MAD Theory and Conservative Psychotherapy: A Detailed Exposition — 2026-3-8
A Proposal for Conservative Psychotherapy Based on the M-Unit Injury and Regeneration Model: An Integrated Perspective from MAD Theory and Sick Behavior
2026-3-8
Author: Tadashi Kon :Shinagawa Psychosomatic Clinic
Keywords: MAD Theory, M-Unit (Manie cells), Sick Behavior (SB), Primacy of Mania, Conservative Psychotherapy, Self-Elimination Program
- Foreword: Reconsidering “Intervention” in Contemporary Psychiatry
- Chapter 1: Redefining Pathology Through MAD Theory
- Chapter 2: Diurnal Variation and the “Toxicity of Sleep”
- Chapter 3: The Theoretical Basis of Conservative Psychotherapy
- Chapter 4: Ethical Intervention in the Self-Elimination Program (Suicide)
- Chapter 5: Application to the Manic-Depressive Spectrum and Reset Therapy
- Concluding Remarks: Redefining the Role of the Psychiatrist
Foreword: Reconsidering “Intervention” in Contemporary Psychiatry
In contemporary psychiatric practice, “active intervention” — aimed at early social reintegration and cognitive modification — has become the mainstream approach. However, in the clinical setting, one frequently encounters situations in which precisely such interventions prolong the pathological state and heighten the patient’s agitation. We ought to reconceptualize the essential nature of mental illness not in terms of “mood,” a subjective indicator, but in terms of the dynamics of functional units within the brain.
In this paper, centering on the “MAD Theory (M·A·D Unit Model)” proposed by the author, we comprehensively describe the full spectrum of mental illness, and present the theoretical and ethical grounds for “Conservative Psychotherapy” as the conclusion to which this framework leads.
Chapter 1: Redefining Pathology Through MAD Theory
1.1 The Three Functional Units and the Primacy of Mania
Mental activity is constituted by the equilibrium of three systems: the M-Unit (Manie cells), the A-Unit (Anankastic cells), and the D-Unit (Depressive cells).
This theory is founded on the “Primacy of Mania,” holding that prior to every state of “depression,” there exists, at some level, an overactivation (crisis state) of the M-Unit. In response to a “crisis” — whether viral infection, psychological conflict, or endogenous elation — the M-Unit (manic drive, optimism, activity) operates at full capacity, and it is the “injury” sustained by the M-Unit itself through this overload — both functional and physical damage — that constitutes the starting point of onset.
1.2 The Dual Function of the M-Unit: Activity and Sleep
The M-Unit not only drives activity but also supplies the “sleep-inducing component” necessary for the brain to repair itself. When the M-Unit sustains injury and freezes, activity ceases simultaneously, and the capacity to put the brain to sleep is lost. At this point, the D-Unit (depression, defense, sick behavior), now stripped of inhibition, becomes exposed. This is the true nature of clinical depression.
(A note on this section: the distinction between the insomnia of the manic state and the insomnia of the depressive state becomes a relevant issue here. The M-Unit encompasses two functions: (1) generating vitality, and (2) inducing sleep at night. The component of “(2) inducing sleep at night” is maintained so long as the M-Unit is present. When the component of “(1) generating vitality” grows excessively strong — stronger than the “(2) inducing sleep” component — the result is a state of absorption without sleep. This is the insomnia of mania. In contrast, when the M-Unit has once come to a halt, the “(2) inducing sleep” component also disappears, producing the insomnia of depression.)
1.3 The Time Axis: The Process of Regeneration
Just as a wound on the skin requires time to heal, the regeneration of a damaged M-Unit requires biological time. From clinical observation, this period of regeneration ordinarily takes two to four months. During this period, the dominance of the D-Unit is an adaptive response serving as a “biological scab (sick behavior)” that protects the injured M-Unit. This is comprehensible as Sick Behavior (SB).
Chapter 2: Diurnal Variation and the “Toxicity of Sleep”
The “worst feeling in the morning” characteristic of depression is explained by the dynamics of the M-Unit during sleep.
1. Nocturnal destruction (autophagic process): During sleep, a process normally operates to organize and dispose of unnecessary M-Units. However, in the depressive phase, when the M-Unit is already injured, this process functions as “further destruction” directed at the M-Unit, and the degradation of M advances throughout the night.
2. The worst feeling in the morning: As a result of M having been minimized over the course of the night, the moment of waking in the morning is the state in which the D-Unit (pessimism, self-reproach) is at its most relatively exposed.
3. Recovery during the day: External stimuli during the day — exposure to morning light, interaction with others, and other such inputs — gradually regenerate the M-Unit. The easing of mood in the evening is the result of M having recovered slightly through the day’s stimulation, with D consequently being suppressed.
