Clinic Treats Mental Illness by Enlisting the Family
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It was hard to tell just who was the patient, as the Cunanan siblings — Jennifer, Adrian and Anthony — sat in a row on three chairs in a sparsely decorated therapist’s office at Beth Israel Medical Center in Manhattan.
Adrian Cunanan, 30, was flanked by his brother Anthony and his sister, Jennifer, as he discussed a recent manic-depressive episode at a clinic at Beth Israel Medical Center.
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Helen Kraljic Fama, 50, was supported by her husband, Anthony P. Fama.
It was Jennifer Cunanan, 27, who did most of the talking, describing life with Adrian, 30, a computer consultant who has bipolar disorder and who went through a severe manic episode in March. He would go two days without sleeping, she said, then become so frazzled that he depended on his family to carry out life’s daily chores, like shopping and cleaning.
“All of us would like someone to sweep up after us,” Ms. Cunanan said, half understanding, half resentful, as her brother listened, his eyelids drooping from exhaustion.
Adrian’s brother and sister, as well as the woman he is dating, are critical components of his therapy at Beth Israel, where a fledgling clinic aggressively treats people with bipolar disorder by involving their family members. The clinic, the Family Center for Bipolar Disorder, was set to be formally dedicated on Wednesday, though it has evaluated some 60 families since 2006, in a program that doctors say is unique in the city and based on a model developed at the University of Colorado.
Family-focused therapy, as it is called, breaks the image of the psychiatrist sitting in his chair, alone in a room with the patient, as well as the traditional wisdom that patient confidentiality is sacrosanct. In family therapy, the family might be treated as part of the problem; in contrast, in family-focused therapy the point is not to treat relatives, but to enlist their help in managing the patient’s illness.
“We’ve tested it in a number of different trials against different types of therapy, and consistently find that if you combine medication and family-focused therapy, you get quicker recoveries from episodes and longer intervals of wellness,” said David J. Miklowitz, a professor of psychology and psychiatry at the University of Colorado, whose pioneering research on the topic inspired the Beth Israel clinic. “So the relapses are less common, and their functioning improves, including relationship and family functioning.”
For many years, Dr. Miklowitz said, the extreme mood swings of bipolar disorder had been thought of “as sort of an exclusively genetic, biologically treated illness,” to be managed primarily with medication. But his most recent study, reported a year ago in the Archives of General Psychiatry, showed that long-term therapy of 30 50-minute sessions over nine months, with medication, cut median recovery time to 169 days, compared to 279 days for those receiving short-term therapy of three sessions over six weeks.
The study also showed that family therapy had slightly better results than other types of psychotherapy, Dr. Miklowitz said, though the difference was found to be statistically insignificant.
Nonetheless, he and the founder of Beth Israel’s clinic, Dr. Igor Galynker, said their experiences with patients showed that families are in the best position to catch early warning signs of a manic or depressive episode.
“It can be something as subtle as a change in lipstick shade,” Dr. Galynker said. “Only a person who knows them very, very well would know.”
Patients often do not recognize the symptoms. “Because the mania feels so good, there’s no way for me to know that I’m doing it,” Mr. Cunanan explained. “That’s why it’s so important to have the family involved.”
Dr. Galynker and his patients agreed to open therapy sessions to a reporter with the hope of dispelling the stigma that surrounds mental illness, which can sometimes make patients ashamed to confide in those close to them.
Because there is data that shows bipolar illness to be hereditary, Dr. Galynker said that being open about the disease could help the children of people with bipolar disorder to understand the risks of inheriting it. People with bipolar disorder can cycle between depression and mania. The manic highs, with attendant feelings of excitement, elation, grandiosity and obsession, can be so gratifying that patients fail to realize they are part of an illness and prelude to a breakdown.
It was a depressive swing that brought Helen Kraljic Fama and her husband to Beth Israel’s clinic, on 17th Street near First Avenue, nearly 30 years after Ms. Fama suffered her first bout with the disease.
Ms. Fama, 50, who was once a bookkeeper and a cashier, said her manic episodes include an obsession with numbers, which she feels are friendly to her. (“I always brag that she scored a perfect 800 on her math SAT,” said her husband, Anthony P. Fama, 60.) In her last bout, in March, she was watching a John Travolta movie, “Swordfish,” when her fingers began working an imaginary keyboard as she communicated with the numbered codes on the screen.
The subsequent depression, coupled with the guilt she feels about her inability to work, or even to make dinner, has left her sometimes feeling like “ending it all,” she said.
Ms. Fama recently walked from her home in Queens to the 59th Street Bridge, thinking of jumping off, but changed her mind when she saw a lot of construction workers on the bridge. So she had breakfast at a restaurant, then called her brother to take her home.
In a therapy session on Monday, Dr. Galynker suggested enlisting Ms. Fama’s brother to keep her company at home while Mr. Fama was at his job as a supermarket manager in Manhattan.
“Can I rely on your brother?” Dr. Galynker asked Ms. Fama.
“Oh, yes,” she replied, clutching her purse as if it were her anchor in a storm. “He’s telling me to look in the mirror, see how pretty I am.”
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