some have argued that impulsivity should be considered the core symptom of mania. We call mania and depression disorders of mood, but we could with equal justification call them disorders of motivation. In depression, the patient suffers from a lack of motivation: nothing seems worth doing, and they have no energy to do it. In mania the drives that motivate behavior surge to a screaming pitch, making the urgency of action irresistible. Kraepelin said the most “striking” aspects of mania is that, “every chance impulse seems to lead forthwith to action.” [xxx] .

There can be painful consequences when you act on impulse without thought of consequences. This might seem obvious, but manics and hypomanics appear oblivious to risk, behaving in ways that are reckless, foolish, reflect poor judgment or just seem outright self-destructive. They rush in where ordinary men and women rightfully fear to tread. And often pay the price.

DSM-IV gives as examples of impulsive behavior: “engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments” and “reckless driving.” These classic examples of manic impulsivity are far from an exhaustive list. Merely speaking impulsively can cause great damage. When interviewing patients we often ask: Did you do anything foolish that could have gotten you into trouble? We inquire specifically about money and sex, but there are innumerable impulses. It is the impulsivity itself, more than the content of the impulse, which makes mania and hypomania distinctive.

Impulsivity and the brain

Recent breakthroughs in technology have allowed us to take detailed three-dimensional pictures of the brain, and even to watch the brain in action. There is now a new generation of scientists trying to use these devices to look at the bipolar brain. One of the most reliable findings, according to Joar Soares, a professor of psychiatry and radiology at the University of Texas, is that bipolars have enlarged amygdales. Two independent teams of investigators found strong evidence of enlarged amygdales in the brains of bipolars using an MRI (magnetic resonance imaging device) to capture pictures of their brains. [xxxi] One of those investigators, Lori Altshuler, professor of psychiatry at UCLA Medical School, even found a correlation between the size of a man’s amygdale (all her subjects were male) and the number of manic episodes he had over his lifetime. [xxxii]

The amygdale is part of the limbic system, what some have called the old brain or reptilian brain because its essential structures emerged very early in the brain’s evolution. It controls the most basic drives and visceral emotions, such as hunger, thirst and sex. Our limbic system does not differ very much from animals. What most distinguishes humans is our large cortex, where higher order thinking is performed. An enlarged amygdale could result in an intensification of those basic drives. In normal subjects, the induction of a happy or sad mood produces evidence of increased activity in the amygdale, as seen using a functional MRI. Electrical or chemical stimulation of the amygdale “can give rise to intense emotional feelings of fear, anxiety, or, in some cases, pleasure,” wrote Altshuler. [xxxiii] In addition to heightening emotion, amygdale activity pushes us to action. Increased activation of the amygdale produces the secretion of the neurotransmitter dopamine in the motor centers, stimulating an increase in goal-directed motor behavior. Thus, it seems likely that manics and hypomanics experience neurologically heightened drive states.

They also have a reduced capacity for inhibition. Harvard Medical School professor Francine Benes has done extensive post-mortem studies on the brains of deceased bipolars. She has found a deficiency in number of neurons in the anterior cingulate cortex. This cortical structure literally wraps around the limbic system. It is a primary point of contact between the new brain and the old, with many connections to the amygdale. Some of the neurons in the anterior cingulate cortex serve an inhibitory function. They modulate the amygdale by telling it when to calm down, using a neurotransmitter called GABA to communicate. It is precisely the GABA infused neurons of the cingulate cortex that Benes has found decimated in bipolar brains. One possible explanation is that the over-activity of the amygdale may burn out the part of the cingulate cortex that is supposed to act as its circuit breaker. As this theory would predict, when Benes injected a drug into the amygdales of living rats that accelerated the amygdale’s metabolism, it produced the same pattern of deterioration in the GABA infused inhibitory neurons of the anterior cingulated cortex as that found in manic humans. [xxxiv]

This brain damage may explain not only manic impulsivity, but also the manic lack of insight into how inappropriate their impulsive behavior is. Kraepelin noted:

