Chapter 5 Manic–Depressive Illness: Analytic Experience and a Hypothesis*

The fascinating phenomena of manic–depressive illness are not well understood psychoanalytically for two reasons. First, conflict psychology and libido theory seem particularly forced when applied to this illness. Freud's few pages on mania are perhaps the most obscure of his writings. Later analytic contributions, though evocative, have not led to the development of theories accepted widely even within the analytic community. More important, analytic experience with manic–depressives is very limited. Analysts have rarely used their most powerful research tool, the psychoanalytic setup, to explore bipolar affective disorders. This lack of experience reflects not only the analyst's appropriate caution but also character defenses common in this disorder that make the patient particularly reluctant to enter analysis. Deprived of systematic exploration of transference configurations, sustained empathic immersion in a patient's psychological life, and the opportunity to study in depth the operations and genetics of character structures, analysts have made little headway in understanding this illness. In the presence of extensive evidence for