Journal of Analytical Psychology 1987, 32, 309-324 MANIC-DEPRESSIVE PSYCHOSIS —A PERSPECTIVE: Binswanger, Jung, Neumann, and the Myth of Dionysus JOLE CAPPIELLO McCURDY, Merion Station INTRODUCTION Manic-Depressive psychosis is predominantly seen today as an illness with an hereditary-biological etiology. Interest in the psychodynamic issues, and even in the psychopathological description of this condi- tion, has decreased greatly since the still rather undefined ‘organic’ etiology has been so widely accepted. The result is that little has been expressed in recent literature which could help or amplify our understanding of this pathology, despite the great fascination and empathy that manic-depressive states evoke in therapists who deal with them. Jung conceived of depression as a regressive state, a‘... sink(ing) down into a sort of embryonic condition. ...’ (JUNG 7, p. 32), and as expressive of an absolute dominance of the unconscious over conscious processes (JUNG 4, par. 75; 6, par. 344). In his paper, ‘On manic mood disorders,” Jung underlines the extremely erratic, chaotic and rootless life-style of manics, as well as the association of the disorder with alcoholism, orality and anti-social behaviour. But he left us neither a unitary description of the psychosis nor an interpretation of it. It is the purpose of this paper, therefore, to formulate a Jungian hypothesis of manic-depressive illness. I propose first that the disorder is not affective, but rather a dysfunction of the ego/self axis. In order to support this hypothesis we will examine Ludwig Binswanger’s pheno- menological approach to and understanding of the disease, and then show how Binswanger’s constructs relate to those of Erich Neumann regarding the ego/sclf axis. Having shown the relationship between (9021-8774/87/040309+ 16 $03.00/0 © 1987 The Society of Analytical Psychology310 J. Capiello McCurdy Binswanger and Neumann and how it relates to the understanding of manic-depressive illness, we will then discuss the myth of Dionysus as an archetypal image of the disorder which further amplifies the theory of its ego-dysfunctional character. BINSWANGER AND EXISTENTIAL ANALYSIS In the writings of Binswanger, the concept of aetiology, of cause, of where the discase comes from, docs not appear and is not considered relevant. What is relevant is the way the world of melancholia and mania are constituted, and the defect that conditions the particular way of being of these states. Binswanger tried to apply to psychiatry the new vision of man that had been formulated by phenomenologic- existential philosophy. That new vision was the result of the Kantian revolution which described a man in whom instinct and spirit could no longer be separated into two distinct entities. Binswanger, who, like Jung, had broken with Freud, did not deny the validity of psychoanalysis; rather, he felt that the biological aspect, so important for scientific psychiatry, did not seize the essence of the experience for the patient. As founder of existential analysis, Binswanger felt that the entire world of the patient is extremely important, that this world represents one of the possibilities of being. In order to understand the patient, it was essential for one to understand this world and the structure that conditioned its existence. It is important to understand the philosophical concepts which gave rise to this psychological approach. These were first formulated by Brentano and Kant, and represented a resolution of the long- standing dichotomy between man and world, between consciousness and nature, between spirit and matter. With Brentano, the concept of the intentionality of consciousness is introduced: consciousness is always consciousness of something, of an object; consciousness is always directed towards an object. With Kant, the philosophical problem of knowledge, until then divided between absolute subjectivism and empiricism, finds its resolution. For Kant, objective reality is constituted in the same moment that it is perceived. What we perceive with our senses are merely passive, undifferentiated impressions which require the organising function of the mind in order to be known. Consciousness knows the world that it structures in accordance with its categories, the Kantian categories of the understanding: “The objects are conformed to our ways of knowing. The mind, that is, is constitutive of its objects. It creates them in knowing them (NEEDLEMAN 11, p. 10). These categories of understanding are envisioned as a priori functions which exist only in the moment they apprchend things. Reality is that which appears to usManic-depressive psychosis 3n7 and which we can know as phenomenon. Existential philosophy can be considered an extension of the Kantian theory of knowledge into the sphere of being. Man, in being, in becoming, in Da-sein, constitutes the world and, at the same time, his own self or ego. The Dasein, or being-alrcady-in-the-world, is the a priori category of every existence. The Dasein is world and indivi- dual, subject and object at the same time, since man, in his being structures his own world in conformity with his existential categories. Being-in-the-world is antecedent to every other