
Chronic mania and persistent euphoric states - apsec112
https://srconstantin.github.io/2020/07/29/chronic-mania.html
======
jjcm
"Now, most of the examples we know of these prolonged euphoric states are
undesirable. They often come with reckless or harmful behavior, delusions, and
cognitive impairment."

I think there's a bit of selection bias here. Often times the only euphoria
cases you really hear of are the ones that come along with some sort of
detriment, leading the patient or people around them to seek help. I have a
gut theory that that chronic elation is just as prominant as chronic
depression, but since it rarely effects the person adversely few seek help for
it.

Throughout my life I've been for the most part overly happy. It's just
something myself, my family, and those close to me have noticed. There are
issues with it, but they tend to be minor and things that I wouldn't really
seek help for:

-being happy in inappropriate contexts (people tend to not resonate with you when you're happy at a funeral).

-much higher tolerance with ambiguity. I'm OK with being lost somewhere, which tends to annoy those around me as I tend to wander towards a destination rather than taking an optimal route.

-and an exageration of smile wrinkles on my face.

The negative impact to my life is quite low. Since I'd never seek help for it,
it would never really be recorded anywhere. I suspect there are plenty of
people with a chronic elation that are in the same boat - there's no onus to
address it as an issue. I have no idea what makes me tick differently, but I
suspect with a larger understanding of human biology we'll eventually be able
to isolate these things and find an optimal amount of happy for humans to have
as a baseline.

~~~
raducu
I think what you describe is nowhere near mania or euphoria, it is just
generally being content with life.

I've also met people who are generally content.

I've suffered from extreme mood swings, and the next day after I punched
myself in the face and hit my head against a wall I would just brush it off as
"Me? No way I did that, I'm always happy".

If a large percentage of the population was generally happy, in the fashion
you described, we'd know, there are countless scientific studies about
happiness and well being.

~~~
owenversteeg
What jjcm describes is almost definitely a FAAH mutation, likely a double
mutation. I believe I have the same, and describing it as a sort of euphoria
isn't entirely incorrect. Furthermore, it does correspond somewhat to the
effects of various drugs on "normal" people. There's a reason some people with
the mutation are described as "slightly baked" [0]. So I think it's extremely
relevant to this discussion.

And a large percentage of the population does indeed have the single mutation.
I've heard figures of 20 and 30%. I think it's also what you do with the
mutation and your life circumstances that play a role in your personal
happiness, of course.

I commented downthread with my personal experience:
[https://news.ycombinator.com/item?id=24009025](https://news.ycombinator.com/item?id=24009025)

[0] Highly recommended article:
[https://www.newyorker.com/magazine/2020/01/13/a-world-
withou...](https://www.newyorker.com/magazine/2020/01/13/a-world-without-pain)

~~~
raducu
Thanks, that was a very interesting read!

I know paracetamol also works to some extent for emotional pain, and perhaps
anxiety and physical pain share some neural and developmental pathways.

Do you feel any physical pain?

How about empathy?

I've always had a profound disliking for people without empathy, and for good
measure -- those people usually are psychopaths or narcissists, but if they
are compassionate but just don't feel empathy, it's ok, I guess... though the
nauseating feeling in my stomach that I first got when I was maybe 5 and I saw
the reaction of a child I struck and robbed of his sunflower, just as
instructed by my older cousin -- that is so fundamental to me, that it seems
inconceivable that you can become a decent human being without it.

I caught myself hoping that at some point in the article some professional
would point out how the lady is in fact flawed in some major ways.

As in you can't have your cookie and eat it too, while the rest of us are
struggling?

I also wish the article elaborated more about why the daughter thought the
lady was in fact horrible -- was that feeling ongoing, or just something in
her adolescence, or just the same nagging feeling I have -- that there MUST be
something terribly bad about someone without empathy.

Take for instance the story of her bipolar husband that died(killed himself?).
Most likely she indeed could not have prevented it.

BUT maybe.... someone feeling empathy and not feeling reciprocated, would over
time feel they are interracting with a robot, not with a human being.

I know I feel that way when I talk with my father and I know he's very low on
the empathy scale -- the whole interaction feels so very fake and scripted
after a while -- I can read his emotional states, I know what he wants, what
he wants me to say, what his fears are, what his intentions are, but it is
absolutely not the other way around.

Overall my father is a good person -- a very good and hard working doctor,
contributes to charities and so on.

I wouldn't get my bad feelings about him if I only knew and spent a couple of
days in my life with him as a writer writing an article about him, but I sure
do as someone who wants a genuine and deep connection with him, just like the
lady's daughter probaby did with her mother.

