THE acutely manic patient, with his ability to create interpersonal havoc with family and therapist alike, can be one of the most challenging, taxing, and difficult of patients. It is our purpose to describe the character structure of the acutely manic patient, to define his patterns of interaction and communication, and to emphasize the impact these qualities have upon those around him.
While previous studies have described the intrapsychic dynamics, pathogenesis, and character structure of patients suffering from manic-depressive psychoses,1-5 the fashion with which the acutely manic patient deals with others, and the impact this has on them, has received sparse attention.
Dooley1 described patients with frequent manic attacks as being headstrong, selfsufficient, know-it-all types of people who will get the upper hand of the analyst. Gibson2 noted that while manic-depressive individuals appear remarkably insensitive to interpersonal subtleties on a conscious level, they
Janowsky DS, Leff M, Epstein RS. Playing the Manic GameInterpersonal Maneuvers of the Acutely Manic Patient. Arch Gen Psychiatry. 1970;22(3):252-261. doi:10.1001/archpsyc.1970.01740270060008