“An Uppy-Downy, Mood-Swingy Kind of Guy”

Question: Can you discuss your experience with bipolar disease?

Stephen Fry: Yes. I was first diagnosed actually not to my knowledge as being possibly bipolar when I was about fifteen. I didn’t know this until much later when I made a documentary about my life as a manic depressive or someone with bipolar disorder, whatever you choose to call it, an uppy-downy, mood-swingy kind of guy. In fact, technically I believe the correct diagnosis for my condition is psychothymic, which is like also known as bipolar light in America, which is rather nice and makes it sound like a variety of cola, but bipolar disorder is a mood disorder rather than a personality disorder such as that might mean to anybody, but I think we all kind of get what that is. To me mood is the equivalent of weather. Weather is real. That’s the important thing to remember about weather. It is absolutely real. When it rains it rains. It is wet. You get wet. There is no question about it. It’s also true about weather that you can’t control it. You can’t say if I wish hard enough it won’t rain and it’s equally true that if the weather is bad one day it will get better and what I had to learn was to treat my moods like the weather. On the one hand denying that they were there and saying I can’t… I’m not really depressed. Why should I be depressed? I’ve got enough money. I’ve got a job. People like me. There is no to be depressed. That’s at stupid as saying there is no reason to have asthma or there is no reason to have the measles. You know you’ve got it. It’s there. It’s not about reason. You don’t get depressed because bad things happen to you. That’s getting pissed off and annoyed. That’s reasonable. Someone hits you in the face you go ow, you know that’s… but depression is something that happens like weather to you inside you and it’s not about… It could be triggered by something unfortunate, but it isn’t… You know it’s not enough to talk yourself out of it by saying but I shouldn’t be depressed because I’ve got people who are nice to me, which is frustrating for people outside. They go, “Don’t be depressed.” “Everyone loves you.” “You’re really happy.” “You’ve got a good life.” I know. That is what is so depressing. I can’t help it. So but once you… It’s not a solution, but anyway, it’s very important at least to get that stage of it out of the way is to recognize it as a mood disorder as something that is akin to weather, but the nature of manic depression or bipolar disorder is it is bipolar. It is two poles. It’s not just depression. The point is that there is this other side to it. You have a depressed mood. You have an elevated mood that is mania, which is the manic side of manic depression and these are hypomanic or hyper manic states in which you can be grandiose. You can be absurdly extreme in your optimism and your creativity and your energy. You can go for ages without sleep. You can be sexually promiscuous. You can be a shopping addict, but people have different ways in which they’re elevated moods are expressed and they talk nineteen to the dozen. They can’t stop thinking, their mind races. They think they can solve the problems of the world. They think they have a unique insight. It can be a very blissful and exciting and extraordinary state of mind to be in and then comes the crash. The problems of it are manifested in tens. One is that people, most people outside family and friends are more annoyed, are more uncomfortable at the manic phase than the depressed phase. The depressed person you can deal with because all they want to do is just sit there and they want to be in dark in the bedroom sleeping and not doing any work and just hating themselves and as long as they’re not you know really considering suicide, as long as the pain isn’t that bad then you can manage them whereas a person in an elevated state is unmanageably annoying. They won’t stop talking. They won’t stop shaking their knees up and down and getting excited and talking about things and changing things and re-tidying rooms and oh, like that. So you know it can be a very frustrating for people around you. At its worst it can be very dangerous. Obviously suicide is the down side of depression. I had several suicide attempts in my life, but also really and this always sounds like a feeble excuse, but it is true. The most natural way you would attempt to cope with something inside you that is affecting your moods and your energy levels is to intervene with chemicals to help and because medical science hasn’t come up with pharmaceuticals that do particularly well you tend to reach for the chemicals that are outside the Pharma counter, i.e. narcotics and alcohol because they can guarantee your mood more or less. They like, like the condition itself will store up a big crash or big reverse, but you just keep at it and you keep getting drunk, keep getting wired and you’ll stave off the inevitable disaster of being alone with your moods.

