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The only guideline offered to mental health professionals
in distinguishing between mania and hypomania is “degree
of severity.” Hypomania is “not sufficiently severe
to cause marked impairment in social or occupational functioning
or to require hospitalization.” But DSM-IV tells us
little else, when there is so much more that could be said.
This relative neglect of hypomania by psychiatry is striking
when we consider that it affects many more people than does
mania. We know from numerous large-scale studies, replicated
both nationally and internationally, that classic manic depression
exists in slightly less than 1 percent of the general population.10
A notably smaller but growing amount of literature on hypomania
suggests that 5 to 10 percent of the population is hypomanic.11
Whatever the exact percentage, psychiatry’s most recent
discovery is not a rare expression of bipolar genes, but its
most common form.*
That hypomania is so much more common than mania may give
us a crucial clue to its genetic function and evolutionary
importance. Mania, according to one school of thought, is
a disease like sickle-cell anemia.12 Sickle-cell anemia is
a blood disease that primarily affects people of African origin.
To contract the disease, you must inherit the recessive sickle
gene from both your mother and your father. Far more often,
people inherit only a single sickle gene from one parent;
epidemiologists call these people “carriers” because
they carry the gene without manifesting the illness. As it
turns out, they are much more than that. They are the reason
the gene exists. A single sickle gene greatly enhances resistance
to malaria, a deadly disease prevalent in Africa. This gene
has been favored by natural selection, even though it causes
a deadly disease, because it saves more people than it kills.
We have not isolated one singular manic gene. Investigators
at the Department of Psychiatry at Johns Hopkins University
Medical School, where I teach, and at other institutions around
the world, have homed in on half a dozen genes associated
with mania.13 Though the numbers may be more complex, the
same principles may apply: a less probable combination of
genes produces the undesirable disease of mania, while a more
frequent combination produces the advantageous outcome of
hypomania. It could be that quantitatively more hypomanic
genes are required to produce mania. Call this the slot machine
model. Three cherries produces a moderate payout: hypomania.
But once in a great while you get five cherries, and you’re
flooded with coins: mania. Alternatively, there may be a specific
gene that needs to be combined with hypomanic genes to produce
mania. Raymond DePaulo, James Potash, and their colleagues
at Johns Hopkins have found a gene that mania and schizophrenia
share in common—a possible “psychoticism gene.”
Mania might be the result when one is unlucky enough to inherit
both hypomanic genes and the psychotic gene.14
The story of the CEO father and his hospitalized son helps
us understand why hypomanic genes exist. Relatives of manic
patients, who have high rates of hypomania, have consistently
been found to be far above average in income, occupational
achievement, and creativity.15 Hypomania gives them an edge
over the competition.
If there is any one trait that distinguishes highly successful
people, it is that they are, by temperament, highly motivated.
From our studies of the brain we now know that mood is an
intrinsic part of the apparatus that controls motivation.
Mood is meant either to facilitate or inhibit action. When
someone is depressed, he has no motivation to act. What’s
the point? Nothing seems worth doing, he has no energy to
do it, and it probably won’t work anyway. Hypomania
is the polar opposite. The drives that motivate behavior surge
to a screaming pitch, making the urgency of action irresistible.
There isn’t a minute to waste—this is going to
be huge—just do it!
This pressure to act creates overachievers, but it also leads
to impulsive behavior (ready, shoot, aim) and confident leaders
who glibly take their followers over a cliff. Depending on
how you look at it, the Internet phenomenon was either an
exciting breakthrough of human ingenuity or a colossal error
in judgment that forces us to ask: What were we thinking?
In truth, it was both. The paradox of the hypomanic edge is
that it is a double-edged sword.