The Painted Ponies: Summary

be aware that they may have bipolar disorder. Whether child, adolescent or adult the treatment will most likely involve psychotherapy, psychoeducation, family support and medication.

Since many clients with this illness attempt suicide, please go to the website of the National Depressive and Manic-Depressive Association for an article entitled "Suicide Prevention and Depressive Disorders" at http://www.ndmda.org/suicide.htm

For a general review from the American Psychiatric Association, please go to:"Practice Guideline For The Treatment Of Patients With Bipolar Disorder" at http://www.psych.org/clin_res/pg_bipolar.cfm

For a General Guide to Bipolar Disorder, please go to:Expert Consensus Treatment Guidelines for Bipolar Disorder: A Guide for Patients and Families http://www.psychguides.com/bphe.html

There is a growing body of literature which suggests that bipolar disorder can be seen in children and adolescents. Currently underdiagnosed, we do not want to err and consider every oppositional or energetic child to be bipolar. It is essential to take a good history of the child, including a family genetic history and to do a differential diagnosis. Another important indicator is if a child or adolescent worsens while taking antidepressants.

For adolescents, the primary comorbid condition to rule out is substance abuse. Adolescents are often labile by nature with dramatic mood swings. Adding alcohol or drugs to this developmental and hormonal stew can mimic a bipolar disorder.

With adults is is important to get a clear picture of the nature of the cycling. (Refer to the DSM or the website of Massachusetts General Hospital to read their on-line DSM-IV for clarification. The Harvard Research Bipolar Program page can be found at:

Although until recently the stigma of such a bipolar diagnosis often kept it unknown, taking a complete family history is important. Sometimes I get reports of "well, something was wrong with my great uncle. He was considered a 'nut' and locked up his whole life, after he got bit by a dog." Family history like this also tends to frighten people, as no one relishes the thought of being 'locked up forever'.

Medication compliance will usually be an issue even with child clients. It is important to treat attempts to go off the meds with respect. Eva, for example, truly wanted to be well and Sophie wanted to be 'normal'. Sometimes it is a challenge to reframe these attempts at health by explaining that 'well' and 'normal' happen with the medication. I often work very closely with the psychiatrist when my client is bipolar.

Working with people with bipolar disorder is a rare gift for the clinician. It is extraordinary to be able to witness neurobiology at close quarters. Please do keep in mind that we are more than our biology and that each of us deserves to be treated with compassion and respect. We all have paths to walk, journeys to take. For some, the path may involve the highest highs and the lowest lows. Nature and nurture, spirit and soul, mind and body are within each of us.

I know, with great humility, that I can not make someone with a bipolar illness better. That is impossible. The best resources we have now are understanding, compassion, consciousness and medications. I thank Sophie, Gary, Eva, their families, and everyone else who has taught me about bipolar disorder. Thank you for allowing me to ride on the carousel with you for a bit of your journey.

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