email page print pageAll Topic Reviews
"Intimate" Violence against Women3 NBS of Julian DrewA Little PregnantA Natural History of RapeA Parent's Guide to Asperger Syndrome and High-Functioning AutismA Stir of BonesAbout a BoyAdult Children of Emotionally Immature ParentsAgainst MarriageAgainst MarriageAlmost a PsychopathAlone TogetherAnatomy of LoveAngelsAnother CountryAnxious ParentsApples and OrangesBe Honest--You're Not That Into Him EitherBeing the Other OneBetrayed as BoysBeyond AddictionBipolar DisorderBoys Will Put You on a Pedestal (So They Can Look Up Your Skirt)Breaking ApartBrief Adolescent Therapy Homework PlannerBringing Up ParentsBut I Love HimCaring for a Child with AutismCaring in Remembered WaysCherishmentChildren of the Aging Self-AbsorbedChildren of the Self-AbsorbedChildren, Families, and Health Care Decision MakingClawsCloserCold HitCoping With Difficult PeopleCouple SkillsCruddyDancing in My NuddypantsDivorce PoisonDoing ItDone With The CryingEcstasyEmotional ClaustrophobiaEmotional Fitness for IntimacyEmotional Intelligence at WorkEntwined LivesErotic PassionsEssentials of Premarital CounselingEvery Pot Has a CoverFacts About ADHD ChildrenFamilies Like MineFamilyFamily BoundFamily FirstFear of IntimacyFinal JeopardyFind MeFlashpointFor Lesbian ParentsForgive Your Parents, Heal YourselfGandhi's WayGeorgia Under WaterGetting over Getting MadGetting the Love You WantGetting the Love You Want Audio CompanionGirl in the MirrorGirl StuffGoing Home without Going CrazyHandbook of AttachmentHandbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual ClientsHappiness Sold SeparatelyHard to GetHe's Just Not That Into YouHealing ConversationsHollow KidsHot ButtonsHot Chocolate for the Mystical LoverHow Families Still MatterHow to Create Chemistry with AnyoneHow to Give Her Absolute PleasureHow to Handle a Hard-To-Handle KidHow to Keep Your Teenager Out of Trouble and What to Do If You Can'tI am Not Sick I Don't Need Help!I Don't Know How She Does ItI Hate You-Don't Leave MeI Only Say This Because I Love YouI'm OK, You're My ParentsIn the Mood, AgainInside the American CoupleIntrusive ParentingIt's Called a Breakup Because It's BrokenIt's Love We Don't UnderstandJakarta MissingKeeping Passion AliveKeeping Your Child in MindLet's Get This StraightLiberation's ChildrenLife's WorkLikely to DieLove JunkieLove SickLove Times ThreeLove Works Like ThisLoving Someone With Bipolar DisorderLoving Someone with Borderline Personality DisorderLust in TranslationMaking the RunMaking the RunManic DepressionMars and Venus - Starting Over.Mating in CaptivityMom, Dad, I'm Gay.MotherstylesMurder in the InnMysterious CreaturesNecessary NoiseOdd Girl OutOpenOpening to Love 365 Days a YearOphelia's MomOrgasmsOur Journey Through High Functioning Autism and Asperger SyndromeOut of the DustOvercoming Your Difficult FamilyParenting and the Child's WorldParenting on the GoParenting Your Out-Of-Control TeenagerParents and Digital TechnologyParents Do Make a DifferencePassionate MarriagePlanet JanetPreventing Misbehavior in ChildrenProblem Child or Quirky Kid?Raising AmericaRaising ElijahRaising Kids in an Age of TerrorRaising Kids in the 21st CenturyRaising Resilient ChildrenRay's a LaughRelationship RescueRelax, It's Just SexRespect-Me RulesRomantic IntelligenceRoom For JSecrets of a Passionate MarriageSelf-NurtureSelfish, Shallow, and Self-AbsorbedSex Addiction: The Partner's PerspectiveShidduch CrisisSickenedSingleSlut!Socrates in LoveSomeone Like YouSong for EloiseSpecial SiblingsSpiritually Healing the Indigo Children (and Adult Indigos, Too!)Staying Connected to Your TeenagerStaying Sane When Your Family Comes to VisitStop Arguing with Your KidsStop SignsStop Walking on EggshellsStop Walking on EggshellsStrong, Smart, & BoldSummer of the SkunksSurviving a Borderline ParentTaking Charge of AngerTelling SecretsThank You for Being Such a PainThe Anti-Romantic ChildThe AwakeningThe Bastard on the Couch CDThe Birth of PleasureThe Brief Couples Therapy Homework Planner with DiskThe Bully Action GuideThe Burden of SympathyThe Commercialization of Intimate LifeThe CorrectionsThe Couples Psychotherapy Treatment PlannerThe DisappearanceThe Dream BearerThe Educated ParentThe Emotional RevolutionThe Employee Assistance Treatment PlannerThe EpidemicThe Ethics of ParenthoodThe Ethics of the FamilyThe Gay Baby BoomThe Good DivorceThe Guide for International Intercultural Couples and Families Intercultural MarriageThe Healing Journey for CouplesThe Hostile HospitalThe Husbands and Wives ClubThe Inside Story on Teen GirlsThe Introvert AdvantageThe Little FriendThe Love HexagonThe Moral Intelligence of ChildrenThe Neuroscience of Human RelationshipsThe New I DoThe Normal OneThe Nurture AssumptionThe OASIS Guide to Asperger SyndromeThe Other ParentThe Philosophical ParentThe Psychology of Parental ControlThe Real Rules for GirlsThe Reflective ParentThe Right to Be ParentsThe Secret Lives of WivesThe Spider and the BeeThe State of AffairsThe StepsThe Story of My FatherThe Velveteen FatherThe Virgin BlueThe Visitation HandbookThe Whole ChildTo Have and To Hurt:Two Is EnoughUnderstanding MarriageUnderstanding the Borderline MotherUnhitchedUp in FlamesWe've Got IssuesWhat about the KidsWhat Goes UpWhat Is Secular Humanism?What It Means to Love YouWhat Our Children Teach UsWhen a Parent is DepressedWhen Mars Women DateWhen Someone You Love Is BipolarWhen Someone You Love Is DepressedWhy Are You So Sad?Will You, Won't You?WomanWorking With Emotional IntelligenceWorried All the TimeYes, Your Teen Is Crazy!