Chapter 3: The Theoretical Basis of Conservative Psychotherapy
On the basis of the MAD Theory set forth above, we propose “Conservative Psychotherapy.” Its rationale lies in the ethical and biological imperative to “not impede” the regeneration of the M-Unit.
3.1 The Active Choice to “Wait”
The depressive phase is an “infrastructure reconstruction period” during which the M-Unit regenerates. It is a period of cellular repair and network reconstitution. To engage in forced cognitive restructuring or encouragement during this period is equivalent to scraping skin that has not yet formed, widening the wound.
Conservative Psychotherapy is not mere neglect; it is an intensely active form of medical intervention — “enduring and protecting, together with the patient, the biological period of two to four months required for the M-Unit to regenerate.”
3.2 Management of the Threshold of External Stimulation
External stimuli during the day — light, conversation, activity — serve as “fertilizer” for the M-Unit. However, if their intensity is excessive, there is the risk of burning out the M-Unit yet again in the course of regeneration, precipitating a manic switch or worsening. The role of the psychiatrist is to become the “tuner of the environment,” managing this threshold of stimulation appropriately — preventing manic switch and controlling mixed states.
3.3 Management of the A-Unit (Compulsive Maintenance)
The A-Unit governs the homeostasis of the system, but during the depressive phase, as M has disappeared, A becomes relatively prominent by contrast. As a result, compulsive behaviors and thoughts may arise. In Conservative Psychotherapy, it is important to quiet this idling of the A-Unit and to assure the patient that “now is the period of safely resting in accordance with the D-Unit (sick behavior, the scab).”
Chapter 4: Ethical Intervention in the Self-Elimination Program (Suicide)
Within MAD Theory, suicidal ideation is positioned as a “bug in the collective survival strategy” brought about by the D-Unit.
1. Cost calculation of a gregarious animal: Convalescence (SB) entails the cost of consuming the resources of others. In a brain from which the M-Unit (optimism, the suicide-stop signal) has disappeared, the D-Unit activates a merciless evolutionary self-elimination program: the calculation that “the departure of the self raises the probability of the group’s survival.”
2. The physician’s duty: This program is a “temporary bug” that disappears when the M-Unit recovers. Therefore, the psychiatrist bears an absolute obligation to “physically and ethically stop, from outside, the runaway of the D-Unit until the M-Unit regenerates.” This is the ethical pillar of Conservative Psychotherapy.
3. It is generally said that suicide is not carried out at the peak of depression, but tends to occur at the point when depression has lifted to some degree and the capacity for action has returned. From my position, this is understood as follows: in the process of M-Unit regeneration, a mixed manic-depressive state is temporarily established, at which time the D-Unit supplies suicidal ideation while the M-Unit supplies motivation toward concrete action. When these two align, a suicide attempt results. It is vital that the therapist navigate this period together with the patient.
Chapter 5: Application to the Manic-Depressive Spectrum and Reset Therapy
Because MAD Theory is grounded in the Primacy of Mania, it is capable of explaining the full spectrum.
Bipolar disorder: The mechanism of onset can be understood from premorbid character.
The positioning of ECT and ketamine: These constitute “reset therapies” — forcibly interrupting the nocturnal M-Unit destruction loop and physically rebooting (re-igniting) the frozen M-Unit. However, in most cases, even if M recovers abruptly and temporarily, the environment and interpersonal relationships remain unchanged, and the individual’s own character tendencies do not change; therefore, the risk of relapse is also considerable. Conservative Psychotherapy adopts conservatism as its approach. There are those who ardently desire to “just get through this one time,” but it is precisely the repetition of that very attitude that has brought about the present situation.
Concluding Remarks: Redefining the Role of the Psychiatrist
MAD Theory and Conservative Psychotherapy transform the role of the psychiatrist — from the former image of “an instructor correcting distorted cognition” to that of “a gardener who watches over and safeguards the process of life’s regeneration.”
The two to four months of depression is a sanctuary necessary for the human being to once again recover “the power to sleep (M)” and “the power to be optimistic (M).” We ought to respect that period, protect the individual from the runaway of the M-Unit and D-Unit in the manic-depressive mixed state (suicide), and await the natural regeneration of the M-Unit — using the day’s external stimuli as fertilizer. This, we are firmly convinced, is the most compassionate and scientifically grounded psychiatric medicine, underpinned by biological and evolutionary evidence.
(Author: Shinagawa Psychosomatic Clinic — Free Memorandum – Tadashi Kon 2026-3-8)
