The Battle To Define Mental Illness

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I knew there was some history between some of the players in DSM-IV, and I’ve read before about all the NDAs and the various accusations that go with them … but I didn’t know that Allen Frances had Risen From Retirement to Stand Against DSM-5, and become Public Enemy Number One with the APA, etc.

I also knew that when I recently read an article about how Schizophrenia is supposed to work in the upcoming DSM-5, it made me feel slighly psychotic myself – and now I have some perspective that maybe I was right to feel that way!

While I agree that the DSM really is nothing more than an attempt at a standardized way of communicating with each other (and our masters … the payors …) – it still seems to have gained much more power over the years, which I suppose is a testament to the power of language and what it means to name things. We jokingly refer to it as a bible – but the emotion surrounding the book seems to really be on a level with The Bible! So much so, I really think some people think that changing the definition of schizophrenia in the DSM somehow actually alters the Disease Itself (as if that really existed outside of the human conceptualization of such …)

And of course there’s a ton of money involved. :-)

As for me, I’ll learn how to use the new book, whenever it’s released, because I’m sure that I’ll have to put the little numbers on some form. Once that chore is complete, I will resume talking to my patient and trying to figure out what is really wrong, so I can actually help.
 

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17 Responses to The Battle To Define Mental Illness

  1. AnonymousAtLarge says:

    I have seen three (3) mental health professionals in my lifetime.
    I have received three (3) different diagnoses.

    The first event was a 2 hour assessment by two psychologists. I consulted with them because I was afraid I was developing schizophrenia. I was 25, and I went crazy that summer… for lack of a better word. Weird things were happening to me, and I have a family history of psychosis. Starting in june I began having incredible spells of energy, as well as disordered thinking. I would pace around, talk to myself, feel elated, high as a kite, powerful, like I was on drugs. Sometimes my thoughts and perceptions would become disturbed, and I would feel paranoid and confused.
    I told them I had mental problems since my teenage years, I had very bad depression off and on since my preteen years. At the worst of my depression I co9uld not leave the house, talk to people, or take care of my hygiene, I was completely nonfunctional. Although then I never had these new symptoms. I told the doctors the first time I felt these energy spells I was 23, and it happened in the summer when I stayed up all night long (I temporarily went a little crazy). It never happened prior to that day.

    They unanimously concluded I clearly had bipolar disorder. I asked them if their was any chance I just needed therapy… I asked them if they were sure it could be anything else but bipolar. They said they were absolutely sure I had a bipolar disorder. They told me if I did not take medicine I would go mad one day.
    By the time I saw the doctors the symptoms had already went away. It was september and it vanished as if it never happened.

    The second time i consulted with a doctor it was that following april. I never could shake the warnings the first ones gave me (“you’re gonna go nuuuuuts one daaaaay”).
    I felt the energy feelings again, starting in april, and I was scared I would go crazy for real this time. I was 26 now.
    That doctor sat with me for 30 minutes and gave me a diagnosis of bipolar II.
    Later she would modify it to many other things – possibly seizures, possibly thyroid,possibly schizoaffective. One time she wrote down on a prescription the code for “severe manic episode”. I began to suspect she just wanted to siphon my insurance money and this was a grand waste of time. EIther she was the most inept doctor in the world (to diagnose me with so many things) or she didn’t care at all if any of these diagnoses were correct or proper and just needed to write something down so I could keep giving her cash/feel crazy.

    I quit that after about 5 weeks of realizing her regimen of antipsychotics was a ridiculous thing to take simply out of fear of becoming insane (when I have never been truly insane before, duh).

    The third, and FINAL TIME I saw a mental health professional was that following december. I was now 27. I had an extremely bad depression starting in october, struggled with it all november, until I started becoming desperately low and decided I should maybe consult a professional (given what the previous doctors told me about being fucking mad as a loon, perhaps maybe i should see someone who specializes in insanity, methought). I was crying every day and thinking of suicide. I was indescribably miserable. I could barely go to work and other than go to work I could not do anything else. It was one of the worse depressions I’ve had (not the worst by a long shot, but it’s up there in the books).

