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The Duchess of the Netherlands*: A Case of Bipolar Disorder

Written by: Lane Gormley, EdS, LPC, NCC
(*This Client is not identified by the title she gave us but by a similar one)

Before I tell you about the Client called the Duchess of the Netherlands, I want to say a word about diagnosis. When doctors diagnose a Patient, they are saying how they conceptualize, and how they intend to treat, that patient’s symptoms. There can, therefore, be several possible diagnoses of one patient’s symptoms, depending on who the doctor is and what he thinks. So, diagnosis is less about the Patient than it is about the doctor.

Diagnosis is not an exact art. It is subject to opinion. I have seen patient files in which a single patient, over the course of his treatments, received as many as four or five different diagnoses although his documented symptoms and behaviors remained consistent. Although I am not interested in diagnosis, I will say, at the outset, that the Duchess of the Netherlands had received several diagnoses of Bipolar Disorder.

Bipolar Disorder is extreme mood instability. It is not simple moodiness. People who have it suffer from crippling, often suicidal, depression alternating with dangerously high moods like mania (extreme euphoria, grandiosity or rage). There are two types of Bipolar Disorder diagnosis. Bipolar I is characterized by one or more manic episodes, while Bipolar II is milder with only hypomanic episodes. The Duchess of the Netherlands was, and had been, consistently diagnosed with Bipolar I.

She was extremely beautiful with vivid blue eyes, elegant features, and long, black hair. She spoke with an educated precision and correctness, although many of her teeth were badly broken. She lived on the street and, I imagine, other places as well. Who she actually was and who was related to her were mysteries that I would try to solve again and again. I did not want her to be without resources. I did not want her to be ill and in danger. She was a frequent Client on the Behavioral Health Services Crisis Unit in a large, inner-city hospital. I was a Clinical Psychotherapist. We met there many times.

The Duchess was highly intelligent and may have been educated in Europe. Her knowledge of the period between World Wars I and II was encyclopedic. When I tried to find out her name, however, she told me that she was the Duchess of the Netherlands. She was also, she said, a doctor and so was her husband – “Cecilia and Jeremy Saint”. “People call us the Doctors Saint”, she said, smiling.

She could be difficult with the staff members and would often only communicate with and through me. She thought that I was Anna Freud, Sigmund Freud’s daughter. No one else would have been qualified to be a Duchess’s therapist, right? She would ask me to tell people what she wanted them to know. Dr. Freud, please tell Amanda not to let people know that I have gained weight. She once cornered one of our Interns in the hospital room of an East Indian patient that she thought was her “husband”, and I had to talk fast to protect my young colleague.

I made many efforts to find out more about the Duchess. Everyone commented on my ongoing research and my indefatigable zeal as a detective. I often asked the Duchess herself for family information for hospital records and the insurance company; but she was unhelpful. I own the hospital, so you don’t need to worry about that. I pored over some papers she carried, comparing dates on them with those in hospital data bases, looking for a clue. I found a man’s name and a phone number, but the line had been disconnected. I searched for his name on the Internet and eventually came across it with another phone number listed. The address was near the district in which the hospital was located. I dialed the number. A man answered. When I told him who I was and what I wanted, he hung up.

The police often brought the Duchess to us in a high and sometimes violent mania. They had arrested her for dangerous behaviors. The doctor would prescribe medication, and we would stabilize her and then, after three or four days, we would discharge her; and she would resume her patterns. She had no known identity (at least by us) and no known support system, so after stabilization in inpatient care, we would sometimes transfer her to Georgia Regional if they had a bed. Once we transferred her there before she was ready to leave us. She had found another “husband” on the unit and did not want to leave him. The Police took her away, but before I had left the hospital at the end of my workday, she was back in the Emergency Room waiting to be admitted to the Crisis Unit. The Duchess really knew how to work the system. That day, however, since she had already been stabilized, she was refused admission.

Why do I think of her so often? Why am I writing about this woman whose name I tried and failed to learn? I think that one reason is because I wanted to help and could not. That was a good lesson for me as a therapist – to understand that I cannot heal another person but only support them in healing themselves. Another reason is that, had she truly wanted help, the possibilities could have been limitless. In fact, the Duchess chose the life she led each time that she was noncompliant with medication and therapy. How could she have made such a choice? The Duchess was, in fact, the Client who taught me the irresistible and fatal attractiveness, for some Bipolar persons, of high moods.

In another blog, I mentioned what a Bipolar Client said about his mania – “It’s like having a drug factory in my head.”. Moods like that are hard to resist, and the Duchess either could not or would not resist them. Clients with manic highs feel as though they owned the world and as if they were the Rulers of the Cosmos. Some of them have a Messianic Complex and believe that they are God or the Messiah. Some believe that they are crowned heads of state (like the Duchess of the Netherlands). Others believe that they are immune to the Laws of Nature and that they can fly or drive cars at the speed of light. If they become frighteningly and uncontrollably high, they might use drugs or alcohol to take the edge off their rapidly combusting nervous system. This is not helpful. Bipolar persons might commit suicide accidentally – or on purpose for fear of coming down or crashing. Their “hyped, stoked, and amped” World View (I am borrowing these terms from my younger Clients) is unsustainable over time.

It is my belief that the Duchess – if she is still alive – is addicted to her highs and that she yields to them at great risk to herself and others. It is a sad thought that mania can be more appealing than life itself.

There is something else. Each time that I think of her, I tick off in my head a list of Bipolar Clients who lead normal and productive lives. They take medicine, check with the doctor if they think the medicine is not doing what it should do, see their therapist, avoid stress, and maintain a close support system. They hold jobs – sometimes very brilliantly – and use their creativity to help themselves and others. Why could she not get well? Why would she not want or avail herself of our help? These are questions I still ask myself.

Please be sensitive to your moods. If you think they are a problem, we are always here to discuss it with you and to come up with a plan. If you would like to read a wonderful first-hand account of one woman’s attempt to come to terms with Bipolar Disorder, read Kay Redfield Jamison’s An Unquiet Mind: A Memoir of Moods and Madness.

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