DEPRESSION DIALOGUES: Within the current psychiatric model, the depression phase of mania is related to as part of the same "illness" - manic depression. This stage, and the mania which preceded it, are seen as going hand in glove, inseparable processes, both of which are the result of a "bipolar" disease of the brain.
I believe the inevitable physical, emotional and mental burnout left in the wake of a manic episode is itself the trigger of the depression which follows - post-elation depression.
This is the only appropriate natural emotional response to realising that you have been the cause of so much chaos, hurt and ruin to yourself and others, with the burden of rebuilding your life. Mania, like depression, needs to be seen as an emotion with its own particular triggers.
q Failure on the horizon
An unconscious manoeuvre to avoid, deny and escape from the feelings of set-back, disappointment and failure which are so much a part of everyday life for the rest of us.
Feeling ordinary, vulnerable and out of control are not part of their everyday repertoire. Preferring to be extraordinary, invulnerable and on top, they will distort any evidence that failure is on the horizon, instead overcompensating in the opposite direction.
q The eureka experience
Some individuals, consumed by an intensely intellectual project, working marathon hours, their brain turbo-charged and exhilarated by the implications of their findings, enter into a phase of sleep deprivation which opens the door to an altered state - mania.
Obsessed by the implications of their "discovery", they can think of nothing else, soliciting support from the influential and powerful. Criticism is brushed off and condescendingly interpreted as ignorance.
q The spiritual opening
Historically, the spiritual experiences of ascetics, monks, prophets and other religious devotees followed a consciously sought "communing with God" breakthrough.
This was facilitated by long periods of fasting, meditation, isolation and sleep deprivation. The state they reached was a psychotic experience, an altered state of consciousness of a transcendental nature.
In modern times some individuals suffering from mania experience similar spiritual openings in environments where the focus is on their inner journey, such as during meditation retreats and personal development workshops.
People can return from places like Medjugorje, Machu Pichu, Lourdes and other vortices of spiritual energy with an expanded sense of their place in the grand scheme of things, and in a state of manic elation.
q Drug-induced mania
Over 30 per cent of individuals diagnosed with mania have misused street drugs such as amphetamine, cocaine, crack and some hallucinogenic substances. (Anti-depressant medication are also capable of triggering an episode in some individuals).
q Post-elation depression
What arrives in the door of the psychiatric hospital during an elation is an exploding bomb which requires emergency measures to extinguish it. The furious firestorms in their minds need to be urgently dealt with with high doses of major tranquillisers.
Their bleak future is overwhelming; gone is the confidence, the powerful energy, the grandiosity, the great plans of the preceding weeks. Most depressing is the fact that there is huge collateral damage to repair. In addition, they are now learning they have a mental illness, a disease of their brain, which will require a lifetime on medication, with no guarantee that it can prevent further episodes.
Having left hospital, many sufferers become career patients, professionally trained mood watchers, a ticking time bomb, with all those around them anxiously awaiting the next explosion. Juggling doses of medication can become the sole focus of outpatient consultations, reinforcing the notion that "relapses" are caused purely by "chemical shifts" and unrelated to setbacks or other life events. Medication is framed as "corrective". Unfortunately, this balancing act can become a lifelong process. (There were 7,545 patients admitted for depressive disorders in 2003, and 68 per cent of these were re-admissions.)
I believe psychiatry has lost its way, that its reliance on excessive use of medication, its revolving door hospitalisation practices, and its ultimate fallback - electro-
shock therapy (859 patients received ECT in 2003) - urgently need to be questioned.
The manic episode itself is the result of an unconscious attraction towards being extraordinary. The climax of mania - the psychotic phase - is a medical emergency, and can only be reversed through the use of sedative medication. This phase is transitory, and once consensus awareness has returned, should be phased out and replaced with a psychotherapeutic approach which has as its primary aim a search for the unconscious triggers, and conscious preventive measures put in place.