Mania, in my experience of it, is a process of giving birth to hope in the soul. It is opposed from within by an equally intense nihilism and fear that the entire creation is nothing more than a cesspool of doom. Inner conflict can make a person labile. The cosmic grandiosity comes from trying to answer the question "Is the universe a friendly place or a hostile place?" This is ultimately a religious question, hence the preoccupation with spiritual and religious issues.

The struggle between hope and utter despair can frighten onlookers as well as the person on the inside of the experience. There is a difference between the expression and the intention of any problematic behavior; the expression of mania, intrusive and melodramatic, gets the attention of onlookers. The constructive intention, concealed inside a person and covered over by layers of wild behavior, must be looked for or it will be missed.

"If you don't think of it, you will miss it," every medical student is told when learning the art of clinical diagnosis. My doctors did not think about the possibility that they were seeing a person in the midst of a spiritual emergency; the concept itself is not on their map of reality. It is not listed in the differential diagnosis of manic episode in DSM-IV. Psychiatrists do not think about it, and they miss it. The patient, unfortunately, pays the price for the doctor's impoverished frame of reference.

It is a very serious matter when a physician mistakes a healing process for a pathological one. The intention of the doctors was positive, but their expression was most destructive. The head of psychiatry at the hospital told me that I was in denial if I insisted that I had been having a spiritual crisis. No, he said, this is a medical disorder like asthma or diabetes. When I finally understood that he meant what he said, I was devastated, and I was feeling suicidal within hours. I could not argue with his self-assured, expert manner.

Where, I wanted to ask, were the mast cells, the inflammatory mediators, the glycosylated proteins of this allegedly medical condition?  But I was too demoralized to speak. I felt only like dying. The whole episode meant nothing; it was just a case of bad DNA making defective protoplasm. If I had accepted the medical model of my experience, I would not have survived to tell this tale. Despair would have consumed me.

I emerged from despair because other people interpreted things differently. One of my housemates said, "This happened for a reason, Ed." A psychiatrist who understands the concept of spiritual emergency accepted the legitimacy of the nonordinary states of mind that I described to him, and he likened them to crises that many people had passed successfully through. Outside the medical profession, there were many people who easily understood what I was saying, and they helped save my life.

Medical education does not prepare psychiatrists to deal with spirituality in human experience. In shaping human lives, spirituality is at least as powerful (and as subject to compulsiveness) as sexuality, and just as irresistible when intensely felt. It is expected that psychiatrists will be able to take sexual histories competently, but spiritual histories seem to be another matter. It saddens me to report that physicians were the main obstacle that I had to overcome on my quest for a hope-filled view of the world.

When confronted with manic patients, psychiatrists ought to ask themselves, "Could this be a spiritual emergency?" When no medical illness or drug intoxication is found, this possibility should be carefully ruled out before a medical model is imposed on the situation. There are features in the territory of human experience that are deleted from the professional maps that psychiatrists use. Those maps must be revised. DSM-IV should include "religious or spiritual problem" in the differential diagnosis of manic episode. Physicians who do not think about it when appropriate may do their patients grave harm.

A delusion is defined as,

a false personal belief based on incorrect inference about external reality and firmly sustained despite of what everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary (DSM-IV, p. 765).

By this definition, I have experienced many delusions in my life, especially when I was highly manic.  Though, it is not clear that in many cases there was proof or evidence to the contrary.  Further, much that I think about is in the realm of the unknown where there is no "what everyone else believes".

Here is another example that I found on the WWW that shows that I am not alone in what I have experienced.

HOWARD'S EXPERIENCE AS A SPIRITUAL EMERGENCY

Both the mental status exam I administered and 15 interviews with him are used to examine Howard's experience in terms of the diagnostic criteria for spiritual emergency.

I. Overlap with the mystical experience

A. Ecstatic mood. After first reporting that his experience was "beyond words," Howard later went on to describe his mood with words including "ecstasy" and "rapture." Despite finding no support or acknowledgment of his situation, this mood persisted for several weeks of his hospitalization.

B. Sense of newly-gained knowledge. Howard believed that he had unlocked some elemental truths of universal importance. He felt his insights were of such importance that the scientific community should study and document what he was discovering.

C. Perceptual alterations. While in his hospital room, Howard had visual hallucinations of yellow birds against a brilliant orange sky. He also saw the face of Death in a tree stump.

D. Delusions with mythological-related themes.

Death: Howard saw the face of Death and agreed that he would kill people if necessary to fulfill his mission.
Rebirth: Howard felt he had been reborn into a new identity as the albatross.
Journey: Howard thought he had the mission to show others the way into the Mental Odyssey experience and that he was being prepared for Enlightenment.
Encounters with spirits: Howard communicated with his muse and the Devil interfered with his trip up the mountain.
Magical powers: Howard believed he had acquired special powers such as mastery over time and space and the ability to summon elevators at will.
New society: Howard thought he was the Pied Piper heralding in a new society.

E. No conceptual disorganization. Although Howard's metaphorical use of language was difficult for others to understand at times, he never showed incoherence or thought-blocking. His ideas were always expressed lucidly.

I too experienced all five of these criteria for a mystical experience.  Not that I doubted it before.  It is just interesting to finally see it in a case study right before my eyes.  I found the following of interest as well.

4. The transpersonal approach to depression is based on the humanistic conceptions underlining the state of human diminution of the depressed subject, who experiences a void of the meaning of life caused by a block in development and freedom, in that safety needs overcome the needs of growth. Aspiration, the expression of talents and creativity, are then inhibited, and the meaning of life is seriously damaged, losing quality and purpose.  The humanistic model underlines that the root of depression is the inhibition of individual potentialities and that recovery requires the development of autonomy, responsibility toward one's life, and the prevailing of one's needs of growth over conformistic conditioning.

The humanistic conception is the platform for the development of the transpersonal approach to depression, which is particularly focused on the fragility and insignificance originated by the separation of the ego from the soul as the inner spiritual center of individuality. To the person who identifies with the biographic ego, life lacks contact with the universal values and is therefore imprisoned in unawareness and lack of truth. Depression is then the natural answer to the failure of the egocentric project and to the void of an existence that is based on empty and impermanent objects.

A contribution to the conception of depression of the ego separated from the soul comes from the wisdom tradition. In the Yoga-Vedanta tradition, in particular, Patanjali recognises that mental suffering (hence depression as well) is rooted in the egoism that develops from the unawareness of the spiritual reality and of its connections to the universal background of existence. This unawareness leads us to get lost in common life events and to develop a terror of death.

Egoism stems from the sense of the ego incapsulated in the body and totally separated from its own fragility: it is constituted by the tendency to possess and to defend oneself, and qualifies a behavior that is centered on attachment to pleasure and the refusal of pain, that makes one vulnerable to the inevitable trials of life. In this context, overcoming depression then requires going beyond the narrow boundaries of the egocentric logic, that brings along attachments, fear, and discouragement; it requires giving up its possessive and defensive modalities, progressively developing the awareness of the soul and the sacred sense of life, as well as an attitude toward values and meanings that make room for the cultivation of spiritual states and qualities. These include love and wisdom, expressed in a social action that is free of personal interest and offered to life. +

The integral approach to depression includes the different views and acknowledges the complementarity and interrelationship of the various perspectives. The integral vision of depression recognises that the different approaches are like different refractions of a prism and relate to the difficulties of the existential path in its various phases.

Well, that was interesting.  So much for not doing research.

I AM THAT I AM THAT YOU ARE!   Be Happy and Create Well!