Existential despair and bipolar disorder: the therapeutic alliance as a mood stabilizer.
ABSTRACT Talking with a manic patient is not easy, but it is also not hopeless. Manic patients are hopeful, ever hopeful, and indeed often too hopeful. But their hopes and dreams, however big, are usually brief and soon damaged by the realities of life. Ultimately, most patients with bipolar disorder become chronically depressed, denied of their hopes by others. Appropriate medication treatment is necessary, but not sufficient, for many such persons. The job of the clinician is twofold initially: first, to seek to existentially be with manic patients and then, to counterprojectively give perspective to those patients about their manic worldview, without completely denying it. This twofold approach then can lead to a healthy therapeutic alliance, which itself has a mood-stabilizing effect. Along with mood-stabilizing medications, this alliance can then lead patients toward full recovery. Put more simply, clinicians need to talk to manic patients about their hopes, to explore the limits of their grandiosity without judging it, to seek out their strengths and to validate them. They also need to go where the patients are, to encounter patients and find the person beneath the illness, to provide a strong relationship, an alliance that cannot be shaken, to conflict with the patient sometimes and not at other times. It is a tall order, and one not infrequently avoided. Yet the times seem to call for a return to actually talking with manic patients, and maybe curing them with such talk. Or perhaps that is grandiose.
SourceAvailable from: Paul Alfred Vöhringer
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ABSTRACT: Diagnosis of depression has low reliability (kappa = 0.28) due to "covert heterogeneity," making the identification of sub-types a focus of research. Very high rates of moderate or sub-threshold depression among adolescents (35-45 % beyond the 20-25 % with MDD), prompt consideration of a potential sub-type of moderate sub-threshold depression, linked to adolescent development. Previously, developmental depression (DD) has been proposed as sub-type of moderate depression that is a normative developmental process of spiritual individuation, the integration of existential and spiritual experience. DD as a potential sub-type is supported both by clinical observation and by an emerging body of research identifying a common physiology to underlie both depression and spirituality (neurotransmitters, structural MRI and long-term clinical course), as well as research showing a surge of spirituality in adolescence (concomitant with window of risk of depression). We test for unique patterns of comorbidity and neural correlates as support for a sub-type. Based upon existing literature, we propose that DD will be (1) associated with the unique neural correlate of increased volume in the occipital region and (2) co-morbid with symptoms of affected regulation and processing. A sample of 125 adolescents (64 girls and 61 boys; ages 15-19 years) from the larger National Institute of Health Magnetic Resonance Imaging (MRI) Study of Normal Brain Development (Evans in Neuroimage 30(1):184-202, 2006) was assessed using the Cloninger Self-Transcendence Scale to examine correlates of sub-threshold mild to moderate symptoms of depression. Findings lend support to the possibility of a DD. Sub-threshold depression was associated with greater volume in the occipital region, as well as comorbidity with symptoms of affected regulation and processing (mania, ADHD, anxiety). By contrast, in adolescents with a low level of transcendence, sub-threshold depression was associated with conduct disorder and heavy substance use, both of which previous research have found to be associated with low levels of personal spirituality.Journal of Religion and Health 04/2015; 54(3). DOI:10.1007/s10943-015-0047-0 · 1.02 Impact Factor
The Psychiatric clinics of North America 03/2012; 35(1). · 1.87 Impact Factor