modality of being. It is connected with the feelings of one’s own existence. It is, simply, the ‘Lam’ experience. If the Dasein is the precondition of every form of being, the existential categories are the preconditions by means of which reality manifests itself to the Dasein. These a priori existential categories ‘are the universals or forms that stand to the experience of cach human being in the same manner that the Kantian categories of the under- standing stand to the objects that we know’ (Ibid., p. 27). These categories are not empty formulae; they are meaning-forming matrices which organise experience following intentionality, direc- tion, meaning. Binswanger calls these categories transzendentale Kategorien, and the most important of these a priori categories for him is time: ‘Temporalisation is not merely one existential phenomenon among others, it is existence’ (Ibid., p.315). Existence, as emerging, as becoming, is always a development in time, always projected toward the future. Being is a continuous process of self-actualisation. Our present is chosen in view of our project for the future; even our past is selected following this project. Time is at the basis of experience, of intentionality, and characterises its continuity and its direction. Time conditions the historicity of human existence. Natural experience, according to Binswanger, is organised in a continuum, or temporal succession. That is, at every moment there are three different temporal elements which have to contribute to the continuum: the present, the past and the future. He uses this example: when I speak I have to know what I am saying, what I just said, and what I am going to say. Only in this way will I be able to organise a coherent and logical discourse. This temporal structuralisation is the premise which makes experience possible and gives content to the present moment. Without temporalisation the course of life itself is stopped, and when past, present and future are not in a regular connection, consciousness is empty, paralysed, unable to deal with new contents and with the actual present theme. In normal existence, every experience is organised naturally and spontaneously in a continuum. In manic-depressive states there is an312 J. Cappiello McCurdy interruption of this natural experience because there is a defect in temporal structuralisation. DEPRESSIVE STATES In his book, Melancholia and Mania (1), Binswanger illustrates this defect in temporal structuralisation in case studies of psychotic depres- sive states. One of those described is that of Cecil Muench, who became depressed after the loss of her husband, who died in a train accident during a trip which she had proposed to him. Mrs Muench was obsessed by the idea that her initiative had caused her husband’s death, repeating continually, ‘If [ hadn’t proposed the trip, my husband would be alive still!’ If we analyse the ‘ifs,’ ‘if nots,’ ‘if [ hads,” we see that they represent empty possibilities because they address what is already past, and the past has no possibilities. Cecil Muench does not account for the present situation. She also expects an empty future, because whatever she might contemplate in the future has already happened, as it were, in the past. The self-accusations express a lack of a real theme, only a mere possibility that has no real motivation and no possibility of future development. The patient remains stuck in the past while viewing the future as a hopeless situation. As a consequence, the experience of present realities is altered. The melan- cholic delusion, according to Binswanger, attributes to the future qualities that belong to the past. The possible future loss or catastrophe seems to have already happened. This is because the depression is not caused by the loss, but is itselfa loss. It is the loss of future possibilities, of the present, and of motivation. This loss is the basic theme of the depression. Melancholic consciousness is empty, and this emptiness is the most intolerable thing. The worries, the self-accusations, the delusions, the obsessions, represent all together an attempt to give content to this terrible emptiness. The normal experience according to temporal sequences has become an impossibility. MANIC STATES In the manic patient, the loss of temporal sequence is evident in the patient’s interaction with others. Binswanger writes about a Mrs Strauss, who had becn hospitalised for her condition. Leaving the hospital one morning at six o’clock, Mrs Strauss wandered about for a couple of hours, ending up at a church where a religious service was in progress. She approached the organist while he was playing and asked him to give her lessons. She then went to a field where some boys were playing soccer, decided then and there to play, and began kicking the ball away from the boys. She was violent and aggressiveManic-depressive psychosis 313 when finally returned to the hospital, beating her nurse and throwing books at her doctor (Ibid., pp. 78-79). In her moments of intrusiveness at the church and in the soccer game, Mrs Strauss was unable to share a mutual experience with the people involved. For example, she could not perceive the organist as part of the church