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“Clark”: A systems approach to bipolar
When my patient, Clark, was first diagnosed with bipolar, he had no intention of questioning the doctor’s diagnosis. He went along with it, just as he had gone along with colic, sensory processing disorder, and ADHD earlier. He is the oldest of three children,
the only boy among his siblings. His therapist decided that individual therapy wasn’t getting him the help he needed, so he was referred to me to “try family therapy.”
The willingness of the whole family to gather around to help him was touching, and clearly help was needed in the family system. Mom and dad were sitting way apart from each other; dad was very hard to hear, while mom was one kind touch away from tears. Clark placed himself in the chair closest to me, perhaps a structural gesture to confirm his identified patient position, his status as the one to be fixed. The girls took up the space between mom and dad, perhaps as buffers.
Oddly, my position as the last remedy for Clark made his chance of surviving bipolar bleaker than ever. After all,
if all attempts had failed, then what was one supposed to think and feel? Facing a family constantly referred from one source to another can be hard to digest for a therapist. This was a family that had lost its vision of health in the never-ending search for the removal
of illness. As Ackerman (1994) so brilliantly stated, “Unless the patient
is able to envisage a new and a better way of living, he will cling to his old way. He will resist exchanging a familiar kind of adaptation for an alternative that he cannot yet perceive or believe in” (p. 42). The family was the jungle Clark was supposed to go back to even after getting the best treatment that was available to him in the comfort of civilization. Whatever the treatment, it
needed to be given in the very jungle that Clark called family, and any professionals attempting an intervention needed to ask themselves if they were up for that challenge.
Clark was failing his classes, he was acting hostile towards his sisters, and
he had an obsession with sharp objects. He had been hospitalized for severe depression and suicidality. Since then, he has been demonstrating aggression, emotional volatility, and belligerence on a daily basis. He had been physically abusive to his sisters, stolen and hid knives as well as other items, and threatened to cut himself when he
was being punished for his behavior.
He demonstrated high impulsivity and appeared to be agitated most of the day, every day. He struggled a great deal with poor focus and barely passed school. His aggressive behaviors were described as escalating following his release from the hospital, and they only got worse; he was hospitalized a second time the following year.
Clark began the family therapy journey saying that he was the problem. Living up to this evaluation, he would at times screech like a Pteranodon or crawl on the floor with buttocks exposed, leaving
us all with varying responses. Midway through the year, he stated that it felt good not having to be the only problem in the family, and afterwards he noted
a discomfort with his bipolar diagnosis. Clark’s insights occurred during a year of family therapy that also included couples therapy sessions for his parents.
Our sessions revealed that the father had been physically and sexually abusive with Clark and Kellie, Clark’s middle sister. Clark was exposed to
his father’s inappropriate touch two years ago, when he was sleeping in
his own room. Interestingly, one of Clark’s so-called symptomatic behaviors as reported to me in the assessment was that Clark had a hard time falling asleep, and the only place he could fall asleep was the sofa in the living room. To his parents’ surprise, he had stopped sleeping in his room. Clark says that
his father touched him only once, but the father’s abuse of Kelly had been ongoing for two years. The chronology of the abuse directly coincided with Clark’s obsession with sharp objects, his suicidality and aggressive behavior, and his hospitalization.
The systems approach to addressing Clark and his family was more successful than previous attempts. Clark went off his medications and reported no worsening in his mental and emotional states. As he himself noted, he “never really noticed any difference anyway” while he was on them. His case, and the existing critique of approaches to bipolar disorder given earlier in this article, give me good reasons to believe in the efficacy of whypolar.
Reference
Ackerman, N. (1994). Treating the troubled family. Northvale, NJ: Basic Books.
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