Mania has an outer aspect and an inner aspect

In May and again in June of 1994 I was hospitalized with a manic episode. I was having delusions of grandeur, flight of ideas (racing thoughts with little apparent connection with one another or with reality), sleeplessness, and rapid mood changes, together with distractibility and impulsive behavior. The whole episode was pretty much straight out of the reference book of psychiatric diagnosis, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or DSM-IV.

I'm writing this account to give a description of mania from the inside. I am not sure how representative I am of mania in general, but because I fit the textbook description so closely, and because I recognize myself in the descriptions given by others who have experienced mania, I hope that this account will give readers an idea of what might be going on inside a person they see who is running around talking and acting crazy. Let me be clear at the outset: this book is a personal account of one manic episode, and is not in any way trying to develop a "theory" that would account for all cases.

The description in DSM-IV gives a good picture of what mania looks and sounds like on the outside. It is described as a disturbance of mood that results in uncontrolled euphoria, cheerfulness, and expansiveness. Self esteem is inflated, leading a person who has never been on a farm, for example, to believe that he has solved the problem of world hunger. The need for sleep decreases, and sometimes vanishes for days at a time. Speech is often loud, rapid, and full of jokes, with puns, rhymes, and sound relationships replacing concepts in governing word choices; these are known as "clang associations." Attention bounces around from topic to topic and can be distracted by irrelevant external stimuli. Sociability increases to the point that passing strangers are hailed as friends, and old acquaintances are called up in the middle of the night; if you've ever received an excited call at 3:00 AM from someone you haven't seen since high school telling you the true meaning of Einstein's theory of relativity, you have probably been listening to a person in a manic state.

Strange behaviors are eventually seen. Impulses are acted upon in ways that get the attention of strangers, policemen, and worried friends, with consequences at work and in personal relationships. Unrestrained spending sprees may result in serious debts. Mood can turn angry and irritable when the person is thwarted, and strings of jokes can give way to furious tirades. Sexual acting out of one sort or another is very common, and seductive propositions may be extended to people who would never receive them under normal circumstances.

The elated mood eventually gives way to depression and self-reproach, which may be severe enough to lead to suicide. Feelings of guilt and worthlessness may replace the expansiveness and inflated self esteem of the manic episode. The risk of recurrence of mania is said to be high, with cycles getting worse when untreated with lifetime medication, usually lithium or an antiepileptic drug, sometimes combined with an antipsychotic medicine. Drug treatment is needed because mania is a medical disease of the brain, and psychotherapy cannot replace the need for lifetime drug therapy. At least, this is the consensus among experts.

Mania is an essential feature of manic-depressive illness, now known as "Bipolar Disorder." I think that "manic-depressive illness" is a fine term; it means that something has gone wrong with you and is causing you to suffer. "Bipolar Disorder" is a lousy term, because this illness has a structure, and should not be called disordered. Finding the structure is the key to healing the illness. Underneath the madness there is a sanity trying to emerge. The sanity is deeper and more real than the madness, and bringing it forth is the most important thing that can ever be done for the sufferer.

I intend to present an alternative view by showing that intention and meaning, not biochemistry, are where the important action is in mania. I am confident that this was the case in my own experience, and precisely because I had such a classic form of mania, I am willing to take the risk of saying that the manic experiences of others are also purposeful and meaningful. If the intention of the mania is brought to pass, and if the meaning is allowed to come forth, then the course of the condition can be altered. True, this may entail a journey through the darkest and most terrifying recesses of the human soul, but if the journey is brought to completion through acceptance of the whole of the manic-depressive cycle, then a manic episode can be the healer of deep wounds that are unreachable in any other way.

It is possible that my diagnosis was incorrect, and that I should never have had the Bipolar Disorder label applied to me. I tried to convince my doctors that I had a ''spiritual emergency,'' a term proposed by Christina Grof and her husband, Stanislav Grof, M.D. Their book, The Stormy Search For the Self, describes the healing potential of spiritual crises such as the one I had. However, the doctors rejected my proposed self-diagnosis and insisted on the correctness of theirs. I have accepted the diagnosis of mania because of the correspondence of my symptoms to those in the DSM-IV.

It now seems elitist to me to try to classify myself in a different category from others who have the Bipolar diagnosis. I am unwilling to say that my episode had meaning and purpose but that theirs are absurd and futile. I have not abandoned the hope that medically defined manic episodes can be seen in terms of human values for anyone who has had one. I accept the manic label, because I have met other people with the same diagnosis who also feel that their experiences had dimensions that were missed or denied by their psychiatrists.

