The Hypomanic Edge

The Hypomanic Edge

The Link Between (A Little) Craziness
and (A Lot of) Success

Energy, drive, cockeyed optimism, entrepreneurial zeal, Yankee ingenuity, messianism, and arrogance are traits that have long been attributed to the "American character."

But what is the source of this American temperament? Is it our economic system, vast resources, teachings of our forefathers, and national pride?

Or is it something deeper? Are we a nation fueled by predominating genetic characteristics predisposed to entrepreneurialism, risky innovative ventures, and a willingness to fail in the pursuit of an ideal?

THE HYPOMANIC ENTREPRENEUR

Entrepreneurs and the markets they energize have been commonly described in the media as "manic." The 1990s, for example, will be remembered as the age of Internet mania, a time when entrepreneurs making grandiose claims for their hightech companies swept up millions of Americans with their irrational exuberance, inflating the biggest speculative bubble in history.

Yet, there has never been a serious suggestion that there might actually be a link between the talent for being an entrepreneur and mania, the genetically based psychiatric disorder... until now. Perhaps because I am a clinical psychologist, it was clear to me that "manic" may have been more than a figure of speech.

So, I called several reporters who had written profiles of these "manic" entrepreneurs and asked them: "Do you think he really was manic?"

None said yes. "Not really manic; not clinically, I mean" was a typical response. They resisted applying the psychiatric diagnosis because the entrepreneurs they had interviewed were boastful, hyperenergized, and zany, but they "weren't crazy."

And the journalists were right. Their subjects were not manic. They were hypomanic. Hypomania is a mild non-pathological form of mania, often found in the relatives of manic-depressives.

Hypomanics are brimming with infectious energy, irrational confidence, and really big ideas. They think, talk, move, and make decisions quickly. Anyone who slows them down with questions "just doesn't get it."

Hypomanics are not crazy, but "normal" is not the first word that comes to mind when describing them either.

For example, Jim Clark [photo], co-founder of Netscape, was described in Business Week by Netscape's other co-founder, Jim Barksdale, as "a maniac who has his mania only partly under control."

I am not suggesting that Jim Clark suffers from a mental illness, but based on his published statements and actions, he can be described as hypomanic.

In The New New Thing, Michael Lewis profiled Clark as a perpetual motion machine with a short attention span, forever hurtling at unsafe speeds on helicopters, planes, boats, and cars.

When his forward motion is impeded, Clark becomes irritable, bored, and depressed. In his search for the stimulation of the "new new thing," he quickly loses interest in the companies he founds and tosses them into the laps of his bewildered employees.

His Netscape IPO is credited with starting the Internet gold rush. After that it seemed he could do no wrong. When he pitched a new company, Healtheon, a medical website, his only business plan was a diagram with five words.

His "magic diamond" put Healtheon at the center of four vertices labeled "doctors, consumers, providers and payers." That was it. His magic diamond, he claimed, was going to "fix the U.S. healthcare system."

It was going to be "bigger than Microsoft, AOL, Netscape, and Yahoo!" As Lewis wrote, "Any other human being would have been thrown into an asylum for thinking such grandiose thoughts."

Those who followed Clark had faith in his messianic mission. "There was a feeling that we were about to change the world," said one of Healtheon's chief engineers.

Successful entrepreneurs are not just braggarts. They are highly creative people who quickly generate a tremendous number of ideas (some clever, others ridiculous).

Their "flight of ideas," jumping from topic to topic in a rapid energized way, is a sign of hypomania.

Consider Bill Gross, CEO of Idealab. Bill Gross's job was not to build or run companies, but just to think of ideas for them. Idealab was an "Internet incubator" company.

On Fortune's cover, next to a picture of a cheerful Bill Gross, was the caption "I lost 800 million in eight months. Why am I still smiling?"

The author, Joseph Nocera, Fortune's managing editor and a highly respected business correspondent, begins his article with an unusual mea culpa. He apologizes to his readers for his previous Fortune article that hyped Gross and Idealab just before the Nasdaq crash. He confesses that Gross converted him into a believer:

I believed him because I was dazzled by him. A small, wiry man, Gross had an infectious boyish enthusiasm that was charming and irresistible. He spoke so rapidly — jumping from topic to topic as if he were hyperlinking — that it was hard to keep up with him, and had so much energy he seemed constantly on the verge of jumping out of his skin. He bubbled over with irrepressible optimism.

