I walked into the secluded psychiatric hospital area where she stood. The words came out in spurts and gymnastic rhythms, incessant and spiraling. She pleaded, cajoled, mocked, yelled and raged, then softened and became charming, seductive. As I listened and tried to reply, she commented endlessly on my features, her level of distrust off the system, her parents, me. Her frustrated words then came out partially in song, in word salad chopped phrases that disappeared into grunts and strange notes. As others left I stood near her as the torrent of words flew around and through me. I was a therapist in a hospital setting and it took a number of days before she came down from that electric mania. We were able to talk later, converse back and forth. She could not remember our previous encounter.
Mania is a powerful experience, and there are varying degrees of intensity. Though many think of the extreme forms of mania with its attending psychosis, confusion, delusions and hyeprverbal agitation, there are lesser forms that many of us experience in our lives. Think of the last time you were alive with thoughts and wonder, animated and not needing much sleep or food. You may have talked excitedly with friends about this idea or that, thought endlessly about a new project or moved around with intense vigor to make art, clean the house or run for many miles.
Alternating periods of mania and depression have been noted since ancient times. In medieval Europe, both mania and depression were seen as an imbalance of one’s “humours”- the 4 fluids that were seen to run through the body known as yellow and black bile, phlegm and blood. In the 13th century, an encyclopedist named Arnold of Villanova remarked that someone who is manic had an excess of yellow bile and stated that “the victim shouts, jumps, runs, is wakeful, and can even assume the guises of animals.” Those who had been taken over by melancholy (excess black bile) would be seen as “dark, shaggy, immobile, depressed, silent, solitary and suspicious.”
In many indigenous cultures, manic and non-ordinary states are frequently experienced amongst shamans, healers, participants in rituals and those going through spiritual crises. Experiences of possession, sorcery and communion with supernatural forces are common stories throughout the world. The experience of being in deep and gnostic connection with complex and mysterious understandings can appear to some as a form of terrifying mania, a disintegration of one’s ego- but these states of dissolution and immersion are often an integral part of the spiritual adept’s deep work.
Later as monotheistic religions began to dominate, these states of consciousness have been seen as a form of dark witchcraft, evil, and of the Devil. In a drive for religious uniformity we have outlawed and persecuted people who follow these ancient paths towards knowledge and healing.
Mania is a deeply immersive state, dissociated and fragmented from consensual reality, but not necessarily without deep meaning and validity. It is only in our current culture that requires linear conformity that we denigrate these states as wrong or pathologize them as a lifelong illness requiring treatment and medication to quell and sedate. And certainly in our modern culture, these forms of wild expression, of fleeing and searching, of flying towards the light of unity- are not acceptable to the dominant culture. We now hospitalize and jail those who fall out of the norm; who have drunk from the well of the wild.
And certainly some of these states should not be lionized. There is a fine line between gnostic unity and fragmented delusional states. In these confused states of mania, our friends and loved ones cannot understand us. We are speaking about planes of existence far outside of the norm. Some who walk these edges cannot move back and forth between the wild and the mundane and become lost in confused and broken states. Finding out how to navigate these realms in a holistic manner can be truly challenging in the modern world that emphasizes disability and treatment.
Modern Diagnosis and Treatment
I mentioned those lesser states of mania. Psychiatrists call these lesser forms of overexcitement “hypomania”, and in 1994, they expanded the term bipolar to add people who not only experienced psychotic manias but also people who experienced this lesser form of mania. The new term for this manic depression is known as bipolar II, to distinguish itself from the more extreme Bipolar I.
With the addition of bipolar II, we have added millions more people to the pool of those diagnosed with bipolar disorder. Today 4.4% of US. adults are diagnosed with some form of bipolar disorder. This expansion of the term bipolar radically changed diagnostic and treatment patterns. Suddenly people who never became psychotic were deemed to have bipolar disorder. From 1997-2007 the diagnosis of bipolar disorder in children increased 40 fold. Usually one gets the diagnosis in early adulthood but increasingly young children and some as young as 2 are receiving the diagnosis and are being prescribed psychiatric medications.
The U.S. has by far the highest rates of bipolar disorder. Compare the U.S. rate of 4.4 % of the population versus the rates of 0.7 % in Japan and 0.1 % in India. Certainly it is likely that we diagnose people with this disorder much more quickly than in other parts of the world.
