Art Buchwald, Mania, and Cycles and/or Triggers
While Jamison (1991, Goodwin FK & Redfield-Jamison, K, Manic Depressive Illness, NY: Oxford) is most interested in cycling phenomena, the late Dennis Cantwell, MD, noticed that some mood episodes can be clearly marked by environmental gains or losses, especially in children. I know adults who report elated, manic, intervals that last for a day or for several months as a function of personal achievement, new personal relationships, or medication (including DHEA!).
Beck (1988, Love is Never Enough, NY: Harper) astutely compared infatuation with mania and noted there are few differences in either the quality or intensity of the emotional experiences. There is less need for sleep, self-esteem soars as do obsessions about the loved one. Realistic thinking erodes, people make substantial changes in careers and location to near a new love. Personal achievement in terms of fame, power, or money dominate the thoughts of other elated people. As Buchwald put it, "There ain't nothin' like it!"
We may not have to choose between the hypothesized, internally-driven cyclers and clients who over react to power shifts. Francis McMahon, MD, also a speaker at the Hopkins Symposium, endorsed the notion that bipolar and other affective disorders are really an entire family of disorders. (1) There may be differences in causation as a function of which parent has the family history of bipolar illness, whether both parents have a family history of the disorder, and other antecedents. These differences will be reflected in age of onset, associated problems, and response to treatment, the probability of still another generation showing similar problems, and in suggestive patterns already seen in chromosome studies.
The Psychological Adaptations model (1992, Barkow et al, The Adapted Mind, NY: Oxford) suggests that all of us have efficient, specialized systems for handling particular kinds of input and translating those signals in to specific kinds of behaviors. Thoughts and moods are steps in a more diffuse system that includes specific sensory, autonomic, endocrine, and sequenced motor components. Thus, Psych Adaptations that largely manage and monitor social power (and/or reproductive opportunities) could be influenced at several levels, including cognition and mood.
"Cognition" and "mood" perhaps describe different, horizontal levels in a vertical system. It may be that some people have clock-driven mood changes. Mood shifts, triggered by time, season, age, or other events, could shift thoughts toward helplessness or grandiosity. Likewise, other people may be far more dependent on external events to trigger euphoria or extreme lows. Environmental data may shift cognitions and elicit further changes in moods as well related organ systems. There may be people who will cycle as well as react to major changes in hierarchic standing. McMahon's (and perhaps others) notion of refining the diagnosis to make more subtle distinctions is perhaps the first step toward understanding these mechanisms and corresponding treatments.
It's possible that cognitions may differ for the cyclers in comparison with the externally driven. I am convinced that the externals will be influenced primarily by changes in power and/or social relationships. Managing coalitions of friends, getting access to resources (including sexual partners), accumulating possessions, and building influence will dominate plans and fantasies.
Treatment for the externally driven will likely contain elements for building personal success. Getting the client into situations where he or she can excel is a powerful intervention for children as well as adults who can switch into hypomania as soon as they accomplish something outrageous. Some of them arrange environmental "self-stimulation" experiences such that special, outrageous accomplishments are scheduled at regular intervals. Current obsessions are tracked and a new ones are in the warm up box when the current one fades. With a bit of coaching for the client and his/her family, euphoric and depressive intervals can be better managed. (See postings about "Rosie.") Brian Goodwin's comment about "getting to places where you can be yourself" come to play. Helping such clients find a setting where they can be Alpha (in both the altruistic and the domineering sense!) could be a permanent gift to them.
The "cyclers" may be more complex in that their energy is put into whatever talents they possess. Kay Jamison's essays (1993, Touched With Fire: Manic Depressive Illness and the Artistic Temperament, NY: Free Press) about poets, writers, and painters imply an exaggeration of whatever their dominant talent may have been. There appears to be a strong relationship between her subjects' mania and their ability to write. Still, it's difficult to say if Byron, for example, was manic and therefore wrote about a champion seducer or if Byron's mania was somehow fed by his obsession with Don Juan. As with most areas of science, causation appears to be reciprocal rather than linear. (There's also the option that Byron wrote great poetry in order to be the Alpha of poetry. It's difficult to be certain of his self-representations during these times.)
1) McMahon has a presentation style similar to the late Carl Sagan with respect to clarity and evident zeal for his ideas about genetic mechanisms and bipolar disorder. He even looks a bit the same! I miss Sagan; science will miss his advocacy.