Mania is a state of consciousness that I worked diligently to avoid for thirty years after my first experience left me psychotic, misdiagnosed, and mistreated for schizophrenia. However, in February of 2017, I made a choice that surprisingly opened a new chapter in my life. Briefly: after decades of assiduously avoiding mania, I took a single large dose of a stimulant prescribed to me for ADHD in full knowledge that it might precipitate mania. And it did.
I do not write what follows to encourage anyone to pursue or embrace mania. Despite what I describe below it is not a state of mind that I would choose to experience again. Also, the things that I describe which I believe enabled me to experience mania in a stable way may seem to simply be a reframing of the experience but are, I suspect, capacities resulting from thirty years of psychotherapy and personal development work. [Edit: this claim raises ideas of personal responsibility for mental illness that are complicated and which I cannot address here, however, I am certainly not implying that we are to be blamed for our mental illness.] Alternative frameworks of understanding are very useful, but it is the ability to operate them effectively that counts. Lastly, although I present my perspectives as insights useful to others, this all remains my understanding of my own experience. The significance of how we hold, relate to, and respect a plurality of such understandings is the central point I am trying to illustrate in writing this.
Mania presented to me as an awareness of power.
Hypomania has energetic qualities experienced by me as increased confidence, more extraversion, and a kind of brightening of reality. Although I recognized immediately that the stimulant I took had shifted my mood into new territory, it took me quite a few days (I am referring to email and social media as I reconstruct my experience) to realize that I was in a completely different state of consciousness. Mania as I experience it has a strong compulsive dimension. There was an overwhelming perception of energy or force that I soon identified as power. While hypomania and mania are related and the first can lead to the second, mania is, to me, a distinct state, different from hypomania in order, not just degree.
I do not know how common or clear feelings of force, power, or energy are to other people’s experiences of full-blown mania. I suspect that it may be useful to see the behaviours that commonly characterize definitions of mania as resulting from personal interpretations of an intense, though perhaps sometimes subconscious, awareness of force, power, or energy.
My understanding is that there were several factors that worked together to ensure that my second experience of mania was harmless (though distressing to some) and did not end in psychosis, as my first did. I will not discuss all of them here. It was very important that I was able to recognize, name and accept the state of consciousness as mania, which invoked an understanding of what to expect (most significantly, grandiosity). Along with this recognition came an almost simultaneous meaning-making of my keen awareness of energy and power. The fact that I made meaning of what was happening to me in terms that did not involve me or my sense of selfhood was central to my experiencing mania without harm. I was not impulsive, and what delusional thinking I was inclined to I was able to resist.
(Hypersexuality has never been a characteristic of elevated mood for me — sexual interest has always been something that I pursued as a dissociative distraction when depressed. Elevated mood for me always registers as a shift in attention away from sex and on to other things. My romantic interest in others was, however, definitely heightened.)
The insight that arose and “protected” me as I experienced full-blown mania for the second time was that power properly belongs to no one.
I am still exploring with my therapist how our fourteen years of work together resulted in the psychological capacities I am describing here but the fact that, thanks to psychotherapy, I now intuitively and skillfully operate very strong personal boundaries was a large part of why I was able to situate the feelings of power I was experiencing as separate from myself. It was only a small rational step from that separation to the idea that ownership and belonging, and particularly the identification they invite, are a flawed way of understanding our relationship to power.
Another reason I think I was able to separate feelings of power from my sense of self is that for many years I have internalized a sense of intrinsic self-worth based on the value of equity. I deeply believe that all human beings are equal in worth and that it is our ability to operate this belief that defines our humanity. As such I have a sense of myself and my value as distinct from my accomplishments or failures. I see my worth as a person as equal to that of all others and a function simply of my existence. The idea that I might have some great power conflicts with this internal belief system and I believe is why I was inclined to operate boundaries around the feelings of power that arose during mania in the ways that I recount here.
I expressed my thoughts about power in a series of messages to bewildered friends on Facebook. I remember visualizing power as this wave which, if we are fortunate, we can ride with an illusion of control. As I have thought much more about it I now understand power as arising through the meaning-making frameworks which we individually and collectively operate in order to manage the energy I was perceiving during mania. In fact, by making meaning of the experience of mania as I did, I was exercising power.
Friends were confused when, during mania, I used words like ‘align’ to describe my emerging understanding of how we could more harmoniously relate to social power. I distinctly remember concluding that many of our social problems arise because we operate power with flawed understandings of its true nature.
Our societies go through periods of significant disruption because the concept of exclusive ownership, and our tendencies to self-identify with ownership, are flawed understandings of how to operate power.
That is an odd conclusion but I’m fairly certain it is not original to me. Within myself, recognizing the awareness of power which mania brings as resulting from a force or energy pervading but distinct from how I understood myself enabled me to experience mania with significantly less behavioural impact than is common. I expanded the scope of that understanding to conclude that the same might be true of society as a whole.
