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Introduction:
Manic episodes mainly occur in the course of bipolar disorder (manic-depressive illness).The typical symptoms of a manic episode are inflated self-esteem or grandiosity, decreased need for sleep, pressure to keep talking, flight of ideas, distractibility, increase of activity and excessive involvement in pleasurable activities (American Psychiatric Association, 2013). Although mania is statistically conceptualized in current diagnostic manuals, the word mania never lost the indefiniteness acquired through its use as an every-day term with various connotations.
In ancient philosophy mania was used for various severe mental disturbances as a common word (for review see Ahonen, 2014). However, the characterization of a manic person by Aristotle corresponds with current psychiatric diagnostics: “a manic person is someone who expresses his feelings spontaneously and acts in accordance with them, being less inclined to rational considerations. These persons are high irritable (Aristotle, 2002). Immanuel Kant elaborated a comprehensive philosophy of mental disorders characterizing mania as an illness of the faculty of desire or passion. He distinguishes between mania for hero, mania for dominance and mania for passion (Kant, 1980).
Currently, various scientific disciplines are working on a comprehensive theory of consciousness and its disorders. A promising model is proposed by Pareira (2019; 2019) incorporating brain biology into philosophical concepts towards a philosophy of neuroscience and psychiatry. However, we should keep in mind that present philosophy of neuroscience and mental disorders is dominated by cognitive models. Though the focus on intentionality (Graham, 2010) and decision processes (Sebanz and Prinz, 2006) represents an action-oriented approach to a philosophy of mental disorders, a comprehensive theory of volition that could elucidate the passion of will on the existential level is still lacking. Here, I propose a model of mania interpreted as a disorder of volition.
The study is organized in the following: first, five principles of volition running in the time scales of ontogenesis, evolution and permanence are proposed. Then, from this theoretical framework disorders of volition and time experience in mania are implicated. Furthermore, based on the action styles of acceptance and rejection, the concepts of acceptance mania and rejection mania are introduced. I conclude that the philosophical- biological arguments suggested, enable a deeper understanding of the reality experience of patients with mania and may improve the therapeutic communication on the existential level.
The Principles of Volition:
In the history of western philosophy theories of reason (intellectualism) dominate theories of will (voluntarism) (Windelband, 1976). The same holds for psychiatry where cognitive sciences prevail. Here, I propose a new interdisciplinary theory of volition based on five principles that may underlie all volitive processes.
These are:
The primordial volition to act;
The volition to self-instrumentalize;
The volition to program realities;
The volition to generate realities by acceptance and rejection;
The volition to permanent existence
The Primordial Volition to Act:
The primordial volition or pure volition underlies all operations and volitive processes. According to Augustinus the primordial will is absolutely free from external and internal constraints and especially independent on reason (Augustinus, 2002). In metaphysical terms the primordial will is driven by the movements of the soul and can therefore not be identified in the brain. However, primordial volition is not a pure philosophical conception, but can be formally described in quantum mechanics by the theory of cognitive action cycles (Baer, 2010). Action cycles function in permanent movement. If we interpret this permanent movement as the action of the primordial volition, then these action cycles do primarily not generate cognitive processes, but represent cyclic volitive processes. Crucially, primordial volition is the conditio sine qua non for further cognitive operations, since “volition without cognition is blind” (Günther, 1976).
The Volition to Self-Instrumentalize:
For the generation of action effects or products the volition to act must self-instrumentalize. Here we deal with the self-instrumentalization in the brain with organs and mechanisms guaranteeing inner homeostasis and the generation of behavior for coping with the environment. An elementary example for self-instrumentalization represents information processing in the synapses of the brain. In so-called tripartite synapses (Aragúe et al. 1999) information is not only transmitted, but is based on feed forward-feedback loops that operate on transmitter substances necessary for the structuring of information (Verkhratsky and Butt, 2013). In contrast to computation machines biological brains are able to self -instrumentalize with biological substances for the generation of subjective behavior. In this context Leibniz (1956) differentiates between a natural organic body of an organism and a man-made machine: “Thus, the organic body of an organism is always a kind of divine machine or natural device, eternally superior to all superficial devices. This is because a machine constructed by the creativity of man is not a machine in all its parts… However, natural machines, that is living bodies, stay machines forever, even in their tiniest parts.” Basically, the history of mankind demonstrates that we are striving for ever better tools in the sense of technical self-instrumentalization.
The Volition to Program Realities:
In the development of the brain various cell types with special structures and functions become generated and are interconnected building networks. In these networks feedback mechanisms operate in different degrees of complexity (Koch, 2012) from recursion, reflective thinking, self-reflection to intersubjective reflection (Mitterauer, 1998). These reflection processes represent not only cognitive operations, but generate also intentional programs in special networks of the brain such as in the hippocampus (Mitterauer, 2007).
Morgan and Piccininii (2018) argue that cognitive Neuroscience can explain intentionality in terms of information and biological function. By identifying special neural representations the puzzling intentional properties of mental states can be explained. In philosophical terms Brentano (1874) gives us an excellent definition of intentionality: “intentional mental states are directed at things, such as flowers, fields, and fairies. Insofar as minds are capable of intentional mental states, intentionality is the mind being directed at things, which may or may not exist.”