service. She could relate to him only out of her own. immediate desire to take organ lessons. She had also lost the notion of her own biography: she did not perceive herself as a mature woman, but only as the subject of her experience of the moment, as when she simply began playing soccer. Manic, she was living in an isolated present, without connection, without a biographic evolution, or the possibility of ordering the present in an internal biographic continuity. This blatant intrusiveness, strong irritability and great openness to all stimuli around him are typical of the manic, There is a continuous contradicting, a curiosity without limits, a desire to touch and experience everything, to interfere in everything. People become only objects of desire or of aggressivity. But if the experience of the other fails, that means that the ego itself has no direction or intentionality. The ego is no longer in touch with a sense of internal biography, of identity and consistency, because it has lost the possibility of organis- ing experience in temporal succession. There is no real goal. Where in the depressed patient the thread of temporal structuralisation weakens to dissolution, with the manic this thread is torn in innumerable isolated pieces. This lack of internal structuralisation gives to the experience of the manic its character of superficiality, changeability, of immediate and simple excitement. The sense of individual historicity is lost. There are only isolated moments. THE ILLUSION OF ANTINOMY IN MANIA-MELANCHOLIA, Usually one sees in the manic-depressive state two different and contrasting moods, that of euphoria and that of melancholia. But, as Binswanger states: ‘The antithesis is to be seen in the whole structure of these two opposites states... If in the form of being of manics the space becomes wide and endless, in that of melancholics it is narrow, shrunken and closed. . . . There (in mania) the rhythm. of the experience is rapid, here it is slow... . While in mania one can speak of a form of rapidly changeable and flowing existence, in the melancholics this experience is static, arrested, sticky, without solution. There we find biographic, intellectual, and social interruptions. Here the biography, the thoughts, the relationships with the world don’t exist any more. In depression there is a life course concentric-circular, in mania only a vital point... (Ibid., pp. 109-110) All of these aspects are the result of the particular structure of these forms of existence. It is not possible to consider them separately. In314 J. Cappiello McCurdy both of them we find an alteration of the experience of time. While the depressed lives in the past, the manic lives only for the moment. Rollo May states: Distortions of the fecling of time necessarily result in distortions of the meaning of life.... Wherever the future becomes empty as with manics, life is a perpetual gamble and the advantage of the present moment is taken into consideration. Wherever the future is inaccessible or blocked as with the depressed, hope necessarily disappears and life loses all meaning. (MAY 10, pp. 106-7). According to Binswanger’s perspective, the antithesis between these two conditions is only apparent. This is because in both states we have recognised the fundamental defect in the ego preventing it from ordering and giving meaning to experience. In both states we find an alteration of time structure. This structure is totally loose in mania, while in depression it is severely weakened. The proximity of these two states is further demonstrated by the number of mixed conditions, where for example, the depressive mood is discernible in the midst of cuphoric states. BINSWANGER‘S THEORETICAL INTERPRETATION OF MANIC-DEPRESSIVE PSYCHOSIS From Binswanger’s analysis of manic depressive states the following points appear to be of fundamental importance: First, both states derive from an alteration of time structure. That is, manic and depressive states reflect an alteration in experience. They are not caused by the experience itself, nor by traumatic events. The alteration of mood which characterises these states reflects only the altered way of perceiving the experience. The change in mood is a consequence of the change in the process of temporalisation. Second, precisely because the experience does not follow a normal course, these pathological conditions cannot be fully understood, nor can they be related to a psychological cause; that is, we are here in the field of psychotic states. According to Binswanger, manic-depressive illness is a disease of consciousness and of the ego rather than a disease of mood or dysthymia. Third, Binswanger underlines the fact that in mania and in melancholia a certain integrity of and identity of the ego are pre- served. That is the reason why in these conditions the patient can despair or triumph. This important observation regarding the integ- rity of the ego in mania and depression leads Binswanger to another essential question: Where is the alteration in the ego which can explain the existence of these forms of psychosis? In trying to find the answer to this question, Binswanger applies Husserl’s theory of the ego to psychopathology. In