Thursday, November 10, 2005

Mama Weer All Crazee Now.

Introduction: The Hypomanic American

The Hypomanic Entrepreneur

The 1990s will be remembered as the age of Internet mania, a time when entrepreneurs making grandiose claims for their high-tech companies swept up millions of Americans with their irrational exuberance, inflating the biggest speculative bubble in history. The idea that some entrepreneurs may be a little manic is hardly new. A Google search for "manic" and "businessman" yields more than a million hits. Entrepreneurs, as well as the markets they energized, were commonly described in the media as "manic." Yet, 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. Perhaps because I am a clinical psychologist, it was clear to me that "manic" was more than a figure of speech in this case.

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," 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 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. Hypomanics live on the edge, betweeen normal and abnormal.

For example, Jim Clark, cofounder of Netscape, was described in Business Week by Netscape's other cofounder, Jim Barksdale, as "a maniac who has his mania only partly under control." In The New New Thing, Michael Lewis profiled Clark as a perpetual motion machine with a short attention span, forever hurtling at unsafe speeds in helicopters, planes, boats, and cars. When his forward motion is impeded, Clark becomes irritable and bored. 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 Web site, 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. health care 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." 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, 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.

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.

My new hypothesis became 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 Web sites devoted to the technology business, expressing my interest in studying entrepreneurs and requesting volunteers. I interviewed a small sample of ten Internet CEOs. After I read them each a list of hypomanic traits that I had synthesized from the psychiatric literature, I asked them if they agreed that these traits are typical of an entrepreneur:


* He is filled with energy.

* He is flooded with ideas.

* He is driven, restless, and unable to keep still.

* He channels his energy into the achievement of wildly grand ambitions.

* He often works on little sleep.

* He feels brilliant, special, chosen, perhaps even destined to change the world.

* He can be euphoric.

* He becomes easily irritated by minor obstacles.

* He is a risk taker.

* He overspends in both his business and personal life.

* He acts out sexually.

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

* He is fast-talking.

* He is witty and gregarious.

* His confidence can make him charismatic and persuasive.

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


I feared they might find the questions 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!" When I asked them to rate their level of agreement for each trait on a standard 5-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 e-mails at 3 A.M. 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 fifteen 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 Web site solicitation by e-mailing 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 e-mail 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 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 ten times and getting ten heads in a row is less than one in a thousand. It felt as if I had tested the waters with my little pilot study and been hit with a tidal wave. It was then that I knew I had stumbled onto something big that had been hiding in plain sight.


Mania and Hypomania

A colleague of mine once told me about a manic inpatient he had treated for many years at an Ivy League-affiliated psychiatric teaching hospital. 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. For example, 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.6 We know that their genes overlap, though we don't know how.

This family's story also illustrates the most radical difference between mania and hypomania. Mania is a severe illness. The son was disabled -- a long-term inpatient at a psychiatric hospital. Manic episodes almost always end in hospitalization. People who are highly energized, and also in most cases psychotic, do 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.

By contrast, hypomania is not, in and of itself, an illness. It is a temperament characterized by an elevated mood state that feels "highly intoxicating, powerful, productive and desirable" to the hypomanic, according to Frederick K. Goodwin and Kay Redfield Jamison, authors of the definitive nine-hundred-page Manic-Depressive Illness. Most hypomanics describe it as their happiest and healthiest state; they feel creative, energetic, and alive. A hypomanic only has a bipolar disorder if hypomania alternates, at some point in life, with major depression. This pattern, first identified only in 1976, is called bipolar disorder type II to distinguish it from bipolar disorder type I, the classic manic-depressive illness, which has been well known since the time of the ancient Greeks. If a hypomanic seeks outpatient treatment it is usually for depression, and he will define recovery as a return to his old energetic self. Not all hypomanics cycle down into depression. What goes up can stay up. Thus, we cannot conclude that someone has a psychiatric disorder just because he may be hypomanic. The most we can say is that hypomanics are at much greater risk for depression than the average population. The things most likely to make them depressed are failure, loss, or anything that prevents them from continuing at their preferred breakneck pace.

