Real, not theoretical patients!!

• Mania by Margaret Blakely, 5/11/96
  • The Affect Pattern Chart in Mania by Don Nathanson, 5/11/96
    • Affect Pattern Chart by Margaret, 5/14/96
      
      

I didn't mean for you to conjure a hypothetical manic patient, but to find a real one and then check out the pattern of affects displays. This time I'll tell you what I see when I work with manic or hypomanic people:

Interest-Excitement very high [8/10, often higher.] (As you know, I believe that the illness involves a biological defect in the regulation of interest-excitement, one in which the affect is not triggered by the normal gradient of stimulus acquisition but by some glitch in the circuitry of the affect.)

Enjoyment-joy also high, but not quite as high [7/10 in some of my cases] These folks seem to have a lot of fun, and often create a lot of fun around them. People laugh, get excited, do new things when they are around manic or hypomanic people because their interest-excitement is so high that is causes lots of resonance around them.)

Surprise-Startle usually not much of a problem; if it is elevated beyond 2/10 the patient is probably pretty irritable in general.

Fear-Terror low; the excitement often makes these patients nearly immune to fear.

Distress-Anguish pretty low, too. There is so much going on in the area of i-e that there is no chance for any stimulus to remain steady-state long enough to trigger d-a.

Anger-Rage high, say 5-9/10. All the books say that these patients are pleasant and engaging unless thwarted, in which case they exhibit a brittle anger. I have never worked with a manic patient who did not exhibit anger in the mode of poking fun at people (humiliating them), twitting people.

Dissmell pretty low. They are interested in everything.

Disgust pretty low. They just turn to something else and rarely exhibit much disgust unless associated with anger as contempt.

Shame-Humiliation very high, say 8/10. This is the big clue. This is what is triggered when a manic is thwarted because thwarted implies impediment to interest-excitement, which triggers shame that then is expressed within an attack other script. It is the cause of all the anger!!

So the affect pattern chart in mania features high i-e, moderately high e-j, high propensity for a-r, and very high propensity for s-h.

Now I did this one for you, which is cheating. Next time you see a manic patient, it is your turn to go over the affect pattern chart and really write down what is there.

Remember: The affect pattern chart is to be done from real live patients, not our memory of patients.

• OK by Margaret, 5/16/96
  • Affect and illness by Don Nathanson, 5/16/96
• Bipolar and Affect-Pattern Chart by Chris Thomas, 1/7/98
• manic affects by john t, 4/21/98