For me, doing the right thing requires pills. Come the first episode after moving to the States I had neither pills, nor a doctor. The first doctor I was referred to believed that the best treatment for mania was for me to talk to him once a week for an hour—no pills, no hospital, no basket to weave, just one session a week of talking to him. He didn't even talk to me, just me talking to him. This was actually harmful because it let the mania develop fully before any effective treatment was given. The men in white coats came.
Recognizing Episodes Early
"Because of their biological bases, you can't fully prevent future manic or hypomanic episodes from occurring altogether. But you may be able to control how severe they get and limit the damage they cause. You can learn to 'head them off at the pass' by recognizing when they are starting to occur, and then putting into motion plans for preventing yourself from spiraling upward even further."
David J. Miklowitz, "The Bipolar Disorder Survival Guide."
The earlier a manic episode is recognized, and the earlier effective medication is taken, the shorter the episode will be. If the episode is recognized early enough I can avoid taking the really strong stuff. I can stay at work with minimal impact. If I have to take the strong stuff it is best to take time off work. If I am not at work I need something else. I need a safe place to spend the day where I can be monitored. That's what the baskets are for.
I have made much use of outpatient programs. An outpatient day program is a life-saver for me. It offers removal from my normal situation and any associated stresses. It gives me people to be with but in a safe setting. It gives me professionals to observe my condition. It gives me baskets to weave—after all, you've got to do something with your hands.
"The dynamic psychotherapies derive their name from Sigmund Freud's model of human mental function. Freud considered abnormal behavior to be the result of conflicting forces within the psychological self (dynamic being another word for force). According to psychoanalytic theory, conflicts exist at varying levels of conscious awareness, with some being entirely unconscious, and this disharmony is played out in the therapeutic relationship—technically called the 'transference'—which the patient develops with the therapist. Attachments, both positive and negative, to parents and other important people who have molded the personality of the patient, are recapitulated in the transference relationship. It is through this recapitulation, with the guidance of the therapist, that the "core conflictual relationships" are brought into conscious awareness and and resolved, promoting healthier patterns of behavior.
No advice or suggestions are offered by the therapist in classical psychoanalysis; the goal is for the patient to reshape his or her life using the insights achieved during the treatment, which may last for years. Analysis is thus of marginal value in the treatment of those who are critically ill, or of limited financial resources. However, the dynamic principles that Freud set forth have had a profound influence on the general practice of psychotherapy, especially in the United States, and have influenced public thinking about what motivates behavior in everyday life. That early experience plays a critical role in shaping adult behavior, and that unconscious forces can influence what we think and do, are concepts which have left an indelible mark on Western culture and literature."
Peter C. Whybrow, "A Mood Apart."
"The 'dynamic' therapies, originating with Freud, consider emotional attachment — specifically the relationship of the patient with the therapist — as the fulcrum for change. The behavior therapies, drawing upon the concepts of behaviorism that were developed by Pavlov and Skinner, consider the paradigm of learning as paramount in modifying behavior and believe attachment to be of little consequence. The cognitive therapies of Beck and Seligman, although commonly called the cognitive-behavioral therapies, in practice lie between these two polarities."
Peter C. Whybrow, "A Mood Apart."
The New Psychotherapies
"[The new therapies are] an evolution in psychotherapeutic practice similar to the evolution that has occurred in antidepressant drug treatment. This shift was, in part, a reaction to the lengthiness of psychoanalytic treatment and to a frequent lack of success in achieving rapid symptom relief. Several time-limited therapies, including interpersonal psychotherapy and supportive-expressive psychotherapy, have been developed. Each focuses upon problems of self-distortion and how these distortions, through conflicted relationships, can initiate a vicious cycle of depression and disturbed behavior. The best known of the new therapies, and the most widely deployed across the globe, is cognitive-behavioral therapy developed by Aaron Beck."
"Cognitive therapy emphasizes positive thinking. The basic postulate is that, given accurate information, the brain can 'think' its way back to health. By harnessing its powerful intelligence, the brain can learn to be objective about itself and replace old destructive schema [thinking patterns] with new, and constructive, thinking patterns. The cognitive-behavioral therapies differ from the psychodynamic therapies by placing greater emphasis upon the active participation of the patient—including mental exercises and homework—in adopting new thinking strategies to tackle specific problems and symptoms. The ultimate goal in developing these new cognitive models is to regain personal control of the social environment through a program of self-education ... 'learned optimism.'
Cognitive-behavioral therapists believe that conscious thought, rather than unconscious motivation, determines behavior. Thus, with the proper guidance, individuals can learn to change their attitudes and behavior toward other people. Cognitive therapy is more actively structured, time limited, and goal directed than dynamic psychotherapy, with the therapist seeking an active intellectual collaboration with the patient."
Peter C. Whybrow, "A Mood Apart."
There tend to be a number of activities organized in a day program—the basket weaving. I don't think I have derived any specific benefit from these activities, but it would not work without them. You have to do something. I have found group therapy useful, but not during an episode. I have not found psychoanalysis useful, though I tried it for a while. I have found psychotherapy to be of great use, but not the sit and talk for an hour sort. The psychotherapy I have found useful is the pragmatic sort. The sort that helped me to accept my illness—the sort that helped me work out an emergency pill drill—the sort that helped me to take responsibility for myself and my illness.
So for me, doing the right thing is:
- Take the medications—I keep my own supply for emergencies.
- An emergency appointment with the doctor, today or tomorrow, never more than that.
- Admission to an outpatient day program (not always required).
- Hospitalization—only necessary if the episode is not caught in the early stages.