Monday, 29 October 2012

What it's Like to Go Crazy: Dr Kraepelin Writes...

IF YOU'RE WONDERING why I say I think I need counselling for the trauma of having lost my senses some 18 months ago, here are some lovely quotes from one of the classic psychiatric texts of all time, Emil Kraepelin's Manic-Depressive Insanity and Paranoia that put it all in a nutshell...

The very last paragraph quoted here describes me with unfortunate accuracy in the throes of hyperacute manic psychosis.

Their linguistic utterances alternate between inarticulate sounds, praying, abusing, entreating, stammering, disconnected talk, in which clang-associations, senseless rhyming, diversion by external impressions, persistence of individual phrases, are recognised.

That's exactly what happened to me!


From the slighter forms of mania here described, imperceptible transitions gradually lead to the morbid state of actual acute mania. The beginning of the illness is always fairly sudden; at most headaches, weariness, lack of pleasure in work or a great busyness, irritabihty, sleeplessness, precede by some days or weeks the outbreak of the more violent manifestations, when a definite state of depression has not, as is very frequent, formed the prelude. The patients rapidly become restless, disconnected in their talk, and perpetrate all sorts of curious actions. They run out of the house in a shirt, go to church in a petticoat, spend the night in a field of corn, give away their property, disturb the service in church by screaming and singing, kneel and pray on the street, fire a pistol in a waiting-room, put soap and soda in the food, try to force their way into the palace, throw objects out at the window. A female patient jumped into the carriage of a prince for a joke.

Mood is unrestrained, merry, exultant, occasionally vision- ary or pompous, but always subject to frequent variation, easily changing to irritability and irascibiltiy or even to lamentation and weeping. Such, fluctuations of mood are very clearly seen in the following letter of a manic patient : —

" When I think of my rude behaviour towards you at the last visit, I do not know how I am to atone for it. I ask you for pardon from my heart ; as far as it hes in my power, such a thing will never occur again. As I now understand, I should have given you an answer and I did not do so. O God, how discourteous !"

Mood is mostly exalted in mania, and in lively excite- ment it lias the peculiar colouring of unrestrained merriment. The patients are pleased, " over merry " or " quietly happy," visionary, " more than satisfied," " cheerful in this beautiful world"; they feel well, ready for all possible sport and banter, "penetrated with great merriment," they laugh, sing and jest. They are "enraptured with everything," " the happiest woman " ; happiness has come upon them ; " now the days of roses are coming." The group of patients in manic excitement (Fig. 3) reproduces the expression of this mood in varied colouring from quiet cheerfulness and proud self-consciousness to unrestrained cheerfulness. Sexual excitability is increased and leads to hasty engage- ments, marriages by the newspaper, improper love-adven- tures, conspicuous behaviour, fondness for dress, on the other hand to jealousy and matrimonial discord. Several of my patients displayed in excitement homosexual tendencies.

Extraordinary Distractibility of Attention certainly plays an essential part in defective perception. The patients gradually lose the capacity for the choice and arrangement of impressions ; each striking sense-stimulus obtrudes itself on them with a certain force, so that they usually attend to it at once. Accordingly, if their attention can for the most part be quickly attracted by the exhibition of objects or by the calling out of words, yet it digresses again with uncommon case to any fresh stimulus. The picture of their surroundings and of events remains, therefore, for them more disconnected and more incomplete than it would be, if it suffered merely from encroachment on the process of perception.

The Flight of Ideas often becomes very distinctly noticeable to the patient's own perceptions. They complain that they cannot concentrate or gather their thoughts to- gether. The thoughts come of themselves, obtrude them- selves, impose upon the patients. "I can't grasp all the thoughts which obtrude themselves," said a patient. "It it is so stormy in my head," declared another, "everything goes pell-mell." " My thoughts are all tattered," "I am not master over my thoughts," " One thought chases the other ; they .just vanish like that," — these are further utter- ances, which give us a glimpse into these processes.

In depressed patients also flight of ideas occurs not alto- gether infrequently, though certainly without being very recognizable in the scanty speech of the taciturn patients ; sometimes it appears distinctly in copious written utterances.

He hears the voice of Jesus, speaks with God and the poor souls, is called by God dear son. There are voices in his ears ; the creaking of the floor, the sound of the bells take on the form of words. The patient has telepathic connection with an aristocratic fiancée, feels the electric current in the walls, feels himself hypnotized ; transference of thought takes place.