And his brain! That's what really set him apart. You could practically see the ideas bursting out of it, one after another, each more offbeat, more original, more promising than the last. The sheer profusion of ideas — and the way he got excited as he described them — was a large part of his charisma.

The reason Bill Gross was still smiling was that his newest new idea was "going to be unbelievably huge" and "revolutionize the Internet." Eight hundred million. Eight hundred shmillion.

Nothing could dim Gross's enthusiastic confidence. As in the case of Clark, there is no evidence that Gross suffers from a psychiatric disorder, but he is a textbook hypomanic.

During the 1990s, I was paying attention to such behavior because I was planning to write a book about religious movements started by manic prophets. But I began to be distracted by messianic movements happening around me in real time, particularly because, as an avid technology investor, I was a member of one — the believers in the new economy.

I was even a millionaire on paper for one exhilarating day in March 2000, at the peak of the market, before my portfolio lost 90 percent of its value. I began to suspect I was writing the wrong book.

To explore my new hypothesis that American entrepreneurs are largely hypomanic, I decided to undertake what social scientists call a "pilot study," a small-scale, inexpensive, informal investigation meant to test the waters.

I placed announcements on several websites devoted to the technology business, expressing my interest in studying entrepreneurs and requesting volunteers.

I interviewed a small sample of 10 Internet CEOs, read them each a list of hypomanic traits I had synthesized from the psychiatric literature, and asked them if they agreed these traits were typical of an entrepreneur:

He is filled with energy.

He sometimes acts impulsively, with poor judgment, in ways that can have painful consequences.

He is also prone to making enemies and feels he is persecuted by those who do not accept his vision and mission.

I was anxious about calling these CEOs to ask them questions I feared they might find insulting. I needn't have worried.

All of the entrepreneurs agreed that the overall description was accurate, and they endorsed all the hypomanic traits, with the exceptions of "paranoia" and "sexual acting out" (these traits in particular are viewed as very negative and thus may be more difficult to admit to).

Most expressed their agreement with excitement: "Wow, that's right on target!" While I asked them to rate their level of agreement on a standard five-point scale, many gave ratings that were literally off the chart: 5+s, 6s.

One subject repeatedly begged me to let him give a 7. I was startled by the respondents' enthusiasm, though perhaps I shouldn't have been. As a psychotherapist, I am familiar with the way people become energized when they feel understood, especially when it helps them understand themselves better.

Having learned in our conversation that they were hypomanic, the CEOs wanted to talk about it. One now understood better why he regularly rented palatial office space he could not afford and why his wife hid the checkbook.

Another could finally explain what drove him to impulsively send broadcast emails at three in the morning to all his employees, radically revising the company's mission.

It was as if merely by asking these questions I had held up a mirror in which these men could see themselves. After talking to them for just 15 minutes, it seemed as if I was the first person to truly understand them.

One respondent seemed to be in an intense hypomanic state when I interviewed him. He responded to my website solicitation by emailing me in huge blue block letters: "CALL ME IMMEDIATELY."

When I did, he talked rapidly and loudly and laughed quite often. At the same time he was charming, witty, and engaging. The interview was a bit chaotic because he was driving and carrying on another phone call at the same time.

He was a serial entrepreneur. After founding one successful company, he had felt he needed to quit his own corporation because he couldn't "make things happen fast enough," leaving him frustrated and bored. Now he was on to a new venture.

He was very enthusiastic about my research and volunteered to send me the phone numbers and email addresses of half a dozen well-known high-tech entrepreneurs (which I never received), who he claimed were his "very close friends."

This was a small sample pilot study, but nonetheless, I was overwhelmed. I had never seen data like this. Because humans are so complex, most effects in psychology are modest and nearly drowned out by the great variability that exists naturally between people.

Not in this case. One hundred percent of the entrepreneurs I interviewed were hypomanic! This couldn't be chance. The odds of flipping a coin 10 times and getting 10 heads in a row is less than one in a thousand.

I felt as if I had tested the waters with my little pilot study and been hit by a tidal wave. It was then that I knew I had stumbled onto something big that had been hiding in plain sight. But I had only scratched the surface of what I would later discover.

