The following correction was printed in the Guardian's Corrections and clarifications column, Saturday May 12 2007
We used the pseudonym Dr Niall Quinn in the article below. The article contains a footnote advising that names and details had been changed. In case there is any doubt we would like to make clear that the doctor in the article was not Professor Niall Quinn (formerly Dr Niall Quinn) who is emeritus professor of clinical neurology at the Institute of Neurology, UCL, and honorary consultant neurologist at the National Hospital for Neurology and Neurosurgery, Queen Square, London.
Though the west of Ireland has some of the highest rates of mental illness in the world, Niall's family still managed to draw its unfair share. His father had two breakdowns, his mother and brother have suffered from anxiety disorders, his sister had acute depression, and he is himself a manic depressive. Yet the remarkable feature of his family, Niall says, is that it appears to have not just a predisposition to psychiatric illness, but also an innate ability to get better.
Niall was around 10 when he first hatched the idea of becoming a doctor, having suffered from wild nightmares after his father's first breakdown in London. Though he was treated by a paediatrician, the nightmares were put down to his being "imaginative". To his parents, who'd had little education in 1940s County Clare, the idea of their son being a doctor in England seemed inconceivable and extraordinary but, at the same time, somehow possible. For Niall, the notion of doctoring struck him as a means of "managing disaster".
The trials of being Irish immigrants in London at the start of the Troubles prompted his parents to return home to Ireland, but Niall stayed on through medical school. With success, and pressure, he began to acquire a near-religious feeling that he was capable of anything. By the time he started as a GP, he had come out as a gay man, was giving psychiatric treatment to HIV patients, working with men in prison, attending counselling courses, reading philosophy, studying construct psychology, writing poetry and doing life-drawing classes at Central Saint Martins art college. He was, he told friends, "either going mad, or moving on to another level".
It turned out to be the former. In fact, Niall now describes the onset of his first manic episode, and its delusions of transcendence, with revulsion - as if he were vomiting up a luridly grandiloquent sense of self. He woke up at 4am one morning, overwhelmed by fear that he was in grave danger in Britain, where the hierarchies of society would strangle him and where, if he spoke the truth, he would die like a martyred saint. The only way of describing his experience of mania, he says, is as a form of religious ecstasy and agony.
After a short period of treatment in London, aged 31, he went on holiday to Dublin where he blazed his way through parties attended by the likes of former Taoiseach Charles Haughey and art gallery openings where people greeted him like a babbling genius. While he has little doubt that he was being driven by illness, Niall also ascribes to his first manic episode a kind of psychic flight from family, class and identity into a bubble of perfection - "a bubble of yourself that only has in it the bits you overvalue: being witty, articulate, sexual, rich, magnificent".
It was like an explosion of the self, he says. "This illness isn't on me like a rash - it is me."
In a moment of insight, he went home and took himself to a psychiatrist in Kilkenny, saying, "I'm not a genius, I need lithium." For the next three months, he slept in a room with his mother. When he woke, he would see her near him and, assured of her love, found himself beginning to put back the pieces.
The streak of fortune in Niall's illness was that its onset occurred after the infrastructure of his life was already in place: he had his training, his qualifications, a job, an apartment. Returning to work in London, he struggled against what he calls his "arrogant and relentless" pursuit of meaning.
His salvation, he felt, lay in embracing the ordinary. And, for that, Niall had the right job. "I look at a child's verrucas, at people whose lives make your jaw drop with horror, at Mrs Davis's dodgy feet," he says. "Am I going to solve the mystery of the universe? No, shut up. I've got to look up Mrs Jones's bottom, and no one will be applauding - there's no gallery!"
Since his first major episode, his colleagues have remained unaware of his episodes - both manic and depressive - and he has not missed a day of work. His own experiences provide insight into his mentally ill patients, but he is cautious not to share them with other sufferers in the clinic. Patients need the assurance of professional sympathy, not the clasp of empathy.
When it comes to the meaning of being a GP, Niall talks about humility. And then he laughs because, in rejecting the grandiloquence of his manic self, he still turns to religious language. "All those thousands of clinical encounters are in some way about what it means to be alive," he says. "But I'm not going to discuss that with a patient who just wants something for a verruca."
· Names and details have been changed