They have already died a thousand times, always come again, can practise magic, can help people by prayer, can make themselves invisible. A patient had " the feeling as if he would get money from somewhere " ; another declared that
he was the most distinguished private detective ; a third called himself the " sanitary physician of all the natural sciences and natural medical science " ; a fourth said that he would be the most famous man in Europe ; a fifth stated that he had found a female 193 cm [6 feet 363⁄64 inches] in height and would get for her 40,000 marks. Female patients boast that they are related to the royal house, are fourfold queens, earthly somnambulists, have a beautiful voice, are going to place the imperial crown on their husband. A female patient declared that she was the Sleeping Beauty, had pricked her- self with the spindle, and was now waiting for the Prince. The patients often narrate all sorts of journeys and adven- tures, secret experiences ; they have encountered men who made assaults ; they were received in the capital with honour. Many patients complain of persecutions, they have been ill- used having been struck with the fist 130 to 150 times ; they are fired at, whipped with rods.

Occasionally the delusions of the patients call to mind those of the paralytic. They possess millions, diamond cups, get a golden crown, have created mountains, built whole cities. A patient wrote that he would offer his fiancee a life such as no princess in the world had. " In Munich I shall build for myself Castle Miramare, in Feldafing the Castle of King Max formerly planned, make Munich the most beautiful city in the world ; I have already designed three hundred magnificent buildings, the most beautiful in the world. I shall construct railways and gain millions by that."

Delirious Mania.

A Delirious State fills up the picture in a further group of cases, whicli is not very large. This state is accompanied by a dreamy and profound clouding of consciousness, and extraordinary and confused hallucinations and delusions. The attack usually begins very suddenly ; only sleeplessness, restlessness or anxious moodiness may already be con- spicuous one or two days, more rarely a few weeks, before- hand. Consciousness rapidly becomes clouded ; the patients become stupefied, confused, bewildered, and completely lose orientation for time and place. Everything appears to them changed ; they think that they are in heaven, in Herod's palace, in the " Christchild Hospital." Mistakes are made about the people in their surroundings ; their fellow-patients are near relatives ; the physician is a Royal Highness, an ecclesiastic, a black devil, A female patient, who in numer-. ous similar attacks always fancied that she was surrounded by historical celebrities, Louis XIV, Caesar, Elizabeth, called that her " historical delusion ".

At the same time numerous hallucinations appear. Some- thing is burning ; birds are flying about in the air ; angels appear ; spirits throw snakes in the face of the patient ; shadows come and go on the walls. The patient sees heaven open, full of camels and elephants, the King, his guardian- angel, the Holy Ghost ; the devil has assumed the form of the Virgin Mary. The ringing of bells is heard, shooting, the rushing of water, a confused noise ; Lucifer is speaking ; the voice of God announces to him the day of judgment, re- demption from all sins. The patient carries on dialogues with absent people, receives revelations ; his thoughts are borne from one voice to another. The coffee smells of dead bodies, his hands as if rotten ; in the house there is a smell of burning ; the food tastes of goat-flesh or of human flesh, the water of sulphur. His head is very giddy, full of fever-heat. The patients think that they are lifted and thrown into an abyss ; they swim with the king in the ocean ; everything is falling to pieces round them.

The patients do not trouble themselves at -all about their surroundings ; they do not listen, they give no information, obey no requests, are resistive, strike out. Their linguistic utterances alternate between inarticulate sounds, praying, abusing, entreating, stammering, disconnected talk, in which clang-associations, senseless rhyming, diversion by external impressions, persistence of individual phrases, are recognised. Other patients only display a slight restlessness, whisper flights of ideas to themselves, when addressed look up astonished and without comprehension, obey simple requests, give irrelevant answers, smile, weep, cling to people, suddenly begin to sing a song or scream. A female patient called out abruptly, " I am justice ; do not touch me ; I am omniscient ; away from me ! " Waxy flexibility, echolalia, or echopraxis can be demonstrated frequently.

All in all, a decidedly inconvenient affliction...


If you want to see what mania really looks like, only real film of an actual episode will do and this is the only genuine-looking clip I have ever found... I think in doctorly terms, if she stayed that excited all day, she would be termed "moderately manic". BTW just because she knows the camera's there doesn't mean she must be putting on an act. Watch closely her eyes, her emotional lability, distractability and disinhibition... it's not easy to fake any of that and I don't think I've EVER seen bipolar mania convincingly portrayed on television or film. Most actors get the elevated mood and grandiosity right but display nowhere near the correct degree of hyperkinesis, pressured speech, cognitive disorganization or generalized excitement... THEY'RE NEVER MANIC ENOUGH!...

Only one clip was ever posted up; some years ago now the brilliant Trisch Li was found dead in her garage having gassed herself to death... terribly sad... but bipolar disorder has the highest suicide rate of any psychiatric illness with one patient in five eventually succeeding in taking their own life...

ANYWAY, HERE'S SOME MUSIC... Lovely trance!