~~~
owenversteeg
You're welcome! It is fascinating, isn't it?

I should have clarified, I'm no Jo Cameron. I'm no different from your average
person in how I feel physical pain and empathy. It's extremely rare to have
what she has, I think there are only a handful of people in the world that
have that. What's far more common, and what I believe I have (and what a few
other people in this thread have) is a double FAAH mutation. (That makes up
the relentless positivity and lack of fear parts of her personality.) I can't
find any estimates on the frequency of that, but around 20% of people have the
single FAAH mutation that is basically a less strong version.

The discussion about empathy is an interesting one. But I think treating it
like it's some genetic binary thing is completely the wrong way to see it.
Empathy, in some ways, is a cultivated skill. The Nazis were elected. Does
this mean that Germans were born with less empathy, unable to empathize with
the Jewish, disabled, Roma, queer, etc? No, it just means that society
succeeded in turning them into an Other who nobody could empathize with. That
is to say, I think that if you gave two identical twins entirely different
upbringings they would end up with different kinds of empathy. So I think
sure, perhaps Jo Cameron doesn't have some of the genetic material for things
we may associate with empathy, but she seems to have taken on many empathy-
adjacent values like selflessness and really caring about others.

I think the thing with the daughter is just teenagers being teenagers. Having
been a teenager once myself, I wouldn't read too far into it :)

~~~
raducu
If I had to speculate, I'd say the lady has 90% of the hardware that enables
empathy, just that she doesn't feel pain, she cannot empathize with pain and
things deriving from pain, just like I can't empathize with bats using
ecolocation.

Perhaps she empathizes with other, more positive emotions.

However, psychopats surely do feel pain, but they lack the hardware to feel
the pain of others and much more.

And sure, there's the fact that you can learn to voluntarily turn off your
empathy.

------
reilly3000
Its really important to understand that mania is not optimism, positivism, or
much of anything positive really. Its a state of euphoric destruction for
bipolar folks, and chronic mania seems to spread those patterns over the
balance of a lifetime. It is a disorder, and it benefits from treatment. Its
not fun for anybody except for the manic.

~~~
erokar
Mania is debilitating, that's one of its diagnostic criteria. The milder
hypomania can be both productive and pleasant for some though.

It can be useful to think of bipolar mood and behaviour along two axes:
depressed vs. elated mood and low vs. high energy levels. Sometimes people
with bipolar can be both depressed and energetic, a so called mixed state.
Some manic episodes will be energetic and accompanied by an elevated mood of
optimism, joy and even ecstasy.

I agree that full blown mania needs to be treated.

~~~
biddit
>The milder hypomania can be both productive and pleasant for some though.

> I agree that full blown mania needs to be treated.

Curious - is it your view that hypomanic symptoms don't need to be treated
then? If so, why?

Edit: formatting

~~~
wayoutthere
So as someone who is normally hypomanic but had a reaction to antidepressants
that put me fully manic for a while, I don't think hypomania really needs to
be treated with anything other than talk therapy. If I'm aware of it, I can
manage the downsides pretty well through emotional regulation techniques like
breathing / meditation and exercise. Hypomania can be overall positive if you
learn to control it.

Mania on the other hand is basically like, you can't control the shit that
comes out of your mouth. You act on every fucking thing that pops into your
head, even when you recognize that it's hurting the people around you. You
just can't stop yourself; its compulsive and incredibly distressing. People
are uncomfortable around you and you can tell. Your judgment is impaired and
you don't understand the grey area between right and wrong. You have like 15
thoughts flying through your head and you can't keep any of them straight for
more than a few seconds at a time. It really, really sucks.

~~~
biddit
> I don't think hypomania really needs to be treated with anything other than
> talk therapy

I generally agree with this to my experience, with the caveat that their
depressive swings are managed well - via medication or other means.

------
vinceguidry
I've spent a lot of time meditating on mood. I'm highly skeptical of drugs as
a tool to produce lasting euphoria. Producing long-lasting euphoric states
through meditation eventually creates a state of mind I call 'hollow'. You're
happy, but there's an undercurrent of loneliness.

I'm completely not surprised about the patient that sank into hoarding and
squalor while remaining euphoric. That's precisely what happens, one's state
of mind, if it is disconnected from their environment, removes your attention
from said environment. Drug addicts do similarly. Since you're not paying
attention, your ability to relate to others plummets and eventually your sense
of self is supported by this one thing, and it becomes an addiction all on its
own.

Humans are just rats, emotionally. If you live in a cage, providing a lever
that makes you happy about it doesn't take you out of the cage.

Unlike rats, humans can make the choice to put themselves into a virtual cage
with a virtual morphine lever.

Wireheading will certainly become a thing in the future, and it will
undoubtedly raise _some_ people's standard of living. There are people that
live worse than caged rats.

------
cc23
This is article is borderline offensive for people that actually experience
mania. The author cherry picks symptoms to say that chronic mania always feels
good for the manic. This is definitely not the case for bipolar mania, and a
quick Google search shows this is not the case for chronic mania. In fact,
many chronic mania patients are characterized as dysphoric.

Yes, mania feels good at times, really good, but at other times, it feels
extremely uncomfortable. Your euphoric emotions can quickly turn to anger.
Being aggressive usually has it's roots in some emotion that is not pleasant.
Even just general speeding is not pleasant all of the time. Sure, there may be
a few people who experience chronic mania in a way that doesn't ever feel bad
for them. But most manic people experience negative subjective feelings from
their mania at one point or another.

To say that mania always feels good, and is a state to aspire to, is dangerous
for people who actually do experience mania, and extremely tone deaf and out
of touch for those who don't experience mania.

