Playing the Manic Game

Abstract

The acutely manic patient, with his ability to create interpersonal havoc with family and therapist alike, can be one of the most challenging, taxing, and difficult of patients. It is our purpose to describe the character structure of the acutely manic patient, to define his patterns of interaction and communication, and to emphasize the impact these qualities have upon those around him.While previous studies have described the intrapsychic dynamics, pathogenesis, and character structure of patients suffering from manic-depressive psychoses, 1-5 the fashion with which the acutely manic patient deals with others, and the impact this has on them, has received sparse attention. Dooley 1 described patients with frequent manic attacks as being headstrong, selfsufficient, know-it-all types of people who will get the upper hand of the analyst. Gibson 2 noted that while manic-depressive individuals appear remarkably insensitive to interpersonal subtleties on a conscious level, they can be extraordinarily perceptive on a subconscious or unconscious one. He felt that these patients are proficient in evoking and utilizing the feelings of others, especially guilt feelings, and that they are extraordinarily adroit at handling and manipulating other people. Four characteristics Gibson stressed regarding the manic-depressive character structure included: (1) difficulty in dealing with feelings of envy and competition; (2) strong dependancy drives; (3) the frequent use of denial as a defense; and (4) a value system based on social conventionality.Fromm-Reichmann 3 described manic-depressive patients as being more clever and successful in finding vulnerable spots than are the people who are targets of their hostility. She stressed their ability to become immediately acquainted with anyone they meet, establishing quick, superficial, contacts which are not accompanied by a genuine interest.Cohen et al 4 reviewed the psychoanalytic literature concerning manic-depressive patients. They summarized Abraham's ideas on the characterological features of manic-depressive patients as including impatience, envy, increased egocentricity, and intense ambivalence. Cohen et al further described hypomanic patients as being conventional-minded, independent, and possessing a certain social facility. They felt that a hypomanic's appearance of closeness is provided by his liveliness, talkativeness, wittiness, and social aggressiveness. They emphasized that, on close observation, the hypomanic can be seen to be carrying out a relatively stereotyped social performance, taking little account of the other person's traits and ____________________________________________________________________________________

Communicability and Thought Disorder in Schizophrenics and Other Diagnostic Groups

“…The manic subjects did not achieve higher communicability scores than the schizophrenics did; this is inconsistent with clinical descriptions of manic speakers as easier to understand than schizophrenics (Redlich & Freedman, 1966;Janowsky et a!, 1970;Lipkin et al, 1970). In fact, the means in Table III indicate that manic speakers were generally the least communicable at both time periods.…”

The dominance behavioral system and manic temperament: Motivation for dominance, self-perceptions of power, and socially dominant behaviors

“…Theorists have noted that during mania people with bipolar disorder tend to display dominance- and status-focused social behaviors (Gardner, 1982; Janowsky et al, 1970). In contrast, when depressed, people with bipolar disorder focus on feelings of inadequacy, and are perceived by themselves and others as subordinate and submissive (Gilbert et al, 2007).…”

“I don't need your help!” Mood-dependent advice-taking in hypomania-prone individuals

“…Clinical experience suggests that people with bipolar disorder often seek out other people for stimulation, validation and coercion into their ambitious plans during the development of hypomania or mania. Systematic studies are consistent with these observations (Goodwin & Jamison, 1990;Jamison, Hammen, Gong-Guy, Padesky, & Gemer, 1990;Janowsky, Leff, & Epstein, 1970). For example, Jamison et al (1990) found that people with bipolar disorder rated themselves as more sociable during hypomania but also 'wild' and uncooperative.…”