I only skimmed the paper. It is very long and I doubt I would be able to read the whole thing. At the beginning they write "evidence from the methodologically strongest studies is inconsistent with the kindling hypothesis."

But it looks like a big part of the paper is about what would be the case if the kindling hypothesis were true.

In my own case, I wasn't symptomatic with mania until my mid 40s and had gone through chronic, severe stress in a hostile work environment. So it was my workplace I feel that literally made me ill, but there was also this underlying tendency I inherited from my father. Since then my episodes have been less tied to any external stressor. I was actually ok when I was diagnosed and treated for lung cancer, but had a severe episode after that.

I had not been given ergonomic furniture despite requesting it over a year and had developed a chronic pain condition from my desk work at the computer. My gp sent me to a psychiatrist when all prescription pain meds failed to make a dent, that she tried. My psychiatrist at the time diagnosed me with 'somataform disorder' and put me on 60 mg of celexa. I ended up going manic on that dose and after my 1st hospitalization got a new psychiatrist. My first one knew my father has bipolar but didn't look out for the warning signs of mania or mixed state.

Later I found the drug Lyrica did wonders for my chronic pain condition and I have also been much better since I stopped working a desk job.

I believe the kindling hypothesis but my first mania was I believe triggered by a high dose of an antidepressant.