They have no understanding whatsoever for the unseemliness of their behavior; they do not comprehend at all why everything they do is taken amiss, are astonished in the highest degree at the complications which arise, but get over it with a few jests. [xxxv]

“Insight, if present at all, is transient,” according to Kaplan and Saddock’s Comprehensive Textbook of Psychiatry. Manics are “notoriously refractory to self-examination.” [xxxvi]

Hypomanics also appear unaware that their behavior is inappropriate and are mystified by the negative reactions they receive. One associate close to Flip Filipowski whom I interviewed was amazed that, “he felt no sense of responsibility for what happened. He blamed everyone else. He became paranoid, especially about the press, who he felt had it in for him. You just wanted to shake him and say, Flip don’t you get it?’’

New brain research may explain why manics and hypomanics don’t get it. In an effort to better understand the brain physiology of mania, scientists have begun to apply a relatively new neuroimaging technique, called positron emission tomography (PET scans), which allows them to actually watch the brain function in real time. The more active parts of the brain will glow red, orange and yellow. The more dormant portions appear dark blue.

Hilary Blumberg, now of Yale Medical School, reported in The American Journal of Psychiatry that one portion of the manic frontal lobe was under firing. [xxxvii] Located just behind the eyes, this structure is called the orbital prefrontal cortex. Like the above mentioned anterior cingulate cortex, this part of the cortex is also linked to more primitive limbic structures deep in the lower center of the brain. The prefrontal cortex is the executive portion part of an emotional circuit that includes connections to amygdale and other limbic structures. The prefrontal cortex is the executive part of a limbic-cortical circuit that monitors a person’s emotional state, notes relevant environmental cues and sifts through memories in order to generate an appropriate behavioral response. If this lobe were underfunctioning in manics, it would explain their total lack of judgment. Their judgment lobe is turned off.

Manics may have a structural abnormality in their prefrontal cortex. Grazyna Rajkowska, a psychiatrist at University of Mississippi Medical School, has been examining the brains of deceased bipolars for almost a decade. In a recent study, not yet published at the time of this writing, she found marked reduction in the density and size of neurons in the prefrontal cortex. [xxxviii] These results are unlikely to be due simply to deterioration over the life span. Joar Soares studied the brains of bipolar adolescents and also found evidence of reduced activity and impairment in prefrontal cortex, and another group at Stanford replicated those results. [xxxix]

So if hypomanics act brain damaged sometimes, it may be because they are.

They have no real awareness of risk, it’s like a kind of color blindness. They are congenitally reckless. Doesn’t it seem like any idea you could think of, no matter how dangerous or ridiculous—there’s some guy who’s actually tried it. Hypomanics are those guys. They don’t need Nike to tell them to “just do it.” They just do it, all the time. They’ll try anything.

What possible benefit could come from such brain damage? Hypomanics try all the crazy ideas you could think of. When one of those ideas really works—“he was a visionary,” we proclaim. Whether he was a visionary or just a lucky fool, society as a whole can benefit enormously through such breakthroughs. Somebody has to the first to try the new solutions.

Also, sometimes it’s better not to think. Mark George, when he was at the National Institute of Mental Health, found that normal subjects also showed decreased activity in prefrontal cortex on PET scans during states of intense happiness. “The neocortical regions used in complex planning shut down in happiness,” he told the New York Times. [xl] When we’re happy, we’re pleasurably uninhibited. It feels good to “just do it.”

