Manic-depressive psychosis: Psychopathology and individual psychotherapy within a psychodynamic milieu

SUMMARY

Manic-depressive patients are not usually regarded by psychiatrists as suitable subjects for psychotherapy, and there are many reasons for this view. Psychological support tends to take the form of helping the patient adjust to his disability, to become more aware of the life situations which may disturb him, of warning symptoms, of the need for appropriate medication, and perhaps to explore the most significant life conflicts. Psychoanalytic psychotherapy aimed at conflict resolution and personality development is widely regarded as impracticable, or ineffectual at best, or, at worst, as a potentially dangerous intervention. Considering the fact that the risk of suicide in the depressive phases may be so great, the problems of containing the disinhibited manic episode so serious, and the social consequences of such episodes so disastrous, it is not surprising that pharmacological control of pathological symptoms is so often regarded as the only therapeutic aim.

This paper is based on an account of a single patient suffering from a severe manic-depressive disorder with schizoid features, and a family history of manic-depressive illness, who was treated with individual intensive psychoanalytic psychotherapy in a context of a psychodynamic psychiatric ward, with encouraging results. Some implications of this experience will be discussed.