What is the experience of psychosis? What does mania look like up close?

In an overview essay that the New York Review of Books has generously posted on line, the neurologist Oliver Sacks explores the phenomenology of bipolar disorder in its extreme phase. The occasion for the piece is the publication of Hurry Down Sunshine, by Michael Greenberg, a father’s account of his daughter’s illness. But Sacks takes the opportunity to remind readers of descriptions by patients, notably John Custance, who wrote in the 1950s, and Kay Jamison.

From the viewpoint of psychiatry, the unbalancing and inflammation of a mind is so common a misfortune that doctors may forget how extraordinary and unfamiliar the state is to the person who experiences it and, then, to those around her. In the passages quoted by Sacks, Greenberg, a contributor to the Times Literary Supplement, approaches psychosis with a writer’s art, using a close third person to evoke his 15-year-old daughter Sally’s deranged ecstasy: “[S]he walked out onto Bleecker Street and discovered her life had changed. The flowers in front of the Korean deli in their green plastic vases, the magazine covers in the news shop window, the buildings, cars — all took on a sharpness beyond anything she had imagined.”

Lately I have been dipping into James Wood’s elegant primer How Fiction Works. Despite the rare clunker, the book, which has been savaged in the press, strikes me as quite fine, especially in its emphasis on what Wood calls “free indirect style.” Wood is referring to that same close third person — Chekhov is its master — in which a single adjective may serve to switch the viewpoint from the author’s to the character’s. We use this technique in psychotherapy. Here, Leston Havens is the great practitioner, offering observations whose provenance is ambiguous, so that the patient may wonder whose thoughts are being exposed, hers or Havens’s. In that uncertainty lie other possibilities, reassurance and perturbation, each stimulating further exploration and discovery.

Sally Greenberg’s doctor employed the first and second persons to advance this sort of speculation: “’I bet you feel as if there's a lion inside you’ are her first words . . .” What a fine example of the skillful use of language in psychotherapy! The speculation, enlivened by metaphor, at once averts resistance to the encounter (through disrupting expectations of how doctors speak) and promises the patient that she will be understood.

Anyway — for me, the Sacks essay led to thoughts about this commonalty between writing and therapy, the need for effective rhetoric. Of course, the review serves a more — I am tempted to say “another” — down-to-earth function. At a moment when the scope of bipolar disorder is, quite properly, in dispute, Sacks (and, evidently, Michael Greenberg) offers a reminder that the core disorder is prevalent, grave, and very real — and that skilled treatment, pharmacologic and psychologic, can provide enormous help.