Husserl’s opinion,Manic-depressive psychosis 31s the ego is a complex structure in which different functions can be isolated, namely the pure ego, the transcendental ego with its a priori transcendental categories, and the empirical ego. The centre of these functions is the pure ego, the origin of intentionality and of the meaning of existence, which organises and directs every experience. The pure ego, through the transcendental categories of the transcen- dent ego, exerts a regulatory and directive function with regard to the empirical ego which directly apprehends experience; through the transcendent ego, the pure ego gives direction, ties together and organises the otherwise chaotic empiric experience. Under normal conditions, the pure ego exercises its functions without problems: everything flows smoothly following a unity, an intentionality, a direction, a meaning. Binswanger underlines the fact that normal experience is problematic. However, as he points out, it is in just those ‘experiments of nature’ called psychosis that we can see the dissociations of the functions of that entity called ego. In psychosis we can best observe the complexity of that structure normally characterised by the attributes of unity, identity, continuity, intention- ality, etc. In manic-depressive psychoses, for example, while the pure go is still capable of self-identity, it is disconnected from the functions of the transcendental ego and the empirical ego. We sce this function being lost in the alteration in the temporalisa- tion of experience. In the depressed person, experience can no longer take its natural course in time. In mania, experience is a flight. In both cases the pure ego is disoriented and disconnected from its essential functions of connection, orderedness and intentionality. It can only despair, as is the case in depression; or try to escape, as in mania. In mania, the pure ego tries to overcome the lack of contents in consciousness by taking control over everything. In melancholia, the pure ego collapses because of the emptiness of the experience. In both cases the pure ego has lost its function in the totality of experience. This lack of function of the pure ego is at the origin of the extremes of depression and elation. As Spiegelburg puts its: the ‘antinomic’ structure of the manic-depressive existence can be under- stood as a malfunction of the pure ego which finds itself caught helplessly, unable to perform its normal constitutions. This leads to a distemper (Verstim- mung) which in melancholia implies anxiety and anguish (Qual), and in mania signifies flight from the task of control (Spiegelburg 15, p. 277) BINSWANGER’S INTERPRETATION OF MANIC-DEPRESSIVE PSYCHOSIS IN LIGHT OF JUNG’S THEORY OF THE SELF In Melancholia and Mania, Binswanger gives not only a wonderful phenomenological description of manic-depressive psychosis, but316 J. Cappiello McCurdy offers as well a convincing explanatory model of the disease. This model is extremely interesting to consider from a Jungian point of view. It is hazardous to compare different schools of analysis, and perhaps even more hazardous to compare philosophical concepts with psychological ones. However, certain analogies between pure ego, transcendental ego and empirical ego and their connections, with self, ego, and ego/self axis are apparent. Icis clear that a philosophy, a vision of man, is always behind every psychological theory. If we consider the vision of man behind psychological concepts, we can approach with greater authority psychological schools which at first scem to differ greatly. For example, if man is not a tabula rasa, but is born with some a priori structures, then there must be some entity which contains these potentialities. And, if there is not an a priori structure responsible for self-identity, how can the ego in the chaos of experience acquire and maintain self-identity? Considering these ideas, we can be led both to Binswanger’s concept of pure ego and Jung’s concept of self. As we have seen, in Binswanger the pure ego is a complex structure with the essential characteristics of unity and multiplicity of functions. The pure ego acts as a connecting system harmonising the transcendental experience and organising, through the transcendental ego, the empirical experience. The consequence is that everything is experienced—oneself, others, the objective world—following a pre- constituted system. This theory of the structure of the ego underlines that the ego is both a unity and a multiplicity of functions and structures; that this unity, with the transcendental categories, is given a priori; that the connections between the parts are the essential element in order for the unity to function as a whole. Relatedness between this construct and Jung’s definition of ego and self are clear. Jung has defined the ego as ‘a complex of ideas which constitutes the centre of my field of consciousness and appears to possess a high degree of continuity and identity ... not identical with the totality of my psyche, being merely one complex among other complexes’ (JUNG 5, p. 425). The self, expressing ‘the unity of the personality as a whole,’ (Ibid., p. 460) is an empirical concept, but, at the