Given how radically different mania and hypomania are, it is perhaps surprising that the diagnostic criteria for these two conditions are identical according to the Diagnostic and Statistical Manual of Mental Disorders 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

* 2. Decreased need for sleep (e.g., feels rested after only three hours of sleep)

* 3. More talkative than usual or pressure to keep talking

* 4. Flight of ideas or subjective experience that thoughts are racing

* 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 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 your father. Far more often, people inherit only a single sickle gene from one parent; epidemiologists call these people "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 may 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 great while you get five cherries, and you're flooded with coins: mania. Alternatively, there may be a specific gene that needs to be combined with hypomanic genes to produce mania. Raymond DePaulo, James Potash, and their colleagues at Johns Hopkins have found a gene that mania and schizophrenia share in common -- a possible "psychoticism gene." Mania might be the result when one is unlucky enough to inherit both hypomanic genes and the psychotic gene.

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.15 Hypomania gives them an edge over the competition.

If there is any one trait that distinguishes highly successful people, it is that they are, by temperament, highly motivated. From our studies of the brain we now know that mood is an intrinsic part of the apparatus that controls motivation. Mood is meant either to facilitate or inhibit action. When someone is depressed, he has no motivation to act. What's the point? Nothing seems worth doing, he has no energy to do it, and it probably won't work anyway. Hypomania is the polar opposite. The drives that motivate behavior surge to a screaming pitch, making the urgency of action irresistible. There isn't a minute to waste -- this is going to be huge -- just do it!

This pressure to act creates overachievers, but it also leads to impulsive behavior (ready, shoot, aim) and confident leaders who glibly take their followers over a cliff. Depending on how you look at it, the Internet phenomenon was either an exciting breakthrough of human ingenuity or a colossal error in judgment that forces us to ask: What were we thinking? In truth, it was both. The paradox of the hypomanic edge is that it is a double-edged sword.


A Hypomanic Nation?

Energy, drive, cockeyed optimism, entrepreneurial and religious zeal, Yankee ingenuity, messianism, and arrogance -- these traits have long been attributed to an "American character." 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.

If a scientist wanted to design a giant petri dish with all the right nutrients to make hypomanic genius flourish, he would be hard-pressed to imagine a better natural experiment than America. A "nation of immigrants" represents a highly skewed and unusual "self-selected" population. Do men and women who risk everything to leap into a new world differ temperamentally from those who stay home? It would be surprising if they didn't. "Immigrants are unusual people," wrote James Jaspers in Restless Nation. Only one out of a hundred people emigrate, and they tend to be imbued "with special drive, ambition and talent."

A small empirical literature suggests that there are elevated rates of manic-depressive disorder among immigrants, regardless of what country they are moving from or to. America, a nation of immigrants, has higher rates of mania than every other country studied (with the possible exception of New Zealand, which topped the United States in one study). In fact, the top three countries with the most manics -- America, New Zealand, and Canada -- are all nations of immigrants. Asian countries such as Taiwan and South Korea, which have absorbed very few immigrants, have the lowest rates of bipolar disorder. Europe is in the middle, in both its rate of immigrant absorption and its rate of mania.18 As expected, the percentage of immigrants in a population correlates with the percentage of manics in their gene pool.

While we have no cross-cultural studies of hypomania, we can infer that we would find increased levels of hypomania among immigrant-rich nations like America, since mania and hypomania run together in the same families. Hypomanics are ideally suited by temperament to become immigrants. If you are an impulsive, optimistic, high-energy risk taker, you are more likely to undertake a project that requires a lot of energy, entails a lot of risk, and might seem daunting if you thought about it too much. America has drawn hypomanics like a magnet. This wide-open land with seemingly infinite horizons has been a giant Rorschach on which they could project their oversized fantasies of success, an irresistible attraction for restless, ambitious people feeling hemmed in by native lands with comparatively fewer opportunities.