Grandiosity

Manic patients frequently pronounce themselves prophets or geniuses, as Kraepelin noted: They are the Messiah, the pearl of the world, the Christchild, the bride of Christ, Queen of Heaven, …Almighty God…a great artist or author…a ‘physician by birth,’ honorary doctor of all sciences.” [xli]

A particular brand of self-proclaimed genius that bears obvious resemblance to our high tech entrepreneurs is the delusional inventor and would be mogul: “They sketch out drawings, build models, search for people who will give money, and they exert themselves about patents,” wrote Kraepelin. [xlii] “The peculiarity common to all these inventors is the unshakable faith in their star…The importance and especially the economic value of their own inventions is immeasurably overestimated; in the opinion of the patients it invariably mounts up to at least millions.” [xliii]

In most cases, these psychotic inventions were sheer flights of fancy—time machines and the like. The hypomanic entrepreneur, on the other hand, has a real invention, or at least more plausible idea. But like his psychotic counterpart, he grossly overestimates its economic and social value. We’re going to change the world and get rich doing it, seemed to be the mantra of the 90’s high tech entrepreneurs. Predictably, in profile after profile, CEOs promised not just that their product was good or that it would make money. It was “going to change everything.” As Tucker Carlson observed in Talk magazine, high-tech capitalism had taken on many of the characteristics of a messianic religious movement: "It's no longer enough to become impossibly rich. If you're a visionary CEO, it is vital that you make a connection between your fortunes and the fate of the entire world." [xliv]

Hypomanics are often prophets in search of a mission. Their messianic identity is what is primary. The vehicle for that star turn is whatever they can find. For example, Steve Jobs aspired to be a guru before he founded Apple. He adopted Eastern religious practices, taking them to an extreme, of course. He followed a regimen of eating “only fruit and occasional drugs,” never bathed, and ended up squatting in an unheated abandoned apartment. "In his vision of himself, Jobs became an ascetic, a holy man unencumbered by the burdens of the material world...Thanks to a horrifying diet, Jobs began to exhibit the emaciated, crazed look of a true Shaman. To perfect the image, he took to staring at people unblinking, for long minutes on end." [xlv] Fortunately, no one bought it, and Jobs was a miserable failure as a Hindu/Buddhist prophet.

Then Jobs discovered his true messianic calling: techno‑prophecy. "Edison," he decided, "had done more to improve human conditions than all the gurus that ever lived." This new Edison believed that he could free mankind with the personal computer. Jobs envisioned Apple as a religious movement, a holy crusade against "Big Brother" (the monolithic IBM). He even created a job description for an "Evangelist." No corporation had ever had an evangelist before, but it became de rigueur for Silicon Valley startups thereafter. Jobs attracted the kind of followers he needed. He aroused in them similar messianic feelings. "Everyone who worked there believed we were on a mission from God," said a former Apple employee. Jobs persuaded the CEO of Pepsi, John Sculley, to switch to the top spot at Apple with one question: "Do you want to spend the rest of your life selling sugared water or do you want a chance to change the world?" [xlvi]

After Jobs, it seemed every technology CEO was a prophet on a crusade. Consider Michael Saylor, CEO of Microstrategy, profiled in a New Yorker article entitled "Caesar.com." "I'm on a mission from God, and if you don't buy from me we're all going to hell. I mean that literally...People will die this year because they didn't buy my software,” said Saylor. His divine software passively mines the Internet for data, and sends customers an e-mail, if, for instance, their normal route to work is congested. Useful, but hardly the cure for cancer to which Saylor compares it. But eventually, “Saylor envisions a world where everyone will have a tiny device planted in his ear that will whisper advice to him as he needs it.” When the SEC cited Microstrategy for questionable accounting practices that overstated the company's economic performance, the stock dropped a breathtaking 60%‑‑a stunning loss of six billion dollars in market capitalization in one day. But Saylor kept the faith, even if Wall Street didn't. In an interview with Reuters the day of the crash, Saylor said, "Mother Theresa never quit in a down quarter, and what we're doing is equally important.” Saylor is depicted in the New Yorker on a cloud in silken robes with a glowing silicon‑chip halo. The author uses words like manic, reckless and grandiose to describe Saylor‑‑but makes no attempt at a real clinical diagnosis. [xlvii] Caesar, it would seem, is taking no meds.

