Charlie is concerned that by being too positive he will trigger mania. He has been hospitalized once a year and the pattern always seems to be the same. He will have settled into a seemingly fixed state of depression, and then will begin to feel frustrated with that state and tried to make changes to escape from the swampy morass. He will want to reduce his medications which she feels are causing him to be “over-medicated” and he will begin to make many other changes in his life. At first this seems positive, it is after all what I and his psychologist have been trying to accomplish with him for weeks, but very quickly it escalates and becomes psychotic mania.
Today Charlie comes in and says that he’s figured that the only solution is to stay comfortable with where he is.
My experience is that mania is a reaction to a constant state of depression that ends up being intolerable. I don’t think that getting comfortable with depression is the answer.
That’s the bottom route on the diagram to the left.
I think the alternative is to focus on a different kind of positive change rather than to abandon positive change.
I propose way out of this trapped state is to be found in making many small positive changes.
The key thing to avoid is a sense of feverish urgency, one good place to start might be a mindfulness practice that may also help him to distinguish between grandiose plans for the future and small steps.
As I’m talking, though, I wonder if I have really got his attention. He seems to be listening, but small changes sound like they are difficult. Maybe it’s safer to stay in this depression?
And I think that may be the ultimate trap. The wish for quick change or no change at all is the thing that connects his depression and his mania.