Alexis de Tocqueville, a Frenchman who traveled throughout America in the 1830s, was among the first to define the American character. He found us to be "restless in the midst of abundance," and the proof was that we were always moving. Tocqueville was astonished to meet people moving from east to west and west to east. That so many people would surrender the comfort and safety of their home in pursuit of an "ideal" struck him as odd. And we are still the most voluntarily mobile people on Earth. The average American changes residences every five years -- more often than the inhabitants of any other nation. We change jobs more frequently, too. Tocqueville "found an entire people racing full speed ahead, and we've kept on racing for more than three hundred years," wrote Michael Ledeen in Tocqueville on American Character.

One outlet for this restless energy has been business. "Americans are constantly driven to engage in commerce and industry....This is the characteristic that most distinguishes the American people from all others," wrote Tocqueville in Democracy in America. He sensed that the American motivation to get rich was more about the excitement of making money than it was about wealth itself. "The desire for prosperity has become an ardent passion...which they pursue for the emotions it excites as much as for the gain it procures." And these people never stopped working. "Everybody works," wrote Tocqueville. The aristocratic European ideal was to become so wealthy that one did not need to labor. In America, "work opens a way to everything; this has changed the point of honor quite around." To Americans it was a disgrace not to work.

Americans work more hours than any other people in the world. We've changed little in that regard since Tocqueville's day. We tend to attribute this habit to cultural influences, without even considering biological causes. America's workaholism is typically attributed to its Puritanical "Protestant work ethic." But is it reasonable to ascribe such enormous influence to a defunct seventeenth-century English Protestant sect on the contemporary day-to-day behavior of hundreds of millions of diverse Americans? The average American recalls only the barest outline of who the Puritans were. When you talk to these strivers, they tell you that their drive comes from within and that they have been strongly "self-motivated" since they were children. They hit the ground running and couldn't tell you why. I would attribute the number of hours Americans work to what I call the "immigrant work drive," an internal biological compulsion passed from parent to child through their hypomanic genes.

Tocqueville noticed that Americans were entrepreneurial risk takers: "Boldness of enterprise is the foremost cause of [America's] rapid progress, its strength and its greatness." Though some individuals failed, the collective efforts of entrepreneurs drove the nation forward. Americans believed so deeply in the "virtue" of "commercial temerity" that they had all but removed the stigma surrounding financial failure:

Commercial business is there like a vast lottery, by which a small number of men continually lose, but the state is always the gainer....Hence arises the strange indulgence that is shown to bankrupts in the United States; their honor does not suffer by such an accident.

At that time, a European who went bankrupt might end up in debtor's prison, so Tocqueville was surprised that there was little shame in bankruptcy here. The stereotypic American success story is of an entrepreneur who fails numerous times before achieving his big success. Such "serial entrepreneurs" will tell you that they shake off failure like a dog shakes off water and are soon raring to go again with a new idea.

That America rewards and celebrates such people is culturally unique. When asked, "Do you think that starting a new business is a respected occupation in your community?" 91 percent of Americans said yes, as compared to 28 percent of British and 8 percent of Japanese respondents. In Japan there is still deep disgrace attached to business failure. Men who lose their jobs often hide it from their families and pretend to go to work each day. Some economists have argued that Japan has been slow to bounce back from its decade-long recession because the population has lost all taste for risk after the fallout of the stock and real estate bubbles of the early 1990s. Most Japanese save a substantial portion of their money in secure savings accounts that yield zero interest, tying up capital that could either be invested in businesses or stimulate the economy through consumption. Americans, by contrast, bounce back from failures, scandals, and bubbles with infinitely renewable confidence. After the stock market and the World Trade Center came crashing down in succession, one might have expected a pessimistic mood to take hold in America. But a subsequent poll taken in 2002 found that 59 percent of American college students believed that they were on their way to becoming millionaires. Our immigrant genes predispose us to optimism. "You had to be an optimist to move. Pessimists didn't bother," wrote Yale historian George Pierson. Because this optimism comes from within, it is not easily discouraged by external events. And optimism, like pessimism, often becomes a self-fulfilling prophecy.

