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Comment by bjornsing | Hacker News Reader

> It is a disorder, and it benefits from treatment. Its not fun for anybody except for the manic.

So whom does the “treatment” benefit? ;P

No, real mania is dangerous and the patient surely benefits from treatment. But there is a rather wide gray zone where I sometimes get a feeling it’s not the patient that benefits from the “treatment”, but rather his or her social surroundings. Not entirely unproblematic from an ethical perspective... depending on the reasonableness of those in the social surroundings of course.

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The patients benefit from the treatment significantly since a lot of time people who are manic are living recklessly, spending all their money, gambling, being hypersexual, trying drugs, getting into fights, committing crimes, tearing up their relationships, and the list goes on. The percent of people with bipolar disorder who die by suicide is 10-15%.

Patients who are hypomanic by definition aren't having marked impairments in social or occupational functioning and won't need to be hospitalized. There's nothing forcing someone who isn't currently on a psychiatric hold to take medication, so if they're taking it it's likely because they believe they're benefitting from it.

Well as I've said real mania should surely be treated (regardless of cause). But there is an interesting gray zone where I think it's more difficult to say if the problem lays with the patient, or with his/her social surroundings.

For example the Swedish journalist Ola Wong recently shared his story on national radio about going hypomanic and then full on manic during the Swedish "refugee crisis" in 2015. It was quite interesting to hear him describe how he just felt that his social surroundings of journalists and opinion makers had gone mad when they refused to acknowledge there were potential problems associated with accepting 160k refugees in a single year (relative to population that's like if the US accepted 5.2 million refugees in one year). After "banging his head against the social wall" for a few months he became more and more agitated and restless, and finally needed hospitalisation. Just weeks after his hospitalisation the debate climate turned around 180 degrees to agree with Wong. That probably helped his recovery. He seems to have had no psychiatric trouble before then, or after.

Now, was the problem entirely with Mr Wong? :P

Yeah for sure. Just wanted to lay out for other passerby's in the thread that there's nothing forcing people to take medication that they don't think is beneficial for them, or for people who've never seen someone in a frank manic episode that we're unnecessarily medicating all of the next DaVinci's or Einsteins.

Great and thought provoking example. I think you could argue there could be some genetic susceptibility to having a manic episode when placed under stressors like that, meaning potentially there's a relative with bipolar disorder or pretty severe major depressive disorder. I don't think most people would fall into a manic episode when placed in situations like that, but it is impossible to know. In my time rotating in the psych emergency department I saw someone with a similar presentation to Ola. No psychiatric history, stressful event happened, didn't sleep for a few days, came in in frank psychosis, treated with Seroquel, left the next day totally fine. Diagnosis given was brief reactive psychosis. Maybe the same happened for Ola Wong.

It seems to have been more prolonged for Ola Wong. I’m not sure how long the manic state / hospitalization lasted, but the overall recovery seems to have taken a year or two (before he felt confident to write professionally on refugee issues again). Seems to have been treated as a (severe) crisis, with therapy and lifestyle changes.

I agree that most would probably not have had the same reaction to the same circumstances. But after listening to Ola’s story I wonder if you couldn’t produce some instability in most people if you take something they care deeply about (in Wong’s case Sweden’s future and the role of his profession in it) and have their social surroundings deny obvious truths and thereby jeopardize it...

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