Even though I feel certain that bipolar affective illness is a biological disorder, it is still a disorder of affect and affect works by certain rules no matter how triggered. It is from those rules that I made my comments. Also I believe that what Bleuler called "The Group of Schizophrenias" is a collection of biological illnesses. Yet even though someone has a specific named disorder, that individual still has nine innate affects that operate according to rules put forth by Tomkins and described more simply in my book Shame and Pride. Much of the symptom complex we see in any schizophrenic patient has to do with affect---in my experience most paranoid delusions have to do with the avoidance of or externalization of shame. I view (at least suditory) hallucinations as the result of intense affective magnification of some thought, usually shameful. And, of course, since the SSRIs are so effective in cases that feature pathological shame, it shouldn't surprise us that more and more psychiatrists are using these medications with great success in schizophrenic patients. The simplest answer to your question, then, would be that although I do believe that both Bipolar Affective Illness and most of the Schizophrenias start with as biological disorders disturbing some piece of brain equipment, I still view every patient as an individual who has great cognitive capacity and both a normal and an abnormal affective capacity. It is from those vantage points that I begin therapy, although I would never begin the therapy of anybody without a thorough history.
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