The Letter, Issue 46, Spring 2011, Pages 13 - 19
Balance and Connection: Bipolar Disorder and Psychoanalysis in Psychiatric Practice
Brendan D. Kelly
Bipolar disorder comprises a pattern of symptoms characterised by disproportionate changes in mood, possible psychosis and various other symptoms at different times. Biopsychosocial management approaches often involve medication (e.g. lithium), psychological therapy (e.g. cognitive-behaviour therapy) and social interventions (e.g. social work support). Psychoanalytic contributions to the understanding of bipolar disorder have come from a range of therapists, including Karl Abraham, Sigmund Freud, Otto Fenichel and others. In recent years, emphasis has been placed on identifying the defence mechanisms most commonly associated with mania, and the relationship between pharmacological and psychoanalytic approaches to the disorder (e.g. links between lithium blood levels and mental processes). It is important that, amidst such therapeutic endeavour, and in the context of emergent neurobiological approaches, the individual’s search for meaning in their experience is not lost. Psychoanalytic approaches have a unique role in this respect. Regardless of resource challenges in public mental health services, there is a strong need for a diversity of approaches to all mental health problems, including bipolar disorder, in order to reflect the diversity of individuals affected, problems faced and pathways to recovery.
Keywords: Bipolar disorder; psychosis; psychoanalysis; therapy; lithium