The lure of mania in bipolar disorder can be irresistible due to its euphoric and productive highs, but it often leads to severe consequences. Balancing both mania and depression is crucial for stability, requiring a shift in individual and societal views on achievement. Promoting community support and realistic goals can help mitigate the lure of mania.
Speech:
Imagine that you had a health problem which had a significant impact on you a lot of the time. It caused embarrassing incidents, the breakup of friendships, relationship problems, substantial debt, had to take time off work sick, and even ended up in the hospital. You’d imagine you would want to change this, wouldn’t you?
So, what would you say if I told you that for this particular problem, some people don’t want to get rid of it? They don’t want to get rid of this health problem. And I’m not talking about addiction to drugs, alcohol, or gambling here. With these problems, people often want to change but feel unable to. This is different. People know that it’s causing problems, but a minority of them don’t want to get rid of it completely.
What I’m talking about here is the lure of mania. Talking about bipolar disorder, a mental health problem characterized by episodes of depression where people feel low, have no energy, feel hopeless, and episodes of mania where people have racing thoughts, loads of energy, and loads of ideas. There is unfortunately evidence linking bipolar disorder to a number of outcomes such as poorer quality of life, difficulty maintaining employment, marital breakdown, and even reduced life expectancy. Yet, for some people, due to the lure of mania, they still don’t want to get rid of it completely.
I’m going to ask you to take part in an optional exercise now. If you feel comfortable, close your eyes; if not, just keep them open. I want you to really picture your wildest dreams coming true. You can let your imagination run wild here. It could be developing superpowers, winning a Nobel Prize, being a rock star playing to a sold-out stadium. It can be any fantasy. I’m not going to ask you to share it with the person next to you, don’t worry.
If you find it hard to imagine this, then just try to think back to a time in your life where something went really well, when you were very happy or got some good news. I want you to really picture that, picture the happy moment, picture the impossible becoming possible.
Okay, now open your eyes if they were closed. Try not to feel too disappointed when I bring you back to reality. How did that feel? Pretty good, right? Now multiply that feeling by 20 combined with being 100% convinced that this will actually happen for real, and you’re probably somewhere close to where mania feels. It feels like you will win the lottery, know the cure for cancer, colors feel bright and beautiful, you have the energy to not sleep for days and not feel tired, the confidence to talk to complete strangers and crack jokes.
For those of you who have taken drugs like MDMA or speed or cocaine, I’m not going to ask you to put your hands up because we’re on camera. This probably feels similar, except that it goes on for days, weeks, sometimes even months. In early stage, in hypermania, which is a less severe form of mania, people may genuinely be especially creative, great at writing, great at sales, really funny. Sometimes friends of people with bipolar disorder welcome mania and encourage people to come out when they’re manic because they’re so much fun, or partners welcome it because of an increased sex drive.
There are many important people in history who probably had bipolar disorder, such as the US Founding Father Alexander Hamilton and the British nurse and statistician Florence Nightingale. Perhaps that drive and energy and overconfidence is what made them become such important figures in history. Research has shown that people with bipolar disorder are often very artistic and creative, and there’s an overlap in the risk for bipolar disorder and successful leadership and entrepreneurship.
When I was 18, I had just finished my A-levels and was starting a gap year. I was working, earning minimum wage in a restaurant, saving money for traveling. I didn’t have a place at university sorted yet, so my future felt uncertain. My dad had recently been made redundant, so I was worrying about money. In retrospect, there was a long build-up to the episode, but it all escalated quite quickly over the course of a night.
When admiring my friend’s music equipment, it escalated from “I’m going to buy myself some recording equipment” to “I’m going to set up an international business empire around music. It’s going to be a recording studio, bars, and restaurants; it’s all going to be linked.” It felt amazing. It felt like I could genuinely do it. It felt like I was on the precipice of something that would change my life and change other people’s lives. It was going to help the homeless; it would give my dad a job. And I really thought I could do it.
In two weeks, with 200 pounds to my name and absolutely no business experience whatsoever, I bought furniture for the studio that I didn’t have, offered complete strangers on the street and old school friends jobs, woke my family up in the middle of the night to tell them about this amazing business idea. My brother didn’t believe me and thought I had taken something because I was so buzzing. I ended up in the hospital, and even then, I still couldn’t drop the idea. The staff just didn’t get it.
But it comes with a catch. When people are manic, they can be overly grandiose, overly confident, even delusional about their abilities, and it can really backfire. If you feel like you’ve got an amazing idea or you’re going to win the lottery, you will do anything to get there, even if it means arguing with a partner, spending your life savings, leaving a perfectly good job. Some people will end up in the hospital against their will or lose that job or lose their marriage, and still, despite this, for some people, the lure of mania is still too much to resist. They still want to go with it.
I was once running a bipolar relapse prevention group, and I asked them, “Who wants to stop getting depressed?” All ten of them put up their hands. “Who wants to stop getting manic?” One of them put up their hands. And this was a relapse prevention group; they knew what they were signing up for. Part of them knows when you’re manic that it’s going to go too far, it’s only going to last so long, and then it’s going to get messy. It’s going to cause problems, but people want to risk that short-term euphoria, confidence, and energy, even though they know it might go too far.
