The hypomanic American
A psychologist argues that America is rich because a lot of us are a little bit nuts
THE PEOPLE WHO come to see Alden Cass, a therapist with a practice in Manhattan, make their living from the market: bankers, brokers, traders, financial advisers. They're a special breed. ''These guys love risk,'' says Cass. ''They eat it for breakfast.'' His clients think, talk, and act fast. They need just a few hours' sleep. They're prone to reckless behavior, sexual promiscuity, extravagant spending. They exhibit all the signs, that is, of what psychologists call ''hypomania'': an energetic, ebullient state that is a milder form of the mania associated with bipolar illness.
Cass claims that the majority of his patients are hypomanic, and though he treats them for the problems that hypomania can produce - depression, burnout, substance abuse, wrecked relationships - he also recognizes its advantages. ''These people have a boldness and a self-confidence that sets them apart from the average citizen,'' Cass asserts. ''Hypomania is great for business.''
John D. Gartner, a psychologist at Johns Hopkins University, agrees. In his new book ''The Hypomanic Edge: The Link Between (A Little) Craziness And (A Lot of) Success In America'' (Simon & Schuster), Gartner contends not only that most of today's successful entrepreneurs and businesspeople are hypomanic, but that many of our history's leading figures, such as Alexander Hamilton, Andrew Carnegie, and Henry Ford, had the condition as well. The United States has more hypomanics than other countries, Gartner claims, and these people are largely responsible for the nation's power and prosperity.
''Energy, drive, cockeyed optimism, entrepreneurial and religious zeal, Yankee ingenuity, messianism, and arrogance - these traits have long been attributed to an 'American character,''' Gartner writes. ''But given how closely they overlap with the hypomanic profile, they might be better understood as expressions of an American temperament, shaped in large part by our rich concentration of hypomanic genes.''
Might - or might not. Gartner himself allows that his book rests largely on unproven assumptions, but doesn't back away from his conviction that they're correct. Hypomania, he proclaims, ''has made us what we are.''
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The most striking element of hypomania, as described in the Diagnostic and Statistical Manual of Mental Disorders, is a wildly elevated and expansive mood. Such episodes last at least a week, and during them hypomanics feel like masters of the universe. Buoyed by a sense of their own importance, they are restless and excitable, throwing themselves with abandon into work or pleasurable activities like shopping or sex.
This state closely resembles the initial stages of full-blown manic depression, or bipolar disorder. But instead of spiraling into debilitating manias and then into a paralyzing depression, hypomanics generally experience only the invigorating effects of the onset of mania and usually emerge from it without professional help (though sometimes a period of mild depression follows).
''If you ask most hypomanics, they don't experience the condition as a problem,'' comments Gartner, who says he is himself hypomanic. ''When they're experiencing hypomania, they feel vital, alive, energized. Their best self, their healthiest self, is their hypomanic self.''
Indeed, while hypomania has been the subject of relatively little research and clinical attention, there are a handful of studies indicating that people in a hypomanic state are more flexible and creative in their thinking, are more motivated and productive, and have more positive expectations for the future. And while there is a large speculative literature on the connection between manic depression and artistic creativity, Gartner claims that ''until now, there has never been a serious suggestion that the talent for being an entrepreneur and mania, the genetically based psychiatric disorder, are actually linked.''
''American entrepreneurs are largely hypomanic,'' Gartner declares, but the story doesn't begin and end with today's would-be Donald Trumps. The United States is a land of immigrants, he observes, populated by those whose ancestors were energetic and optimistic enough to leave a familiar homeland for strange shores. This self-selected group, Gartner surmises, likely included many hypomanics. In addition, studies have found that immigrants generally have higher rates of bipolar disorder. Because there is a genetic link between the disorder and hypomania - the relatives of manic-depressives are more likely to be hypomanic - America's long history of immigration, Gartner concludes, has made it a ''hypomanic nation.''
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Some mental health experts endorse many of his ideas. Psychiatrist Kay Redfield Jamison ends her recent book, ''Exuberance'' (Knopf), with musings about the influence of immigration on Americans' characteristically exuberant temperament. ''Individuals who sought the new, who took risks that others would not, or who rebelled against repressive social systems may have been more likely to immigrate to America and, once there, to succeed,'' she writes.
