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American ManiaReview - American Mania
When More Is Not Enough
by Peter C. Whybrow
WW Norton, 2005
Review by S. Nassir Ghaemi, MD
Dec 22nd 2005 (Volume 9, Issue 51)

The philosopher Hegel once said that philosophizing should not be confused with mere analogical reflection. This whole book is based on one analogy: that Americans are running around as if they were "manic". The author's credibility for passing this judgment appears to be that he is a psychiatrist who has done some work on mania.

Yet this book has nothing to do with mania or bipolar disorder, and very little to do with psychiatry. It is rather a critique of American society that is rather muddled. On the one hand, Whybrow wants to say that American society is too fast and furious, and that we are too single-minded in pursuing our self-interest. He acknowledges that this pursuit of self-interest is part of the core philosophy of capitalism, enshrined in the work of Adam Smith and the philosophy of America's Founding Father revolutionaries. Yet instead of fleshing out this critique, he seeks to uphold it while at the same time absolving capitalism and Adam Smith. He does so by emphasizing what Adam Smith had to say about "social sympathy", or the tendency of humans to relate to each other interpersonally and in communities. Basically, Whybrow says we need to leaven the personal self-interest focus of our culture with a greater appreciation of the importance of community and social connections.

There is nothing new about this perspective. The author barely mentions those who have made the same argument (and then almost always in passing), and at times he either does not know about other key thinkers or he has simply ignored them. For instance, Thorstein Veblen is mentioned briefly on page 41, Karl Marx only briefly on page 234 and in one footnote in which only "Capital" is referenced (as opposed to his much more relevant early essays on alienation), and John Kenneth Galbraith in only a footnote without any elaboration. The term "present moment" is discussed in relation to a Buddhist oriented meditative response to our current consumer society (which Whybrow puts in the context of the ideas of a young entrepreneur he interviewed) but no mention is made of the book by Jon Kabat-Zinn of the same name, or Kabat-Zinn and his colleagues' extensive work on this topic. The term "affluent society" is mentioned once, but the key book and ideas written by Galbraith are not referenced or discussed. Henry David Thoreau is not mentioned at all in the book, despite a recommendation at the end of the book that we should simplify our lives. The key work of Herbert Marcuse (especially "One-Dimensional Man"), which represents a much more profound psychological analysis of modern society (influenced in depth by Freud and Marx) than this book, is not mentioned at all.

Perhaps I had been expecting something of more scholarly depth. Or perhaps the editors of major presses, and readers, no longer can handle such scholarship, preferring instead, as is the case in this book, portraits of airport discussions with yuppies.

The only new aspects to Whybrow's text comes down to three ideas. One: that Americans are especially prone to selfish acquisitiveness due to the genetic inheritance of a risk-taking disposition transmitted by those who emigrated here. Two: that we are biologically predisposed to addictiveness and rewarding behavior. Three: that we are also biologically predisposed to empathy and social cohesiveness. However, the third biological predisposition is weaker than the second, and thus we need to make cultural and political efforts to strengthen social and community bonds.

The evidence that he provides for the above three ideas come from the following: 1. Primate studies that suggest that emigration occurs more with risk-taking impulsivity, which is associated with some decreases in serotonin activity in the brain; and human studies that link dopamine D4 receptors with risk taking behavior; and some evidence that offspring of such primates are also more likely to be impulsive. 2. Some biological studies about the role of dopamine circuits in pleasure and addiction. 3. Some biological studies about the nature of empathy. Most of this biological information is provided through descriptions of interviews with relevant researchers, almost all colleagues of the author at the University of California at Los Angeles. Very little detail or context is provided to either convince or fail to convince the reader about the validity and relevance of these biological speculations.

The bottom line is that Whybrow simply provides brief descriptions of the fact that there is a biology of empathy, and pleasure, and risk-taking. But there is a biology to everything. To state that there are biological aspects to these behaviors is simply to state a fact. This does not explain that those biological factors are important, or essential, or more important than cultural or political factors. The book should have tried to make those arguments if it wanted to break new ground.

Further, even if, for instance, D4 receptors had anything to do with immigration, and some presumed biological basis to American creativity and impulsivity, I do not understand what this has to do with mania. D4 has never been implicated in mania or bipolar disorder; it is related to the personality trait of risk-taking behavior. But then again, mania in this book is merely an analogy, not a real idea with flesh and blood, nor a scientifically valid idea as it is used in psychiatry.

This book would have been much better if, given Whybrow's background in behavioral neurobiology, he provided more attention in detail to the ideas of Marx and Galbraith and Marcuse and Thoreau. That book could have placed Whybrow's few biological speculations into the context of those formidable social and cultural critiques. Whybrow either does not know those critiques in depth, or he really believes it is sufficient to dismiss them with a wave of the hand, pointing to D4 receptors. Yet he makes no convincing case why we should agree with this approach. Why is it that these biological facts should explain the excesses of our capitalist society better than some inherently problematic aspects of capitalist ideology, or Calvinist culture, or the libertarian politics of the Founding Fathers? Whybrow never makes this argument; he simply states it as a given.

One might make other relevant criticisms. For instance, the book jacket states that Whybrow offers "for the first time a comprehensive physical explanation for the addictive mania of consumerism." What exactly is "addictive mania"? One might be inclined to overlook these comments as written by marketing employees with little knowledge of psychiatry but presumably Whybrow could have edited the jacket. Also, I failed to find much of a physical explanation as claimed above. The technical points in this book are minimal in the text, with mild elaboration in the endnotes; there is hardly any convincing physical explanation of anything.

The jacket continues: "He sheds critical light on the dangerous misfit emerging between our consumer-driven culture and the brain systems that evolved to deal with privation 200,000 years ago." This is an interesting idea, but it is clearer in the jacket than in the book. In fact, though he assumes the relevance of evolution, Whybrow does not directly discuss the issue of evolutionary views in psychiatry in any but the most superficial manner.

Finally, the jacket concludes: "Drawing on scientific case studies and colorful portraits..." The portraits are colorful, but I found only one clinical case study (not the plural) and that was a lady with panic attacks, not mania. Perhaps the book should have been titled "American Panic", but that would have ruined the analogy.



2005 Nassir Ghaemi


Nassir Ghaemi, M.D., M.A., M.P.H., Associate Professor, Department of Psychiatry and Behavioral Sciences; Director, Bipolar Disorders Program, Emory University School of Medicine. Dr. Ghaemi is author of The Concepts of Psychiatry: A Pluralistic Approach to the Mind and Mental Illness, Johns Hopkins University Press, 2003.


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