There are two views of mania, one from the outside and one from the inside. The inside view gives information that the outside view lacks, namely the context that gives the meaning to the experience. Mania, which makes no sense at all when seen as an isolated phenomenon, may appear less bizarre when seen against the background out of which it emerges. While the content of manic thought is quite absurd and nonsensical, the process that generates the content has a certain deep intelligence and purpose. This deeper sanity is what makes mania so irresistible to someone immersed in it and so impervious to feedback from others who see that something is terribly wrong. Outside help is resisted vigorously, because it appears to lack any understanding of the importance of the intense inner process.

The would-be helpers are on the outside, looking with dismay at the insane behavior and listening with alarm to the crazy content, while the manic person is on the inside, trying to carry on the deep and urgently important process. Both perspectives are valid, but the difference in vantage points makes communication between the two nearly impossible. The person on the inside of the manic episode just won't listen to reason, and insists that all is well, while the people on the outside try in vain to convince the person running around in his underwear that something is badly amiss. In understanding any complex process, context is everything, and I will be using my own dual perspective on the illness to try to make it more intelligible to baffled observers who are trying to help.

Perhaps you have gone backpacking in the wilderness, carrying on your back a load of 50 or 60 pounds or more with all your food and provisions for several days. You may have hiked for several hours with this weight on your shoulders, finally reaching a campsite where you could finally throw off your pack and walk around without carrying it. If you have done this, you can probably remember how very light you seem to be in the first few seconds of freedom. It feels almost as if you could float off the ground or even fly. Of course, you cannot; you are still in the gravitational field of the earth, weighing whatever you weigh without the backpack. It takes a minute or so for your brain to adjust to your new burden-free status, and before it does, you feel much lighter than you actually are. Your feeling of levitation is just an illusion, but it arises from the way our brains work, which is by making comparisons and calibrating differences, in this case the difference between what you weigh with and without your backpack. You have not become a levitating Swami and you are not Superman or Superwoman, but you are free of those 60 extra pounds. The feeling that you could fly does not arise from any chemical imbalances in your brain; it happens to you because your brain is working, not because it isn't.

Now imagine that you had been carrying around some invisible but oppressive burden all your life, as if you had a ball and chain around your leg, or iron shackles around your ankles, or maybe a large pack of stones strapped to your back. It prevents you from being able to do what you see other people doing. In some vague way you are aware that you are weighted down by something, and from time to time you have tried to cast it off, but never very successfully or for very long. You have grown increasingly frustrated with its heaviness and you have almost given up hope of ever walking free; you have had fantasies about what it might be like to be rid of your burden, but they have never been more than wistful longings.

Eventually the burden has become a part of you, so accustomed are you to carrying it. Your entire identity is caught up in shouldering it; if it were not there, you would no longer be you. Your body has become shaped by its unceasing presence. The way that you walk and breathe are molded by the unseen straps and buckles that fasten the load to you. For long periods of time you are completely resigned to carrying it, and however much you might resent being bound by this burden, you would be lost without it. You would not know what is real and what is imaginary unless you had your chains and manacles as reference points. You have bitter memories of believing that you could someday let go of your burden and move freely, but always these hopes have proved illusory. You may have responded to promises that you could be set free by attending weekend workshops and following various psychological teachings, but all these promises sooner or later failed, and you stopped listening to them, knowing that they all came from charlatans. However much you might want to get out of your chains, you sense that you are stuck with them for life.

You look with envy at people who appear to be going through life free of the particular burden you are struggling with, and wonder what it might be like to be one of them. You wonder what terrible defect you have that makes you unable to function as well as they do. At the same time, you notice that many other people are also afflicted with various burdens, that most of the world is saddled with sorrow, futility, and despair. You are ashamed of yourself for having felt sorry for yourself when others are in such pain, too.

My mania emerged from a context like this. Four features are relevant. First, there is a sense of being "defective" in comparison with those who are "adequate." Their apparent adequacy was for me a source of vexation; this is what defines envy, traditionally enumerated among the seven deadly sins. St. Thomas Aquinas described it very well: "Another's good is apprehended as one's own evil."

Second, there is a sense of futility regarding the prospect of ever emerging from the burden of deficiency. Many momentary liberations have proved to be nothing but illusions, and hope is no longer to be trusted, since it always proves to have been false. Third, there is a rigidity to the shackles that bind. The oppressive structure that constricts the soul is inflexible and its components are tightly welded together. Fourth, there is a feeling that your futility is part of something cosmic; you may suspect that the whole universe is ultimately hopeless, and that the optimists among us are those who have failed to see the awful truth.