This is especially the case if you’ve been depressed for months, depression being the flip side of bipolar disorder. Imagine that you’ve spent months with no confidence, no energy, no sex drive, and then suddenly something comes along which gives you all of those things back and more. You’d be tempted to go with it, wouldn’t you?
People think they can just turn the mania on, use it a little bit, and then turn it off again. But it doesn’t work like that. If you try and use the mania, you’re going to do things like go out more, socialize more, spend money, take drugs, which is all going to bring your mood higher and higher until you can’t switch it off, you can’t calm it down. You start to lose touch with reality, and it gets out of control, and it becomes unpleasant and scary.
Despite this, the lure for some people is still too much to resist. And I get it. Even as a clinician who has witnessed the devastation that mania can lead to, even experiencing it myself, there is still a part of me, a little bit of me, that feels like I can be uber-productive at work if I’m just a little bit high. But staying a little bit high is a risky game. Sometimes people want to keep hold of the mania but let go of the depression, but it doesn’t work like that. They are two sides of the same coin. Stability means working on balancing both sides out. The same drive and goal focus and high standards that lead people to mania when they reach their goals also leads to depression when they don’t reach their goals. So you can’t really have one without the other.
So where does this lure come from? Why do people want to go with this, even though it’s risky, even though it might cause all these problems? Well, the messages we get about achievement might be a big part of it. Families that place a really big emphasis on career and achievement may strengthen unhelpful beliefs about achievement, which are known to be higher in people with bipolar disorder.
Society at large also has a big role. One study looking at 17 different countries showed that countries that favor individualism, individual performance, and achievement actually had a higher prevalence of bipolar disorder. Such societies, often seen in the Western world, may actually put people at greater risk of mania because it leads us to set our goals ridiculously high and drive and not sleep enough and work too hard until it goes too far and it turns into mania.
We absorb messages about the American Dream: anyone can make it if they work hard enough, everyone for themselves. Our media is filled with stories about the one person who had one idea, risked it all, and became a billionaire, changed the world. We don’t hear about the hundred people who risked everything and lost everything because it makes people more tempted to go with it, to go with the mania, to have a short-term burst of achievement so they can start that business, write that book, finish that play.
This is why for bipolar disorder, it’s not just negative life events that can trigger a relapse; it’s positive life events as well. People can get a promotion at work, but due to the high standards and focusing on goals, they don’t stop there. They want to work harder, do more, work more, sleep less until they push it too far and they become unwell. It’s like an athlete: they set their running time here, and then when they get to that, they just lower the time lower and lower. In the same way, a relentless focus on goals is a losing game and it never ends because
once you get to a certain point, you just go higher and higher and raise the standards, it never ends. Trying to stop mania from escalating is impossible; it’s like being on a skateboard on the top of a really steep hill. It’s fun at first, but if you don’t get off soon, it’s going to get faster and faster until it feels out of control, you crash, and you get hurt.
So what can we do about this? How can we make mania less tempting? At an individual level, it’s important to acknowledge that although mania can feel great at first, it comes with a cost. Think about if it’s worth it. Remind yourself that even though it’s tempting to go with it for a little while, the more you go with it, the harder it’s going to be to switch it off and it might get unpleasant and it might get you into trouble.
If you have a friend, loved one, or colleague with bipolar disorder, it’s important to send them the message that you don’t need them to be manic to be productive, to be funny. You appreciate them, respect them, and love them as they are. Stable them is enough.
As a society, we need to rethink the messages we give people about achievement. We want to encourage people, we want to celebrate successes, of course, but we need to acknowledge that life is hard. We won’t always get what we want. Some things just aren’t possible, no matter how hard you work. Some people are just lucky. Some people are just privileged. And sometimes credit isn’t given where credit is due. We need to acknowledge that stories in the media about celebrities, industry leaders, and the very wealthy are a minority, that our social media doesn’t represent reality because we all tend to share good news more readily than bad news.
I don’t mean to burst your bubble here, but statistically speaking, most of us are average. And maybe that’s okay. Maybe those of us who are doing okay need a little bit more publicity. We should all talk more about what we’re struggling with, not just what’s going well. We need to celebrate mistakes as well as successes and achievements because that’s life after all.
Maybe in Western societies, if we think outside of the traditional nuclear family and try to relax this focus on individual achievement and think more about our community and our neighbors, as other countries in the world do, we genuinely feel like we’re actually all in this together. No one can change the world single-handedly; we need to work together, we need each other’s help. This will reduce the lure of mania.
And I know it’s hard to do this. I stand here now acknowledging the irony that my own high standards and drive are what has put me on my career path that brings me here today. And it can be hard to soften up these standards we’ve developed over our lives. When I said to my wife that I wanted to do a talk about how we need to have softer standards and be a bit kinder to ourselves, her response rightly so was, “That’s a great idea, are you going to do that yourself?”
Fortunately, only a few of us will experience the lure of mania, but we can all do something to try and reduce it for others. Thank you.
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