~~~
ditonal
Thank you so much for saying this. Bipolar disorder is badly misunderstood by
the general population, but one of the most common misconceptions is that
mania is the opposite of depression and therefore good. For me, mania was hell
on earth. The risk of self-harm is a lot higher in mania than depression and
doctors are far more concerned with stopping mania than depression, to the
extent they won’t treat depression if the risk of mania is too high.

One source of this misconception is the stereotype of people creating art
while manic (probably hypomanic). Another is that bipolar disorder is a big
spectrum and many type 2 people having hypomania with some euphoric aspects.
But I don’t think I’ve met anyone who isn’t type 1 or knows someone who is
that has a good understanding that mania is very often a nightmare. After my
last manic episode finished I pretty much laid in bed for 6 months doing
nothing but fantasizing about killing myself and I’d much rather relive that
then relive the mania that preceded it.

------
skim_milk
Here's a very similar article from yesterday!
[https://news.ycombinator.com/item?id=23992913](https://news.ycombinator.com/item?id=23992913)

Apparently we're all getting burnt out from meditating too much during our
lockdown. Instead of trying to work towards a permanent good mood, here's some
perspective from a psychotherapist on high mood (or higher consciousness as it
is described here)
[https://www.youtube.com/watch?v=vqCOss4hqnE](https://www.youtube.com/watch?v=vqCOss4hqnE)

Perhaps instead of trying to make it permanent, we should gather insights from
our temporary high mood when it comes, and learn to embrace our default non-
euphoric mood because high mood doesn't sit so well with our important tasks
at hand. Now get back to work.

~~~
DenisM
Climbing the mood mountain is highly individual but the basecamp is shared by
most - suspend all responsibilities for two weeks, reduce or suspend all
media, load up on favorite music, find HIIT You love, disconnect the phone
apart from maps, go somewhere sunny, read enjoyable books, hang out with other
people who are chilling (Climbers, hikers, mnt bikers, etc).

Two weeks of this will put you way above the clouds, the path up from there
will be more individual.

------
motohagiography
Currently reading Philip K. Dick's "Exegisis," which are his letters and diary
entries about his descent (ascent?) into something similar, before he died of
a stroke.

I'm reading it because after reading about other great minds chased down a
similar theme where they seemed to discover something later in life and
retreated from the world to explore it. I wanted to see what a set of
reference points might look like.

The end of this article references something called "wireheading," which seems
to be a deeper explanation of why the article was written.
[https://qualiacomputing.com/2016/08/20/wireheading_done_righ...](https://qualiacomputing.com/2016/08/20/wireheading_done_right/)

~~~
yourad_io
> Exegisis

"explanation" in Greek

------
stcorbett
Are Tibetan monks training their brains and their surroundings to produce a
prolonged or constant positive state?

The positive psychology movement in some senses is a brain training for
prolonged positive feelings.

~~~
maze-le
I am not sure if this is a good state in the long run. What do you live for
when everything is always/mostly positive in your head -- but reality is as
sad as it ever was. Do you really have an incentive to change something to the
better if you are in a constant state of happiness?

I think happiness is a state the brain produces to reward itself for good
outcomes in life decisions. The fact that it is only of limited time and
intensity has its (evolutionary) reasons -- they are not the worst of all
reasons.

Like with depression as chronic sadness and fatigue, chronic happiness is not
something we are capable of handling long-term if we want to optimize outcomes
for ourselves and others.