So for a long time I was I suppose dependent is the word on cocaine powder and naturally when you take a lot of cocaine powder you tend to take a lot of alcohol with it as well, so for many years really I never went out without at least four or five grams of cocaine powder on my person and I would ingest it intranasally as was the fashion through the use of some sort of straw or rolled up currency note and managed to get by on it. I never did that when I was working. I didn’t do it onstage or on while filming or anything. It was a way of ending… As soon as you… Because work provided its own high, but as soon as I finished work that was it. I was out. I was in clubs and things. I can’t believe it now. I don’t know how I managed to do it. It’s just extraordinary, but I did and anyway, then I had a bit of a disaster in the mid nineties. I was in a play and it just all went wrong and horrible and I ran for the hills as it were. Well actually I ran for Belgium which are not hills at all. I ran for the low countries and through Belgium went to Germany and I was… and so declared missing by the British for awhile and then I was found and it was all very ghastly, but it sort of made me confront the whole business of this diagnosis and I saw doctors and things and they confirmed the diagnosis and then a few years later when I was back on a more even keel and more used to dealing with things and a little bit more clear about myself I made a program about… called Manic Depression and Me or The Secret Life of the Manic Depressive was the proper title. And in which I… It was two one hour films in which I went around America and England actually and talking to people with the problem, talking to doctors, talking my own history and my own condition and it was really interesting because it was considered something of a success this program and something of a breakthrough and because aside from all the problems I’ve spoken about one of the major problems is not the person who suffers with the disease. It’s with the rest of the world and mental health disorder and its stigma. People just are terrible at coping with it, other people. They don’t like anyone mentioning it if possible.

 

I had the great pleasure of dinner last night here in New York with Dick Caveat, the talk show host of the sixties and seventies, a brilliant talk show host. Look him up on YouTube if you don’t know his… the show he… I mean he is absolutely wonderful, but his career was pretty much stalled in many ways by his fight with depression and he has written about it superbly and he talked about it and we were chatting about it last night and it is that problem of you know say to someone I’ve got a broken leg or I’ve got diabetes, particularly if you say diabetes and asthma say, which are both chronic conditions that won’t go away. People go, “Oh, do you take insulin or do you take that little wheezer thing for your asthma?” You go, “Yes.” If you say I’ve got a mental health condition they go, “Oh, do you?” “That’s nice.” And they want to be somewhere else. They don’t want to be anywhere near you and I can understand that. Of course I can understand it, but you know that it’s like six degrees of separation I think. You know that you know all six of Kevin Bacon or whichever. I don’t think that you’re ever more than three or four steps away from someone close to you who has a mental health problem and I think the more we accept that it is us, it is part of being human then the better we are because then we can start concentrating on the things that matter in terms of coping with it.

 

Question: What do you think about medicating children who appear manic depressive?

Stephen Fry: It’s a really… It’s a really tricky business that of diagnosing children. On the one hand it is very good if the diagnosis is sound and you believe in it to spot the early signs of what could be a very difficult growing up for a child, on the other hand, to give Ritalin or powerful antipsychotic drugs to a child as young as four or five. I spoke to a professor of psychiatry at Stanford University. He is one of the leading people in his field who is quite prepared to diagnose very young children as being bipolar, not just ADHD and things that we’re used to in children and his point is that non intervention is not a neutral act. Not giving someone drugs when you’ve diagnosed it is in itself allowing the brain as he would put it to toxify itself, that whatever is happening as the brain is forming if it is forming in a bad way, bad pathways, bad neural signals are being sent and they’re creating bad pathways as it were or you know bad demands for you know because let’s face it. We don’t really understand that balance between hormone… if you like or hormone and neurotransmitter, but that’s his argument is that nonintervention allows the brain to build itself badly, but it’s a heck of a thing to give a child as young as… Well as young as ten or even as young as fourteen frankly some of these powerful drugs when the brain is still growing. I find it tricky and certainly in Europe it’s considered outrageous, but it happens a lot in America, but then you have more mad people. No, I mean sorry. You have a bigger population and better scientists.

 Recorded December 8, 2009

Stephen Fry’s own experience with manic depression lead him to create a documentary about the condition.

