Biological explanation of the case

¶ … Steven V.'s psychoanalytic needs have not been met is exhibited by his rejection of the lithium carbonate treatment that has had the greatest positive physical effect upon his problems. However, a major issue with Steve has been his going "on and off the wagon" in terms of therapy. Much like an alcoholic, a person in Steve's position has to come to a point of realization that they have a problem. He has to realize a personal value in the treatment or he will not want to continue with it. This is especially the case with Steven who has exhibited more depressive behavior than manic. Therefore, while there is a biological reason for his predicament, the causes for his depression must be dealt with, especially getting at the childhood issues at the core of Steve's problems that are a mystery to the psychoanalyst. Therefore, the psychoanalyst's plan to engage Steve in discussion to discover the necessary psychological milestones that have contributed to his depression is so necessary.

The problem here is that Steve has to be convinced that the behavior of his father was not correct. Steve's father abused Steve emotionally and abused his mother by running around with other women. If Steve continues to abuse women, whether in real life or in a fantasy world, he has descended to the level of his father and his father has won. In the psychosocial plan therefore, Steve's psychosocial needs as well as a pharmaceutical plan need to be dealt with. In this way, he will be more willing to accept a return to lithium carbonate or some other medication that will return him to stability. While lithium carbonate has its limitations, it provided the most control and stability that he ever had over the bipolar problems.

To map out a proper treatment regimen however, a holistic approach is necessary. This will incorporate psychoanalytic dialogue to recover the missing data milestones from Steve's life, such as how much of his problems are due to the repressed emotional baggage that he experience as a child. Limited long-term studies have indicated that children who have later received the diagnosis of bipolar disorder may show subtle and early traits such as cyclical mood abnormalities and full major depressive episodes. This can cause hypersensitivity and irritability. While there is some disagreement about whether the experiences are fluctuating or chronic, it has been shown that the repressed memories and especially Oedipal trauma and early sexual content can accentuate the bipolar or manic depressive disorder. The evidence goes on to suggest that environmental factors play a very significant role in the development and course of bipolar disorder. The data is fairly consistent that recent life events and problems in interpersonal relationships contribute to the likelihood of onsets and recurrences of bipolar mood episodes, just as they do for onsets and recurrences of other types of depression. The total number of stressful events in childhood is much higher in the adult diagnosis of bipolar disorder as compared to those without, especially where events stem from the harsh environment rather from the child's own behavior. These early experiences of adversity and conflict are very likely to make the subsequent developmental challenges in adolescence more difficult and make the diagnosis and treatment of the malady more difficult later (Hammersley et al., 2003, 543-544)..

Such realizations about the interrelatedness of psychoanalysis and drug treatment have brought about a new holistic approach to treating patients such as Steve. The systematic review and metaanalysis of randomized, controlled clinical trials have shown that other anticonvulsants worked as well as lithium carbonate. Since 2000, it was found that lithium effectiveness was less robust than was expected, so other results need to be investigated as well (Geddes et al., 2004, 217-218).

While Steven V.'s psychoanalytic needs have not been met, by meeting them, it is hopeful that he will not reject lithium carbonate treatment or some similar treatment since they have had the greatest positive effects upon the treatment of his illness. To get Steve back on the wagon, we have to have a psychoanalytic version akin to alcohol treatment where Steve will acknowledge that he has a problem. As stated above, he has to realize the personal value in the treatment or he will not want to continue with it.