MANIA AND HYPOMANIA

A colleague of mine once told me about a manic patient he treated for many years at a nationally known center for long-term inpatient care. The patient's father was the CEO of a Fortune 500 company.

Each time he visited his son on the unit, he would behave in a dramatically hypomanic fashion. He would make numerous business phone calls around the world on the patients' pay phone, while frantically yelling "back off" at patients or staff who tried to interrupt him.

Clearly, Dad was not normal, but he had made his hypomania work for him. He was a very rich man.

This family's story illustrates the concrete relationship between mania and hypomania. Manics and hypomanics are often blood relatives. Both conditions run together in families at much higher rates than we would predict by chance. We know that their genes overlap, but we don't know how.

This family's story also illustrates the most radical difference between mania and hypomania.

Mania is an illness. The son was disabled — a longterm inpatient at a psychiatric hospital. Manic episodes almost always end in hospitalization.

A person who is highly energized, and also in most cases psychotic, does bizarre things that are dangerous, frightening, and disruptive. They urgently require external control for everyone's safety, especially their own. Most people who have experienced a manic episode remember it as a nightmare.

Hypomania, by contrast, is not an illness. It is a temperament characterized by a mildly elevated mood. Most hypomanics describe it positively as their happiest and healthiest state.

"Highly intoxicating, powerful, productive, and desirable" is how hypomanics experience their mood, according to Frederick K. Goodwin and Kay Redfield Jamison, authors of the definitive 900-page Manic-Depressive Illness.

If a hypomanic is hospitalized, or seeks outpatient treatment, it is usually for depression. Not all hypomanics cycle down into depression. What goes up can stay up. But if one does become depressed, he or she will define recovery as a return to his or her old energetic creative self.

Given how radically different these two conditions are, it is perhaps surprising that the diagnostic criteria for mania and hypomania are identical in the most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (usually referred to simply as DSM-IV):

A) A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week.

B) And at least three of the following:

1. Inflated self-esteem or grandiosity

5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

The only guideline offered to mental health professionals in distinguishing between mania and hypomania is "degree of severity." Hypomania is "not sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitalization," but DSM-IV tells us little else, when there is so much more that could be said.

This relative neglect of hypomania by psychiatry is striking when we consider that it affects many more people than does mania. We know from numerous large-scale studies, replicated both nationally and internationally, that classic manic-depression exists in slightly less than 1 percent of the general population.

A notably smaller, but growing amount of literature on hypomania suggests that 5 percent to 10 percent of the population is hypomanic. Whatever the exact percentage, psychiatry's most recent discovery is not a rare expression of bipolar genes, but its most common form.

That hypomania is so much more common than mania may give us a crucial clue to its genetic function and evolutionary importance.

Mania, according to one school of thought, is a disease like sickle cell anemia. Sickle-cell anemia is a blood disease that primarily affects people of African origin. To contract the disease, you must inherit the recessive sickle gene from both your mother and father.

Far more often, people inherit only a single sickle gene from one parent, and epidemiologists call them "carriers" because they carry the gene without manifesting the illness.

As it turns out, they are much more than that. They are the reason the gene exists. A single sickle gene greatly enhances resistance to malaria, a deadly disease prevalent in Africa. This gene has been favored by natural selection, even though it causes a deadly disease, because it saves more people than it kills.

We have not isolated one singular manic gene. Investigators at the department of psychiatry at Johns Hopkins University Medical School, where I teach, and at other institutions around the world, have homed in on half a dozen genes associated with mania.

Though the numbers may be more complex, the same principles could apply: a less probable combination of genes produces the undesirable disease of mania, while a more frequent combination produces the advantageous outcome of hypomania.

It could be that quantitatively more hypomanic genes are required to produce mania. Call this the slot machine model. Three cherries produces a moderate payout: hypomania. But once in a while you get five cherries, and you're flooded with coins: mania.

The story of the CEO father and his hospitalized son helps us understand why hypomanic genes exist. Relatives of manic patients, who have high rates of hypomania, have consistently been found to be far above average in income, occupational achievement, and creativity.

John D. Gartner, Ph.D., is a clinical assistant professor of psychiatry at Johns Hopkins University Medical School. He is a graduate of Princeton University, and widely published in scholarly journals and books.

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