~~~
pkos98
there's no 'better' state when you're already happy. They don't need to change
anything when their reality is 'happy'.

~~~
maze-le
Yes, but only for you. The people you live your life with (some of whom you
even love) are in the same state of mind as before, and you have no (or at the
very least less) reason to change something for the better for them.

~~~
TomMarius
I can't understand this position. A positive person often does positive things
without a reason or need, especially for their loved ones, as that brings more
happiness.

~~~
hutzlibu
The position is: you are sitting smiling happily and doing nothing, while the
nazis come to take your family and you away to the KZ.

(read stories about that actually happened in reality. Basically a form of
madness/strategy of the brain to deal with a situation it seems impossible to
solve)

~~~
TomMarius
I don't think this is how people usually think of positive people. This is
resignation, not positivity. IMHO a positive person in this situation would
believe in their chance of surviving and fight back.

------
himinlomax
I knew a family most of whose members could qualify as chronically hypomanic.
I made the observation because I had just read on bipolar disorder and mania,
and the material stated that mania or hypomania could not be sustained and had
to be followed by depressive episodes. This was over 20 years ago so the
current understanding, if I'm not mistaken, of bipolar as metabolic
(specifically mitochondrial) in origin might not have been the consensus then.

I'm not sure about the parents, but the _many_ kids (Catholic) were:

\- extremely religious, exalted even you could say. At least two of them
joined the Church as nun and priest

\- promiscuous (lol) in at least one case (my roommate) or at least very
flirtatious

\- talked very fast all the time

\- always bouncing around

And so on. As far as I know none had had significant depressive episodes.

~~~
andai
There's a theory that a "unipolar" variant of Type II bipolar, ie. unipolar
hypomania, is the condition most commonly associated with successful
entrepreneurship.

~~~
himinlomax
I'm not so sure about that, one the typical characteristics of even mild
hypomania, impulsivity, is clearly incompatible with long term endeavors. I've
seen papers saying that very mild chronic depression might be associated with
professional success, not sure how well they'll hold up.

From the five factor point of view, as far as I understand there is some
evidence that high openness to new experience (for new ventures), high
conscientiousness, below average agreeableness along with high IQ are strongly
correlated with success. Not so much for neuroticism and extraversion, though
the latter probably helps in some specific jobs (but surprisingly, not
necessarily sales).

~~~
JackMorgan
I'm fairly sure I know someone who's unipolar BP type II, and while sometimes
they can be very depressed or fatigued, the vast majority of the time they
have absolutely mind boggling stamina for challenge. They constantly read,
think, plan, experiment, and just get stuff done. When combined with a work
ethic and intelligence, they manage to somehow pull off remarkable feats on a
daily basis. It's not at all surprising to consider that they'd be extremely
successful at starting a business, if that was what they chose to do.

They're almost like the guy from Limitless, when they put their mind to
something it just happens like magic. Of course, they rarely stay focused on
anything for too long, so starting a business they'd likely feel too trapped.
They're always eyeing the exits, because they're so restless and need freedom
like we need air.

This makes sense to me, every change from the average comes with corresponding
pros and cons. The same traits in an office that make someone successful in
business might not translate to a survival situation, etc.

In their case, I'd say it mostly comes out in the wash. They do decently well
at work, but don't commit well to bigger projects, and they don't finish
projects well.

~~~
himinlomax
What you allude to is not really mania or hypomania. It's just having a lot of
energy and focus. Manic people have a lot of energy for sure, but it's defined
by its harmful consequences. They drive too fast, they sleep too little, they
talk too much and keep interrupting people, they have sexual urges that are as
strong as they're inappropriate.

Take this older lady I knew of who, when she was stopped by a traffic cop for
speeding, was absolutely convinced he was just hitting on her. Seriously. Or
that guy I knew personally who squandered his sizable inheritance within just
a couple years on ... escorts. I don't know the exact numbers but it was over
a million €.

The family I referenced earlier struck me as subclinically hypomanic not
because they had lots of energy, but because they approached the limits of
harmful behavior.

