When my daughter “Alice” was 24, she came home from graduate school one day at three in the morning in a new red Camaro. She sat outside in her new convertible, honking the horn.
She had spent her educational loan on the down payment for the new car’s lease, arguing that the car was necessary for her new consulting business. She wanted to quit graduate school one semester before receiving her degree so as to immediately start the business.
I noticed that she was talking so fast that I couldn’t interrupt her. Continuously pacing, Alice stayed up the rest of the night talking, making numerous phone calls to bewildered friends to tell them about the new car and business plans. I took her to the hospital in the morning, when it was apparent she was not going to go to sleep or stop talking.
At the hospital, Alice smiled and shook hands with everyone she encountered. While she was waiting for the doctor, she repeatedly sang the jingle, “See the USA in your Chevrolet.” Alice told the doctor she felt “wonderful” and asked him if he wanted to go for a ride in her convertible.
I explained to the doctor that Alice had been depressed her senior year in high school but got better after taking an antidepressant for six months. She had no related problems until her sophomore year of college, when she was hospitalized for sleepless nights, boundless energy, rapid speech and purchasing two dozen red dresses in one day. During that two-week hospital stay, she improved by taking the medication lithium. She stayed on lithium for a year, and then spontaneously stopped her medication. She had been well for four years before this last episode.
Following the initial assessment in the hospital, which included a negative result on a test for drugs and alcohol, Alice was admitted to the inpatient psychiatric unit and prescribed lithium. The dose was gradually increased over the next five days. Alice became more organized in her thinking and behavior and was discharged on day six. A follow-up appointment with an outpatient psychiatrist revealed an appropriate lithium level in Alice’s blood, and she was able to resume her usual activities. Alice was aware of her manic behavior and its potential for disaster. She vowed that she would be diligent with her medication and treatment.
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