“The more biologic the illness the more the need for psychotherapy.” These words of Kaye Jamison still ring true twenty years after hearing them. At a National Institute of Mental Health (NIMH) neuroscience and psychopharmacology review course Dr. Jamison presented her work. Initially it puzzled me that a psychologist would be presenting at a review course for psychiatrists on how to prescribe drugs. It didn’t take long into her presentation to see why she was on the program. At the time she was a young professor at Johns Hopkins. This was long before her incomparable book Unquiet Mind and her revelation of her own personal struggles with bipolar illness. She presented clear data about how those patients with bipolar illness who received psychotherapy and medication, as opposed to just medication, had fewer relapses, enhanced compliance with their medications, and a better course. I was deeply impressed and never forgot that lecture. Since then no opportunity to see her speak has gone unattended. Her extraordinary memoir has helped countless numbers of my bipolar patients. Although I do not know from first hand experience what it is like to suffer bipolar illness, Dr. Jamison’s description of her life with bipolar illness has remained with me since its first reading. Her emphasis on living with the illness and helping individuals cope with its echoes in their personal lives guides my treatment to this day.
This book arose out of a conviction born of experience that if adequate interventions are made at this formative time in a young bipolar patient’s life, considerable suffering can be eliminated, and the patient has a greater chance of fulfilling his or her potential. We know that the more episodes of mania and depression an individual suffers, the more the brain is affected, and the more the threshold is lowered for future recurrences. Reducing suffering now not only spares the patient present misery, but protects the patient’s future. The likelihood of a more severe life long course is reduced.
My route to this book is largely a traditional one. My undergraduate education was at Duke University from 1966 to 1970, and I graduated with a degree in chemistry. My medical school education from 1970 to 1974 was at the University of Virginia. My psychiatry residency at the University from 1974 to 1977 was psychoanalytically oriented. I saw few bipolar patients, or so I thought. I probably saw more than I knew, and diagnoses were missed and opportunities to assist were lost.
The bulk of my career has been spent in a private practice in Charlottesville, Virginia where I have my own individual patients with whom I work psychotherapeutically and with medication. I also do medication consultations and medication management for patients who are seeing non-M.D. therapists. A decade ago I had the good fortune of being hired as a staff psychiatrist at the Student Health Service at the University of Virginia. There I have had the privilege of working with even more young adults with bipolar illness, now in collaboration with Dr. Federman. We have built a treatment approach that combines individual therapy, medication management, and group therapy. It is through the lens of these young men and women that the heart of this book has emerged. It has been and continues to be a privilege to work with them. Their journeys are reflected in the material that we hope will engage other young men and women who have to face this lifelong illness.