Jim Clark’s Netscape IPO is credited with starting the Internet gold rush. After that it seemed he could do no wrong. When Jim Clark pitched a new company—Healtheon-- a medical web site, he showed the investment bankers a diagram with only five words. His "Magic Diamond" put Healtheon at the imaginary center of four vertices labeled "doctors, consumers, providers and payers." That was it. Clark had dispensed even with the perfunctory business plan. His Magic Diamond was going to "fix the U.S. health care system." [xlviii] It was going to be bigger than Microsoft, AOL, Netscape and Yahoo! "Any other human being would have been thrown into an asylum for thinking such grandiose thoughts," Lewis accurately noted. [xlix] But the venture capitalists and New York investment bankers battled and groveled for the privilege of giving money to the "Moses" of the new economy.

You had to believe that Clark was Moses to work at Healtheon. Like Apple, the company was a visionary enterprise, staffed by a spiritual elect, who believed that they would set the whole world free. "The passion to change the world" was what Clark said he looked for in an engineer‑‑religious fervor he could inflame. [l] Clark needed true believers, and he found them. "There was a feeling that we were about to change the world," said one of his chief engineers. [li]

The infectious nature of mood

Moods are contagious. One secret to the charismatic power of hypomanics is that they infect others with their optimism, confidence, energy, enthusiasm, urgency and purpose.

The infectious nature of mood is well illustrated by the multi-million dollar “motivational speaking” industry, an entire industry dedicated exclusively to the sale of hypomania. Giants like Zig Ziglar and Tony Robbins are well known to most, but there are thousands of motivational speakers, especially in America. Their seminars are embarrassingly thin in content, studded with platitudes and hokey gimmicks. For example, one “motivational guru,” Brian Tracey, recommends writing down ten goals, and checking the list in twelve months to monitor your progress. Overall, probably not a bad thing to do, but Tracey guarantees that the results of this intervention will “amaze” you. “Only 3 percent of adults have written goals,” Tracey said. So it stands to figure, that “if you do this, you’ve already joined the top three percent.” [lii]

The content isn’t the point. It’s the buzz, the mild high that the participants get from the speaker, that they are buying, and the confidence. “Feeling good for no reason at all,” is the title of an article by Steve Salerno about motivational speakers. Participants “come away feeling pumped.” Often times, to keep energy levels high, these seminars have singing, games, and athletic challenges between motivational talks. In an outward bound wilderness based seminar Salerno attended:

A realtor finished sliding down the side of a mountain on a tether. I asked him whether he felt he benefited from the experience. He said, enthusiastically, yes. I then asked him whether he expected it to help him sell more homes. Another yes. When I asked him how, he grimaced. “I don’t know,” he said, impatient with my probing, “but I’m sure it will.” [liii]

Phillip Chard, a psychotherapist who has written about motivational speakers, told me that he was convinced that they were experiencing hypomanic mood: “They get high. Talk about a runner’s high, this is a Speaker’s High. They’re zipping. They’re getting a buzz.” He has observed a “positive feedback loop,” in which the speaker and the audience elevate one another’s mood. “I’ve seen seminar participants get really high, so hyped up, so mesmerized that they blast off out of their seats.”

Salerno bemoans an American culture that equates confidence with achievement. “America is awash with confidence for its own sake. Confidence we are led to believe will govern our success…but real accomplishment is something rarely glamorous or ecstasy-filled.” [liv] Chard agreed that these speakers are selling “self-delusional optimism.”

In addition to infecting their audience with their euphoria, energy and optimism, motivational speakers encourage risk taking. An ongoing theme of these seminars is that participants should dare to try. “I’ve seen them encourage people to take stupid risks, totally out of context, not knowing anything about what would really happen to them if they actually did these things,” Chard told me. One speaker insisted everyone should skydive.