------
throw18376
i'm a little bit perturbed that the rationalist subculture might be seeing
these mental states as desirable.

the big problem, apart from the obvious issues with impulsive and reckless
decision making, is delusional and bizarre thinking. full-grade mania can have
full-grade psychosis, but even the "desirable" hypomania here can come with
lesser forms of something obviously related.

somebody might be a little too prone to see coincidences, to make unjustified
inferences about other people's mental states, to perceive "messages from the
universe", to perceive patterns and connections between unrelated things, to
believe that they have the ability to somehow influence or foretell the
future, etc.

like euphoria, these are all pretty much harmless and common things in
themselves. it seems to me that hypomania (and drugs, etc.) ramps them up in
the same way it does euphoria, and as long as it doesn't go too far, it
doesn't outright prevent people from functioning.

i wonder whether it's even possible to separate the two -- i find "predictive
processing" explanations of mania to be intuitively convincing, so it seems
like euphoria and weird thinking might be connected in some way.

i don't like the idea of the rationalist crowd, many of whom are smart,
driven, and capable, and value clear thinking, getting into states of mind
like this, especially since they tend to come with anosognosia. it doesn't
seem good.

Even if the goal is "wireheading done right" with some future technology such
that problems can be avoided, the pattern with this subculture seems to be
that some people will try to experiment with whatever closest equivalent is
available now seriously underestimating risks.

if you're thinking to yourself "how can I become hypomanic to make myself more
productive and creative", please don't.

(also, if rationalist types do start trying to make themselves hypomanic, one
result might be that the AI/singularity/simulation stuff will turn into
something that really is a religion.)

~~~
DenisM
Risky behavior is an inalienable right much like riding a motorcycle or
climbing rocks. There is more to life than longevity.

------
pyentropy
I think all emotional states can be triggered electrochemichally for arbitrary
durations.

The reason all humans aren't like the manic people mentioned in the article is
that it's not an evolutionary stable strategy. They hoard, steal, flirt too
much and cooperation cannot happen.

Which brings me to a scary question - what stops a future radical extremist
from capturing enemies and triggering the most extreme pain that no one has
ever felt before with electrodes? Or gene editing millions of babies to be in
constant extreme pain for their whole lifetime, without limbs or senses to be
able to change anything (inspired by Metallica - One)?

~~~
kanobo
That's horrible food for thought - but I think humans have pretty good sensory
adaptation, we don't constantly thinking about how we have clothes on. I
imagine after a couple years or so people will adapt or be numb to the pain.

~~~
pyentropy
The article says adaptation can be bypassed.

------
afarrell
I'm curious what knowledgable folks think about Slate Star Codex's description
of Mania as "high confidence optimism". It sounds like the top-right quadrant
of [https://slatestarcodex.com/2018/03/08/ssc-journal-club-
frist...](https://slatestarcodex.com/2018/03/08/ssc-journal-club-friston-on-
computational-mood/).

~~~
afarrell
Sidenote: I've just realized why the 4-quadrant graph has a "missing emotion"
for the top left (low-confidence optimisim):

1\. English does not have a specific word for that feeling of excitement about
things accompanied by inability to stick with any particular thing if it
doesn't give immediate positive feedback. "Hyperactivity" comes close the half
of it that isn't wandering around on Wikipedia, but that describes a behavior,
not an internal state.

2\. The people who come to see psychiatrists and therapists about their own
problems don't tend to complain about that emotion. Seeing a bunch of
different exciting possibilities is fun! We tend to want help with resulting
difficulty managing their schedules, sleep, relationships, priorities, and
yknow... actually following through on finishing things rather than getting
distracted...

\------------------------------------------------------------------------

There is a mental health book written as an allegory to an IT department
called The Phoenix Project.

While it mostly seems to deal with anxiety, it is pretty applicable here. This
is the same pattern of executive dysfunction that swaps Brent from task to
task and leads the protaganist to say to the Chief Executive [Function]
Officer "Commitments like the compliance work are made without any regard for
what’s already on people’s plates, like Phoenix.”

~~~
ngold
This sounds a lot like chronic decision fatigue. Without basic human help, we
are told to go get the American dream, but never ask for help when you get
cancer and it wipes out all future generations wealth accumulation.

------
chrisweekly
Related tangent: Author Richard Powers (2019 Pulitzer winner for "Overstory",
an amazing novel about trees) wrote an under-appreciated novel called
"Generosity: An Enhancement", which centers on a young woman with
extraordinary resilience and positive affect in the face of difficult
circumstances. Highly recommended.

------
dhruvkar
Often, counterpoints used to cast doubt on someone's state of consciousness
take current societal norms as the bar to cross, e.g.

'he couldn’t hold down a job' or 'he was divorced twice'

I feel this is an apples/oranges situation. Living up to society's current
standards is no indication of evolved consciousness.

------
maybe-idiot
I’m surprised this article makes no mention of hypomania, which is close to
mania but doesn’t cross the threshold. People can be hypomanic for years
without rousing concern amongst friends, family, coworkers, medical staff.

------
FrankyHollywood
'The Subtle Art of Not Giving a F*ck' is a good read in the same spectrum