In some ways, mania is a variation on these four themes, with emotional responses being the exact opposite, but with the ideas being similar. That is, envy and self-inflation are both expressions of the idea, "I'm essentially different from other people." Futility and euphoria alike place everything that happens into one basket; the only difference whether the basket is labeled "everything is futile" or "everything is wonderful." Rejected is partial satisfaction of desire and the vulnerability of ordinary hope (which never acquires everything that it might want). The loosening of associations is a response to the rigidity of the imprisoning mental frame of reference, and is part of the way that mania is trying to cure the person. Finally, the suspicion that the whole universe is futile is already a form of cosmic grandiosity. When hope begins to arise in the manic soul, it seems as if it must be filling the heavens as well.

Mania is a life and death crisis for the person going through it. The process is an effort at self-repair, however destructive it seems to onlookers. Mania is an attempt to release the madness of rigid, despairing thought; it is not the madness itself. Rather, shame, fear, and envy are the pathological process. Mania is a transformation of them which tries to escape from their pernicious influence.

Shame, you see, has a structure, and mania has a structure. Light cast on one will illuminate the other. Both see the self as uniquely set apart from everyone else, and both are preoccupied with self and its comparative worth. Being on the bottom of the heap of humanity--or on the top--excludes being in the middle: an ordinary, finite, limited human being. The commonplace is the rejected element in both extremes; its integration is crucial for healing. This is a theme that will come up again: a system defined by two extremes is inherently unstable. The integration of a third possibility defined by neither extreme is what is needed for lasting stability of mood.

The structure of shame is familiar to most of us. The primary focus of shame is on the failure to measure up to some minimum acceptable standard of achievement. Along with this is some form of self-condemnation, and a wish not to be seen by others who will also notice that we fall short of the standard. Perhaps you make less money or have advanced less far academically than you think you should have. You ought to be this way; instead you are that way, and the mismatch begins to command a great deal of your attention. You try to improve yourself, but the shortfall remains, and you interrogate yourself about your failure to eliminate it . Shame constantly measures the difference between what you are and what this inner standard represents, but one thing is exempt from scrutiny: the ideal you have set before yourself as to what you must become.

Furthermore, you may become convinced that others have what you lack, and that you are defective by comparison. They, by virtue of being made of the right stuff, have overcome in their lives all the obstacles that you have been unable to surmount in yours. They have faced all of the difficulties and doubts that you have been unable to deal with, and because they have what you don't, they have prevailed where you have failed. You must be missing something quite essential to being human.

To summarize the structure of shame so far: it involves (1) an internal ideal which defines what you assume you should be, (2) an ongoing process of comparison between you and your ideal, in which you are critically scrutinizing yourself but never examining it, (3) a comparison of yourself with others, coupled with the assumption that they have what your ideal represents, and (4) a judgment of yourself as a failure in both comparisons, with an emotional response of vexation to each. Shame, as I'm describing it here, includes within it a comparison with others who are seen as possessing what is lacking in the self; this I call envy.

Envy creates grief in three ways. First, there is the idea that "I am lacking what others have." Second, there is "I do have something. But it means nothing because others have it, too. Having it doesn't erase my deficit in comparison with them." Third, there is "It is essential that I be special. Special means having something unique, that no one else has. Having what others also have is not good enough." The sense of lack, the devaluation of the commonplace, and the need to be special conspire to create a system in which nothing that you do ever constitutes evidence that you are OK; that is, you have a closed system of perception and thought which are impervious to corrective feedback from reality. This immunity of an assumption to counterexample is good practice for the monumental non-responsiveness to external input that characterize a manic episode.

Shame works through making comparisons which focus attention on the mismatch between what you are and what some unattainable standard looks like. It has one other effect that is relevant to the eventual emergence of mania: the idea that you could erase the mismatch if you accomplished something absolutely extraordinary. It would need to be something never before accomplished by any human being, perhaps something never before dreamt of, something that would shake the world. Then you would be as good as your inner ideal, you would have something that others lack, and the pain of envy would no longer gnaw at your inside.

Or if some event of cosmic importance were to occur, such that all of creation were set free, then maybe you would be too. If something happened that meant that the universe was transformed, then your desolation would be changed into joy. What a wonderful day that would be!