This is a very concise, very readable, and very comprehensive guide to bipolar disorder geared toward caregivers and loved ones. In its purpose, at least, it fills a significant need and I commend Last her clarity and accessible style. The author is herself a Survivor, with Type II bipolar disorder. Her experience managing her condition with the assistance of her husband will lend her credibility to many readers, and supplement her letters as a practicing psychologist. Her description of bipolar behaviours, triggers and contributing factors is quite sound (chapter 2); her advice on forming a “treatment team” and her exploration of caregiver stress are also well handled (both chapter 5); and many will doubtless be helped by her diplomatic solutions to the domestic standoffs inevitable in a “bipolar household”. As a day-to-day guide, then, this is likely to be of use to many, replete as it is with the worksheets and informative bullet-listed talking points we expect from self-help literature.
That said, the book suffers from some major flaws. In her therapeutic leanings Last is strictly conventional, presenting the run of boilerplate treatment modalities and endorsing medication optimistically and uncritically. But medication is not neutral. Its role in the treatment of mental conditions involves a host of extra-clinical considerations, many of which are related to simple expediency. Meds are the gold standard merely because nothing else works as well--but that doesn’t mean they work particularly well, or often at all. On this she has precious little to say (p.153). Moreover, in situations where side effects are severe, she comes down on the side of sticking with the meds at the expense of what some would call a significant diminishment of quality of life (p.157ff), and her assumption that we must at all costs flatten the highs of mania or hypomania in order to essentially fill in the trough of depression (p.161ff) smacks of moralizing: not all bipolar individuals are capable of remaining in a baseline state for any length of time, regardless of treatment method, and a glance at Survivor accounts by those who have learned to positively channel their prodigious energies suggests that mania is not de facto a bad thing. At any rate, without alarming the reader or attempting to incite distrust of the medical profession, there is an onus on the writer of a book such as this to prepare one for a truly long haul, including the very real prospect of not finding an adequate meds protocol, and encountering difficulties with corporate or government bureaucracy if the chronic nature of one’s condition defies “timely” solutions.
Next, the author unwittingly raises some disquieting questions concerning her construction of bipolar as an illness. While being careful to avoid the blatant untruth that bipolar is physiological, she pushes on us the tired analogy of chronic medical conditions such as diabetes (p.67); this may be helpful to the uninformed reader who needs some way of coming to grips with a complicated situation that involves medication, but it is not correct. Worse, a statement such as “unlike a number of other psychiatric disorders, bipolar disorder is an illness that gets ‘managed,’ not cured” (p.67) is wrong on both semantic and medical grounds. Cured? Assuming that all the DSM-IV conditions are in fact diseases, which of these is ever “cured?” Such pronouncements are not small potatoes. They undermine her legitimacy.
My biggest beefs, though, are with her countenancing the use of coercion and underhanded methods. It’s one thing to resort to subterfuge in moments of extreme crisis when the bipolar individual is irrational and potentially dangerous. But it’s a different matter when dishonesty is used as a tool to ensure compliance to caregiver wishes. Thus, in trying to convince one’s partner to take meds, the caregiver is called upon to claim that “people are taking these drugs in record number today so that the stigma once associated with this form of treatment no longer exists.” (p.67). Ignoring the implications of the first (true) half of this statement, the second part is patently absurd. Psychiatric conditions and meds are prominent and visible, but the stigma surrounding them is arguably as powerful as it has ever been. And what are we to make of the following: “Look at all those commercials on TV--the drug companies wouldn’t be spending all that money on them if there weren’t tons of people taking those drugs”? (p.68) It’s a self-supporting proposition, a logical non-sequitur apparently meant to establish some sort of implausible connection between the prevalence of meds and their effectiveness, but really stating nothing. Truly problematic, though, are Last’s unabashed (and admitted) uses of direct manipulation, such as her feeding into a client’s delusions in order to convince him to obtain counseling (p.74f), or the advice on how to sneakily get around signed consent for(p.130). Actions like this by medical personnel diminish faith in the system; such behaviour from loved ones is a major violation, the consequences of which in a loving relationship Last utterly avoids. When such actions are discovered--and surely they will be!--a person prone to manic paranoia can find their fears unwittingly confirmed by the people they trust the most.
Regrettably, this is not the book it could, or should, have been. Last has an engaging style, and her book is bursting with information, yet I await a more ambitious treatment: one with a more balanced presentation of psychiatry, which engages less simplistically with some issues (the consequences of hospitalization, for example), less summarily with others (suicide and self-harm get short shrift), and which presents us with strategies that focus more on empowerment and not at all on manipulation.
© 2011 Richard-Yves Sitoski
Richard-Yves Sitoski is a psychiatric Survivor and writer on mental health, social justice and food topics based in Owen Sound, Ontario, Canada. He maintains an advocacy blog at www.wundernutbar.wordpress.com.