In this chapter, I am hoping to explore the inner world of a patient suffering from bipolar affective disorder (BPAD), here referred to as manic-depressive illness. Psychiatric research strongly suggests the existence of organic pathology in bipolar affective disorder. (McGuffin et al.’s [2003] genetic studies show marked heritability associated with bipolar affective disorder. Farmer, Eley, and McGuffin (2005) recently emphasized that what is inherited is a genetic vulnerability that then requires certain environmental factors to trigger genetic transcription. Haldane and Frangou (2004) used neuroimaging technology to suggest there are permanent structural brain changes associated with the disorder. Savitz, Solms, and Rajkumar (2005) neurocognitive studies illustrated deficits in both the acute and remittance phases. Psychoanalysts such as Fenichel (1945), Jacobson (1971), and Loeb and Loeb (1987) have also argued biological factors to be causative in mania.) This chapter is not entering into an either/or debate; organic vs. psychological. It is hoping to explore the psychic life of a patient suffering from an organic disorder. I am also not hoping to make generalized 62statements about the inner world of BPAD in general; it is an exploration of the psychic life of one case. The only generalized comment which would be applicable is the obvious one, in that all patients suffering from so-called organic conditions or mental illness still have a psychic world populated by internal objects and object relations, which play a role in how the condition is expressed and, indeed, are influenced by the condition itself. Even though someone may be in need of psychiatric intervention and medication, it does not preclude the fact that the person has a rich inner world, exploration of which would hope to bring meaning and hence containment.