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Treatment of character and personality — the special domain of psychoanalysis and psychodynamic psychotherapy — focuses on relationships and the psychological meaning of life events. It presumes that through understanding, motivation, and choice people can bring about change in their lives. (For simplicity, I will use the related terms, character and personality, interchangeably.) In contrast, treatment of manic-depressive illness is based more on medical factors, often viewed as outside the realm of meaning, motivation, and choice (cf. Cooper, 1985). To be sure, sophisticated understanding of personality dynamics is invaluable in gaining medication compliance, combatting demoralization, managing family issues, and fulfilling a range of other duties in the care of any severely ill patient. I would like to press further, however, to describe why psychotherapy of personality may directly influence the course of manic-depressive illness in some patients and help diminish the frequency and severity of affective episodes. To discuss this I will develop three ideas:
Recent psychobiological and clinical research suggests that in some circumstances stressful life events precipitate affective episodes.
Personality functioning and dynamics are factors in the occurrence of and responses to stressful life events. To understand these dynamics in manic-depressive patients, however, we must consider the complex, reciprocal interplay between affective illness and personality.
Dynamically oriented psychotherapy of personality may reduce the impact of life events on manic-depressive illness to the extent that it helps a person to control the occurrence and impact
* Associate Clinical Professor of Psychiatry, Columbia University, College of Physicians and Surgeons; Associate Director of Psychiatry, Presbyterian Hospital.
Presented at the Annual Meeting of the American Academy of Psychoanalysis, May 1992.
of these events. Combining this technique appropriately with medication requires a fl