Understanding Depression and Mania - Andy Dunn (Bonobos)

So I want to talk about hypomania. We may be familiar more so with depression. It affects 20% of the population. We think it was up to 50% of American adults during COVID By those numbers, we have so much personal experience with it or we have loved ones who've gone through it. So depression, we can understand. And unfortunately for bipolar, for bipolar I in particular, the depression can become so crushingly catatonic that the suicide attempt rate for bipolar I over a lifetime is 60% and the suicide rate for bipolar is 19%. And so picture being 20 years old, and there are definitively by stats people in this audience who have been through this. You're fine one day and then this thing happens to you. You're diagnosed. Typically that's either a major episode of depression or a major episode of psychosis or what you could also call mania, which we'll get into. And all of a sudden you learn that there's a 1 in 5 chance that you're going to end your own life. The most probable way that you'll die is by suicide. And that is just unacceptably too high. And I believe we can bring that way down and we're bringing it way down because of advances in treatments, advances in the quality of medical care, and also so critically, advances in us having conversations, noticing folks who are suffering and finding ways to get them help. On the flip side, we have mania. And what is mania? Mania is typically delusions of grandeur, racing speech, the flight of ideas, messianic zeal, a decreased need for sleep, risk-seeking behaviors sexually, financially, and otherwise, intersection with substance use. All of these ingredients can lead one to a place of having a psychotic break, one where you no longer have your feet rooted on the ground. And so often that comes with delusions of being super powerful in some way. For me, my first episode, I thought I was God. It was the turn of the millennium. It was turning from 1999 to 2000. I remember watching a TV show, a bunch of folks praying for the return of the second coming. I was smoking a lot of pot. I had done mushrooms for the first time. I was drinking a lot. I was partying like it's 1999, which is literally, I think, a Prince song. And the millennium was turning and I went off the rails. And I had this moment after a few nights of sleeping less and less. And my friends and family helped me stitch together as writing the book that we think I was up 4 nights in a row with zero sleep, 4 nights. And I came to this conclusion of, oh, I know who God is. God is coming back. It's me. And one of the things that makes bipolar so humiliating to talk about is this idea that we thought that and how embarrassing that that is. And it took— I was probably 200 sessions deep with my psychiatrist So maybe it took a year of 2 sessions a week to begin to be able to talk about that without being embarrassed, to realize that we're all incepted with a God delusion as infants. We get everything we need. If we survive infancy, every time we cried, we were comforted. Every time we wanted food, we were given food, mother's milk, or formula, as it were. And so we have this amazing sense that the universe is a safe place. In the womb, I mean, talk about the womb is a beautiful place to be, right? It's just, it's a perfect state. And then we learn as small children that our parents are going to die and later we're going to die. And our culture is just filled with stories of superheroes and superpowers. It is the stuff of most religions. It is the stuff of, you know, what does Disney do other than educate us on our parents' eventual demise and the fact that we're going to transcend that? Harry Potter, Marvel, DC Comics. And so the problem with someone going into a manic state is they let that little thought slip through, hey, maybe I have superpowers, and they don't disbelieve that thought. And that then leads to terrible things. And so the week that you spend— and I don't know, those of you that have been God for a week, I've got to tell you, it's very fun. It's like, it's very exciting to be the Messiah for a week, but it is a nightmare for everyone else. Is a nightmare for everyone else in your life trying to figure out how you get back to the ground. And that requires sleep, medication, typically hospitalization. And then you come out of that and bam, this sledgehammer diagnosis hits. And unfortunately, the result— you talked about my biracial family. One thing that the Indians and the Scandinavians had in common was no talking about mental health. You know, we don't talk about mental illness. And so it became this ghost lurking in the background. And later we can go deeper if you'd like on— I'll give you the highlight on a mood state called hypomania, which is very difficult to discern. Hypomania is just like mania, a lot of the energy and a lot of the delusion, but without fully leaving the stratosphere. And for better or for worse, those criteria for hypomania that I laid out, convergent with those for mania, are more or less essential casting traits of an entrepreneur having a good day. What is an entrepreneur if not someone with delusional self-belief? What is an entrepreneur but someone who has a flight of ideas? What is an entrepreneur but someone who might be working too hard and sleeping too little? What is an entrepreneur other than someone having relentless energy and potentially indulging in high-risk behaviors? When it runs amok, we get, you know, really calamitous, the calamitous examples that we have out there, right? People who really start drinking their own Kool-Aid, And we, we can see it in the news. You can turn on the news right now. And so I think our job as a Stanford community, which is such a wonderful community, such a birthplace for entrepreneurial innovation, is to figure out how do we approach being an entrepreneur with a mindset of having great mental hygiene, of taking care of our brains. And I think we can do it. I think it's possible. And I think it's beautiful that this conversation is happening because it's a great community to be talking about this.