Understanding psychoses

How do persons afflicted experience depressive or manic phases?

bildAlso in bipolar mood swings (depression or mania) verbal images by persons experienced put across well the diversity of experience.

A depression means for me....

  • “the freezing of the heart into a lump of ice.”
  • “the petrifying of the mind.”
  • “having to trek through landscapes of one’s one self, which are scorched, dead, trampled down or simply only empty.”
  • “…. that the mind is a sea on which water lilies bloom and on whose floor a bomb lies. It is depression if the bomb surfaces, explodes and blast the water lilies to tatters. That does not mean that water lilies will never again bloom in this sea.”
  • “being very sensitive like a raw meat; then when it cannot be endured any longer there is a sudden change. I then have incredible energy like if I were in love. The mania means a relief of the depression. It is really amazing how the body starts up its own chemical factory in order to come out of the depression.”


bild A mania means for me....

  • “Suddenly to have a mild feeling like a high flyer. All scruples leave me. I then start to provoke others. This attitude can also become independent and become the provocation to a self-seller. I am then always in search of limits”
  • “….that the depression will tilt over to an incredible energy and then tilts back again into exhaustion.”
  • “Consciously infringing norms which I have seen as general norms. But I have never done anything that is prosecuted under criminal law or which infringe other people's dignity. I was always aware of an own inner limit and I have stuck to that.”
  • “… that sad experiences will come up to me. I sense in the meantime really how it goes click. My organism sets off the mania so that I overcome certain experiences. This occurs within a few hours. The depression comes only much later.”

Mrs Kunst’s story

Mrs Kunst suffers from a frequently relapsing bipolar disorder. Her thick patient’s file talks of a “seasonally specific biologically-induced mania.” For half a year she has been taking part in a special therapeutic group. All members have experienced at least one mania and one depression. The coincidence of the various phases is intended to counter the very agonizing disturbance of sense of time disorder typical of the disorder (feeling of eternal damnation in the depression and timelessness in the mania). The example of Ms Kunst is intended to show the occurrence in the group. Finally, the principles of the work are set out.

Hitherto, Mrs Kunst fell ill regularly each year in June. It is April. The group is interested whether “she already senses anything.” –“No”. “What happens then otherwise in June, apart from the mania?” –“Well, it is my birthday, but that was already always the case, even before the mania”. - “and how do you celebrate your birthday?” – “like everybody else. I invite my friends and family”.

Mrs Kunst is married, has two children of seven and nine years old. The parents from Southern Germany come regularly for the holidays, also to see the grandchildren. For Mrs Kunst all of this is goes without saying. In the group there are questions:

“What is it like to celebrate with friends and family at the same time?” –“No problem” - “and how do you manage to prepare?” –“my mother helps me.” The group inquires. It turns out that the parents come earlier on purpose in order to help out in the preparations. The mother brings with her much pep, has precise ideas about how such a party should proceed. The daughter is grateful at first, but then feels ignored. She begins to defend herself against the specifications and wants to make her own specifications. For this, she must come out of the defensive and depression and mobilize power reserves. Mrs Kunst develops more and more extravagant ideas and more and more energies to realize these. She “plays the mother easily against the wall” The mother backs down and yet her daughter cannot be held back any longer. The party is supposed to be marvellous. And yet Mrs Kunst exhausts herself too much. The flight has torn her apart. In the end, there is a shameful scene, shocked guests, bitter reproaches. The reality of the mania has caught up with Mrs Kunst - punctually, in June. The ruffled feathers are smoothed. The parents feel for her, take care of the grandchildren and promise to come a little earlier next June so that the party can succeed better.

A tragicomic story? Rather bitter reality with much desperation. The group is impressed, urgently advises her to invite the parents later this time. Mrs Kunst waves aside. That would not work in any case; she would not be able to endure the conflict, then become manic at most already in May. Some group members refuse to back down. Fortunately, the husband goes along. The telephone call with the mother is practiced in role play. Mrs Kunst put into effect what she had practiced. The parents are as expected deeply insulted; adapt themselves however to their fate. – The party proceeds unspectacularly. The parents come 14 days later. In hindsight, they are satisfied; this way more time remains with the grandchildren. Mrs Kunst does not become manic, not before, during and after the party, not the whole year.

(Source: T. Bock, A. Koesler, Bipolare Störungen, Psychatrieverlag, Germany)

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