These speakers practice the irrational optimism they preach. Consider this profile of a lesser-known Canadian motivational speaker, Grace Cirocco, author of the book, Take the Step: The Bridge Will Be There. [lv] She told The Ottawa Citizen that she had a dream in which she was on Oprah: “ I know it’s going to happen. Oprah is going to happen. My publisher says ‘Grace don’t get your hopes up’ But I know I will be there.” How does she know? “I have an angel,” was her explanation. And she will not be undermined by “doubt demons,” one of the pitfalls she preaches against in her book. It is this kind of faith that has made her a successful Canadian in an industry that, according to The Citizen, “the Americans practically invented.” (“Motivation and inspiration must come more naturally to Americans,” they mused sarcastically). [lvi]

Cirocco sounds like a “New Age preacher.” “My real gift is getting people to believe that they have wings,” said Cirocco. “Faith and action are like two wings of an airplane. You need both if your life is to take flight.” [lvii] It is the combination of irrational self-confidence and precipitous action that make up the essence of Cirroco’s formula for success--both core traits of hypomania. If you take the leap of faith, the “bridge will be there.”

“People tell me I have changed their lives,” claimed Cirocco, and that her book has become their “Bible.” On her web site, Grace lists some of the testimonials she has received. One participant asked: “Can her energy and enthusiasm be bottled?” That seems to be the idea behind the motivational speaking industry.

Hypomanics have a unique ability to infect others with their excitement and inspire them to take risky action. That is why being hypomanic is practically part of the job description if you want to be a charismatic leader.

[i] Goodwin and Jamison, pg. 23

[ii] Quoted in Peter Whybrow, A Mood Apart, Harper Perennial, 199, pg 44-47

[iii] American Psychiatric Association, Diagnostic and Statistical Manual, fourth edition, Washington, DC: American Psychiatric Association, pg. 332

[iv] George Winokur, Paula Clayton and Theodore Reich, Manic Depressive Illness, St Lois: C.V. Mosby: 1969, pg. 15

[v] Hagop Akiskal, “Mood disorders: Clinical Features,” in Harold Kaplan and Benjamin Saddock (editors) Comprehensive Textbook of Psychiatry, sixth edition, Baltimore: William and Wilkins, 1995, pg. 1131

[vi] Arianna Enjung Cha, Washington Post, 11/13/2002, pg.1

[vii] For an excellent review of manic depressive disorder in Virginia Woolf see: Thomas Caramago, The Flight of the Mind: Virginia Woolf’s Art and Manic-Depressive Illness, Berkeley: University of California Press, 1992

[viii] Kraepelin, pg. 57

[ix] Kraepelin, pg. 26

[x] American Psychiatric Association, DSM-IV, 332

[xi] Kraepelin, pg 26

[xii] Interview with Michael Rubin, 2/17/01

[xiii] Fieve, pg. 80

[xiv] Quoted in Lewis, pg. 180

[xv] Quoted in Lewis, pg 209

[xvi] Goodwin and Jamison, pg. 36

[xvii] Henderson and Gillespie, pg. 238

[xviii] Goodwin and Jamison, pg. 23

[xix] Edmund Morris, The Rise of Theodore Roosevelt, New York, Ballantine, 1979, pg. 174

[xx] Edmund Morris, pg. 170

[xxi] Fieve pg. 81

[xxii] Quoted in Fieve, pg. 81

[xxiii] Goodwin and Jamison, pg. 32

[xxiv] Kraepelin, pg. 14.

[xxv] quoted in Goodwin and Jamison, pg. 27

[xxvi] Saul Bellow, pg. 13

[xxvii] Falret quoted in Goodwin and Jamison, pg. 23

[xxviii] Tom Ashbrook, The Leap: A memoir of love and madness in the Internet Age, New York: Houghton Mifflin, pg. 6

[xxix] Joseph Nocera, “I lost $ 800 million in eight months. Why am I still smiling?” Fortune, 3/5/01, pg. 72

[xxx] Kraepelin, pg. 26.

[xxxi] Interview with Joar Soares, 10/15/02

[xxxii] Interview with Lori Altschuler, 10/20/02; Lori Altshuler, George Bartzokis, Tom Grieder, John Curran, Tanya Jimenez, Jeffery Wilkins, Robert Gerner, and Jim Mintz, “An MRI study of temporal lobe structures in men with bipolar disorder or schizophrenia,” Biological Psychiatry, 48, 2000, 147-162

[xxxiii] Altshuler et al. pg 157.