same time, a postulate, because of its unconscious components. It is further a transcendental concept because ‘it presupposes the existence of unconscious factors on empirical grounds and thus characterises an entity that can be described only in part. . .” (Ibid.) Moreover, the self is ‘the central archetype, the archetype of order’ (JUNG 9, p. 424). The concept of archetype, of course, is central to Jung’s psy- chology, and in defining the term, Jung has made extensive use of philosophical concepts. In Psychological Types, in his definition of archetype, he refers to the ‘primordial image’ whichManic-depressive psychosis 317 “gives a co-ordinating and coherent meaning both to sensuous and to inner perceptions which at first appear without order or connection... . At the same time, it links the energies released by the perception of stimuli to a definite meaning which then guides action along paths corresponding to this meaning (JUNG 5, p- 445). The archetypes are for Jung a priori structures which organise and direct the activity of the psyche. In his essay, ‘On the nature of the psyche’, Jung defines the archetypes as patterns of behaviour, and he states: ‘...he [man] has in him these a priori instinct-types which provide the occasion and the pattern for his activities, insofar as he functions instinctively’ (JUNG 8, p. 201). Later, he says: ‘We may say that the image represents the meaning of the instinct (Ibid.) And, ‘...a dark impulse is the ultimate arbiter of the pattern, an unconscious a priori precipitates itself into plastic form... . (Ibid., p. 204). The self is an archetype and, in this sense, an a priori structure. The notion of ‘a prior’’ is thus a fundamental one in Jungian psychology, as are those of intentionality and meaning. Scen in the notion of a priori structure, the self is at the same time the starting point and the goal. It is the child archetype and the archetype of wholeness. It is the centre and the totality. It is an ever-unfolding a priori. The analogies between Binswanger’s pure ego and Jung's self are evident. However, to trace these analogies does not mean to assimilate one concept to another. The notion of pure ego is essentially a philosophical one, while Jung underlines the empirical nature of the self. The self is the totality; it comprehends all the conscious and unconscious elements of the psyche. The notion of the unconscious does not even appear in Binswanger’s approach. Nevertheless, it can be said that Jung’s self is connected to the ego in much the same way that the pure ego of Binswanger is connected to the transcendental and empirical egos. Just as the pure ego gives direction and meaning to existence, the self is the archetype of meaning and order. The ego is a representative of the self. All of the history of the development of the ego is a history of relationship to the self. This relationship is expressed by the concept of the ego/self axis formulated by Erich Neumann. Jung had always maintained that the ego’s roots were to be found in the self, that the ego carly in life emerged from the self. Neumann's ego/self axis not only recognised this fact, but maintains that the ego, under optimal circumstances, retains a connecting link with its place of origin, the self. It is from this living connection that the ego receives the ongoing nourishment and grounding it needs for healthy exis- tence. Binswanger states that in the manic-depressive psychosis the integrity of the ego is preserved, but the empirical ego is disconnected from some of the functions of the pure ego. If we translate this318 J. Cappiello McCurdy conclusion of Binswanger into Jungian terms, we could say that in manic-depressive states what is altered is the relation between the ego and self; or, in other words, that the ego/self axis is damaged or broken. NEUMANN'S DEVELOPMENT OF THE EGO-SELF AXIS Neumann suggests that an infant is born into a pre-ego state, very much merged with its mother, and that the nature of this state is predominantly transpersonal or archetypal. That is, the personal mother functions and is experienced primarily according to collective, transpersonal traits and images: ‘The bond of dual union is a specific situation in which a not-yet individualised being in the pre-ego stage is joined with a transpersonally, archetypally functioning being in a unified field’ (NEUMANN 13, p. 40). The infant’s fusion experience with the mother dominates over states of separateness during the first year of life. This means, for example, that the infant’s nceds and its mother’s fulfilling them are not two distinct experiences, but are experienced rather by both as part of a whole. This experience of union, of totality between mother and child, represents the archetypal constellations which evoke in both mother and child the archetype of the self. Despite this experience of union and totality, however, mother and child in fact are separate entities. The term which most accurately describes the dual and paradoxical nature of the primal relationship as being both separate and merged at the same time is participation mystique, It is out of this paradoxical participation experience, from within a matrix of totality, that the developing infant