Thursday, December 28, 2017

Playing the Manic Game

This paper* came out decades ago but is still fresh: Playing the Manic Game. I had long forgotten it, but it was passed around today.

The use of it is if you are enmeshed with someone with this diagnosis it helps remind you that this is not coming from you. Or, you may see yourself, and make changes.  I see a bit of myself in this.  More than a bit, actually.

The caution is that this is not true of all people when they are manic.  With a few, it is even quite untrue. Be slow to apply this to yourself or others.  When medical students are learning about diseases, they all hit this stretch where suddenly every symptom appears to apply to them.  This is doubly so of psychiatric illnesses. A second caution is that the population sample observed are folks in more intense episodes, or coming out of them.  People who just get hypomanic from time to time are much more fun than this. If one is coming out from a fully manic episode it may take a while for some symptoms to disappear, even weeks.  Coming out is harder than going in, and harder on those around them.

Of historical interest is that the authors are still trying to find the psychological meaning of all this, especially at the end. Why are these people doing this?  What do they hope to accomplish?  I would take a much more biological approach these days.  Some systems go into overdrive when mania sets in, and that has downstream effects.  They aren't trying to do anything.  They are responding to body stimuli.  In fact, many are trying hard not to do something.

*If the link doesn't work for everyone, put a bing on the title, and let me know so I can try to solve it.

1 comment:

Texan99 said...

Reading the last sentence: "It may be that the psychotic manic patient hears most easily the nonverbal
communication implicit in the setting of limits-the statement that indeed, the patient is controllable and that
the therapist cares enough and is powerful enough to protect him from his self-destructive activities."--I realized once again how passionately I detest being expected to protect anyone from his own self-destructive activities. Nothing so readily brings out the uncharitable in me. Unluckily for me, manic-depression is all over my family tree. I've freely made use of what the authors characterize as the usual temptation to withdrawal and distance. Truth-telling sometimes seems to help, if I can accomplish it without bitterness or vindictiveness.