Exuberance: The Passion for Life

by Kay Redfield Jamison

  Mood is not just “positive” during mania, it is, as the nineteenth-century German psychiatrist Emil Kraepelin put it, “unrestrained, merry … exalted and cheerful … overflowingly so.” Aretaeus of Cappadocia, who is often called the clinician of mania, wrote two thousand years ago that those who are manic are gay, active, and expansive. They are, he said, naturally passionate and joyous. They laugh, they joke, “they show off in public with crowned heads as if they were returning victorious from the games; sometimes they laugh and dance all day and all night.” They become “wholly mad,” he wrote. “Some run along unrestrainedly, and, not knowing how, return again to the same spot.… Some flee the haunts of men, and going to the wilderness, live by themselves.” Aretaeus also observed—accurately, as it turns out—that mania, which is strikingly dependent upon the length of daylight, “is connected with temperature of the season,” and that “in those periods of life with which much heat and blood are associated, persons are most given to mania, namely, those about puberty, young men, and such as possess general vigour.”

  Soranus of Ephesus, writing in the second century A.D., emphasized both the anger and merriment so evident during mania; he also noted the “continual wakefulness” of the manic state. The nineteenth-century French alienist Jean-Etiènne Dominique Esquirol agreed that manic patients were lively and irritable and enthusiastic, but he emphasized that they were, as well, volatile and takers of risk. Although susceptible to rapid switching into irritability and anger, mood and energy generally soar during mania. And with them soars thought. (The artist Benjamin Haydon once said of himself that when manic he was “like a man with air balloons under his armpits and ether in his soul.”)

  People think, feel, and act very differently when they are manic. Manic speech differs unmistakably from depressed speech: not only is it faster and far more abundant, it employs more colorful language, more action verbs, and more adjectives. Rhyming and sound associations dramatically increase. (Vincent van Gogh, for one, wrote that his exuberant mood propelled not just his art but his speech: “There are moments,” he said, “when I am twisted by enthusiasm or madness or prophecy, like a Greek oracle on the tripod. And then I have great readiness of speech.”) Depressive speech, in contrast, is slowed, vague, and punctuated by qualifying adverbs. Artwork produced during mania is distinguished by its vividness, expansiveness, and bright colors as well as by a euphoric, positive, and excited emotional tone. Depressive artwork, on the other hand, is characterized by cold and dark colors, and a poverty of ideas.

  Observers from ancient times and scientists from modern ones have emphasized that quick speech and thought almost invariably accompany the elated mood of mania. Indeed, rapid or pressured speech (which is more objectively measured than rapid thought) is present in virtually everyone who is manic. Unusual talkativeness and “flight of ideas,” or the subjective experience that one’s thoughts are racing, are among the formal diagnostic criteria for mania. The opposite is also true: depressed mood is associated with greatly slowed thinking in more than 90 percent of patients with bipolar depression; a paucity of ideas is one of the defining features of the clinical condition.

  A Royal Navy officer named John Custance wrote a remarkable account of mania and depression in his 1952 memoir, Wisdom, Madness, and Folly: The Philosophy of a Lunatic. The exquisite sense of well-being he felt during early stages of his manic attacks permeated every aspect of his being: “First and foremost comes a general sense of intense well-being,” he wrote. “I know of course that this sense is illusory and transient…[but] the general sense of well-being, the pleasurable and sometimes ecstatic feeling-tone, remains as a sort of permanent background of all experience during the manic period.”

  Custance’s thoughts took flight with his mood. “As I sit here looking out of the windows of the ward,” he wrote,

  I see flocks of seagulls who have been driven inland by the extreme cold. The mere sight of these seagulls sets up immediately and virtually simultaneously in my mind the following trains of thoughts:—

  1. A pond called Seagull’s Spring near my home.

  2. Mermaids, i.e. “Sea girls,” sirens, Lorelei, Mother Seager’s syrup, syrup of figs, the blasted fig-tree in the Gospels, Professor Joad who could not accept Jesus as the supremely perfect Man owing to particular incident…

  4. Gulls equal girls, lovely girls, lovelies, film-stars, countless stars in the infinite wastes of space, query: is space really infinite? According to Einstein it is not.…

  Manic thought initially gallops along in a straight line, but chaos ensues as the mania progresses. Thoughts proliferate malignantly and race mindlessly about in the increasingly overloaded and cluttered brain; then they collide and splinter. All governance is lost. Madness settles in and swiftly obliterates whatever advantages mood may have given the mind. The wide-flung ideas of mania and the rush of their flight lead to a terror not imaginable to those who have not lost their minds in this particular way. One patient, writing a hundred years ago, described the initially compelling, then ultimately horrifying path she took to insanity: “All the problems of the universe came crowding into my mind, demanding instant discussion and solution—mental telepathy, hypnotism, wireless telegraphy, Christian Science, women’s rights, and all the problems of medical science, religion, and politics. I even devised means of discovering the weight of a human soul, and had an apparatus constructed in my room for the purpose of weighing my own soul the minute it departed from my body.… Thoughts chased one another through my mind with lightning rapidity. I felt like a person driving a wild horse with a weak rein, who dares not use force, but lets him run his course, following the line of least resistance. Mad impulses would rush through my brain, carrying me first in one direction and then another. To destroy myself or to escape often occurred to me, but my mind could not hold on to one subject long enough to formulate any definite plan.” Like Custance’s mind, this patient’s was on high alert and lit up like a pinball machine: everything seemed to connect and ideas jumped. But then, as her mood ratcheted up, her thinking pelted utterly out of control.