begins to apprehend separateness and the existence of opposites. The primal relationship of the participation experience is character- ised by intense empathic warmth, loving attention and attentiveness of the mother to the needs of the child. For Neumann this Eros aspect is the essential clement of the relationship. As a totality, the relationship constellates the theme of connections. Positive Eros connectedness between self and ego cannot occur with the child alone since ego and self are not yet formed and differentiated. Only in so far as the mother positively incarnates the self for her child through the Eros aspect of the primal relationship can the developing ego consciousness ex- perience its connection to a nourishing and sustaining centre of totality. With the passage of time and the child’s growing perception of its mother in her personal reality, the latent self imago in the child grows increasingly separate from the mother’s self and becomes the child’s self. The self of the child then grows and relates reciprocally with its developing ego in accordance with the experience of theManic-depressive psychosis 319 mother-child connection, or axis, in the primal relationship. Neu- mann concludes that ‘the primal relationship is the ontogenetic basis for being-in-one’s-own-body, being-with-one Self, being-together, and being-in-the-world’ (Ibid., p. 26). Certainly the primal relationship as described by Neumann repre- sents a kind of ideal situation, not entirely corroborated by clinical observations of early child development. Fordham criticises Neu- mann’s views on several grounds, (FORDHAM 3). Neumann’s assump- tion that the mother is the child’s self especially has encountered the most vehement criticism. Here, in using Neumann's model of deve- lopment, I am interested in stressing only some aspects of it which are relevant to the theme of my paper. First, Neumann’s reference to the archetypal matrix allows for a psycho-dynamic approach to mental disorders which are otherwise labelled as hereditary or constitutional, and, therefore, not accessible to psychological analysis. Second, the concept of the ego/self axis, although it can sound artificial and mechanistic, really stresses the concept of intrapsychic connection. It is the nature of the connection that is critical: the Eros bond which characterises the relationship between mother and child is the basis not only for interpersonal relationship, but also for the intrapsychic relationship between the different structures and functions of the psyche. Neumann defines the ego/self axis as ‘an initially unconscious experience of the harmony of the individual ego with the totality of its nature, with its constitutional make-up, or in the last analysis, with the Self’ (NEUMANN 13, p. 43). When the ego has established a vital connection with its place of origin and with the ground of its being, the results for the person include high levels of self confidence and self- esteem: the self accepts itself and through self-acceptance makes contact with the rest of the world. The absence of a viable ego/self axis, however, is marked by an inability to make those connections, so that a weakened ego/self axis can lead to an ego vulnerable to depression and to many symptomatic attempts to compensate for the resulting state of rootlessness. The more severely damaged the ego/self axis, the more potential for severe pathology. Undue displacement of the ego/self axis in the direction of the self, Neumann believed, could lead to the disinte- gration of the personality due to a psychotic absorption and destruc tion of ego by the overwhelming power of the unconscious (Ibid., p. 49). But another kind of pathological development is possible if the ego becomes split off from its connecting axis with the self. In this situation the ego retains its essential identity, but, being more or less cut off from the self, manifests the accentuated rootlessness reminiscent of conditions found in the phenomenology of manic-depressive320 J. Cappiello McCurdy psychotic states. In these cases there is a loss of true orderedness of the world, with its rules of temporal sequence and natural cause and effect. Moreover, we can hypothesise that the transcendent function, as an expression of the connection between the unconscious and the con- scious, between the self and the ego, is paralysed or blocked. There- fore, in manic-depressive states, the ability to form symbols is lost, with the result that life, instead of following a natural flow, becomes, in Binswanger’s terms, extremely problematic. The antinomy melancholia-mania can be seen, therefore, as the expression of the rupture of the ego/self axis. As a consequence of the rupture, the self cannot actualise itself through the ego: it cannot fulfil its directive function or produce symbols or a synthesis through human consciousness. The ego remains suspended between two opposites of the totality, between its dark and luminous sides, oscillating between the two poles of depression and elation. Binswanger theorised that the apparent polar conditions of manic and depressive disorders derived from the same basic inability of the ego to order and give meaning to experience. Although