Wisdom, Madness and Folly: The Philosophy of a Lunatic
The Seduction of Madness: Revolutionary Insightsinto the World of Psychosis and a Compassionate Approach to Recovery at Home
“On July 5, 1996,” Michael Greenberg starts, “my daughter was struck mad.” No time is wasted on preliminaries, and Hurry Down Sunshine moves swiftly, almost torrentially, from this opening sentence, in tandem with the events that it tells of. The onset of mania is sudden and explosive: Sally, the fifteen-year-old daughter, has been in a heightened state for some weeks, listening to Glenn Gould’s Goldberg Variations on her Walkman, poring over a volume of Shakespeare’s sonnets till the early hours. Greenberg writes:
Flipping open the book at random I find a blinding crisscross of arrows, definitions, circled words. Sonnet 13 looks like a page from the Talmud, the margins crowded with so much commentary the original text is little more than a speck at the center.
Sally has also been writing singular, Sylvia Plath–like poems. Her father surreptitiously glances at these, finds them strange, but it does not occur to him that her mood or activity is in any way pathological. She has had learning difficulties from an early age, but she is now triumphing over these, finding her intellectual powers for the first time. Such exaltation is normal in a highly gifted fifteen-year-old. Or so it seems.
But, on that hot July day, she breaks—haranguing strangers in the street, demanding their attention, shaking them, and then suddenly running full tilt into a stream of traffic, convinced she can bring it to a halt by sheer willpower (with quick reflexes, a friend yanks her out of the way just in time).
Robert Lowell described something very similar in an attack of “pathological enthusiasm”:
The night before I was locked up I ran about the streets of Bloomington Indiana…. I believed I could stop cars and paralyze their forces by merely standing in the middle of the highway with my arms outspread.
Such sudden, dangerous exaltations and actions are not uncommon at the start of a manic attack.
Lowell had a vision of Evil in the world, and of himself, in his “enthusiasm,” as the Holy Ghost. Sally had, in some ways, an analogous vision of moral collapse, seeing all around her the loss or suppression of God-given “genius,” and of her own mission to help everyone reclaim that lost birthright. That it was such a vision which led to her passionate confrontation with strangers, her bizarre behavior imbued with a sense of her own special powers, her parents learn when they quiz her the next day:
She has had a vision. It came to her a few days ago, in the Bleecker Street playground, while she was watching two little girls play on the wooden footbridge near the slide. In a surge of insight she saw their genius, their limitless native little-girl genius, and simultaneously realized that we are all geniuses, that the very idea the word stands for has been distorted. Genius is not the fluke they want us to believe it is, no, it’s as basic to who we are as our sense of love, of God. Genius is childhood. The Creator gives it to us with life, and society drums it out of us before we have the chance to follow the impulses of our naturally creative souls….
Sally related her vision to the little girls in the playground. Apparently they understood her perfectly. Then she walked out onto Bleecker Street and discovered her life had changed. The flowers in front of the Korean deli in their green plastic vases, the magazine covers in the news shop window, the buildings, cars—all took on a sharpness beyond anything she had imagined. The sharpness, she said, “of present time.” A wavelet of energy swelled through the center of her being. She could see the hidden life in things, their detailed brilliance, the funneled genius that went into making them what they are.
Sharpest of all was the misery on the faces of the people she passed. She tried to explain her vision to them but they just kept rushing by. Then it hit her: they already know about their genius, it isn’t a secret, but much worse: genius has been suppressed in them, as it had been suppressed in her. And the enormous effort required to keep it from percolating to the surface and reasserting its glorious hold on our lives is the cause of all human suffering. Suffering that Sally, with this epiphany, has been chosen among all people to cure.
As startling as Sally’s passionate new beliefs are, her father and stepmother are even more struck by her manner of speaking:
Pat and I are dumbstruck, less by what she is saying than how she is saying it. No sooner does one thought come galloping out of her mouth than another overtakes it, producing a pile-up of words without sequence, each sentence canceling out the previous one before it’s had a chance to emerge. Our pulses racing, we strain to absorb the sheer volume of energy pouring from her tiny body. She jabs at the air, thrusts out her chin…her drive to communicate is so powerful it’s tormenting her. Each individual word is like a toxin she must expel from her body.
The longer she speaks, the more incoherent she becomes, and the more incoherent she becomes, the more urgent is her need to make us understand her! I feel helpless watching her. And yet I am galvanized by her sheer aliveness.