The Volition to Generate Realities by Acceptance and Rejection:
The volition to generate realities operates on the action styles of acceptance and rejection enabling the individuum to decide which reality becomes generated selected from a repertoire of possibilities. However, the possibility to generate a reality depends on the availability of appropriate subjects and objects in the environment. Basically, an intentional program is striving for its feasibility in the environment. Decisively, for guaranteeing individuality information must be structured by rejecting inappropriate information. Günther (1962) characterized rejection as the “index of subjectivity”. Moreover, the action style of rejection is decisive in communication, since it makes us free not only to reject inappropriate conditions, but also to reject appropriate possibilities. In the latter case the volition to create a novel reality absolutely determines the selection process. Generally, normal behavior and communication is based on interactions between acceptance and rejection.
The Volition to Permanent Existence:
As outlined above, the primordial volition to act can be described in quantum mechanics as a permanent rotating cycle (Baer, 2010). In this model the volition to act works in the “timeless” time of permanence which allows the interpretation that we are striving deep in our soul for permanent existence (Mitterauer, 2009; 2019). Excitingly, although it may not be possible to detect the volition to act in biological brains, Gödel (1995) has computed that materia is permanently rotating. Importantly, the conception of the volition to permanent existence is the watershed where natural science ends and metaphysics is coming in. In the “Ethics of pure will” Cohen (1904) states: “the pure will of ethics generates eternity... eternity, detached from time and related to the pure will, means nothing but the eternity of progress of ethical work” (our translation).
The Passion of Volition in Mania:
In a manic episode the volition to act and the volition to generate realities are totally event-oriented or work spontaneously without any goal directed programming. Moreover, the volition to permanent existence and immortality is experienced as grandiosity, but the generation of realities is fragmented and mostly destructive. Basically, self-instrumentalization is impaired. The underlying mechanisms can be shown on dysfunctions of tripartite synapses responsible for the pathophysiology of mania as follows: the brain has a cellular double structure consisting of the neuronal cell system and the glial cell system. Whereas the neuronal cell system processes information from the inner and outer environment, the glial cell system may generate intentional programs which modulate neuronal information processing. The interactions between these systems occur in tripartite synapses (Arague et al., 1999). A tripartite synapse is composed of the presynapse and the postsynapse as the neuronal component, and the astrocyte and its network as the glial component. Information processing and information modulation is based on the equipment with neuronal and astroglial receptors for the occupancy with neurotransmitter substances (Ketenmann and Zonec, 2013). If all receptors are activated by an appropriate amount of transmitter substances, synaptic information-processing is balanced.
The core pathophysiological mechanism responsible for mania may be caused by the underexpression of astrocytic receptors, since underexpressed astrocytic receptors cannot exert a balancing function in tripartite synapses. A surplus of neurotransmitters relative to the available receptors arises that leads to a flooding of the astrocytic receptors with neurotransmitters. This hyperactivation of astrocytic receptors and the glial network leads to a rapid synaptic information processing caused by shortened feedback loops in tripartite synapses (Mitterauer, 2018). Importantly, it has experimentally been identified that in patients with acute mania the excitatory neurotransmitter glutamate is overactivated (Öngür et al., 2008).
According to Mellerup and Kristensen (2004) re-entry may be faster in mania, what the repetitive recursive signaling concerns generating a conscious state faster than usual. Reentry is defined as a process of ongoing parallel and recursive signaling between separate neuronal groups along parallel fibers that link these groups anatomically (Edelman and Tononi, 2000). I suggest that the fastening of feedback loops in tripartite synapses is in some aspects comparable to the hypothesis of dysfunction in reentry in neuronal networks (Mitterauer, 2006). Basically, rapid cycles in tripartite synapses could be explanatory of manic distractibility, flight of ideas, overactivity and circadian disturbances such as insomnia.
Crucially, since synaptic information processing is shortened or accelerated, the volition to self-instrumentalize cannot complete actions or thoughts. This may explain the rush of activities and “nonsense-actions” observed in manic behavior. However, patients in an acute manic state are convinced that they can practice anything that he (she) wants. But this is not a well-programmed intentional behavior, since the actions are fully environment-dependent and not event-oriented controlled. I call this manic reality experience pseudo-omnipotence (Mitterauer, 2006).
Time Experience in Mania:
Basically, in depression the patient perceives time too slow and in mania too fast. (Northoff et al., 2018). This opposite time experience in bipolar disorder may be caused by imbalances in tripartite synapses (Mitterauer, 2018). In the perspective of phenomenology Moskalewicz and Schwartz (2018) discuss the manic self and the underlying neurobiology on manic temporality. It is argued that the manic self is fundamentally altered, not living into the future, but in an instantaneous existence. “Mania is a rebellion against the limiting facticity of existence. A leap towards the future is ultimately a leap beyond temporality, one that results in quasi-eternal or timeless experience.” This phenomenological analysis of manic time experience is based on the time concepts of past, present and future. However, if we introduce the time concepts of ontogenesis, evolution and permanence (Mitterauer, 1989, 2009), then manic time experience can be interpreted on a more fundamental level.