At several points, after I took the stimulant, I had an awareness of a strong pull to grandiosity and messianic feelings. However, I recognized these feelings as a mistaken misidentification with power. While my behaviour exhibited great confidence, I was able to distance my choices from messianic feelings and understand those feelings as arising from a combination of our habitual, day-to-day misunderstanding of how we operate power (as belonging to us), and the intense awareness of power/energy that I was experiencing.
The energy that I was perceiving in mania is an energy that we all experience.
However, we rarely consider the nature of our relationship to that energy and commonly take it for granted. Power and agency result from the many ways in which we individually and collectively make meaning out of our experience of this energy. Some of our collective meaning-making, and the power that meaning-making gives rise to, are more harmonious with the essential qualities of this energy and how it animates our experiences. I can’t clearly articulate these qualities, but I have some ideas about how to work more effectively with them.
I did not attempt to name the force or energy I was feeling until quite recently. When I did, it struck me that the simplest way to understand this force or energy is as consciousness itself. That consciousness is energy is hardly an original idea. That mania can be understood as a state of heightened, reflexive awareness of consciousness, not limited to oneself, is not an idea that I’ve encountered but I would be surprised if it were original. That social power results from the meaning-making frameworks we individually and collectively operate is also not a new idea. Combining this understanding of power with ideas about consciousness is not yet an analysis of which I am aware.
Although my second experience of mania felt like sitting next to a nuclear reactor, instead of fear, for much (but not all) of the time what I felt was a profound sense of inner peace. I created a private Facebook group to discuss my experience with select friends. The following post is ten days after I took the single stimulant dose.
I concluded that the energy that I had a new, direct awareness of was driving the unfolding of all reality. All of us experience and relate to it, just not usually with keen awareness. I did not perceive an intelligence behind this energy but I sensed that there were rules and qualities which gave it coherence. My task was to observe and try to understand, particularly given a heightened sensitivity to patterns, synchrony, conceptual resonance and fortune. This sensitivity gave a magical quality to the space in which I sat.
This magical quality was the thing I remember most clearly about my first manic and then psychotic episode. I am curious to what degree people with lived experience, especially of schizophrenia, associate a feeling of magic with what some of us self-affirmingly call madness.
During my first experience of mania, thirty years before this at the age of eighteen, my perception of energy was expressed in my compulsion to walk. Overall I suspect my second experience of mania was actually significantly more intense than my first. Psychiatrists may be inclined to dismiss what I am describing here as something other than “true” mania. Perhaps the following post that I made in a private friend-group on Facebook from that time will cause you to reconsider:
I can assure you that while I experienced what was happening to me with complete coherence, some of what I wrote to others, unless you were to ask me to explain it, at first comes across with a very strong flavour of crazy. It all still makes perfect sense to me, but I was clearly experiencing reality in a distinctly different way.
The intensity I felt grew over time, long after the medication that caused it had left my system. There were points at which I felt that my experience of mania was over and then I realized that it was, in fact, not over. My sleep during these weeks was minimal and light. Unlike my first experience, my second experience of full-blown mania lasted weeks rather than a few days. Ultimately I ended it by taking a relatively high-dose of antipsychotic medication (lurasidone — can’t recall if it was 120 or 160 mg) for a couple of days. In my other experiences of elevated mood states (hypomania) the new ideas and insights that sometimes arose made no sense to me once the mood state ended. However, when my last experience of full-blown mania ended, all of the perspectives and insights I had during the experience continued to make sense and were accessible to me. What ended was the intense awareness of energy.
Our minds have many ways of meaning-making.
I have come to think of these as frames or frameworks (slightly different — frameworks exist within or through frames). Language is a common frame and many but not all of us employ it in thinking, which we experience as an interior conversation. My sanity, despite feeling tremendous power coursing through me, was partly a result of my ability to form and operate an effective meaning-making framework to explain this feeling. My sanity was also based on my deeply internalized sense of intrinsic self-worth already mentioned above. I felt very secure in my sense of self. (This security is, I suspect, related to the idea of ipseity being explored by Parnas et al around psychosis and schizophrenia.)
Having both an undisturbed sense of self and a coherent framework for understanding what I was feeling that enabled my selfhood to remain undisturbed were both important. However, I believe that my ability to maintain my sanity was also a result of an ability to operate both my own framework of meaning-making around my interior experience and the frameworks with which we more commonly understand our day-to-day reality, simultaneously. I never lost sight of how strange my perspectives seemed to others, though that did not always stop me from sharing them. Much of the considerable mental energy I was experiencing was spent attempting to translate between frameworks for a small circle of affirming friends and my MD psychotherapist. I also spent a lot of energy reassuring people that I was okay, despite the strange things I knew I was feeling and saying.
