Saturday: sorta routine

With T. back, he attempted to go to martial arts. The regular teachers are both on vacation, however, there was an alternate who was supposed to be there but who was … not. T. gave up and had breakfast at Vic’s. He did not tell me until he got home, so I checked in with the owner, and apparently the substitute did not show up for the later class, either. *shrug* It’s summer. Things happen.

I walked with M. before the piano lesson. The really nice thing about getting up at a reasonable hour is that morning walks are so much cooler. Even by 10 am, it’s gotten pretty warm.

Piano lesson did happen, tho! Nice to see F.

I’m finishing up the last of T.’s camp laundry. It’ll be nice to have that all put away. There’s a sleeping bag hanging to dry, and a jacket in the washer, and that’s about the end of it, I think.

T. has gone to see Mission Impossible. He wanted to see Oppenheimer, but when he was looking for tickets last night, there wasn’t much selection. People are apparently going to see movies again. He’s got a party later in the evening as well. R. has an appointment to get a new tire mounted for the i3; that’s good, because we were functionally down to 2 cars and while that didn’t matter while T. was at camp, it is starting to matter now.

From Ellen Frank, _Treating Bipolar Disorder_

I’m reading the kindle version; this is 74% of the way into the book.

“In the original 1984 manual, Klerman and colleagues state that role disputes arise from “non-reciprocal role expectations.” … In other words, in any relationship, things go well when each party has a clear idea of what his or her role in the relationship should be and what the role of the other person should be, and each is able to meet the other’s expectations without having to give up his or her own. Things go badly when the parties don’t have the same role expectations and/or when one or both parties cannot meet the expectations of the other.”

I haven’t read the work in question. IPSRT builds on top of Klerman et al’s work by adding an explicit social rhythm component to the underlying Interpersonal therapy. I’m really here for the social rhythm component, _not_ what feels to me like an overly structured and suspiciously retrograde perspective on relationships. However, I’m now here and if I can ever figure out where I dropped my jaw, I’ll probably have something to say about this. In the meantime, I will type.

Frank goes on to say, “This can certainly be true of therapeutic relationships and is likely to lead dissatisfication and, eventually, to dropout.” Frank dropped a “to” between lead and dissatisfaction. Given the typos, wordos and other confusion I routinely produce, mild mistakes of this sort warm the cold cockles of my heart.

“Unfortunately, many aspects of the specific psychopathology of bipolar disorder and the complexity of its treatment can interfere with the development of the ideal, reciprocal-expectations-met therapeutic relationship.”

Well, now, let’s not go _right_ down the path that this is the gate to. This is a theory of interpersonal relationship based heavily on the idea of people — really, here, persons — as monadic. That is just never not going to cause me to jump up and point and see, see, see, see!!!! Somebody did it again! Further it is a theory of interpersonal relationship with a massive bootstrapping problem, in the therapist - bipolar client context _for sure_, and also just in general. Where did those expectations come from, anyway? I mean, if you are kinda trad, and writing in the 1980s, you can walk around going, well, of _course_ a wife has these expectations from a husband and _of course_ a husband has these expectations from a wife and you can diagnose people who argue with you. Can’t do that anymore! Someone will diagnose you. But even in the 1980s, a therapist had to _teach the bipolar client_ what the disease was and what treatment involved and what to expect and so forth. The therapist is walking into this with the intention of carpetbombing the client’s expectations and replacing them with the therapist’s idea of what the client’s expectations should be.

This is a not great theory of interpersonal relationship. But wow, is it bonkers here.

I’m absolutely _here_ for a theory of relationship that involves people being reciprocal and people having expectations of each other. I am _much less here_ for an idea of “role”. I understand that if I have custody of a minor child, I have assumed some legal obligations associated with that role. But why is this idea of role popping up _here_? Probably to import into a dispute between _two_ people a bunch of laundered opinions of a third and additional people. Got a husband and a wife arguing about how much money one of them is (not) spending? Sure, why not add everyone else’s ideas about how much should (not) be spent. Got a parent and a child arguing about when the child should get up, go to bed and what the child should be doing between those two things? Sure, why _not_ add everyone else’s ideas about all that? That’ll help so much!