One may call it mania, madness, or psychosis—a chemical imbalance in the brain—but it presents itself as energy of a primordial sort. Greenberg likens it to “being in the presence of a rare force of nature, such as a great blizzard or flood: destructive, but in its way astounding too.” Such unbridled energy can resemble that of creativity or inspiration or genius—this, indeed, is what Sally feels is rushing through her—not an illness, but the apotheosis of health, the release of a deep, previously suppressed self.
These are the paradoxes that surround what Hughlings Jackson, the nineteenth-century neurologist, called “super-positive” states: they betoken disorder, imbalance in the nervous system, but their energy, their euphoria, makes them feel like supreme health. Some patients may achieve a startled insight into this, as did one patient of mine, a very old lady with neurosyphilis. Becoming more and more vivacious in her early nineties, she said to herself, “You’re feeling too well, you must be ill.” George Eliot, similarly, spoke of herself as feeling “dangerously well” before the onset of her migraine attacks.
Mania is a biological condition that feels like a psychological one—a state of mind. In this way it resembles the effects of various intoxications. I saw this very dramatically with some of my Awakenings patients when they began taking L-dopa, a drug which is converted in the brain to the neuro-transmitter dopamine. Leonard L., in particular, became quite manic on this: “With L-dopa in my blood,” he wrote at the time, “there’s nothing in the world I can’t do if I want.” He called dopamine “resurrectamine” and started to see himself as a messiah—he felt that the world was polluted with sin and that he had been called upon to save it. And in nineteen nonstop, almost sleepless days and nights, he typed an entire autobiography of 50,000 words. “Is it the medicine I am taking,” wrote another patient, “or just my new state of mind?”
If there is uncertainty in a patient’s mind about what is “physical” and what is “mental,” there may be a still deeper uncertainty as to what is self or not-self—as with my patient Frances D., who, as she grew more excited on L-dopa, was taken over by strange passions and images which she could not dismiss as entirely alien to her “real self.” Did they, she wondered, come from very deep but previously suppressed parts of herself? But these patients, unlike Sally, knew that they were on a drug, and could see, all around them, similar effects taking hold on the others.
For Sally there was no precedent, no guide. Her parents were as bewildered as she was—more so, because they did not have her mad assurance. Was it, they wondered, something she had been taking—had she dropped acid, or something worse? And if not, was it something that they had bequeathed her in their genes, or something awful they had “done” at a critical stage in her development? Was it something she had always had in her, even though it was triggered so suddenly?
These were the questions my own parents asked themselves when, in 1943, my fifteen-year-old brother Michael became acutely psychotic. My brother saw “messages” everywhere, felt his thoughts were being read or broadcast, had explosions of strange giggling, and felt he had been translocated to another “realm.” Hallucinatory drugs were rare in the 1940s, so my parents, who were both doctors, wondered whether Michael might have some psychosis-producing illness—perhaps a thyroid condition or a brain tumor. It ultimately became clear, though, that my brother suffered from a schizophrenic psychosis. In Sally’s case, blood tests and physical exams ruled out any problems with thyroid levels, intoxicants, or tumors. Her psychosis, though acute and dangerous (all psychoses are potentially dangerous, at least to the patient), was “merely” manic.
One can become manic—or depressed—without becoming psychotic: having delusions or hallucinations, losing sight of reality. Sally, though, did go over the top, and on that hot July day, something happened, something snapped. All of a sudden, she was a different person—she looked different, sounded different. “Suddenly every point of connection between us had vanished,” her father writes. She calls him “Father” (he was “Dad” before), and speaks in a “pressured, phony voice, as if delivering stage lines she has learned”; “her normally warm chestnut eyes are shell-like and dark, as if they’ve been brushed over with lacquer.”
Greenberg tries to speak to her of ordinary matters, asking her if she is hungry or wants to lie down:
Each time, however, her otherness is reaffirmed. It is as if the real Sally has been kidnapped, and here in her place is a demon, like Solomon’s, who has appropriated her body. The ancient superstition of possession! How else to come to grips with this grotesque transformation?
…In the most profound sense Sally and I are strangers: we have no common language.
The special qualities of mania have been recognized and distinguished from other forms of madness since the great physicians of antiquity wrote on the subject. Aretaeus, in the second century, gave a clear description of how excited and depressed states might alternate in an individual, but the distinction between different forms of madness was not formalized until the rise of psychiatry in nineteenth-century France. It was then that “circular insanity” (folie circulaire or folie à double forme)—what Emil Kraepelin later called manic-depressive insanity and what we would now call bipolar disorder—was distinguished from the much graver disorder of “dementia praecox” or schizophrenia. But medical accounts, accounts from the outside, can never do justice to what is actually experienced in the course of such psychoses; there is no substitute here for firsthand accounts.