At some point after my second experience of mania, based on my reflection on the process of translation I describe above, I came to my own definition of sanity:
Sanity is the ability to consistently think and behave in ways that build a credible, coherent relationship between personal experiences and the experiences of others.
Implied in this definition are many components to the project of sanity. We need internal frameworks of understanding, the more coherent, effective, and robust, the better. We need an ability to appreciate, respect and understand the frameworks of others. We need an ability to relate these understandings to one another. We need a psychological ground from which to operate these frameworks (our “pre-reflexive self”). Very importantly, though not at all obvious from the above definition, we need relationships in which our ability to operate these capacities is supported, respected and affirmed. Also not obvious but central to the point that I am making is that an awareness of, and respect for boundaries is very important to the project of sanity. Both the boundaries of the frameworks we operate and the boundaries between all the different components of sanity embodied in the above understanding.
I understand psychosis as a complete breakdown of sanity as defined above. Not all people with lived experience embrace the term psychosis, but those who do sometimes understand it as referring to a partial breakdown of a connection to reality such as delusional thinking or experiences of hallucinations. To me, as a distinct state which I have thankfully experienced only once, psychosis describes when the ability I describe above breaks down pretty much completely. Including, ultimately, an apparent breakdown in our ability to think coherently.
My previous experience of psychosis had left me with a sense that our common, day-to-day experience of consciousness actually has an edge.
Psychosis to me is, among many other things, the experience of going beyond that edge. Once I understood my state of altered consciousness as mania I also perceived that I was now closer to that edge than usual. Or in other words, given my past experience, I was aware that psychosis was now a more immediate possibility. However I also remember feeling that the ground of reality that I was sitting on was firm and comfortable, and the edge beyond which psychosis lay, while closer, was still clearly some way away. I was not too worried.
During my experience of mania, I was involved, as a person with lived experience of psychiatric diagnosis and treatment, in the education of psychiatry residents. This put me in regular contact with psychiatrists as a colleague, rather than a patient. When my behaviour began to exhibit unusual confidence as a result of mania, the psychiatrist in charge of this work reached out in concern and in order to try to manage the significance of this change in me for the education work that we were doing. Despite the fact that he was being cautious and caring, I experienced my interaction with him, all of it by email, particularly when he decided that I should take a break from this work, as someone kicking me from the safe place where I was sitting to a spot right next to the edge of sanity.
My attempts to explain this feeling of being kicked closer to psychosis by the apparently cautious and caring actions of a psychiatrist have centred around the idea that psychiatrists leverage a tremendous amount of poorly understood social power. This power arises through the professional role of policing and managing madness that many societies have invested in psychiatrists. That this doctor decided that in my mental state I should not join a training meeting between psychiatry residents and people with lived experience was profoundly psychologically consequential.
Madness (a non-clinical term I am using, self-affirmingly, to describe a range of possible unusual mental states) is, to me, a manifestation of the energy of consciousness outside of commonly held frameworks of understanding and sometimes completely absent any obvious meaning-making framework. As such madness is disruptive and a challenge to the exercise of power, which is about how we individually and collectively operate meaning-making frameworks so as to be effective in the world.
My insight into the true nature of power: that ownership, and personal identification with ownership, are a flawed framework with which to operate power, is perhaps especially apt when applied to psychiatry. When we are experiencing full-on psychosis we are likely to find ourselves confronting the most extreme expressions of social power embodied in psychiatry: restraint, involuntary confinement, and coercive treatment. Society, in its fear of the raw truths regarding consciousness manifested in madness, has invested psychiatrists with a role and power that, in my way of understanding, actually make it much more difficult for doctors to support mental wellness and healing.
It is here that my understanding of power, and the normative impact of pathologizing in psychiatry, perhaps served me most effectively while I was experiencing mania. I simply stepped, assertively, away from the psychiatrist concerned. Psychiatric frameworks for understanding unusual and sometimes dangerous mental states now dominate in most cultures. The cultural dominance of these frameworks is power. Intuitively I perceived this doctor’s actions, however cautious and well-intentioned, as a disruptive incursion of this power into my own, powerful, personal, meaning-making domain.
Many of us with lived experience of recovering from extreme mental states eventually reach an awareness that medicine and psychiatry often attempt to usurp the internal conversations and frameworks that we use to manage our wellness and sanity. Indeed medicine sometimes demands us to accept that we have lost the capacity to usefully have these conversations in the first place.
I am not disputing that there are situations where this capacity is far from evident. Psychosis or madness or extreme states of consciousness are different terms to describe these situations. And delusional beliefs, paranoia and hallucinations are real and deeply challenging to both experience and manage. Sometimes they are dangerous. It is possible that in these situations the capacity for forming and operating meaning-making frameworks, and the undisturbed ground upon which one needs to stand to operate those frameworks, may all have been lost.
