Illness and autonomy: Neurobiology, behavior, and treatment of bipolar mania

Bipolar disorder (BD) is a severe and crippling mental illness, affecting 2.6 millions adults every year. Though pharmacological treatment for the disease is quite effective, we are still in our infancy in terms of our understanding of its underlying neurobiological mechanisms. Nevertheless, a variety of hypotheses have emerged that provide a strong empirical framework upon which we may construct a clearer and more definitive theory of its neural substrates. The present review focused on mechanisms of mania, as it is most commonly associated with the performance of impulsive and detrimental behaviors. Moreover, I have explored the critical question of whether BD patients experience free will and autonomy or instead are the victims of a deterministic illness, the directives of which are inevitable. It seems that, to some extent, a patient’s genetic circumstances and consequent neurobiological processes determines her behaviors. That being said, it must be assumed that each patient is, for the most part, an autonomous agent that has the ability to interfere with the forceful dictates of the disease. An agent theoretically has the choice to comply with medication, though it may be far more effortful than it would be were he not ill. However, a patient experiencing severe mania may truly be outside of the realm of autonomy, and any consequent criminal or otherwise destructive behavior should be seriously considered for exemption. Ultimately, it ought to be appreciated that no one chooses to be ill, and that it requires enormous fortitude to resist what the illness compels one to do. Those of us with healthy brains should be cognizant of this fact and sympathize accordingly