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Why compassion fades

A scientific look into a ubiquitous phenomenon.

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Sex & Relationships

One victim can break our hearts. Remember the image of the young Syrian boy discovered dead on a beach in Turkey in 2015? Donations to relief agencies soared after that image went viral. However, we feel less compassion as the number of victims grows. Are we incapable of feeling compassion for large groups of people who suffer a tragedy, such as an earthquake or the recent Sri Lanka Easter bombings? Of course not, but the truth is we aren't as compassionate as we'd like to believe, because of a paradox of large numbers. Why is this?

Compassion is a product of our sociality as primates. In his book, The Expanding Circle: Ethics, Evolution, and Moral Progress, Peter Singer states, "Human beings are social animals. We were social before we were human." Mr. Singer goes on to say, "We can be sure that we restrained our behavior toward our fellows before we were rational human beings. Social life requires some degree of restraint. A social grouping cannot stay together if its members make frequent and unrestrained attacks on one another."

Attacks on ingroups can come from forces of nature as well. In this light, compassion is a form of expressed empathy to demonstrate camaraderie.

Yet even after hundreds of centuries of evolution, when tragedy strikes beyond our community, our compassion wanes as the number of displaced, injured, and dead mounts.

The drop-off in commiseration has been termed the collapse of compassion. The term has also been defined in The Oxford Handbook of Compassion Science: ". . . people tend to feel and act less compassionately for multiple suffering victims than for a single suffering victim."

That the drop-off happens has been widely documented, but at what point this phenomenon happens remains unclear. One paper, written by Paul Slovic and Daniel Västfjäll, sets out a simple formula, ". . . where the emotion or affective feeling is greatest at N =1 but begins to fade at N = 2 and collapses at some higher value of N that becomes simply 'a statistic.'"

The ambiguity of "some higher value" is curious. That value may relate to Dunbar's Number, a theory developed by British anthropologist, Robin Dunbar. His research centers on communal groups of primates that evolved to support and care for larger and larger groups as their brains (our brains) expanded in capacity. Dunbar's is the number of people with whom we can maintain a stable relationship — approximately 150.

Some back story

Professor Robin Dunbar of the University of Oxford has published considerable research on anthropology and evolutionary psychology. His work is informed by anthropology, sociology and psychology. Dunbar's Number is a cognitive boundary, one we are likely incapable of breaching. The number is based around two notions; that brain size in primates correlates with the size of the social groups they live among and that these groups in human primates are relative to communal numbers set deep in our evolutionary past. In simpler terms, 150 is about the maximum number of people with whom we can identify with, interact with, care about, and work to protect. Dunbar's Number falls along a logorithmic continuum, beginning with the smallest, most emotionally connected group of five, then expanding outward in multiples of three: 5, 15, 50, 150. The numbers in these concentric circles are affected by multiple variables, including the closeness and size of immediate and extended families, along with the greater cognitive capacity of some individuals to maintain stable relationships with larger than normal group sizes. In other words, folks with more cerebral candlepower can engage with larger groups. Those with lesser cognitive powers, smaller groups.

The number that triggers "compassion collapse" might be different for individuals, but I think it may begin to unravel along the continuum of Dunbar's relatable 150. We can commiserate with 5 to 15 to 150 people because upon those numbers, we can overlay names and faces of people we know: our families, friends and coworkers, the members of our clan. In addition, from an evolutionary perspective, that number is important. We needed to care if bands of our clan were being harmed by raids, disaster, or disease, because our survival depended on the group staying intact. Our brains developed the capacity to care for the entirety of the group but not beyond it. Beyond our ingroup was an outgroup that may have competed with us for food and safety and it served us no practical purpose to feel sad that something awful had happened to them, only to learn the lessons so as to apply them for our own survival, e.g., don't swim with hippos.

Lapses

Imagine losing 10 family members in a house fire. Now instead, lose 10 neighbors, 10 from a nearby town, 10 from Belgium, 10 from Vietnam 10 years ago. One could almost feel the emotion ebbing as the sentence drew to a close.