    I had a serendipitous moment, a week before my psychiatry appointment… I realized the seasonal nature of my mood swings.
    The first time I was ever “high” was july (when I was 23).
    The time I was insanely /frequently high was june-august (when I was 25). It ended in september, correlating with decreasing daylight and decreasing ambient temperatures.
    The time I began to become rather depressed was october (when I was 27) and it progressively worsened as the season drew into fall and I saw no light.

    It was like, eureka… light and temperature control my moods.

    So I started using a light box, and viola I blinked and I cured my brain just like charlie sheen.

    Well, no it wasn’t that easy. Most of the worst of the depression left after a week of light therapy. The first day of light therapy it was like a shot blast full of energy, I could easily take a shower for the first time in weeks. I still had a cotton batting head but my body was able to move relatively normally.

    By the time my appointment with the (third) psychiatrist came I was much better. I was at a level of depression which was mild and unremarkable for me. I was still depressed but not to the point where I felt I even needed his services. I only went because, you know, that whole fear that I am a crazy person and need to be under the ward of a crazy doctor.

    This third doctor was the wackiest of the bunch. Even though I don’t necessarily agree with the previous doctors, at least their diagnoses sorta made sense and were based in some kind of objective evidence.

    This guy was just like a marvel of nature. He conducted no assessment at all. He asked me 2 questions, and then proceeded to define my personality as being very sensitive and unable to cope with the problems in my life, which then leads to me becoming depressed. He refused to listen to me when I explained that my depression clearly comes and goes in episodes and is not a chronic problem. His defininition of my personality was completely off the mark – I am a very AGGRESSIVE, MOTIVATED person who solves problems assuming I am NOT depressed. I am not the sort of person to internalize issues and fail to express myself and lilt like a deprived flower. Anyone who knows me IRL knows I fight and have no problem calling out a problem if it’s important.

    It’s like he looked at me and said “oh, a young woman complaining of depression” and then proceeded to randomly assign me a misogynistic diagnosis based on his preexisting ideas of women and emotions.

    I was still pretty depressed when I saw him, normally I would have handed his ass to him and fought and explained myself but I could barely even talk… so after he ranted for like 30 minutes I just broke down crying and left and went home.

    After that third and final run in with the crazy doctors, I vowed never to see another one again.

    I look back at the past and see the various diagnoses I’ve been given over my 1.5 years of consulting with crazy doctors, and I realize none of them know SHIT.

    The diagnosis you get is highly prejudicial and says more about the biases of the doctor than it does anything about you.

    If the doc thinks you’re weird, they’ll try to schizo you. Second doc thought I was a weirdo, she was keen on calling me potentially schizo.

    If the doc thinks you’re a weak woman, they’ll pin some kind of personality shit on you. Borderline, or dependent, or something. They’ll figure out a way to make your “problems” the result of hypersensitive emotions.

    Maybe the first doctors were right, maybe I will one day flip my shit and end up in the ER ranting about jesus christ while nurses hold me down and inject me with major tranquilizers.

    But there is no point living afraid that is true because there is no way to know the future. I’m pretty old now. Odds are if I was going to have a major psychotic manic episode or something, it would have happened by now.

    So, until that happens, I will never ever see another psychiatrist, because their diagnoses are totally made up and off the cuff and the profession sees nothing wrong with telling people they have incurable serious brain diseases when there is no evidence for them.

  2. AnonymousAtLarge says:

    Oh and, I still get tiny highs… nothing like the time that lead me to the crazy doctors. For example, I no longer ever have disturbances of thoughts or confusion of perceptions, ever.
    The last time I was high was march. This was triggered predictably by the season change and loss of sleep resulting from the season change. It was like I was using invisible stimulants for about 2 weeks, then it went away and I was normal again. I’m cool as a cuke.

    I’m old enough to the point where it is unlikely I will get any worse, so it looks like I probably won’t ever go nuts for serious after all.