Because of our excessive zeal for diagnosing people with bipolar, I urge a more cautious approach to that diagnosis. If one has been diagnosed with the milder bipolar II, it is also important to understand what caused one to get the diagnosis. Many people go through periods of insomnia, heightened mood, restlessness, agitation and feeling excessively excited and there are many reasons for these states. A few reasons include excessive caffeine consumption, stimulating street drugs (cocaine, meth), stress and trauma, poor diet, processed foods and sugar, sleeplessness and overwork. One of the increasingly most common ways to get the diagnosis of bipolar is to be started on an antidepressant that causes hypomania. A doctor may then conclude that you have underlying bipolar instead of just a poor reaction to a very stimulating antidepressant.
The treatment for both bipolar I and II are essentially the same (though dosages may vary) and generally includes mood stabilizers such as lithium, depakote and lamictal. Increasingly anti-psychotics such as abilify, geodon, zyprexa and risperdal are being offered to people diagnosed with bipolar disorder. Though these drugs can be helpful to some people, they tend to come with a wide list of side effects and often can induce health complications when taken for prolonged periods of time.
Holistic Approach: The Neurodiversity Model
When I was a younger man in my early 20’s I went through a profound struggle that involved deep emotional lows and periods of excitement, strong energy bursts, confused thinking and restless agitation. Its very likely that if I had gone to psychiatrists they would have diagnosed me with bipolar. Its a label that can be life changing. For some it is a validation of one’s experience as having strong changes in mood, cognition and behavior and can be seen as an underlying explanation of one’s problems in life. But for others it can feel like an oppressive label that separates one from the rest of society as one who has a lifelong illness.
Though many see bipolar as a disorder and a disability, there are increasingly groups of people who view themselves as “neurodivergent” and see their experience as unique, important, and as a type of gift. The experience of bipolar does not just include swinging from highs to lows but often the tendency to feel life more strongly and to be more perceptive and sensitive to the people and world around them. This can lead to profound insights and dramatic shifts in awareness. This heightened sensitivity can lead to overreactions, crushing sadness or elated joy. This is the world of the edge walker, the empath and intuitive type who can be overwhelmed by sensory experience.
Like bipolar, in and of itself, right there, is ridiculous, because for me, it’s not. Bipolar suggests two poles. My poles feel like a circle. It’s holistic. It’s everything. It’s a pole in a globe of reality. Again, talk about reductionistic. Talk about two poles, when I feel like there’s millions.- Monica Cassani from Beyond Meds
Just as there are wide varieties of expression in the natural world that are key to the strength and resiliency of an ecosystem, those who embrace the term neurodiversity also feel it is valuable to have a wide variety of human perception and experience. Being in touch with more complex non-ordinary states is often key for those who are creative, artists, healers and visionaries; and some feel that trying to suppress or sedate that potential is akin to eradicating one’s essential personality.
Psychiatry has pointed to bipolar as having a strong underlying biological etiology and that those diagnosed with bipolar have a life long illness rooted in genetics. Certainly it is likely that there are underlying constitutional and genetic connections to those labeled with bipolar but researchers are increasingly pointing to a link between early “adverse childhood events” (ACEs), trauma and receiving the label of bipolar later in life. There is also increasing research that factors such as stress, oppression and poor diet increase the likelihood of experiencing psychosis, mania, depression and getting the diagnosis of bipolar.
But the idea of bipolar as a static and fixed disorder has been losing ground. We are seeing that trauma, environmental and dietary changes strongly influence our emotional state and that working with these factors can markedly improve our wellbeing. I have known and worked with many people who have experienced complex distressing emotional states but have gone on to recover and feel the term bipolar is too limiting and excessively emphasizes disability. Most traditional healing systems see the extremes of bipolar as temporary and that through the proper use of diet, herbs, loving support and lifestyle changes one could heal from crisis states.
Holistic Approach: Finding A Healing Rhythm
In much of my work to help those with a bipolar label move through these complex and challenging experiences, I continue to circle around the idea of rhythm. All creatures live in some form of rhythm. Plants and animals live in tune with the ever changing seasonal rhythm of light and heat, the rotating Earth, its moon and its relationship with the sun. Our energy levels shift and change according to the time of day, the season and our age. But at times these essential rhythms can become imbalanced, suddenly departing from the natural ebb and flow.
Planetary rhythms can change suddenly, radically at times. Watch as a winter snow dissolves and melts into torrential flooding. Watch as a lightning storm screams across the sky or an iceberg cracks and breaks off from a glacier. There are times when we as humans also need these periods of radical change, shifts in consciousness that help us to change and adapt, grow and heal. But when we live in a state of constant movement and heightened pace, our nervous system starts to break down, we start to feel frazzled and then ultimately depressed- manic depression.
