Developmental psychology.pdf

Therapy 473
Figure 17.14
JW's Mood Changes. This record
was made from nurses' ratings. The
patient was rated +3 when he was
almost constantly abusive and
quarrelsome, and —3 when he was
inactive and despondent. Note the
regularity of the results (Jenner,
Gjessing, Cox, Davies-Jones, Hullin,
& Hanna, 1967).
-2
-3
14
Drug Treatments
For J. W., who apparently had some brain damage, the simplest and most promising
somatic treatment seemed to involve drugs. This treatment can be readily instituted;
it can be altered in various ways; and especially for short periods, it does not involve
the negative consequences associated with electroconvulsive shock and psychosurgery.
Analysis of the Situation The first step in drug treatment is to determine the nature
and extent of the problem. Such studies showed that J. W.'s cyclic mania and depression
had lasted for years. The stories about his ups and downs would fill a notebook. One
day at work J. W. crammed the suggestion box with ideas for improving the engineering
industry; the next day he apologized. Two days later he made more suggestions. Then
he put together a piece of firewood, a pencil, and handkerchief, and he described the
apparatus as a perpetual motion machine. Another piece of wood with a few lines on
it became a revolutionary approach to chess, darts, and cards. But the next day these
"inventions" were disowned.
These studies also showed that J. W.'s mood change invariably occurred while
he was asleep, a few hours after midnight. Kept awake all night, the change still occurred.
When placed in an altered day-night cycle of 22 hours, living in a special room
in the hospital, the full pattern occurred every 44 hours rather than every 48 (Jenner,
Goodwin, Sheridan, Tauber, & Lobban, 1968).
In eleven years there were only seven or eight occasions on which J. W. "missed
a day." In a few instances the mood change occurred a few hours later than usual, but
otherwise the cycle was highly predictable (Jenner, Gjessing, Cox, Davies-Jones, Hullin,
& Hanna, 1967; Figure 17.14).
Need for Trial-and-Error Approaches Next, J. W. received a medication known
as lithium, and it appeared helpful. The reaction of any therapeutic drug with any
patient is partly unpredictable, for the person's diet, general health, and constitutional
factors all influence the outcome. Soon it was discovered that lithium was not effective
under certain conditions, and after further study the problem was identified. A highsalt
diet was interfering with J. W.'s response to the lithium (Hanna, Jenner, Pearson,
Sampson, & Thompson, 1972).