Psychotherapy and Bipolar Disorder

Finding lost selves by asking the right questions

Posted Jun 10, 2013

By Alan Slomowitz, Ph.D.

In a recent New York Times article, Linda Logan writes of her decades-long battle with Bipolar Disorder and describes a life stolen by this severe, disabling and at times life threatening illness The Problem With How We Treat Bipolar Disorder (April 4, 2013).  As poignant as this story is, I couldn’t help wondering whether a good psychotherapist asking the right questions might have made a difference in the course of her life.

Ms. Logan chronicles her growing realization, at age 27, that she is not suffering from fatigue. She can barely push the baby stroller to the park, she cannot summon the breath to ask the store clerk, “Where are the Pampers?” All medical tests come back negative, yet she can barely function. Ms. Logan struggles on—with three young children and a teaching career--but by her mid 30’s is suicidal, and hospitalized. Thus begins an uphill battle that includes multiple lengthy hospitalizations and myriad psychotropic medications.

Why was this intelligent, reflective woman not in psychotherapy? This is not a criticism of Ms. Logan or those who tried so hard to help her. There is no guarantee her life would have been different had she, in combination with the right medications, been in an intensive analytically focused treatment.  But I write with a feeling of regret about a life that might have been very different.  Perhaps, more fulfilled, less tortured.

There are so many “ifs” to contend with: if she had found the right therapist, if she had the resources and the will to come several times a week, if she could have faced the pain and discouragement that often accompanies long-term treatment.

Ms. Logan describes a number of events, warning signs that should have raised questions about her mental state: a change in her appearance in high school accentuated by dressing all in black for several years, her panicked leap from a car on the way to a party, a period of time when she spent most of her day sleeping, her noting a gun store on the way to her poetry group and thinking she now knows where to go when the time comes. 

Ms. Logan struggled with psychiatrists who wanted to try different combinations of medications—doctors concerned about her minimal eye contact, but not her fear that she had lost herself. She comments, “For many psychiatrists, mental disorders are medical problems to be treated with medications, and a patient’s crisis of self is not very likely to come up in a 15-minute session with a psychopharmacologist.” 

Where is the psychotherapy? Where are the good questions that might provide her the opportunity to discuss and explore her experience?

I imagine her coming into to my office at age 27, a “hot mess,” as a patient once described her depressed self, searching for some way out of it.  What might I have asked her? 

I might have started with a question about what happened when she was in high school. Why did she begin to dress in all black?  What did her parents say or do? Did they notice a change? Ignore it? Fight it? What was the meaning of this change of appearance? Was she trying to disappear or perhaps, to let others know of her suffering?

Apparently, Ms. Logan was a very competent and high achieving person who often became overwhelmed by unbearable, life-sapping despair. More questions: On the way to a party with her husband, how did she manage to jump out of the car? Could she recall the panic, a word or two perhaps that might provide us a clue into her unbearable-ness of being? What was she escaping? Did she sometimes similarly feel the need to bolt my office? Could she allow us to create a space to explore her internal world?

Could there be some unacknowledged motivations to self-destruct that we might locate together? Perhaps, she could have more authority over her life, her choices. Could we look at them from a different angle? Might we shed light on how to manage her panic and pain?

Change is difficult and often feels impossible. And psychotherapy is time-consuming. As Edgar Levenson commented in a recent blog post, patients do not always want to change despite our best intentions. 

Unquestionably, medication often helps to lessen severe psychological symptoms and can make a significant difference in many people’s lives. But in order to alleviate the most intractable of human problems, I believe that the individual needs to discover or recover the self and sometimes this means refusing psychopharmacological solutions.

Perhaps, in order to be where she is now and to survive, Ms. Logan needed to fight all these decades in her particular, very painful way. Her life is far from over. She might now decide that talk therapy will enable her to re-examine her life; it could illuminate her suffering and how she became who she is.

The past cannot be redone but it is possible to reformulate what has occurred in new ways that add meaning to our past, our present and our futures. I hope that Ms. Logan will encounter an excellent psychotherapist who will ask the right questions that might enable her to do so.

Alan Slomowitz, Ph.D., is a 4th year candidate in the Psychoanalytic Training Program at the William Alanson White Institute. He is a Supervising Psychologist at the Beth Israel Medical Center Dept. of Psychiatry. His private practice office is at Columbus Circle on the Upper West Side in New York City.