Because I recognized bipolar disorder in children in the 1980’s, before early onset was generally accepted, and because I have treated many of these children well into their adult lives, I have specific expertise in treatments that improve long-term outcomes in mood and productivity.
In a performance-based culture, parents can be so busy that their children never develop a core sense of self. Even high achievers can fail to value themselves beyond measurable phenomenon (grades or income). This can leave people vulnerable to feeling empty or inadequate. Even more problematic is a traumatic upbringing, which can lead to distrust, a negative self-view, and self-defeating behaviors.
A client who has had these or other symptoms for some time may conceive of himself or herself as a collection of those symptoms, e.g. an anxious misfit, an unmanageable bipolar, an addict, or a perennial failure. I ask clients to identify abilities, strengths, and goals, and help them to reframe their symptoms as obstacles temporarily impairing the use of their abilities to achieve those goals.
In the case of young children, I may hear the parents’ goals first, but even children can describe some things they want to make better. It’s remarkable how often even rebellious adolescents have personal goals to which their parents would not object.
In my practice, I provide both insight-oriented and CBT psychotherapy to about 25% of my clients. In the majority of cases, I provide medication management for patients in treatment with non-MD psychotherapists. For any client who does not have a psychotherapist, I help match the patient with a therapist best suited to their needs.
Biological treatments have advanced, but are only partially understood. We do not yet know why some patients remain stable on a simple medication regimen, while others become treatment resistant. Nevertheless, we are developing new biologic strategies to treat refractory patients that include medication, nutritional supplements, and Transcranial Magnetic Stimulation.
Treatment Philosophy Who needs Psychiatry?
While many debate the purpose of life, the only one that makes sense to me is to achieve inner fulfillment while making the world a better place; in other words, to be happy and productive. Most religions say something like this; some secular philosophers agree. Clinical psychiatry and psychology exist to help people meet these basic goals.
Freud and most others have defined normal function as the ability to love and to work, i.e. to sustain intimate relationships and to be productive. Note how similar this measure is in function to the commonly held purposefulness described above. Being fulfilled and happy while functioning is an extra treat, easy for some and difficult for others.
Psychiatric problems break down into two broad categories: impaired function and impaired fulfillment. Those with impaired function vary from mild underachievers to those who cannot meet their daily needs. And of course, both low and high achievers can be unhappy, anxious, or dissatisfied, and feel unfulfilled.