I am all in favor of ransacking cultural products for more ideas for how to solve problems. Go forth and expand your repertoire of ideas and tools! And also, if you are doing something with/to other people and we’ve got legal constraints on how that can and cannot be done, probably increase your awareness of all that and if it looks like you are not going to be acting within those limits, factor that into planning (not legal advice!).

In general, if someone is involved in a role dispute, my very first piece of advice is going to be, let’s get rid of the roles and see if the dispute exits with the roles. If it doesn’t, let’s address the dispute between persons, with the “role” elements on the list with everything else about the persons that the “role” excises from our understanding of each other.

However, I have not read the underlying book; I’m just having a metaphorical allergic reaction to the “role” construct.

ETA:

In a case study of Janis, 78% of the way into the book.

“She reported a history of bipolar disorders beginning in her early 20s, with yearly episodes of both mania and depression that clearly had a seasonal pattern. Her mood began to dip each September, with worsening symptoms over the fall. Her mood tended to lift in mid-February, and by April she experienced hypomanic symptoms.”

Ahhhhhhh. I can’t even express how familiar this is, in its subclinical (or, at any rate, undiagnosed!) form. So. Many. People.

A Few Remarks about Viewership Data

First, a link that I stole from wikipedia:

https://archive.org/details/variety66-1922-03/page/n46/mode/1up?view=theater

That links to a 1922 article in Variety magazine, in which they say they’ve got some box office receipt estimates, describe how they generated them, and how they planned to expand on those estimates in the future and why. Specifically, this was aimed at part at “the independent producer and distributor who had something that the Broadway house wanted and he will be in a position to combat the “poor business” argument handed him”.

Next, the observation that in the same article, big movie venues were identified with specified studios in 1922, a practice that would continue until the Paramount antitrust case of 1948:

https://en.wikipedia.org/wiki/United_States_v._Paramount_Pictures%2C_Inc.

After that, studios were prohibited from owning theaters, until that decree finally ended in 2020 (well, okay, maybe the process of ending that decree started in 2020 and was fully baked in August 2022).

Next, the observation that anyone reading this grew up accustomed to hearing about Nielsen ratings. Nielsen is of course a company that pays consumers to tell Nielsen what they watch on TV and then Nielsen sells that data to interested people. As of 2020, Nielsen started to generate streaming viewing data as well as broadcast and cable viewing data.

In the course of me not successfully avoiding conversations about the strike, I’ve now had two conversations (at least — two that went on long enough for me to remember) that involved someone who Was Not Me saying I don’t really know why streamers are so unwilling to share their viewership data and me saying, well, we didn’t get really good box office data until the antitrust stuff for movie studios, so why would it be any different here. Streamers, like all studios, know that the data they have, in the hands of creators, would give creators a much better chance to negotiate fairly with the streamers, just as data had that effect on studios.

Were box office receipts possible to estimate during the pre-Paramount decree era? Sure, in more or less the exact same way that Nielsen can now estimate the top 10 streaming shows.

There’s a pattern here. One of the ways that trusts, monopolies, people who don’t really want to have to deal with That Much Competition make sure that they don’t have to deal with That Much Competition is by making it so people don’t even realize _why_ they are doing what they are doing _while doing it to suppress competition_. Streamers are very selective about the data they share on viewership because they know just how bad it is for them if everyone got a peek at a lot of it.

ETA: Only very marginally related (<— might be a joke!): there has been news coverage of Netflix subscriber growth again in the wake of the Stop Sharing Passwords campaign.

Ellen Frank, Treating Bipolar Disorder: A Clinician's Guide to Interpersonal and Social Rhythm Thera

This is a clinician’s guide. I have absolutely no training in the field that this is a guide for. What happened here is that I heard about this type of therapy and immediately thought: Most Walkitout Thing Ever. I have read Clinician’s Guides before, the first being Ellen Quick’s _Doing What Works in Brief Therapy_, which is wonderful. I’ve also read other books in this general field, such as Xavier Amador’s amazing _I’m Not Sick I Don’t Need Help_, as well as memoirs/own voices books in the field such as _The Buddha and the Borderline_, by Kiera Van Gelder (and, I think, A Lifelong Journey, by Sarah Russell). I don’t usually go looking for books of this sort — but sometimes, a really good one crosses my path, and I am struck once again by how amazing people are, that they are willing to really put themselves out there to try to help those who so many others give up on.

