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I have worked analytically with four patients who were clinically diagnosed as having manic-depressive bipolar affective disorders. In addition, I have worked with several patients who have reported experiencing and feeling at least two different forms of depression at the same time, and I have worked with two patients analytically who were bulimic and one who was anorexic.
On the basis of this clinical research, which has been ongoing for ten years, I have concluded that (1) there can be multiple emotional and psychological disorders existing concomitantly, one overshadowing the other unless it is controlled pharmacologically; (2) concurrent therapy combining several modalities is indicated so that both disorders can be treated at one time; and (3) the time has come for us to return to an earlier model of illnesses that does not necessarily present a new paradigm.
Much psychoanalytic literature has appeared on the subject of manic and depressive illness. The clinical and theoretical reports go back more than seven decades and include statements by Abraham, Freud, Fenichel, Lewin, and Jacobson, among others. However, there have been other reports which yield significant data about these affective disturbances. Gacnsbauer, Harmon, Cytryn, and McKnew (1983) have identified as high risk a group of infants (twelve-eighteen months of age), whose parents were manic-depressives, and who (the infants) appeared to show disturbances in the quality of their attachments and a diminished capacity to self-regulate their emotions and affects. As they grew older, this difficulty increased, and by