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What it is like to be manic: a response to Director
  1. Nuala B Kane
  1. Health Service Executive, Dublin, Ireland
  1. Correspondence to Dr Nuala B Kane, Health Service Executive, Dublin, Ireland; nuala.1.kane{at}


In a recent article, Director makes the case that many individuals with bipolar disorder have the capacity to consent to many decisions while acutely manic, even when those decisions are out of character and cause harm. Referring to recent qualitative evidence, I argue that Director overlooks a key mechanism of manic incapacity, an inflexible experience of the future that impairs one’s ability to value. Without attention to the illness-specific experience of decision-making, capacity assessments risk false negatives in people with mania.

  • Decision Making
  • Mental Competency
  • Psychiatry
  • Ethics- Medical

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  • X @nualabkane

  • Contributors NBK is the sole author of this paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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