I'm reading articles on the major mental illnesses and how they may be the result of trauma rather than a biological disorder. The article regards and article by Dr. Benjamin Levy, "The Broad Relationship Between Bipolar Disorder and Disorders of Psychological Trauma - Time-Limited to Life-Long Need for Mood Stabilizers". In short, why treating the trauma resolves the patient's need for medication for the rest of their life.
Dr. Levy writes, "While bipolar disorder is generally thought of as a life-long illness, naturalistic studies report that some patients have a self-limtited course." He adds that "in some of these patients, the bipolar disorder has a course that mirrors the recovery from the disorder of psychological trauma. This notion that Bipolar Disorder may have a self-limiting course is not usually presented to patients. They are typically told they have a "biological" disorder which will require life-long medication maintenance and that has a poor prognosis.
Mood Swings vs. Mood Episodes
Dr. Levy does a wonderful service to the psychological community of distinguishing between "mood swings" and "mood episodes" and posits that this distinction "has everything to do with recommending the right treatment". He states, "the 'mood swings' of trauma disorders are treated primarily with psychotherapy, with psychopharmacology added for symptom relief. The 'mood episodes' of bipolar disorder are treated primarily with psychopharmacology, with psychotherapy added to help the person adopt to and manage a chronic mental illness." Dr. Levy then presents three case studies of patients who were originally diagnosed with Bipolar Disorder who were able to discontinue their mood stabilizers after addressing the original trauma.
I have seen this repeatedly. Clients who are very emotionally reactive when triggered by events in their present to remember trauma from their past are labeled as having "mood swings" and put on a mood stabilizer. But their "mood swings" are immediate, intense and transitory, usually not lasting more than a few minutes to a few hours. They also typically induce great anxiety and sometimes pure terror, not the euphoria for which mania is known. This is a different pattern from the gradual descent into depression or ascent into mania which lasts for weeks or months at a time and which Dr. Levy describes more accurately as "mood episodes".
I believe we are going to see greater awareness of the effects of trauma and less emphasis on the "biological" emphasis when treating mental illness in the near future. If you would like to see what mania looks like I recommend the film, "Mr. Jones" with Richard Gere. Though not an impeccable portrayal of mania, Gere does a fairly accurate job of capturing mania with grandiosity and thought disorder.
Levy, B. F. (2007). The broad relationship between bipolar disorder and disorders of psychological trauma-time-limited to life-long need for mood stabilizers. Journal of Psychological Trauma, 6(2/3), 99-125.