the pure ego is still capable of self-identity, it is, however, paralysed in its directive function because the transcendental ego, with its category of time, is dysfunctional. From a Jungian point of view, I suggest further that the ego’s defect derives ‘from a severely damaged egojself axis, an expression of a failure of the primal relationship. In order to underscore further the relatedness of Binswanger’s phenomenological approach to mania~depression with Neumann’s ego/sclf developmental theory, I will now examine the myth of Dionysus as a paradigm which includes and combines both approaches. THE MYTH OF DIONYSUS To describe the aspects of Dionysus—his appearances and disappear- ances, his wanderings, his oppositions and contradictions—is to give a phenomenological description of manic-depressive psychosis. And if we look beyond description, to the origins and meanings of the myth, we discover aspects which enhance our understanding of the illness and its psychodynamics. THE NATURE OF DIONYSUS Dionysus is the god of dual aspects, of paradoxes, the god in whom the opposites find the greatest expression. He was born twice: first from his mother, then from his father. He is the only son of Zeus and aManic-depressive psychosis 321 mortal mother. He is the god who appears and disappears, who comes and goes, who gives both intense joy and terrible suffering. Remnants of Cretan cult practices illustrate very clearly the dual nature of the god. The first year of the Cretan ritual cycle was of that of the god’s absence: Dionysus chthonios, the subterranean Dionysus whose creative powers germinated underground, was called to awaken by his worshippers until his epiphany, which marked the beginning of the second year of the cycle. During the second year, Dionysus is now the god of all living creatures, rousing all beings to life. He arrives with his Bacchantes, carrying an explosion of excite- ment which culminates in death and dismemberment. In Athens, this cycle was condensed to one year. In both aspects (above and below, creative and destructive) Dionysus was the ruler of the whole year. His disappearance and withdrawal in silence is as important as his epiphany. During his apparent absence, he is in the depths of the sea or in the underworld; but, no matter how remote, when he emerges, his presence is felt immediately and overwhelmingly. His arrival creates among the women waiting for him frenzy, passion, music, dance, unbelievable noise. However, as Walter Otto notes, ‘there is nothing which reveals the supernatural meaning of the incredible noise- making so well as its counterpart of deathlike silence into which it suddenly changes (Oto 14, p. 93). ‘Indeed,’ Otto continues, ‘melan- cholic silence becomes the sign of women who are possessed by Dionysus’ (Ibid., p. 94). Dionysus is the god of ‘infinite rapture and infinite terror’ (Ibid., p. 145). In Euripides’s play, The Bacchae, the Bacchantes fall into hushed silence of deep despair when Dionysus leaves them: the joy, the life that Dionysus brings, along with creative energy and unlimited strength, leaves an unbearable void when it departs (EuRIPrpes 2). So the energy of mania turns into the emptiness of despair. The creative power can also be blind and turn, suddenly, without awareness, into destructive power. In a state of frantic excitement, Agave, in The Bacchae, runs to the mountain to honour Dionysus and unconsciously kills her son, thinking him to be a lion. The lack of awareness is similar to the absolute denial of the manic patient, as is the energy turned to violence. Water and fire powerfully symbolise the paradoxical nature of Dionysus. They are creative, but they become symbols of death and destruction when out of control. Water and fire, therefore, can very well symbolise the depth of depression and the burning exaltation of mania. Like his symbols, Dionysus brings life and death, creativity and unconsciousness. Disrupter of lives, god of polarities, he stands as an apt symbol for the paradoxical suffering of the manic-depressive.322 J. Cappiello McCurdy ORIGINS AND MEANINGS OF THE MYTH Dionysus’s father was Zeus, his mother Semele who perished in Zeus’s lightning. Zeus sewed Semele’s unborn child Dionysus in his leg until it was time for his birth. After his birth, Dionysus was attended by a series of nurses. Dionysus’s loss of mother is critical to the development of the myth. Semele is at the centre of Dionysus’s life, of his desire for revenge, of his deep frustrations, and of his sorrow. The myth tells of his almost obsessive relationships with women— with nurses, and the Menads, whose main function is to nurse the god. Women who are mothers and nurses appear again and again in the stories about Dionysus. On the one hand, Dionysus secks revenge against the women in his life; on the other, again and again he looks to reconcile and merge with them in ecstasy. Separated from his mother from the beginning, Dionysus never experienced the state of bliss of the primal relationship, the wonderful experience of Eros-contact which creates connection and avoids separateness, and which leads, according to Neumann, to the creation of the solid ego/self axis. Dionysus’s birth, then, can be seen