A psychoanalytic interpretation of bipolar disorder

Abstract

The author proposes viewing mania as a form of defense against the state of depression resulting from “narcissistic overidentification with the depressive object” (i.e., the object in relation to which the depressive state developed), rather than as a periodic rebellion against such an internalized object. An account of the analytic psychotherapy of a clinical case of bipolar depression serves to illustrate this point of view, linked to the author’s specific conception of the dynamics of depression.

Key words:

• bipolar disorder, mania, identification

Author

Giancarlo Ventimiglia, PhD, is a full member of the SIPRe (Società Italiana di Psicoanalisi della Relazione), IFPS (International Federation of Psychoanalytic Societies), and IARPP (International Association for Relational Psychoanalysis and Psychotherapy). He lives in and is in private practice as a psychoanalyst in Pisa, Tuscany, Italy. He has a relevant interest in research in psychoanalysis.

Notes

1 By the term “identification,” I refer here to a broad concept of internalization, including both the coincidence and the relationality of the internalized object, with the self as the subject.

2 Rado admitted the possibility of double identification, of the ego and the superego, with a lost object. His attributing a definitively good quality to the latter (superego) and a bad quality to the former (ego) did not, however, consider any possible variation of their relative significance over time.

3 This is a concept that can be applied fruitfully alongside Eissler’s (1953) ”parameter,” as a form of procedural or implicit analytic intervention (suitable for a particular psychopathological area or for a certain stage in the analytic therapy), based on the analyst’s perception of his or her own countertransference and insight into the total transference situation, which does not, however, require any subsequent specific verbal formulation.

4 Such a dynamic of identificatory inversion has been described, albeit in different terms, by Anna Freud (1937) as identification with the aggressor with simultaneous role reversal, and by Klein (1946) as projective identification with object introjection.

5 Drugs that, in synergy with psychotherapy, become our best allies if and when certain extreme symptoms can be controlled through them, but are certainly not so if they are thought able by themselves to resolve psychic disorders of a certain severity by acting on the structure of these.