Having _read_ this book, I am forced to conclude that while it is not actually the Most Walkitout Thing Ever, it is at least adjacent to that. The spirit in which the author invented this therapeutic approach, and the meticulous and compassionate way in which she presents this therapeutic approach are all definitely both more professional and much … better as a person than anything I, personally, am capable of. (Look, if you want to argue, that’s on you; I’ll switch to, “Have any commitment to” vs. “capable of”.)

Also, I feel like she’s a whole lot more optimistic than I have been capable of being for a very long time.

Enough about me!

Frank is coming from a background in short-term therapy, but obviously, you work with people with bipolar disorder and you are going to realize that short-term therapy is probably not an appropriate expectation for all of your clients. She’s very cognitive behavior oriented, very present/future and problem solving oriented. And she’s hard core about routines and consistency of what you are doing at what time of day. The big ones are when you get out of bed, when you start work, when you have dinner, when you go to bed.

Frank is extremely committed to using pharmacotherapy with bipolar I, and most bipolar II. She addresses the text to both people who are providing the pharmacotherapy and to people doing the talk therapy component with a good, close relationship with the prescriber and with people who … don’t have that. I have absolutely no argument with any of that. Responsible approach.

Frank has a proactive approach to side effect management. Good for her! She’s pretty emphatic that the reader should not be waiting for their client to bring the problem to the talk therapist’s attention — ask about the possible side effects, _specifically_, and then ask again at appropriate intervals as many take a while to show up.

I’m not loving the stuff about weight in this book, however, it could be so much worse. Kinda neutral on that.

My biggest issue with this book lies in the IPT component that the circadian rhythm stuff is layered on top of. The approach she uses is very role focused and I, personally, have a profound “allergic” (hey, it’s a metaphor, but it’s a powerful metaphor — I feel like I’m about to crawl out of my skin whenever I encounter it) to “roles”. I get the basic idea of “roles”. And also, you can definitely understand how someone who self-described as loving to fuck with other people’s ideas of what gender means _long_ before ever knowing terms like “nonbinary”, well, I’m not going to be okay with “roles”. I get there are laws and norms and expectations, and I am absolutely prepared to learn about them and incorporate them in my planning. And also, just _no_ to role based expectations.

_That_ _said_, if you just edited out all of the “role” shit, I’m fairly certain you would have something I’d have very little to complain about in her psychotherapy approach. I’m not sure any of the practitioners would _recognize_ what was left, so that would surely be an issue.

Anyway.

It’s hard to recommend a $30+ clinician’s manual to ordinary readers. But this one’s really good. It’s not painful to read, and I really cannot emphasize how unusual that is. Her guidelines are reasonable and her advice is solid. She provides quite a lot of granular detail on how to structure a 16-24 session program, and how to work with various other providers. This book is not right up to date, but she absolutely includes phone contact as a way to keep tabs and catch prodromal indicators.

If your kinship network includes a lot of people with clear seasonal mood changes, and somebody in that network has had more than one psychiatric hospital stay, you should read this book. If you treat people with bipolar, in any capacity, you would likely find value in reading this book. If you participate in public policy making on any level, and you are struggling to understand how much psychotherapy support should be included in your policy platform, this book might be helpful to at least skim. Especially the last couple chapters.

Outside of those cases, if you like reading super in-field things that are really, really well written, independent of _what_ field, maybe get it from the library and see if it does it for you.

I’m going to poke around and see what’s been built on top of this, if anything.

ETA:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812517/

2019 overview of interventions in clients with bipolar, focusing on disrupted circadian rhythms. Really great! Lots to think about here.

This one is too technical for me to make sense of all of it, but has some interesting observations about how some quick but transient treatments for depression might all be accessing circadian rhythm in similar ways:

https://www.psychiatryinvestigation.org/m/journal/view.php?number=1042