Temporality in mania: Phenomenological, neurobiological and therapeutic consequences

Abstract

Manic disturbances of temporality are underemphasized in present-day accounts. For example, they are not included among criteria for manic episodes in DSM or ICD. Nonetheless, as already claimed by Binswanger (1964), aberrant temporality is core to the disorder. Persons with mania live almost exclusively in the present and hardly into the future. Especially in the larger scheme of things, their future is already here. There is no “advancing, developing or maturing,” anticipations have been achieved, all that I strive for is present – if you will just get out of my way! A half century ago, Binswanger spelled out this temporal foundation for mania and summed up consequences. The manic self, not living into the future, “is not, to borrow a word, an existential self.”

This presentation will describe phenomenological characteristics of such a manic self and then present correlating findings from contemporary neuroscience. Importantly, such findings clarify present and future therapeutic interventions. Of critical importance is manic chronobiology: clocks in our brains afford receptor sites for the lithium ion. At these sites, lithium potently inhibits the circadian rhythm regulator glycogen synthase kinase 3 and alters the biological cascade that follows. By taking a close look, we can comprehend implications for mania as well as for treatment with lithium: Neurobiologically, lithium disrupts manic rhythm dysregulation and restores a more “normalized” temporality. The consequence is no less than the return of the existential self.

A receptor mechanism of action for lithium additionally portends future specific and safer treatment options “after lithium.”

Disclosure of interest

The authors have not supplied their declaration of competing interest.