There are two other important factors which contribute to the softening of our compassion: proximity and time. While enjoying lunch in Santa Fe, we can discuss the death toll in the French revolution with no emotional response but might be nauseated to discuss three children lost in a recent car crash around the corner. Conflict journalists attempt to bridge these geotemporal lapses but have long struggled to ignite compassion in their home audience for far-flung tragedies, Being a witness to carnage is an immense stressor, but the impact diminishes across the airwaves as the kilometers pile up.

A Dunbar Correlation

Where is the inflection point at which people become statistics? Can we find that number? In what way might that inflection point be influenced by the Dunbar 150?

"Yes, the Dunbar number seems relevant here," said Gad Saad, PhD., the evolutionary behavioral scientist from the John Molson School of Business at Concordia University, Montreal, in an email correspondence. Saad also recommended Singer's work.

I also went to the wellspring. I asked Professor Dunbar by email if he thought 150 was a reasonable inflection point for moving from compassion into statistics. He graciously responded, lightly edited for space.

Professor Dunbar's response:

"The short answer is that I have no idea, but what you suggest is perfect sense. . . . One-hundred and fifty is the inflection point between the individuals we can empathize with because we have personal relationships with them and those with whom we don't have personalized relationships. There is, however, also another inflection point at 1,500 (the typical size of tribes in hunter-gatherer societies) which defines the limit set by the number of faces we can put names to. After 1,500, they are all completely anonymous."

I asked Dunbar if he knows of or suspects a neurophysiological aspect to the point where we simply lose the capacity to manage our compassion:

"These limits are underpinned by the size of key bits of the brain (mainly the frontal lobes, but not wholly). There are a number of studies showing this, both across primate species and within humans."

In his literature, Professor Dunbar presents two reasons why his number stands at 150, despite the ubiquity of social networking: the first is time — investing our time in a relationship is limited by the number of hours we have available to us in a given week. The second is our brain capacity measured in primates by our brain volume.

Friendship, kinship and limitations

"We devote around 40 percent of our available social time to our 5 most intimate friends and relations," Dunbar has written, "(the subset of individuals on whom we rely the most) and the remaining 60 percent in progressively decreasing amounts to the other 145."

These brain functions are costly, in terms of time, energy and emotion. Dunbar states, "There is extensive evidence, for example, to suggest that network size has significant effects on health and well-being, including morbidity and mortality, recovery from illness, cognitive function, and even willingness to adopt healthy lifestyles." This suggests that we devote so much energy to our own network that caring about a larger number may be too demanding.

"These differences in functionality may well reflect the role of mentalizing competencies. The optimal group size for a task may depend on the extent to which the group members have to be able to empathize with the beliefs and intentions of other members so as to coordinate closely…" This neocortical-to-community model carries over to compassion for others, whether in or out of our social network. Time constrains all human activity, including time to feel.

As Dunbar writes in The Anatomy of Friendship, "Friendship is the single most important factor influencing our health, well-being, and happiness. Creating and maintaining friendships is, however, extremely costly, in terms of both the time that has to be invested and the cognitive mechanisms that underpin them. Nonetheless, personal social networks exhibit many constancies, notably in their size and their hierarchical structuring." Our mental capacity may be the primary reason we feel less empathy and compassion for larger groups; we simply don't have the cerebral apparatus to manage their plights. "Part of friendship is the act of mentalizing, or mentally envisioning the landscape of another's mind. Cognitively, this process is extraordinarily taxing, and as such, intimate conversations seem to be capped at about four people before they break down and form smaller conversational groups. If the conversation involves speculating about an absent person's mental state (e.g., gossiping), then the cap is three — which is also a number that Shakespeare's plays respect."

We cannot mentalize what is going on in the minds of people in our groups much beyond our inner circle, so it stands to reason we cannot do it for large groups separated from us by geotemporal lapses.

Emotional regulation

In a paper, C. Daryl Cameron and Keith B. Payne state, "Some researchers have suggested that [compassion collapse] happens because emotions are not triggered by aggregates. We provide evidence for an alternative account. People expect the needs of large groups to be potentially overwhelming, and, as a result, they engage in emotion regulation to prevent themselves from experiencing overwhelming levels of emotion. Because groups are more likely than individuals to elicit emotion regulation, people feel less for groups than for individuals."