But Jamison, who recorded her own struggles with manic depression in ''An Unquiet Mind'' (1995), thinks that Gartner may take his ideas too far. ''Certainly there have been studies, long before his book, suggesting that there is a disproportionate rate of bipolar illness in immigrant populations, which is not surprising, really, when you think about the energy and the optimism and impulsiveness that drives people to immigrate,'' she said in a recent telephone interview. ''Now, does that mean that most Americans are hypomanic? No, that means - at least from my point of view - that a very real minority may be hypomanic, though perhaps a very important minority.''
Others in the field are less receptive to Gartner's conjectures. ''Gartner is trying to use a few fascinating cases to explain an entire country's economic behavior, and that's a bit of a stretch,'' says Jon McClellan, an associate professor of psychiatry at the University of Washington in Seattle who has written about the dangers of overdiagnosing bipolar illness. Besides, he adds, ''I'm really bothered by this notion that we're genetically superior to people from other countries. That's an argument that's been used for all sorts of bad things, and we should be very careful about making it.''
What's more, McClellan notes, Gartner's claims go beyond what the rather meager research on hypomania can support. (For example, estimates on the prevalence of the condition range from as low as .1 percent to as high as 10 percent.) ''Scientifically,'' he says, ''the evidence just isn't there.''
Peter C. Whybrow, a psychiatrist and neuroscientist at UCLA, agrees - though he has his own theory about how Americans' genes make them different. He has just published a book, ''American Mania: When More is Not Enough'' (W.W. Norton), that he describes as ''the flip side'' of Gartner's cheerful depiction of a country full of enterprising entrepreneurs. But, Whybrow explains, ''I use the word 'mania' metaphorically, not literally.'' In contrast to Gartner's largely upbeat assessment of American culture, Whybrow's book warns that our innate desire for all that's new and exciting has spun out of control, leading to rising levels of anxiety, depression, and obesity.
In the book, Whybrow traces the unique character of the United States - what he calls ''America's astonishing appetite for life'' - not to hypomania but to a genetic variation, found more frequently among Americans than among other peoples, that inclines individuals who have it toward taking risks.
''We don't know enough about the genetics of hypomania to say that it's what drives the American temperament,'' says Whybrow (himself an immigrant from Britain). ''But we do know that in the American population you find a much higher prevalence of the D4-7 allele, which is the risk-taking gene. I think the factor that distinguishes the inhabitants of the United States is much more likely to be a novelty-seeking gene than some form of manic-depressive illness.''
Gartner concedes that his book is partly ''speculative.'' While he points to studies suggesting that the United States (along with Canada and New Zealand) has the world's highest incidence of manic depression, he acknowledges that there is no data available on countries' relative rates of hypomania. And he admits that his ''pilot study'' - in which he diagnosed as hypomanic all 10 Internet CEOs who responded to ads he placed on various websites - is far from conclusive.
''What I'm doing is putting certain things together, drawing an inference,'' he says. ''I'm saying: 'Look, isn't it interesting that the countries that have been havens for immigrants also have the highest rates of bipolar disorder? And isn't it interesting that those are the countries that have the highest rates of new company creation?' Yes, it could be coincidental - but in science, we say that the simplest explanation is usually the right one.''
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But as controversial as Gartner's book is among scientists, it is likely to find even less of a sympathetic hearing among historians. ''The Hypomanic Edge'' offers case studies of well-known Americans who Gartner believes to be hypomanic. Some of them are contemporary, like Craig Venter, the brash scientist whose company won the race to decode the human genome. ''My self-diagnosis: I probably have a very mild case of manic depression,'' he is quoted as telling the author. Others died centuries ago.
Gartner makes his most vigorous case for a posthumous diagnosis of hypomania on behalf of Alexander Hamilton, the founding father and immigrant from the West Indies. Unable to conduct an interview with the man himself, Gartner turned to five of Hamilton's biographers, who he claims recognized typical hypomanic characteristics - ''restless and impatient''; ''unusually active at work and other pursuits''; ''supremely confident of success'' - while declining to identify them as signs of pathology.
One of these biographers was Richard Brookhiser, author of ''Alexander Hamilton, American'' (1999), who Gartner reports was ''cool to the idea of diagnosing'' his subject. But Brookhiser said in a recent telephone interview that he simply doubts the usefulness of such diagnoses.
As a student of American history, he said, ''you have to be willing to use anything that comes to hand if it looks promising or if it's going to teach you something or take you further into the minds of these fascinating people. You just have to be careful about imposing psychiatric terminology from the 21st century on people who will never be able to answer back.''
Annie Murphy Paul is a writer living in Cambridge. Her book ''The Cult of Personality'' was published last September.