[xxxiv] Interview with Francine Benes, 10/21/02; Frances Benes and Sabina Berretta, “GABAergic interneurons: Implications for understanding schizophrenia and bipolar disorder,” Neuropsychopharmacology, 25, 2001, pp 1-27; Francine Benes, Mark Todtenkopf, Pangiota Logiota and Mark Williams, “Glutamate decarboxylase65-immunoreactive terminals in cingulate and prefrontal cortices of schizophrenic and bipolar brains,” Journal of Chemical Neuroanatomy, 20, 2000, pp. 259-269.

[xxxv] Kraepelin, pg. 128

[xxxvi] Hagop Akiskal, “Mood disorders: Clinical Features,” in Harold Kaplan and Benjamin Saddock (editors) Comprehensive Textbook of Psychiatry, sixth edition, Baltimore: William and Wilkins, 1995, pg. 1132

[xxxvii] Interview with Hilary Blumberg 9/30/02; Hilary Blumberg, Emily Stern, Sally Ricketts, Diana Martinez, Jose de Asis, Thomas White, Jane Epstein, Nancy Isenberg, Anne McBride, Ingrid Kemperman, Sylvia Emmerich, Vijay Dhawan, David Eidelberg, James Kocsis and David Silbersweig, “Rostral and orbital prefrontal cortex dysfunction in the manic state of bipolar disorder,” American Journal of Psychiatry, 156, 1999, 1986-1988

[xxxviii] Interview with Grazyna Rajkowska, 10/2/02; Grazyna Rajkowska, Angelos Halaris and Lynn Selemon, “Reductions in neuronal and glial density characterize the dorsolateral prefrontal cortex in bipolar disorder,” Biological Psychiatry, 49, 2001, pp. 741-752

[xxxix] Interview with Joar Soares,

[xl] Daniel Goleman, “The brain manages happiness and sadness in different centers,” in The Science Times Book of the Brain, Nicholas Wade (editor), New York, Lyons Press, 1998, pg. 79.

[xli] Kraepelin, pg. 68

[xlii] Kraepelin, pg. 232

[xliii] Kraepelin, pg. 232

[xliv] Tucker Carlson, Talk

[xlv] Michael Malone, Infinite Loop: How the World’s Greatest Computer Company Went Insane, New York: Currency/Doubleday, 1999, pg. 38-9.

[xlvi] Malone, pgs.

[xlvii] Larissa MacFarquar, “Caesar.com: A beltway billionaire and his big ideas,” The New Yorker, 4/3/00, pp. 34-40

[xlviii] Quoted in Lewis, pg. 103

[xlix] Lewis, pg. 100

[l] Quoted in Lewis, pg. 111

[li] Quoted in Lewis, pg 124

[lii] Quoted in Columbus Dispatch, “Lure of success motivates 15,000 to sit and listen Zig Ziglar, Collin Powell, Lou Holtz among speakers at all day seminar,” 4/16/99, pg. 6B

[liii] Steve Salerno, “Here’s your motivation: Feeling good for no reason at all,” Milwaukee Journal Sentinel, 7/5/98, Crossroads section, pg 3.

[liv] Salerno, pg. 3

[lv] Grace Cirocco, Take the Step the Bridge Will be There, New York: HarperCollins 2001