This is a bit more subtle than the other features of shame, because it is has a deep relationship with truth. Buddhism, Christianity, Judaism, and other great religions all teach this idea in some form. It can look and sound a lot like compassion, except that it is commiseration, which is not quite the same thing. Compassion flows out of a sense of love and giving to others. Commiseration feels sorry for itself, and predisposes to self-absorption. Wherever religious energy is strong, it is lurking at the gates, seeking not to feed but to be fed. It may pretend to nurture but it devours. It is one of the deadliest and most dreadful snares in the spiritual landscape.

The linkage between personal hope and global hope makes it very tempting to see any pattern in world events that looks like freedom for all humanity. Universal redemption is your only hope; the despair of the world is your despair. People in manic states are well known for their tendency to see cosmic implications in their own ruminations. This looks completely crazy unless you ask what motivates it. The manic way of seeing is motivated by a linkage between one's own deliverance and the deliverance of every person, with a willingness to alter one's perceptions of reality in order to see the universal redemption.

The more deeply embedded an assumption, and the longer it has been present, the greater the fallout when it finally begins to change. The madness of mania emerges from the fact that so much of any person's functioning is built upon a foundation of assumptions, which are stable and unquestioned most of the time. When these crumble, everything built upon them starts to fall, and that is when things get very odd for the observers and the person whose sense of reality is changing.

This oddness is not necessarily pathological, but it receives energy from both the new freedom and from the old fear. One basic principle, known to soul explorers for millennia, is that any deep inner struggle involves opposite parts of a single whole. "Bipolarity" is recognized in many ancient traditions as part of the human condition. Perhaps one day psychiatrists will see the struggles of its bipolar patients in terms that they can relate to as human beings, rather than in terms of abnormal brain functioning.

Now, in my life the ideal with which I compared myself was my father; the shame arose from failing to be him, the envy was of guys who did well with work and with women. The fear was of entanglement with other people, and the assumption was that I had to become just like my father, and that I could someday do this if I tried. He was a truly great dad. I was lucky to have him, but I had lost him before I could consciously separate from him.

He was killed in a mountaineering accident in Peru when I was fifteen. When the news came that he had died in the descent of a 21,000 foot peak in the Andes, something inside me froze. I spent the next twenty nine years trying to heal that wound, carrying with me an image of a man without hang ups or flaws, resolving to get back the relationship that was disrupted by his death. It was the pivotal event of my life, and healing the wound left by his sudden loss triggered the episode in my life that was diagnosed by doctors as manic. Because I knew that I was healing from the wounds of his death, I was sure that the manic process was trustworthy, that it was doing something to repair old injuries and restore me to life.

Beginning the day after hearing the news of the accident, I began to wish that I could turn back the clock and prevent his death. This orientation to time, wishing to go back to earlier events, became a habit which did not serve me well. I knew that it was irrational, but this did not stop its occurrence. I wanted to contact him again and get his blessing, but this too was impossible. Unconsciously, I eventually tried to become my dad, such was my desire to find him again. Although I was not cut out to be a clinician, I went to medical school to be a doctor like he was. I thought that I was making choices freely, not recognizing that I was trying to make myself match an image in my mind that was not my true nature.

The project of matching myself to an image of my dad was doomed to fail. I never felt right acting in the physician role, always thinking of myself as a counterfeit who would eventually be exposed and denounced. I was not succeeding in medical practice, struggling along with a few patients a week and feeling ashamed of failure. Because doctors aren't supposed to have personal problems, I felt ashamed of feeling ashamed.

My program of becoming my father was not working. I had unconsciously set a deadline to succeed in life by the time I was the same age he had been on the day I was born, namely forty-four years, four months, and two weeks. A few weeks before the deadline, something peculiar began to happen in my poor deluded brain. I had been living an illusion for almost thirty years. The chickens had come home to roost.


• Mania has an outer aspect and an inner aspect. The outer aspect looks disorganized and crazy, but the inner aspect has structure and purpose. Underneath the madness is sanity which the madness is trying to find.

• Mania emerges from the context of a person's entire life, and cannot be understood apart from that context. It is not a random event.

• Mania is an attempt to escape from shame, envy and fear. It operates by trying to loosen the rigid thought processes that bind a person to these emotional states.

• Mania has a structure, and therefore should not be called a disorder.

• Part of the structure of manic thinking is its linking of the personal and the universal, such that inner processes seem to be related to events in the cosmos as a whole.

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Continue To Chapter Two


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