An opportunity arises to consider the role that analytic thinking has to offer in the area of bipolar affective disorder or recurrent manic-depressive states. In manic depression, the psychotic part is dominated by a deadly drive for an omnipotent fusion with God and treats sanity, as advocated through the non-psychotic part, as its life-long rival. Facing up to the management of manic-depressive states truly invites a synthesis of the organic and the inner world, and Trudie Rossouw’s presentation has truly provided such an opportunity for reflection in this challenging area. As Dr Rossouw points out, analytic observations allow people to observe the recurrent process in a unique way as it unfolds within the patient’s inner world. Dr Rossouw decided first to try to make contact with the patient’s non-psychotic reflective part. He then decided to be more robust and actively confront the psychotic part and take up the destructiveness.