[lvi] Elizabeth Payne, “The motivation game,” The Ottawa Citizen, 2/2/02, pg E2

[lvii] Elizabeth Payne, “The motivation game,” The Ottawa Citizen, 2/2/02, pg E2

A Scary Idea

noreply@blogger.com (John Gartner) — Sun, 10 Apr 2005 15:32:00 +0000

Mr. Saletan's New York Times review of my book The Hypomanic Edge and Peter Whybrow's American Mania was so uninformative, distorted, and viciously ad hominem, as a psychotherapist I had to wonder: What did Whybrow and I do to provoke this primitive reaction? Saletan is a well respected left wing intellectual. This is not how he normally behaves. But we have scared and offended him, with a radical idea--genes may have contributed to America's character.
I wrote a book review for the New York Times once. OK, it got cut before it was published, but they paid me a $100, and gave me an education. When I emailed the first draft, I received a reply with 67 corrections, many punctuated with terse derisive remarks. My editor, Michael Anderson, proceeded to explain the job he was hiring me for: Take the book seriously. Adopt a neutral tone, i.e. don’t be a wise-ass. First, I was to explain what the book was about, and then offer fair, balanced arguments. Where was Michael Anderson when I really needed him?
Within a month of each other, two professors of psychiatry at prestigious medical schools published books reporting a whopping dose of hypomania in the American gene pool. Both point to evidence of mild American mania, yet disagree about its implications. That should be the starting point for a serious discussion. But these ideas are too radioactive to even touch. We can't be taken seriously. We are so toxic that we must be discredited and mocked from the very first sentence. Saletan's reaction to the simultaneous publication of these books is that they provide an intoxicating opportunity: a "delightful twist in the marketplace of ideas" that "yields a felicitous result: a case study in the psychology of psychologists."
Uh oh.
Rubbing his hands in glee at this delightful opportunity, Saletan begins his review, not with descriptions of our books, but with ad hominem attacks on both of us. The first thing you learn about me is that "Gartner concedes he can be high strung," After all, I confessed that I "hooted like an elated primate" the day my stock portfolio hit a million dollars. Yes, I hooted. It's true. But I don't dance on my desk as you might imagine from that introduction. I wrote that sentence in the context of a section illustrating how basic primate behaviors are shared by both humans and chimpanzees, which led me to argue that hypomanic genes predate humanity. But Saletan is more interested in lampooning me than actually discussing what I have to say. For him, my propensity for hooting is just proof that the entire book was whipped up in a state of mania. I have "thrown together a few entertaining mini-biographies" (at least he admitted they were entertaining) and on that basis, I "leap to radical genetic conclusions on minimal evidence and disregard negative feedback." According to Saletan, I am not just crazy, but dangerous, a "social Darwinist" hiding in scientist's clothing, misusing my position to justify free enterprise because I "love the market." Whybrow, on the other hand, is sober enough, but he is a misguided liberal, anti-capitalist, tarring all Americans with a manic brush because he yearns for the peaceful contentment he found in "rural village where he farmed a bit as his daughter grew up." His call for a less manic America only reflect his misguided "grandiose" fantasies of "healing society."
Because our premise is so offensive, we must both be either deluded or intellectually dishonest. "This is the danger of diagnosing a whole society: you start out selecting theories that fit the evidence, but you end up selecting evidence to fit the theory." Ironically, Saletan sounds like he is describing himself here, given his habit of lifting quotes out of context and deceptively splicing them together. This would be an example of what psychoanalysts call projection. Saletan systematically employs his skills to distort what we have said. For example, I criticize the methodology of a large study which reported that hypomania is rare. "The survey indicates that one in 1,000 people is hypomanic, so Gartner broadens the criteria, arguing that anyone who admits to having gone through 'a period of greatly increased energy' is hypomanic." What I actually said was that this survey underestimated the frequency of hypomania because they asked subjects "Have you ever had a period when you were a little high, so high you were out of control?" If they said no, no further questions querying the presence of hypomanic symptoms were asked. This screening device is called a stem question. The problem is that hypomanics don't think they are out of control when they are hypomanic. Just the opposite, they feel they are happy, productive, and at their best. So of course, the vast majority of hypomanics answered no, and the researchers never assessed whether they met diagnostic criteria for hypomania. Another study, by respected Swiss psychiatrist Jules Angst, asked subjects if they had ever had a period of increased energy as a stem question. If they said yes, they were not, as Saletan says, branded hypomanic. They were then assessed according to traditional criteria. Studies using this approach found between 5-10% of subjects to be hypomanic. Just using common sense, the one in a thousand figure is wrong. That would mean there are only 300,000 hypomanics in the United States. Everyone I have spoken to immediately volunteers that they know multiple people who live on the hypomanic edge, including perhaps themselves. But you'd be more likely to cross paths with an immigrant from Tobago at the rates Saletan insists must be accurate. What he could not have known is that among the many emails I have received from senior scientists praising the book, one is from the author of the very study he defends. What he had to know was that both my book and Whybrow's were the focus of a New York Times article in the Science section (http://www.nytimes.com/2005/03/22/health/psychology/22hypo.html), which failed to reveal us to be the frauds Saletan--who is not a scientist--claims we are.
Close to the end of the review, Saletan concedes that "Capitalism's manic energy has made us wealthier but at a price." Ironically both Whybrow and I clearly agree on that thesis statement. Isn't that an idea worth discussing? Mr. Anderson would tell me: Put that in paragraph one--and stop being a wiseass.
Behind Saletan's gleefully snide tone is fear, fear of an idea so politically incorrect that Whybrow and I have become enemy combatants, no longer protected by the New York Times literary conventions of accuracy and fairness

