Bipolar Mood Disorders

Dr. David Trappler

Psychiatrist & Jungian Analyst

We all have moods that affect our functioning to some extent. We can feel energised and creative and then slow and irritable or even a bit negative. But when fluctuating moods or changes in psychic energy become a regular part of our lives to the extent that they interfere with our quality of life, or impair our social or occupational functioning, it may then be that we are on the spectrum of a “bipolar mood disorder.”

Some are mild, some severe, but the most important aspect of these disorders, is that everybody who suffers from them, has a different experience. One can look up the symptoms outlined in a psychiatric diagnostic manual, but the type and extent of mood swings and their response to treatment, is unique to each individual. The milder forms of bipolar can still be disruptive to adaptive levels of functioning and the severe forms may even cause a rupture with “reality”, by manifesting in inappropriate behaviour due to “impaired judgement” or psychotic features.

Treatment should be with the minimum effective dose of a mood stabiliser, perhaps together with one or two other medications, depending on the various symptom manifestations. The medication should be carefully titrated to meet the individual’s particular sensitivity to psychoactive drugs and also to the degree to which pharmacotherapy is needed at all. Over-medication is a frequent mistake made by overzealous psychiatrists trying to “normalise” people by applying drugs to “straightjacket” them in order to appease family members and societal norms.  “Dulling the patient down” with drugs, and slapping a medical diagnosis on their “offensiveness” is seen by society to be the responsible response to a patient’s change in energy and behaviour.

Marie Louis von Franz’s made a very sad but true statement when she said: “madness is not what you may be thinking, but rather who you share your thoughts with.”

Sometimes, the person goes into the “madness” of the “underworld” or the unconscious processes. It is as if there is a blurring of the boundary between the unconscious and conscious contents of the mind or “psyche”.

Such an individual may then behave in accordance with the truth of that symbolic “other” reality. Here we need the psychiatrist and psychologist to diminish the porousness between the unconscious and conscious contents of the psyche, by using medication and psychotherapy. Excessive or diminished psychic energy and mood swings can disrupt this boundary, and this may result in socially inappropriate or even disruptive behaviour.

If the individual having these excursions into another reality, has a good social support system and a a good relationship with a "de-institutionlised" mental health carer, then hospitalisation may be unnecessary.

With the psychiatrist available daily, and a supportive family being prepared to temporarily adjust their normal life routine, for the patient’s containment, without fear or prejudice, and with psycho-education, the episodes will resolve.

As soon as possible, psychotherapy must be introduced into the treatment process, for both the patient and the family.  Therapy varies from psycho-education, various forms of behaviour therapy, to more in-depth psychotherapy. The purpose is to give the patient insight into themselves and for the family to learn that they too need to understand certain family and intra-psychic dynamics, hitherto not understood.  

I have yet to meet anyone that couldn’t benefit from looking at their own coping mechanisms and how their own defensive manoeuvres, avoid self-development. It seems easier, as we all know, to use the other person as an alibi to avoid self-reflection. Isn’t it infinitely less threatening to label the “other” as “sick” rather than to examine one’s own idiosyncrasies, personal problems and the frightening relativity of “reality” and “normality”.

This in no way is trying to diminish the hugely disruptive effects that mood swings can bring about to a person's family or social milieu.

When the situation becomes more contained, the patient becomes more cooperative, and better equipped to regulate their own medication in discussion with the professional.

It may be, that one notices seasonal aspects to the condition, so that one can take less or more medication at various times of the year, but also changing social and psychological circumstances can be monitored carefully and factored into the treatment, thereby avoiding any relapse.

Self-knowledge, attained through psychotherapy equips one to communicate properly with others, and to understand what emotions are activated internally and what  “triggers” are set off by others.  

In a close working relationship with the therapist, one can pre-empt a relapse or know when the mood shifts are due to stress, and can better be managed psychologically, rather than by always increasing the doses of medication.

It is a challenge to have a mood disorder of any kind, but I am always reminded of Jung’s quote, that the “divinity may first become manifest in morbidity.”

What I understand by that, is that unconscious factors reveal themselves to us unexpectedly, and offer a chance for psychological transformation and the creation of a new self-awareness or consciousness. Jung used the word “divinity”, because he regarded the unconscious processes as being mysterious and being able to bring about creative transformations in us all. His study of mythology, where in ancient cultures people worshiped and propitiated deities, for example the Goddess of Love and God of War, brought him to understand the power of unconscious processes that could overwhelm one. He later called these projections, the archetypes.

I believe that I am deeply influenced by my biometrics, my family dynamics, my early childhood experiences and traumas, by factors like economics, race, culture, religion and geography. However, one can and must transcend these deterministic forces to abide by a compelling force within, and that is to realise ourselves as the unique beings we are capable of becoming.

In fact, working with the problems we face, offers a teleology, that makes us find, that through the suffering and resistances we encounter, something new is born within us. It feels like an old friend has finally showed up, that only I was too ashamed to introduce. I have had him hiding in the cellar, out of shame and and fear of rejection or disloyalty to others. Bringing these "split off" parts back into ones personality is the beginning of individuation.

Given these ideas, one should never be defined by the fact that one has a “mood disorder,” any more than that we should be defined by our skin colour, height, weight  or family background. We are born as individuals, and in my experience we must learn to live out our truth.

This experience is called individuation, which is different from the more modern western notion of self-actualisation, which for me carries self-indulgent connotations.  

A patient is not a “Manic Depressive”, but rather a person on the bipolar mood spectrum, and as consciousness and "psychological mindedness" develops, the influence of the mood disorder becomes less disruptive or burdensome.

Not only does the patient have an opportunity to grow through the disruptions in life brought about by mood swings, but the family can too, if not indoctrinated into the binary thinking of the medical model, where people are either considered “sick” or “healthy”.

More Notes of Interest
Alcohol Abuse
What one tries to achieve with patients who drink too much, is to encourage them to have a more conscious relationship with alcohol. I have great respect for the 12-step programme, but one needs to refrain from a “one size fits all” approach when dealing with the complex issue of people’s relationship with alcohol.
Cocaine Abuse
Cocaine has become a ubiquitously used drug amongst the higher earning strata of our population. It starts off for recreational purposes, to enhance energy, social chatter and intimacy, but eventually develops into a serious problem for all regular users. Its frequent use is unsustainable, resulting in devastating problems.