What I am calling attention to is that those who are working to support someone around their mental well-being need to intentionally operate a keen awareness of the nature and appropriate boundaries of their power as they attempt to do so.
One of the things intrinsic to the idea of a framework is that all frameworks have boundaries. They are also constructed out of something. Language is a very common component of frameworks of meaning-making. This is why language is passionately contested territory between psychiatric survivors and psychiatrists. Psychiatric frameworks for understanding unusual and sometimes dangerous mental states now dominate in most cultures. The cultural dominance of these frameworks is a form of power. At the root of this exercise of power, through the cultural prevalence of medical and psychiatric frameworks of understanding mental health, is the role society has granted to psychiatrists to decide which of our experiences are “real”. This is a formidable role and power that needs to be operated with great care and intention.
About nine months after my experience of mania ended, thanks to that same psychiatrist who literally almost made me crazy, I joined two other people with lived experience to present a lecture to second-year medical students on our experiences of psychosis.
A key point that one of my co-presenters made was that doctors need to accept and affirm that our experiences during psychosis are our reality.
As I have reflected on this point, my experiences of mania, and on my own consequent definition of sanity, I’ve concluded that interactions with individuals in various states along the route to full-on psychosis need to be a delicate, paradoxical, interstitial maneuver. Central to this maneuver is that professionals need to affirm the integrity of our meaning-making capacity by authentically communicating respect for the fact that our understandings are real to us. Simultaneously, others need to consistently teach those of us grappling with personal experiences characteristic of psychosis to thoroughly understand that our perspectives on reality are not shared by anyone else.
There is a kind of equity to this endeavour. Rather than assume that medicine’s understanding of our experiences is the only truth, in my experience, the best doctors, through their very way of being, acknowledge the boundaries of their own understanding. They operate the power invested in them by society with profound humility and restraint. The shared circumstance of doctor and patient implies that an individual in treatment must reckon with a medical framework. However, the best professionals work from a place outside of this framework. They are able to act and relate to those in their care from the equitable common ground on which we all stand as human beings. They can be critical and skeptical of their own professional knowledge and can recognize the deep investment they themselves have in this knowledge. They can put boundaries around this investment and be present with others in a space separate from it.
In doing so what psychiatrists and other professionals can facilitate is an individual’s ability to hold and interpret between potentially dissonant frameworks of understanding. Whatever we may be experiencing internally, our survival and thriving require that we also understand and respond constructively to the frameworks being operated by others around us. Rather than dismiss our own frameworks of understanding, and thus potentially destroy our ability to construct and work with meaning-making frameworks in the first place, professionals can, in stepping outside of their own framework of understanding, model the need for us to do the same. Meaning-making frameworks are a form of power. And like all power, associating our selfhood too closely with them is dangerous. Instead what helps is to recognize our meaning-making framework as just one of many. And our selfhood as separate and apart from any of them.
When psychiatrists act in ways that suggest that they take their socially appointed role for granted they can easily and unintentionally intrude upon the boundaries of personal meaning-making in ways that are, at best, not helpful. This gives rise to an observer effect that can be challenging for some doctors to escape. Many psychiatrists have some awareness of their socially-invested prerogative to pass judgement over our very right to personal understandings of reality, However, relatively few doctors seem to be able to put boundaries around the power arising from this prerogative, and to act and operate outside of it. Epistemic injustice is one way of understanding this power dynamic.
Also, while psychiatrists are unique in the social role western society has granted them, many mental-health professionals can overstep the bounds I am trying to describe. My ignorant sense of principles of psychodynamic therapy suggests that they are consonant with much of what I describe above, and in fact offer guidance for intentionally working with the above dynamics. However, it is still possible for someone acting as a therapist to identify with their understanding of these principles in ways that are, in fact, not helpful.
How we hold and treat ourselves and others as we operate frameworks of meaning-making, and the respect we show for the ground of self from which we operate these frameworks, is foundational to the collective project of sanity, mental health, and well-being.
Lately, I have engaged my own psychotherapist, who is a doctor but not a psychiatrist, in an examination of our therapeutic journey. One of the central things he said that he worked on with me over the past fourteen years is disentangling my experience of my emotions from my identity as a person with manic depression (a term I prefer to bipolar disorder). My intense focus on interpreting all of my emotional states in terms of risk of mania was what, I believe, enabled me to avoid mania’s recurrence (I would always intervene with medication when I became hypomanic in order to avoid mania). And yet, despite being a doctor, my psychotherapist recognized that it was critical for me to create a sense of myself and my emotions separate from this identity. I believe we succeeded, and the stable experience of mania I describe above is the evidence of our success.
I will leave it there for now. And yes, others have told me, I need to read Foucault. Power is, indeed, everywhere.