  To understand the connection between exuberant mood and thought is to understand the striking changes in both the quantity and the quality of thinking that occur during mania. John Ruskin described the pell-mell traffic of his thoughts while manic: “I roll on like a ball, with this exception, that contrary to the usual laws of motion I have no friction to contend with in my mind, and of course have some difficulty in stopping myself when there is nothing else to stop me.… I am almost sick and giddy with the quantity of things in my head—trains of thought beginning and branching to infinity, crossing each other, and all tempting and wanting to be worked out.” Samuel Taylor Coleridge, in a different but quite wonderful way, described his times of mental exuberance: “My thoughts,” he said, “bustle along like a Surinam toad, with little toads sprouting out of back, side, and belly.” The abundance of thoughts during manic exuberance is matched only by their bounce and velocity.

  Manic thought, like exuberance, is usually infused with a sense of immediacy and high significance. It demands an audience or a record: notice must be taken. Individuals when manic are inclined to act—to write, paint, compose, petition—rather than to remain passive. (Robert Lowell astutely observed that “mania is a sickness for one’s friends, depression for oneself.” Little remains unstirred anywhere within hailing distance of a manic.) The writer Morag Coate captured this sense of fervid grandiosity in describing one of her psychiatric hospitalizations: “I must record everything and later I would write a book on mental hospitals. I would write books on psychiatric theory too, and on theology. I would write novels. I had the libretto of an opera in mind. Nothing was beyond me.… I wrote a fairy tale; I wrote the diary of a white witch.… It was all vitally important.”

  There is a surprisingly large body of empirical evidence linking creative thinking to manic-depressive illness. More than twenty studies show that artists, writers, and other creative indi
viduals are far more likely than the general public to suffer from mood disorders, especially manic-depression. Clearly, most people who are creative do not have a mood disorder, and most people who have a mood disorder are not unusually creative. But, as a group, creative individuals have a disproportionately high rate of depression and bipolar illness. Many explanations have been put forward to explain this finding—high levels of energy and enthusiasm, a tendency to take risks, an underlying restlessness and discontent, more finely tuned senses, a need to impose order on chaos, and a range and intensity of emotional experiences common to the artistic and manic-depressive temperaments—but the most commonly and persuasively suggested are the types of changes in mood and thinking that take place in both manic and creative thought.

  Creative and manic thinking are both distinguished by fluidity and by the capacity to combine ideas in ways that form new and original connections. Thinking in both tends to be divergent in nature, less goal-bound, and more likely to wander about or leap off in a variety of directions. Diffuse, diverse, and leapfrogging ideas were first noted thousands of years ago as one of the hallmarks of manic thought. More recently, the Swiss psychiatrist Eugen Bleuler observed: “The thinking of the manic is flighty. He jumps by by-paths from one subject to another.… With this the ideas run along very easily.… Because of the more rapid flow of ideas, and especially because of the falling off of inhibitions, artistic activities are facilitated even though something worthwhile is produced only in very mild cases and when the patient is otherwise talented in this direction.” The expansiveness of thought so characteristic of mania can open up a wider range of cognitive options and broaden the field of observation.

  Both individuals who are manic and those who are writers, when evaluated with neuropsychological tests, tend to combine ideas or images in a way that “blurs, broadens, or shifts conceptual boundaries,” a type of thinking known as conceptual overinclusiveness. They vary in this from normal subjects and from patients with schizophrenia. Researchers at the University of Iowa, for example, have shown that “both writers and manics tend to sort in large groups, change dimensions while in the process of sorting, arbitrarily change starting points, or use vague distantly related concepts as categorizing principles.” The writers are better able than the manics to maintain control over their patterns of thinking, however, and to use “controlled flights of fancy” rather than the more bizarre sorting systems used by the patients.

  Manic thought is often wildly combinatory, humorous, and playful; it galumphs and in so doing, especially in its milder forms, contributes significantly to performance on tests measuring creativity. Kraepelin and other nineteenth-century physicians tested their patients for fluency of word associations during mania and found that it increased dramatically. Later, in the 1940s, researchers at the Payne Whitney Psychiatric Clinic in New York demonstrated that, when elated, their manic-depressive patients showed greatly increased verbal and associative ability. They also found that normal subjects (or, more accurately, medical students), when given a mild dose of the stimulant dexedrine sulfate, improved on tests of associative fluency. The performance of the normal subjects while on dexedrine remained significantly lower than that of the manics, however.