This argument seems to imply that we have more control over diminishing compassion than not. To say, "people expect the needs of large groups to be potentially overwhelming" suggests we consciously consider what that caring could entail and back away from it, or that we become aware that we are reaching and an endpoint of compassion and begin to purposely shift the framing of the incident from one that is personal to one that is statistical. The authors offer an alternative hypothesis to the notion that emotions are not triggered by aggregates, by attempting to show that we regulate our emotional response as the number of victims becomes perceived to be overwhelming. However, in the real world, for example, large death tolls are not brought to us one victim at a time. We are told, about a devastating event, then react viscerally.

If we don't begin to express our emotions consciously, then the process must be subconscious, and that number could have evolved to where it is now innate.

Gray matter matters

One of Dunbar's most salient points is that brain capacity influences social networks. In his paper, The Social Brain, he writes: "Path analysis suggests that there is a specific causal relationship in which the volume of a key prefrontal cortex subregion (or subregions) determines an individual's mentalizing skills, and these skills in turn determine the size of his or her social network."

It's not only the size of the brain but in fact, mentalizing recruits different regions for ingroup empathy. The Stanford Center for Compassion and Altruism Research and Education published a study of the brain regions activated when showing empathy for strangers in which the authors stated, "Interestingly, in brain imaging studies of mentalizing, participants recruit more dorsal portions of the medial prefrontal cortex (dMPFC; BA 8/9) when mentalizing about strangers, whereas they recruit more ventral regions of the medial prefrontal cortex (BA 10), similar to the MPFC activation reported in the current study, when mentalizing about close others with whom participants experience self-other overlap."⁷

It's possible the region of the brain that activates to help an ingroup member evolved for good reason, survival of the group. Other regions may have begun to expand as those smaller tribal groups expanded into larger societies.

Rabbit holes

There is an eclectic list of reasons why compassion may collapse, irrespective of sheer numbers:

(1) Manner: How the news is presented affects viewer framing. In her book, European Foreign Conflict Reporting: A Comparative Analysis of Public News, Emma Heywood explores how tragedies and war are offered to the viewers, which can elicit greater or lesser compassionate responses. "Techniques, which could raise compassion amongst the viewers, and which prevail on New at Ten, are disregarded, allowing the victims to remain unfamiliar and dissociated from the viewer. This approach does not encourage viewers to engage with the sufferers, rather releases them from any responsibility to participate emotionally. Instead compassion values are sidelined and potential opportunities to dwell on victim coverage are replaced by images of fighting and violence."

(2) Ethnicity. How relatable are the victims? Although it can be argued that people in western countries would feel a lesser degree of compassion for victims of a bombing in Karachi, that doesn't mean people in countries near Pakistan wouldn't feel compassion for the Karachi victims at a level comparable to what westerners might feel about a bombing in Toronto. Distance has a role to play in this dynamic as much as in the sound evolutionary data that demonstrate a need for us to both recognize and empathize with people who look like our communal entity. It's not racism; it's tribalism. We are simply not evolved from massive heterogeneous cultures. As evolving humans, we're still working it all out. It's a survival mechanism that developed over millennia that we now struggle with as we fine tune our trust for others.

In the end

Think of compassion collapse on a grid, with compassion represented in the Y axis and the number of victims running along the X. As the number of victims increases beyond one, our level of compassion is expected to rise. Setting aside other variables that may raise compassion (proximity, familiarity etc.), the level continues to rise until, for some reason, it begins to fall precipitously.

Is it because we've become aware of being overwhelmed or because we have reached max-capacity neuron load? Dunbar's Number seems a reasonable place to look for a tipping point.

Professor Dunbar has referred to the limits of friendship as a "budgeting problem." We simply don't have the time to manage a bigger group of friends. Our compassion for the plight of strangers may drop of at a number equivalent to the number of people with who we can be friends, a number to which we unconsciously relate. Whether or not we solve this intellectual question, it remains a curious fact that the larger a tragedy is, the more likely human faces are to become faceless numbers.