'Anti-Psychotic' Drugs and Bipolar Disorder

A few words on the odd seeming fact that all of the drugs for schizophrenia, all of the 'anti-psychotic drugs,' have been found useful for bipolar disorder. Schizophrenia is a disorder characterized by loosening of ego boundaries. As a recent cartoon in the New Yorker captioned 'I can't tell if that is an internal thought or something I already said.' Viewed in a topographic sense, these drugs tighten up those boundaries. I can recall walking down the hall of the ward with the Vice Chief of Psychiatry at the VA and a patient walked up to us and indicated some way in which he had been hostilely treated by Dr. Charles. Dr. Charles would respond passively and entering the nurse's station would take the man's chart and write in the orders 'Mellaril 100 mg three times a day.' The patient had indicated a psychotic transference toward Dr. Charles. The Rx would help the man not project on to Dr. Charles his negative feelings about himself.

Now depression can often be seen as a narcissistic problem; you know a problem of self esteem. The standard mythological portrayal of Narcissus is of a young good looking man looking at his reflection in a lake in ancient times. One might speculate he is having trouble holding a positive view of himself internally. The 'anti-psychotic medication' helps pull the feeling of 'I am beautiful' back into the person. So an adolescent who is both angry that others aren't affirming him sufficiently and depressed that he can't see himself as beautiful might be able to pull his self regard back and not have the depression or anger. And it may be that the fact that bipolar spectrum disorder responds in adolescence much more favorably to anti-psychotic drugs than to other drugs used for bipolar in adults may indicate that the disorder at that developmental age is more basically a narcissistic problem.