Paranoid Illness changing into Bipolar Disorder

A woman in her early forties came to her monthly session, primarily to get her medications for she does not like to talk about herself or her illness, and complained that she is once again in her down mood.

"It started a week ago and it is so bad that my son - the only one who still lives at home - left the house. To add insult to injury I flipped my finger at him as he was leaving, which is insane. For the poor boy had done nothing wrong.  All week long I had been on his case. It is good he left on his own because last night given my nasty mood I could have physically kicked his ass out. When I am in that down mood I want nobody around. My son called me this morning to ask if it was safe to return. Thank God he is not upset because he knew it was my mood and not me which was making me behave like that. What lies behind such nastiness of mood?"

Patient denied that anything triggers it. With no leads to go upon as to why she went nasty the session shifted into talking the next thing that was bothering her. It was her anger at her mother. Patient could not be more angry, "She has chest pain but refuses to go to a doctor, treating herself with cold water and aspirin. I am afraid she will die just like my father did."

It too had started a week ago. What came first her worrying about the mother and getting angry over it or her nasty mood.

Patient first claimed that they had started simultaneously but then after being forced to carefully examine had to admit that mother's chest pain had begun a few days earlier. She also recalled that when her anger towards mother could not be contained it was only then some of it had escaped control and despite her best intentions to not do so had begun to get displaced upon her son.

"Why did you think that she will die just like your father?"

"Yes, that is my fear. All I can think of is that she is going to die like my father did. It was traumatic seeing my father die in 2009. He had clogged arteries, just like my mother has."

"Did your mood swings start when your father died?"

"No. His illness and death did not affect me quite that way. I did not get upset. I did not care for him that much. He was not around. For that matter my mother was not around either."

"Then what started the bad moods?"

"The death of my grandmother in 2010. But in the beginning they were not bad moods. It began as a slowly emerging conviction the house in which she had lived and died was haunted. I missed my grandmother very much. She was my real mother. My father and my mother were never really available to me. After her death I started hearing her voice and could feel her presence. I was admitted to the hospital and diagnosed as paranoid schizophrenic because of those voices. They put me on a lot of Seroquel which was the only thing that could block out the hallucinations and allow me to sleep. Even now I am afraid to go off the Seroquel despite your warning that it is making me fat and may cause me diabetes, because I am afraid of the return of the voices.  When I came back from hospital I moved out of my grandmother's house. But her presence followed me to the new house."

"When did the mood swings start?"

"They came gradually. As my fear of my grandmother's presence hovering over me decreased the mood swings started. They are always accompanied by anger towards my mother."

"You became sick after your grandmother's death, but your anger is always directed towards your mother, why is that?"

"Because I think I have a big time grudge against my mother. I loved my grandmother but hated my mother."

"Why you hated your mother?"

"Because she favored my brother over me. He was my half-brother. She preferred him over me, because his father was not around, while mine was,  and she felt he deserved special treatment because of that."

This patient's illness which started as paranoid schizophrenia shows no trace of it now. She is quite warm and social in her interactions when she is not in her down mood. This transformation occurred when she could allow her rage to emerge against her mother. This happened after the death of her grandmother. Prior to that her loving relationship with her grandmother kept her rage bound. Once her grandmother died her rage emerged unchecked and could only be contained through developing a paranoid projection . She started hearing voices that kept her rage from being acted out.  

Once the rage could be expressed against others - the latest being her son - it did not have to be projected and come against her in forms of voices. However since she could not be permanently in a state of rage her psyche developed bipolarity. A time was allotted to be in rage and a time to be nice and good to other people.