It is important to define mania in two ways:
- By defining symptoms.
- What those symptoms mean for each individual.
Many of those suffering with these symptoms only choose medication for treatment and disregard psychotherapy because the underlying suffering seems too painful or impossible to make any sense out of it. This is the reason for a psychotherapist, to help make some sense out of the symptoms and how they are related to underlying stresses that need working through to ease the over all struggle.
Both need treatment: the branch and the root.
We first need to define manic and the manic episode. They are definitions used by medical and psychological practitioners to have a common language. They name and categorize sets of symptoms which are essential for prescribing medications and doorways into resolving deeper emotional pain through psychotherapy.
For example: “Inflated self-esteem or grandiosity”, the first symptom in the following list. This symptom can be compensating an unconscious negative self-esteem with self hatred and grandiose shame. That is roughly how symptoms can point the way to useful suffering. Working through the unconscious suffering is actually easier than the suffering that comes with destroying ones own life or that of others. Easier said than done.
Define manic and a Manic Episode:
This is the main section in determining the clinical diagnosis for a manic episode, there are more specifics in the DSM-V.
Three or more symptoms lasting one week:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (e.g. feels rested after only three hours of sleep)
3. More talkative than usual or pressure to keep talking
4. Flight of ideas or subjective experience that thoughts are racing
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g. engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
Here is more on the full clinical definition of manic episode:
A hypomanic episode is milder than a manic episode. It can precede a full blown manic episode.
Here is the clinical diagnosis:
Like any other symptoms, manic symptoms can become overwhelming. I would say everyone has experienced the symptoms above at various times in their life, but when they begin to dominate ones experience or become destructive, help is needed. We need help in managing the symptoms and looking into one’s individual story and what these symptoms mean for us today, at this stage of life. Each stage of life calls on the past to move into the future. The past isn’t a place to hide or make excuses for the present situation but it is ours now and it is vulnerable. What we do with that vulnerability is our work and that at the least “takes a village”.
“In dwelling, live close to the ground. In thinking, keep to the simple. In conflict, be fair and generous. In governing, don’t try to control. In work, do what you enjoy. In family life, be completely present.” 
Lao Tzu
Bipolar disorder(mania and depression) “usually appears between the ages 15-24”
Symptoms pointing to the deeper work
When I look at these “symptoms” for manic episode, I remember the clients over the years and myself in the teens and early twenties. This is a time of finding one’s own perception about life and how that matches up or doesn’t match up with the perceptions in the culture about right and wrong, success and failure, should and shouldn’t.
This can be very confusing and stressful because we are having to trust our own view as it is being challenged by others. It can be stressful standing up for what one believes is right and it is stressful admitting where someone else is right.
These “symptoms” can be just part of finding ones way and becoming a young adult, but when they become too extreme they indicate something else; a transition that needs help.
Therefore, this transition can go from smooth to extremely painful depending on life circumstances. If emotionally painful events have occurred in one’s earlier life, it becomes more complicated. This could include: divorce, learning difficulties, addictions in the family, violence of any nature, or death of a loved one.
This transition is on a spectrum of difficulty that can range from finding ones place fairly smoothly in relationship to parents, friends, school, sex and intoxicants, to varying degrees of emotional suffering, harming oneself, addiction, cutting, and playing around with suicide.
A common theme at this age is extreme highs and lows, “polar” again. Extreme use of intoxicants, extreme sexual interactions, extreme on-line activity and a very distant relationship with parents.
What’s crazy?
The feelings of mania can be “ecstatic”, “erotic”, “excited”, “terror”, “overwhelmed”, “crazy”, “obsessed”, “possessed”, “madness”, “fragmented”, “broken”, and “intolerable guilt and anxiety”
The biggest problem with manic feelings is not being aware of the escape quality involved. Trying to escape a problem can be exhausting and destructive. Escape has to do with the question: “Escape from what?”. There is usually some problem people need help figuring out. Help not only with what to do about the problem, but also, how to talk about the problem.
The escape behavior makes “crazy” sense because the emotional pain can seem impossible to deal with. The only problem is escape makes it worse.
But what is even more crazy, the answers and relief are in talking through these negative feelings and experiences with someone who knows the way. The healing is through it.
For example, I have seen so many people in their teens and early twenties in therapy. At some point in the process they ask, “Am I crazy or are they crazy?”, referring to other kids at school, parents, teachers, friends, relatives, religions or simply the state of the world we live in today.
This is a very important question because it is the beginning of being on the path of uncovering, “How am I the same and different from others?” and “How do I want to live my life?”, “What is important and meaningful to me?” given my circumstances.
These same symptoms can appear at mid-life which is another time of major change. Stresses of family, career, and aging bring about the same questions of finding one’s new place in life with new attitudes and a little different style of living.
