Do People Lose Their Autonomy During Manic Episodes?

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People who experience manic episodes often describe the sense of being overwhelmed by the intensity of life. This can interfere with careful and thoughtful deliberation, replacing it with impulsive behavior that can make the manic feel they are not in control.

In philosophical terms, we could ask whether manic episodes involve a loss of autonomy, the ability to make your own decisions, and control your own actions. In a recent paper in Philosophical Psychology, philosopher Elliot Porter argues that manic episodes do not imply a loss of autonomy, but simply change the way it works—and we in society can understand this so people prone to manic episodes aren't excluded from meaningful life activities.¹

Understanding Autonomy

As Porter explains, autonomy involves two capacities:

1. Reasons-tracking: We need to be able to identify reasons for action and then act on them.

2. Regulative guidance: We need to monitor how well we’ve done this.

On the surface, manic episodes would seem to compromise both of these: people experiencing such periods may not feel they are responding to any reasons, much less reflecting on their manic behavior (at least not during the episode itself). Porter argues the picture is much more nuanced, but first, we need to appreciate a unique way to characterize manic decision-making and behavior.

Characterizing Mania

Based on the testimony of people describing their manic episodes, Porter narrows in on the concept of demandingness. During these periods, people describe an overwhelming imperative to act on whatever reasons present themselves. He quotes the late actress Carrie Fisher, who wrote in her memoir that “when you’re manic, every impulse feels like an edict from the Vatican.”² As Porter writes, problems that manic persons “respond to seem to call for immediate, swift, and decisive responses” (p. 9). Responses to stimuli become not just appropriate but necessary as if they were compelled and enforced by some external authority (papal or otherwise).

An aspect of demandingness alluded to above is the sense of urgency, which makes the manic person feel not only that they must act decisively on reasons but that they must do so right now. There is no time for careful and thoughtful deliberation, which most accounts of autonomy and rationality require; as Porter writes, “urgency narrows the gap between thought and action” (p. 10). In such cases, further deliberation seems irresponsible if not dangerous, as if every decision were of life-and-death importance and there is simply no time to ponder the fine details.

Autonomy Under Urgency and Demandingness

Do the urgency and demandingness that people feel in manic episodes imply a loss of autonomy? Porter argues no: such states may reflect limited or compromised autonomy, but not a total absence of it.

To be sure, manic episodes present unique problems for autonomy. For example, Porter says that feelings of demandingness or urgency lead the manic sufferer to place too much weight on reasons pointing to immediate, decisive actions, and too little weight on reasons that encourage deliberation. This may be an improper balancing of these reasons, threatening to compromise the pursuit of important life goals, but “this is a limitation" and "not a fatal injury to reasons-tracking capacities,” which demand only that we track our reasons for action, not that “we get relative weights right” (p. 15). Such a mistake is common to all of us from time to time, and it simply may be more common during manic episodes, but not to such a degree that it suggests a complete loss of autonomy.

A similar picture emerges concerning regulatory guidance. People do assess their behavior during manic episodes, often explaining to others in significant detail why they are doing what they are doing, as well as why they need to do it now. Judged from the outside, or even by themselves following an episode, we may be able to say their behavior was excessive or mistaken, but we can’t say they didn’t engage in reflection or self-assessment at all. Once again, most of us can look back on our past behavior and ask ourselves: “What was I thinking?” At the same time, we remember that, at the time, we sincerely thought what we did then was a good idea—but we wouldn't doubt that we had autonomy when we did it.

Perfect Autonomy Is Impossible

The fact is that none of us is perfectly autonomous. One of history's most important philosophers who wrote about autonomy, Immanuel Kant, said that every person has the “capacity” for autonomy, but that it must be exercised and cultivated to be fully realized (which we have a moral responsibility to do).³ Again, I suspect that each of us can identify a time in our lives when we acted impulsively and unreflectively, allowing circumstances or other people to guide our actions more than our own sense of judgment—and some people are more prone to this than others, regardless of any manic tendencies.

Porter concludes his paper by advocating for a better understanding of, and more compassion for, how people express their (imperfect) autonomy during manic episodes. The exercise of autonomy is not just in our minds: most of it takes place in the outside world in collaboration with other people, who must acknowledge and respect the unique ways each of us makes our way in life. People who misjudge those prone to manic episodes as “crazy” may not take them seriously, or may exclude them altogether, limiting how much they can exercise their autonomy out in the world.

In general, society needs to be more understanding and welcoming of neurodivergent people whose behavior does not always conform to the expectations of the neurotypical—and everyone should be able to recognize that reason as very urgent indeed.