This is not bad:

♩ ♪ ♫ ♬ ♩ ♪ ♫ ♬ ♩ ♪ ♫ ♬ ♩ ♪ ♫ ♬ ♩ ♪ ♫ ♬ ♩ ♪ ♫ ♬ ♩ ♪ ♫ ♬♩ ♪ ♫ ♬ ♩ ♪ ♫ ♬ ♩ ♪ ♫ ♬ ♩ ♪ ♫ ♬ ♩ ♪ ♫ ♬ ♩ ♪ ♫ ♬ ♩ ♪ ♫ ♬


GLEDWOOD said...

What am I saying about "not bad"... the music is transcendently beautiful!

Fallen Angel... said...

I have never gotten that manic but then again ive never been sober since about age 13 ive been on SUMTHING. But im finding these last 2-3 times ive detoxed, tried staying clean nd have made it bout a wk by day 4 im feeling stark raving mad nd I can tell im very manic more manic then ive ever been nd my mood is profoundly pleasent for no reason nd I smoke at everything at nothing my mind races I just wana move talk do sumthing ANYTHING to occupy my brain or I feel I might actually freakin explode. I do get decent sleep but usually dont fall asleep until at least 4-5 am nd im eating nd do have the mental war over using. Idk I feel as tho sumthin in me is off nd im wondering if this mania im getting is why I cant seem to make it past bout a week. So far im on day 5. Basically cold Turkey. Only had half a 8 mg suboxin nd 10 vistaril to get MD thru the detox. I did it nd no longer physically ill but mentally ima freakin mess. But im about to get to day 6 nd keep fighting to make it to day 8 tht will be my new personal best. I must say tho this mania is making being sovereign more pkeasent than if I was all down nd angry. Maybe it'll be a positive. Guess we'll see. Wish me luck!!

Fallen Angel... said...

Gosh I just read my comment. I appologise for all the wrong nd misspelled words. It's partly bcz im in hyper drive nd do everything to dam fast nd partly bcz im typing on my dam phone. So im sorry if sum of wat I said makes no sense. Like where it says smoked it shud say smile nd sovereign shuda been sober lol.

Gledwood said...

Of course I never got ALL those things, but I remember reading this book close to the time when I had been totally over-the-top manic and saw so much truth in there it was as shocking as if the Victorian doctor had somehow got inside my head and written down my own experiences specially for me.

You sound like you're manic but without the deliriously cheerful mood ~ that sounds most inconvenient. I did used to get exceedingly moody and I've been a bit "up" all this past week but not anxious or uptight at all, so how fantastic is that~!!~??

O don't worry about the spellings ~ they just look like text message language to me :-)

Best of luck with Detoxification or whatever it is precisely that you're going through... ! ;-)

Julie Greene said...

Not quite true, anorexia nervosa is the most potentially fatal of all mental illnesses, not bipolar disorder. One reason is because of the medical complications involved. Another is because the so-called "treatment" for eating disorders, is (in my opinion) worse than the disorder itself. This "treatment," for the most part, is inaccessible to most of us anyway, and does not "work," and is exclusive, that is, it is designed only for those that can afford it, and like to pet horses, or are the right gender or age, and once the money runs out, or you get too old or too sick...well, I guess you're just outa luck.

Julie Greene

Gledwood said...

Julie: by treatment for anorexia, do you mean force-feeding either by subtle or assaultive means?

By fatal illnesses I meant ones where death is caused directly by intentionally suicidal acts intended to produce rapid death... death from anorexia is a completely different matter ~~ I mean, aren't I right in believing that most anorexics who die don't truly intend to kill themselves (although they might have become depressed enough not to care whether they live or die)

hey wasn't it your blog where I left the comment about hyperacute mania being the only psychiatric state where a person can die DIRECTLY and RAPIDLY as a direct result of being so excited they literally cannot keep still. How fantastic is that. I'm really pleased to have a mental illness that is fatal "in a large proportion of cases" according to the Victorian medical reports I perused on the matter..!!!

ps the stats I had on suicide and death from mental illnesses were bipolar 20% successful suicide and only 10% in unipolar... schizophrenia was lower than bipolar ~ only 10%... I never got a figure for anorexia

pps shouldn't anorexia nervosa really be called "aphagia nervosa" ~~ being as loss of appetite is rarely if ever a true symptom of the condition...

hey I just googled a thing up on the Hunger Illness and it says an estimated 15-20% of anorexics are males!


but that website gives the anorexic death rate as only 18-20%... don't you know a website with a glamorously higher result..?

Father Sylvester said...

Does all this happen to you? Because if so, my child, you need exorcism and fast!

Gledwood said...

Oh yes, Father S. Every single thing Dr Kraepelin mentions above has happened to me... Dur! Of course not. He's only giving a flavour of experiences collated from a vast number of patients over an extended time-span. I have never spent the night in a field of corn. Nor have I fired a shot in a waiting room. But tolling bells taking the form of words (for example) ~~~ that is exactly the manner of thing that was apt to happen to me...