In the ontogenetic time period the volition to self-instrumentalize is determined by the finite function of the available material for self embodiment running from conception to death. Evolution is an open time starting at a time point and developing during a potential endless process. In this time period the volition works to generate novel realities and is driven by the volition to permanent existence or immortality. This “timeless” time is permanence. Considering the volition to self-instrumentalize again, manic patients are under the pressure to self-instrumentalize causing rapid event-dependent decisions. Therefore, the necessary time for cognitive programming of intentions is not available, clinically observed as flight of ideas. Since the patient acts spontaneously, uncontrolled by reflection, he (she) experiences a kind of omnipotency and grandiosity. Crucially, patients inclined to bipolar disorder suffer from unfeasible high aspirations or desires fundamentally driven by the volition to permanent existence. If we assume that the volition to permanent existence is working deep in the soul of all human beings (Plato, 1954), then mania can be interpreted as a coping-attempt with the unfeasible by an unconstrained volition to act, but with incomplete self instrumentalization.
Acceptance Mania and Rejection Mania:
As discussed above, the volition to generate realities is based on the acceptance and rejection of environmental information. Clinically, three elementary communication styles of manic patients can be distinguished. One group of manic patients impress with their serene mood and accepting the fate of treatment. This type of manic communication I call acceptance mania. Another group of manic patients is highly irritable, angry and spontaneously aggressive. This kind of manic communication can be characterized as rejection mania. However, the manic communication style often shows a rapid change between an acceptance and rejection type of behavior (Mitterauer, 2006).
In acceptance mania a euphoric mood dominates communication: “everything is going well”. Concerning the perception of environmental communication, acceptance means that the patient must react to all stimuli of all sense organs causing a high perceptual irritability. Since the patient must act out his (her) confused ideas and thoughts, meaningless and incomplete actions occur. Moreover, social communication often becomes worse because of social disinhibition like hypersexuality and ideas of grandiosity, such as being very rich. Hence, marital, social and legal problems occur. However, sometimes manic patients are “overadapted”. For example, a female patient always answered my questions with the stereotypical statement: “dumb servant”. Importantly, in the Islamic culture manic people mostly have fewer social problems than people in a western culture (El-Azayem, 1987). Taking into account that “Islam” means “submission to God” (Webster, 1976), patients with acceptance mania can be easily integrated in Islamic communities, since their acceptance style of communication also connotes their religious view of society.
In contrast, patients with rejection mania are basically non-adapted to society. They are highly irritable accompanied by anger. All intersubjective communication is determined by the radical rejection of information that is absolutely inappropriate to the reality experience of the patient. Basically, rejection results from the fact that these manic patients exclusively accept what is exactly corresponding to their actual and rapidly changing intentions. Of course, family members, friends or other contacting people do not agree with this manic behavior so that he (she) often reacts with sudden and unexpected violent behavior. Note, here we do not deal with typical aggression, but with a destructive behavior intending to “strike free” the subjective way of the patient's life.
Concluding Remarks:
The significance of the perspective presented lies in a brain-based model of volition that may provide a deeper understanding of manic behavior. The model focuses on the five principles of volition: the primordial volition to act; volition to self-instrumentalize; the volition to program realities; the volition to generate realities by acceptance and rejection and the volition to permanent existence. In a manic episode the volition to act and the volition to generate realities are totally event-oriented or work spontaneously without any goal-directed programming. The volition to self instrumentalize is also impaired shown on dysfunctions in the tripartite synapses of the brain. Basically, the volition to permanent existence and immortality is experienced as grandiosity, despite the generation of realities is fragmented and mostly destructive. Manic patients are under the pressure to self-instrumentalize causing rapid event-dependent decisions. From these dysfunctions of volitive processes the main symptoms of mania can be deduced and interpreted.
As mentioned in the introduction, current psychiatric research focuses on cognitive impairments in mania (Daglas et al., 2015). However, in the model here proposed the cognitive impairments represent effects of the dysfunctions of volitive processes and not vice versa. The same argument may hold for abnormal decision processes in mania or bipolar disorder. Although abnormal decision processes have been identified in the brain (Sebanz and Prinz, 2006; Graham, 2010), the reason for rapid decisions in mania remains obscure.
My model of the passion of volition in mania attempts to elucidate the complex mechanisms for abnormal behavior in mania. Moreover, the philosophical-psychological arguments enable a deeper understanding of the reality-experience of patients with mania. If we consider the volition to permanent existence and the failed attempt to realize this existential destiny in mania, we can explain the patient in the stage of remission that mania is an abnormal coping-attempt with his (her) striving for permanent existence and immortality. The therapeutic consequence is to encourage the patient to creative work as a constructive strategy on the way from “Here to Eternity”.
Acknowledgement: I am very grateful to Marie Motil for preparing the final version of the study.
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