Immigrants are often described as a highly entrepreneurial group. "There is more than a grain of truth to this perception," according to a 1997 report by the International Migration Policy Program at the Carnegie Endowment for International Peace. In every census from 1880 to 1990, as long as they have been keeping records, immigrants were significantly more likely to be self-employed than natives. The single exception to this 110-year-long trend was the roaring 1990s. In that decade, when every American college student wanted to found the next Yahoo!, native-born Americans increased their level of self-employment to match the immigrants': both immigrants and native-born Americans were self-employed at a very high rate, just above 11 percent. Temperament may not be the only factor. An immigrant who doesn't speak the language of his new country might find economic opportunities limited outside ethnic niche industries, such as Korean grocery stores, where fellow countrymen can help him start his own business. But even this speaks to the psychology of the immigrant: if he had stayed in Korea, no one would be extending him credit to open a store.

Thus, it follows that nations that absorb more immigrants should have more entrepreneurial activity, and that is indeed the case. In the past decade, America, Canada, and Israel were the top three countries in new company creation, according to a 1999 cross-national survey of ten industrial nations conducted by the Global Entrepreneurship Monitor, a joint project of the London Business School and Babson College. "What's unique about the top countries is that all three have been created by people moving into them," Paul Reynolds, one author of the report, told Business Week. Moreover, the magnitude of these differences is large. The average American is four times more likely to be the founder of a company than a Frenchman, for example.

As Tocqueville predicted, there is a solid statistical relationship between entrepreneurial activity and the wealth of a nation. Gross domestic product growth and employment rates both correlate with new business creation. Because they are "constantly driven to participate in commerce and industry," Americans, who make up only 5 percent of the world's population, account for 31 percent of its economic activity.

Because of its origins, America has an abundance of people with hypomanic temperaments. And it has made good use of them by giving them freer rein, more opportunity, and greater respect than they have received elsewhere. As British economic historian Edward Chancellor noted in his history of financial speculation, Devil Take the Hindmost, the result is a society of people both culturally and genetically predisposed to economic risk:


The American is equipped with more than just a hopeful vision of the future and a drive for self-improvement. He is prepared to take enormous risks to attain his ends. To emigrate to America was itself a great risk. This appetite for risk -- so great one might say it was imprinted in American genes -- has not diminished with time but remains a continuing source of the nation's vitality.


The next gold rush, the next boom, the next market mania is coming. Hold on to your seat. America has been a ship riding the waves of irrational exuberance for hundreds of years, and she's not likely to change course any time soon. It's in our blood.


Captains Outrageous

America has been good to hypomanics -- a land of opportunity that has liberated their energies and lifted their spirits. In return, hypomanic Americans have been good to America, powering a wilderness colony ahead of every other nation on the planet in just a few hundred years. They may be our greatest natural resource. An untold number of hypomanics helped make America the richest nation on Earth. This book tells the stories of just a few.

It was not easy choosing the people to focus on, nor was it a scientific selection process. There were so many candidates to choose from. To show America's development through a kind of time-lapse photography, I searched for people from each century of our five-hundred-year history who played a leading role in America's growth, especially her economic growth. Christopher Columbus discovered America; prophets such as John Winthrop, Roger Williams, and William Penn populated it; Alexander Hamilton was one of a handful of men who conceived its national future and economic potential; Andrew Carnegie sparked an industrial revolution that led to mass production; the Selznick and Mayer families helped create Hollywood, usher in the age of mass media, and portray a national self-image; and Craig Venter cracked our genetic code, the implications of which are only beginning to be fathomed.

Each chapter of this book is a small biography. Written by a psychologist, they are also clinical case histories that illustrate hypomania in action. These men were outrageous -- arrogant, provocative, unconventional, and unpredictable. They were not "well adjusted" by ordinary standards but instead forced the world to adjust to them. Their stories are inspiring, comical, and sometimes tragic, as the hubris that fueled their improbable rise often led to their fall as well. Yet without their irrational confidence, ambitious vision, and unstoppable zeal, these outrageous captains would never have sailed into unknown waters, never discovered new worlds, never changed the course of our history.

Copyright © 2005 by John D. Gartner

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