as symbolising the rupture of the ego/self axis, and his dual and paradoxical nature is the consequence of this rupture. And his obsession with women, with mothers and nurses, can then be seen as a frantic attempt to repair the break, to experience the primal relation- ship he never had. Aspects of the myth do indeed reveal several possibilities regarding means of experiencing the unitary reality missed because of the failed primal relationship. For example, wine, intoxication and ecstasy, which are always associated with Dionysian rites, can be seen as means of attempting to recreate a totality experience. From a clinical point of view, we can then better understand the association of manic- depression with drug and alcohol abuse. A more significant redemp- tion occurred when Dionysus was assimilated into the Eleusinian Mysteries as the divine child. The goddess of death (Brimo-Demeter/ Kore) bore a son in the fire (Dionysus) (NEUMANN 12, pp. 318-320). As divine child of the Mysteries, Dionysus now emerges directly from the womb; his rebirth is a product of a loving relationship between Demeter-Persephone, the original feminine matrix. Semele’s failure has been repaired. The story of Ariadne also symbolises another possible successful resolution of the fate of Dionysus. The content of all the various Ariadne myths is that she is abducted and must experience terrible sorrow, which then alternates with joy and bliss. Ariadne, as Diony- sus’s bride, thus becomes another symbol of the ecstasy, suffering andManic-depressive psychosis 323 death which are associated with Dionysus. But in addition to these aspects relating to Dionysus, Ariadne also has the shining crown (given her by Dionysus) and the thread, both of which allow Theseus to find his way out of the labyrinth. These two symbols differentiate Ariadne from the rest of Dionysus’s women and scem to indicate a two-way connection: the thread connects consciousness to uncon- scious, and the shining crown lights the way from below to above. Therefore, Ariadne symbolises connectedness, relationship among different realms of the psyche. She thus personifies the Eros-contact element of the primal relationship. As the bride of Dionysus, Ariadne supplies the god, the symbol of self, the Eros-contact clement necessary for the self to actualise itself. Ariadne, who bears the shining crown and the thread, thus personifies the ego/self axis. We can see that some aspects of the myth can be interpreted as an attempt to constellate the primal relationship, to experience the unitary reality never experienced and to create a unio oppositorum. Some of these attempts, such as those associated with wine, drug intoxication and ecstasy, are ephemeral and dangerous because of the Jack of awareness and the state of fusion which accompanies them. Others, however, such as the experience of rebirth in the mysteries, and the marriage to Ariadne, can represent real possibilities of transformation and the synthesis of opposites. CONCLUSION Ludwig Binswanger described the disordered world of the manic- depressive in terms of an ego dysfunction deriving from the lack of connectedness between the normally unifying pure ego with the a priori transcendent categories of the transcendent ego and the ex- perience of the empirical ego. Having shown the correlations between Binswanger’s complex ego construct and Jung’s ego/self construct, we can move beyond a pure phenomenological description of manic- depressive psychosis and propose an explanation of the manifestation of the disorder in the rupture of the ego/self axis which Erich Neumann described as product of the primal relationship. The inter-relatedness of Binswanger’s, Jung’s and Neumann's approaches is underscored by an interpretation of the myth of Dionysus as an archetypal paradigm which describes and illuminates mania-depression, its psychodynamics, and further suggests possible outcomes. In his polarities and extremities revealed in the various versions of his story, the mythic Dionysus descriptively mirrors the manic-depressive patient Binswanger encountered in his clinical prac- tice. In his unfortunate beginnings, Dionysus enacts an archetypal version of the failed primal relationship, with the resultant swings324 J. Cappiello McCurdy between the opposites and inability to find the centre. And with his role as divine, reborn child in the Eleusian Mysteries, and bridegroom of Ariadne with her Eros-connected possibilities of redemption, Dionysus suggests ways to regain unitary reality. Understanding the manic-depressive patient in the light of these perspectives has various clinical implications. For example, as Bins- wanger noted in his cases, external stressing factors are generally present prior to the manifestation of the depressive, and even manic, symptoms. Although these stressing factors are not considered causa- tive, their importance could be understood in terms of further decompensating an unstable balance. The stressing factor calls for a new adjustment of the ego/self axis, for a new orientation and direction. Naturally, these tasks will be extremely difficult, if not impossible, for an unstable ego/self axis. 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