What I Wish Clinicians Knew About Mania

Looking back on my experiences of mania and psychosis, there are several things I wish clinicians better understood.

Firstly, mania does not always feel like suffering. Clinicians often see the consequences of mania—hospitalisation, relationship breakdowns, financial problems, risky behaviour, and psychosis. What they may not fully appreciate is that, from the inside, mania can feel amazing. I loved being manic. Everything felt exciting. I was productive, creative, energetic, and deeply engaged with life. Ideas flowed effortlessly, and everything seemed meaningful. Because mania can feel so good, it can be difficult for people to accept treatment or medication. If clinicians do not understand why people are drawn to these states, they may struggle to understand why some people resist interventions designed to reduce them.

Secondly, I was both insightful and delusional at the same time. One of the central themes of The Dialectics of Mania is that insight and psychosis can co-exist. Clinicians are trained to identify delusions, but they may sometimes overlook the fact that people are still thinking, reflecting, creating, and searching for meaning during these experiences. Not every thought generated during mania is meaningless simply because some beliefs become detached from reality.

Another important lesson is that recovery does not begin when the mania ends. My manic episode lasted only two or three weeks, but the recovery process lasted years. Following the episode, I experienced panic, depression, loss of confidence, unemployment, damaged relationships, and the challenge of rebuilding my identity. At times, I became profoundly depressed and suicidal. During a trip to Canada later that year, I found myself thinking about countless ways I could end my life. Many people spend far longer recovering from the consequences of mania than they do experiencing the episode itself.

I also wish clinicians understood that the loss of mania can feel like a loss. When medication stabilised my mood, I lost not only the dangerous aspects of mania but also the excitement, energy, urgency, creativity, and sense of possibility that came with it. While clinicians often view stability as the goal, consumers can sometimes feel as though they have lost a part of themselves.

Being told that you are unwell rarely works. My experience with my mother is a good example. She was desperately trying to help me, but the more she told me I was unwell, the more convinced I became that she simply did not understand what I was experiencing. Our disagreements eventually led me to jump out of her moving car and cut her out of my care altogether. People experiencing mania often need connection, patience, and understanding rather than repeated arguments about whether they are sick.

I also wish clinicians recognised that there is usually a story behind the episode. My manic episode did not occur in isolation. It was preceded by months, perhaps even a year, of instability, job losses, stress, personal challenges, spiritual exploration, and years of accumulated experiences that shaped the content of the episode. The symptoms matter, but the story behind the symptoms matters too.

Finally, people experiencing mania are often trying to make meaning, not simply acting irrationally. Even when my beliefs became delusional, my mind was attempting to create a coherent explanation for what I was experiencing. Clinicians may see disorganised thinking, but from the inside, many people are desperately trying to make sense of a world that suddenly feels overwhelming, intense, and profoundly significant.

Ultimately, I wish clinicians understood that mania is not simply a collection of symptoms. It is a lived experience that can feel exciting, meaningful, creative, frightening, confusing, and destructive all at the same time. Understanding that complexity is one of the most important steps toward truly understanding the people who experience it.