bipolar

[Adam Blatner]

 The discussion copied by Joann about bipolar reveals the turbulence in the field. Before the 1980s, the idea of bipolar disorder happening to kids (earlier than mid-teens) was considered quite rare, and even the diagnosis of Borderline Personality Disorder was not widely used, especially for (again) kids.
     Another turbulence: The difference between nomothetic research (generalities about statistsical groups---which dominates much of modern academic practice) and ideographic research (the case study, making a meaningful story about the many particularities of a person's life story). 
      The problem with ideographic research is that it was overly associated with psychoanalysis, and that field is in turn overly associated with some major errors in the field---as described in the book, "Madness on the Couch." 
      The trouble is that in the 1950s-early 60s, psychoanalysis over-diagnosed, and treated schizophrenia, autism, and other conditions as caused by family dynamics. Evidence has accumulated to discount these views, but the shift away from psychoanalysis should not, in my opinion, be allowed to discount the general idea of seeking to understand and give proper weight to the story-nature of pathogenesis (how problems arise). 
       In other words, reading questions and answers and the general discourse about bipolar disorder reinforces my thinking that we need a good formulation in each case. (On my website is a paper on the art of case formulation, and the hundreds of factors that need to be woven into the creation of a plausible life story.) We need to weigh strengths as well as weaknesses, and identify the actual meanings of events as experienced by the client (i.e., the existential-humanistic approach) (in contrast to thinking in terms of categories devised by professionals who may not be in contact with the individual client). This isn't just Freudian, but the whole mixture of depth psychology approaches plus humanistic psychology approaches---both of which have been pushed to the periphery by trends in biological psychiatry. (While I respect these, they, too, seem to have overshot their proper role in the work.)

     Going back to Bud's original email, I'm not sure what kind of help you are asking for, Bud, since it seems as if you have lined up at least one resource and perhaps several others in which you have a good deal of faith. So the next step would be to see what they (i.e., the docs at Windhorse?) have to say. My approach, if I had been called in consultation, is to take a good history. This is a more comprehensive task than it might seem, involving sources that include the patient, family members, and others. When finished, if there are still questions, before proceeding to various psychological or medical tests, get a consultation, come up with more questions that hadn't been asked, and take the history again. 
          Warmly, Adam 
        
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