  Verbal associations increase in different ways during mania. Researchers find, for example, that the number of unusual responses to word-association tasks (similar to those used in studies looking at the effect of positive mood induction on associational fluency in normal subjects) increases threefold. The number of statistically common responses drops dramatically. The increase in word associations is generally proportionate to the severity of manic symptoms.

  The changes in mood and thinking that accompany mania are far more intense than those induced by psychologists during experimental studies. This suggests several things. The relationship between elated mood and fluency of thinking is, up to a point, linear: the more elevated the mood, the more fluent and diverse the thinking. Too much elevation, however, results in fragmented thinking and even psychosis. Likewise, the level of enthusiasm with which an idea is held has an impact on the likelihood that it will be put into action. (People who have manic-depressive illness are, when manic, more likely to act, to be utterly certain of their convictions, and to put their ideas into action without the brakes or judgment provided by rational thought.) In other words, mood affects not only thought, but the uses, if any, to which thought is put. This is particularly important for those individuals whose work is strongly tied to mood.

  Several years ago I conducted a study of eminent writers and artists and found, like most researchers before and after me, that they were much more likely than the general population to have been treated for mania or depression. One of my major interests was to look not just at psychopathology, however, but to try to better understand the role of moods in the creative process itself. Virtually all the writers and artists had experienced extended periods of intense creative activity, which were characerized by striking increases in enthusiasm, energy, rapid and fluent thought, and self-confidence. Most reported that a sharp rise in their mood preceded the onset of their creative work. Ruth Richards and Dennis Kinney, in a Harvard study of manic-depression and creativity, found that the overwhelming majority of their subjects experienced at least mildly elevated moods during the periods when they were most creative. When their moods were most elevated, so were the ease and expansiveness of their thinking and the quickness of their mental associations. Eugene Fodor, of Clarkson University in New York, has shown that students vulnerable to manic-depressive illness are particularly creative when their mood has been experimentally elevated.

  The act of being creative, it is assumed, occasions elation. No doubt this is true, but studies of mania and creativity, along with results from studies of experimentally induced positive mood, suggest that the opposite may be at least as important: that is, elevated or expansive moods come first; creative thinking follows. Creativity may then, in its own right, elevate mood; this can lead to extended periods of reverberating moods, energies, and imagination. It may lead to decreased sleep as well, which can further elevate mood.

  The links between manic-depression and creativity suggest some ways of understanding the connections between positive mood, thinking, and behavior. But mania is a pathological condition and represents extremes in mood and behavior. More illustrative of positive emotions and high energy—of “normal” exuberance—are the temperamental qualities closely allied with manic-depressive illness. Emil Kraepelin, who remains for most of us who study the illness the preeminent authority on the subject, describes a temperamental variant, which he called a manic predisposition. “The slightest forms of the disorder,” wrote Kraepelin, “lead us to certain personal predispositions still in the domain of the normal. It concerns here brilliant, but unevenly gifted personalities with artistic inclinations. They charm us by their intellectual mobility, their versatility, their wealth of ideas, their ready accessibility and their delight in adventure, their artistic capability, their good nature, their cheery, sunny mood.” But, Kraepelin goes on to say, there are liabilities to this temperament: “they put us in an uncomfortable state of surprise by a certain restlessness, talkativeness, desultoriness in conversation, excessive need for social life, capricious temper and suggestibility, lack of reliability, steadiness, and perseverance in work, a tendency to building castles in the air.” People who have this temperament, he observed, may also be inclined to depression, although it is usually their relatives who show the most severe pathology. This tendency toward depression, together with a typically strong family history of manic-depression, led Kraepelin to his belief that the manic predisposition (or the sanguine temperament) is to be regarded as “a link in the long chain of manic-depressive predispositions.”

  Modern researchers tend to support Kraepelin’s belief in the existence of “manic-depressive predispositions.” Hagop Akiskal and his colleagues, as we have seen, find that certain temperaments, including hyperthym
ia—characterized by optimism, high energy, enthusiasm, and extraversion—are part of a continuum of traits in the general population. Individuals who score high on hyperthymia are more likely to switch into mania than those who score very low. This is also true for college students who obtain high scores on the Hypomanic Personality Scale, a test developed by psychologists to identify people at high risk for developing bipolar disorder. A thirteen-year follow-up study of students who scored high on the test found that they were more likely to experience subsequent attacks of mania and depression. (Typical items on the scale are: “I am frequently so ‘hyper’ that my friends kiddingly ask me what drug I’m taking”; “I often have moods where I feel so energetic and optimistic that I feel I could outperform almost anyone at anything”; “I often get so happy and energetic that I am almost giddy”; “I often get into excited moods where it’s almost impossible for me to stop talking.”) The Hypomanic Personality Scale correlates with personality dimensions such as extraversion and openness to new experiences. Six percent of college students tested meet the criteria for hypomanic tendencies, a figure reasonably close to the 8 percent who were categorized as hyperthymic in a study of American and Italian students. These estimates are comparable to the 10 percent of children described as exuberant by Jerome Kagan at Harvard, and the 10 percent of infants characterized as exuberant by Nathan Fox at the University of Maryland.