Hypomanic Chic

noreply@blogger.com (John Gartner) — Thu, 31 Mar 2005 07:59:00 +0000

Before I published The Hypomanic Edge, virtually no one outside of the mental health professions had ever heard of hypomania. Now everyone wants to be hypomanic! My thesis was that the advantageous aspects of hypomania propelled America to its success. It was always my mission to both educate the public (and my colleagues) about hypomania, and to inject some identity and pride among my fellow hypomanics.
Mission accomplished?

It seems to be a pattern that movements advocating for the rights and dignity of minorities eventually result in the idealization of a group that was previously despised. Though African-Americans have had a long and bloody struggle for civil rights, the eventual outcome has been a running cultural joke about how slow, physically awkward and unsexy white people are. Now, suburban teenagers want to dress and sound like rappers, while inner city youth are hardly breaking down the door of Abercrombie to look like preppies. Gays have made breathtaking strides in recent years. Now, us shlumpy straight guys suddenly discover we urgently need the help of queer eyes. My teenage daughters, who adore "Queer Eye for the Straight Guy," have officially declared me a fab five fashion emergency (For God sake, is there a gay man in the house? This poor man needs help). And metrosexuals--hip urban straight guys who appear chic by looking gay--have been born.

Now, it may be our turn.

Cornell University psychologist Harry Segal wrote in his blurb that my book would "incite hypomania envy among the normal people of the world." How prescient he was. It amazes me: suddenly, every day now, people tell me they wish they were hypomanic. None other than Robert Spitzer wrote to me in an email, "I wish I could be hypomanic more often." Spitzer, in case you don't recognize the name, is creator of the Diagnostic and Statistical Manual (DSM-IV)--what psychiatrists simply call "the Bible." But you won't find that sentiment expressed in DSM-IV. In the recent New York Times article, "Hypomanic? Absolutely. But oh so productive," Harvard psychiatrist Ronald Kessler, is quoted as saying: "The goal in life is constant hypomania." Really, since when? We never learned that in graduate school. "This psychiatric syndrome is hot, hot, hot" wrote blogger Steve Sailer in a recent blog entitled "hypomania mania!" (to read his article click here: http://isteve.blogspot.com/2005/03/hypomania-mania.html)

How could this have happened so fast? My book--the first ever written about hypomania, even though the term was first used by Kraepelin almost a century ago--was published only 17 days ago! Well, hypomanics are nothing if not fast. I could make a fortune if my next book were entitled "10 steps to becoming hypomanic." But, as my grandfather the doctor used to say when people asked him how to live to a 100: "first you have to pick your parents." Not much self-help potential there.

Of course, do any of these people really know what they are asking for? If you want to accomplish the impossible, talk to a hypomanic. But if you want to pursue happiness, talk to the Dalai Lama. Hypomania is no easy road, as I'm sure I don't need to tell you.