Springtime's Here, and It's Mania Season

About 2.5 out of every 100 Americans is diagnosed with bipolar disorder, a very heritable mental illness that is characterized by cyclical periods of intense negative or positive mood. A particularly strong cognitive characteristic of the manic (very positive) mood state is a lack of impulse control. This can result in people spending money at a rapid pace, jumping on a plane at a moment's notice, quitting a job without thinking it through, or taking up with a new romantic partner without consideration for existing relationships. Impulsive behavior is generally seen as reflecting problems with executive functioning, a mental ability that's strongly localized in the prefrontal cortex and therefore associated with the logical, sequential, and language-based Narrative mind. 

In a detailed analysis of specific mental functions, Bora et al. found that response inhibition was the most pronounced cognitive problem associated with bipolar disorder. This was true even among people with bipolar disorder when they were in a non-manic state, and also based on studies of their first-degree relatives who had not been diagnosed with bipolar disorder. Other mental functions like processing speed, verbal fluency, or sustained attention were not affected in people with bipolar disorder. Furthermore, the pattern of cognitive test results was different from that seen in people with another major mental disorder, schizophrenia. Response inhibition is what we often mean when we talk about "conscious control" over our own behavior, and can be seen as the ability of the Narrative mind to execute a last-minute veto over what the Intuitive mind has decided to do next. When that veto mechanism isn't working properly, impulsive behavior results. Similar executive-function deficits have been observed in connection with trauma and substance use.

Other evidence about cognitive processing in bipolar disorder comes from studies of children. Attention deficit-hyperactivity disorder (ADHD) is another common childhood condition with strong executive-functioning deficits, and indeed ADHD and bipolar disorder are often mistaken for one another among children. Walshaw, Alloy, and Sabb found that children with bipolar disorder were more likely to have problems with planning actions in advance, shifting mental "sets" from one task to the next, and ignoring irrelevant information (e.g., based on the Stroop task). They didn't necessarily have trouble with memory, or with inhibiting responses in general, which were more common in ADHD. Distraction and lack of planning seem to be the core cognitive changes associated with manic states. Besides impulsive actions, this type of thinking can result in trouble completing activities or following through on promises, which can exacerbate problems in jobs or relationships. 

Despite the level of disruption that bipolar disorder creates in people's lives, manic states often feel intensely exciting and creative to people who experience them. The highly positive feelings of many manic states are the single greatest reason for treatment nonadherence among people with bipolar disorder: After the highs of mania, everyday thinking often feels bland and slow. In her book An Unquiet Mind: A Memoir of Moods and Madness, psychiatric expert Dr. Kay Redfield Jamison writes this of her own manic experience in a chapter called “missing Saturn”: 

People go mad in idiosyncratic ways. Perhaps it was not surprising that, as a meteorologist's daughter, I found myself, in that glorious illusion of high summer days, gliding, flying, now and again lurching through cloud banks and ethers, past stars, and across fields of ice crystals. Even now, I can see in my mind's rather peculiar eye an extraordinary shattering and shifting of light; inconstant but ravishing colors laid out across miles of circling rings; and the almost imperceptible, somehow surprisingly pallid, moons of this Catherine wheel of a planet. I remember singing "Fly Me to the Moons" as I swept past those of Saturn, and thinking myself terribly funny. I saw and experienced that which had been only dreams, or fitful fragments of aspiration.

Dr. Jamison is an exceptional writer, and this lyrical passage about Saturn is striking as much because of her artistry as because of her hallucinatory experience. But creativity -- actual, real creative excellence as judged by outside experts -- is in fact more common among people with bipolar disorder, and perhaps to an even greater degree among their first-degree relatives who have some of the manic energy without the destructive effects of full-blown mania. The list of famous people who are believed to have had bipolar disorder includes Vincent Van Gogh, Carrie Fisher, Sir Isaac Newton, Francis Ford Coppola, Ernest Hemingway, Mariah Carey, Gustav Mahler, Frida Kahlo, and perhaps President Lincoln. Many people with bipolar disorder have talked about their mental health condition as a source of their success, as in John Dryden’s trope "great wits are sure to madness near allied, and thin partitions do their bounds divide.” Later in Dr. Jamison's life, she writes that she experienced a great sense of melancholy when remembering her earlier manic states:

People say, when I complain of being less lively, less energetic, less high-spirited, "Well, now you're just like the rest of us," meaning, among other things, to be reassuring. But I compare myself with my former self, not with the others. Not only that, I tend to compare my current self with the best I have been, which is when I have been mildly manic. When I am my present "normal" self, I am far removed from when I have been my liveliest, most productive, most intense, most outgoing and effervescent. In short, for myself, I am a hard act to follow. And I miss Saturn very much.

 A final unusual feature of bipolar disorder is that it shows a strong seasonal pattern. Many people feel down in the autumn and winter months, a situation now known by the diagnostic label Seasonal Affective Disorder (SAD). People with bipolar disorder may have that, but they also often have a corresponding upswing in mood in the early spring. (Interestingly, for about 10% of people who experience seasonal mood shifts the pattern is exactly reversed). In one study, seasonal exacerbations were associated with deeper depression in men and with rapid-cycling moods or eating disorders in women. The presence of seasonal patterns may be associated with hours of daylight: some evidence shows that seasonal mood shifts are more common the further one lives from the equator.

Bipolar disorder clearly affects the Intuitive mind (strong emotions, reactivity to daylight, creative intuition and energy), but has affects on the Narrative mind as well (distractibility, planning difficulty, lack of inhibitory control). In combination, these features can exert a powerful pull on behavior, especially at this particular time of the year.