In the modern world our essential rhythm is constantly being tested. We are no longer walking at a natural Earth based pace. We are staying up all night working under florescent lights. We are drinking energy drinks and tall coffees, binge watching Netflix while reading social media posts, eating refined foods and pushing our natural limits to sustain an unnatural rhythm, the need for speed as a way to adapt to modernity’s pressures. And many of us become at least hypomanic, burning up our juices in an incessant need to keep up. And then when we can’t sustain that pace and rhythm we fall apart, fragment and dissolve into illness and depression.
When working with a tendency to swing between highs and lows, the key is to connect to a rhythm that is sustainable. Some of the most powerful techniques are time-honored and have been practiced by traditional peoples for thousands of years. They help us to regain a slower, more nature based pace that is healing. Here are some of my favorite techniques that help to reset a more natural rhythm and pace:
1- Rewild: Spend time out amongst the trees and the plants. They have long learned how to set their rhythm to the seasons and to their environment. By simply spending time amongst these wise souls we can change our pace to one that is slower and more sustainable.
2- Sleep earlier: The body does best when getting to sleep before 11. This is especially the case during winter when the body craes more rest and sleep.
3- Nourish your body: Take in whole foods that will strengthen and nourish you. Processed and refined foods have lost their nutritional value and their connection to the land, the sun and rain.
4- Unplug: Turn off the gadgets and the electronics as much as possible- especially a few hours before bed.
5- Reduce stimulants: They are giving us energy we don’t have. They are like a credit card taking out debt we will have to repay.
6- Take up a daily practice that includes deep slow breathing. Qi gong, tai chi, gentle yoga- will help reset your internal rhythm towards one that nourishing.
7- Drink herbal tea. Taking in nourishing and relaxing tea. The process of sipping tea will help slow you down and bring more steadiness. A few great gentle herbs to have on hand are linden, chamomile, lemon verbena, mint, rose, oat straw, hawthorne and licorice.
8- Listen to your body. We hold stress, tension and strain in our body and it will tell us when we are moving too fast, or not moving enough. Check in and listen to its story.
9- Connect with Allies. Reaching out to a few key trusted people is really important, especially if one is nearing a crisis. These should be people you can share everything with and will honor you completely.
10- Get Support. Good therapists, herbalists, massage therapists, acupuncturists and integrative medical practitioners can be deeply helpful in supporting you; especially if there are more complex issues of trauma or deep health concerns. If extreme states are leading to crisis, please look to some of these resources listed below.
Conclusion : Honor the Sky, Ground to the Earth
A holistic approach to bipolar honors the experience of periodically being in touch with heightened and non-ordinary states while trying to steer one away from the scary and overwhelming crisis states that include fragmentation, severe psychotic mania, chaotic confusion and dark depression. I call this practice honoring the sky, grounding to the Earth. Instead of trying to sedate and suppress those complex states, it is key to try and integrate practices that help establish natural sustainable rhythms.
For those with this diagnosis it is essential to have good friends and allies that can offer good support when one is feeling extremes of sensitivity and emotion. A combination of good peer supports, good housing, nourishment and daily holistic healing practices can be key for people with this diagnosis and help steer you along a good road.
From Icarus: - Their words: ”The Icarus Project is a support network and media project by and for people who experience the world in ways that are often diagnosed as mental illness. We advance social justice by fostering mutual aid practices that reconnect healing and collective liberation. We transform ourselves through transforming the world around us.”
1. Navigating Crisis
- Crisis As an Opportunity for Growth and Change – Shery Mead
- Mapping Our Madness: A Workbook for Navigating Crisis, Extreme States, or Just Foul Moods - by Momo
- Crisis Planning – Documents from Wellness Recovery Action Plan – WRAP
2. Suicidal feelings
- When it All Comes Crashing Down: Navigating Crisis – The Icarus Project
- Sometimes Wanting to Kill Yourself… (handout) -The Icarus Project
- Alternatives to Suicide – Western Mass. Recovery Learning Community
- Video on Suicide – Will Hall
- Six Ways You Can Really Help Prevent Suicide – Leah Harris
- Living with suicidal feelings — Will Hall
3. Hotlines and Warmlines
- What is a Warm Line and What Should I Expect When I Call One? by C. Grossberg
- National Mental Health Consumers Self-Help Clearinghouse Warmline Inde
4. Psychosis/ Hearing Voices
- Psychosis recovery: stories, information and resources – Beyond Meds
- Intervoice – the International Hearing Voices Network
- Coping Strategies for Hearing Voices – New Zealand Hearing Voices
- Alternate Dimensions or Psychotic Delusions? – The Icarus Project, Discussion Forum
- Find a Group – Hearing Voices Network
You can also find me at the Facebook group Herbs for Mental Health