    It sucks though that my records say like “major manic episode” and “schizoaffective” because I have never had a major manic episode and I am not psychotic. If I ever try to get insurance, or collect on my insurance, I’m screwed.

    QUESTIONS!

    Why do psychiatrists think nothing of labeling a person seriously mentally ill? Why are some psychiatrists so greedy that they use no caution at all in assigning diagnostic labels, no regard for how it might affect that person’s future if the diagnosis is incorrect?

    Why do psychiatrists feel forced to diagnose a patient with serious mental illnesses in order to retain insurance benefits from the patient?

    Why does the patient have to then walk around with this stigmatizing label which they don’t even have, which will fuck up their insurance for the rest of their life, simply because they wanted to ask a medical doctor if they were okay in the head?

    Perhaps I do have a “bipolar spectrum” illness. Lets assume I have bipolar disorder, lets be risky and say I have bipolar II. I’ve never been in an ER for insanity. I take no medications now. I have never been in a psych ward. I have been coping very well. I’m employed. Why should I be labeled as a high risk patient when I have never demonstrated that I am going to be a costly patient? I am super duper healthy physically as well, more than most people. Why should I pay outrageous insurance premiums when I use less insurance services than other people?

    I mean it just sucks.

    The whole point of the DSM 5 is to create more frigging labels for doctors to stick on people, so that they can then suck the teat of the insurance companies. This is the only purpose of the DSM.

    Psychiatry is sort of a joke. Right up there with the guy who butchered michael jackson and heidi montag, and all the doctors trying to cut out the uteruses of females for no reason but $$$.

    • statelymulligan says:

      Perhaps I do have a “bipolar spectrum” illness.

      I’d put good money on it. Welcome to the club.

      • AnonymousAtLarge says:

        I’m not against the idea that I have a bipolar spectrum illness. Given my history, if I am honest with myself, bipolar disorder is the most likely explanation. I think of the worst of my depressed, and I think of the highest of my highs, and it is obvious it’s not normal.

        However, look at myself today – I am a functioning person with a full time job and I do not use psychiatric services. I have to date not had a major manic episode. I have never had a psychotic episode. It’s not fair that my medical records are sullied with false labels, which any insurance company can scout out and use as ammo against me in the future.

        At the age I am now, it is highly unlikely my mental problem will get any worse than it is. It’s very rare to have a first manic episode this late in life.

  3. The real purpose of the DSM isn’t to diagnose a guy, but to elicudate the epidemiology. Not, “does this guy have bipolar?” but “what kinds of people have bipolar? If we redefine it this way, who gets included or excluded?”

    Yes, it’s about the money, but no, not the way you think. Pharma will find a way to benefit any way it can, and if it’s allowed to create diagnoses, it will. No surprise.

    The real money, the big money, is in the social services. When bipolar is Kay Redfield Jameson type I mania/depressions, that helps her and no one else. When bipolar includes impulsivity and aggression then you have a way of medicalizing crime, etc. Before, you had to really decide whether a husband who punched his wife should go to jail, or not. Binary– criminal, or not. Now, you can arrest him but sentence him to probation and psychiatry.

    Point is, if the medicalization of social problems was effective– if it did make the wife beater less abusive or the drug user stop using, then whether it was “true” that he had “bipolar” or not might not matter. But it doesn’t work. It does, however, delay the day of reckoning, which is sort of the point from the government’s perspective.

    • CubaLibre says:

      No wife-beater is “sentenced” to “probation and psychiatry.” They get jail. While in jail, are they more likely than ever to receive psychiatric services? Yes. (The number of times I’ve heard the words “anger management”…) But they’re still going to jail. The only place in the criminal justice spectrum where probation+treatment has become a dominant form of punishment/monitoring is in drug crimes, which is as it should be (actually, it should be decriminalized, but).

    • AnonymousAtLarge says:

      But will society really tolerate medicalizing people who are clearly behaving in an abhorrent way for non psychiatric reasons? I think that there will be a moral backlash to such an attempt.
      I’m not against medicalizing crime if it means a reduction in crime. This might work for some criminals such as sex offenders. It would make chemical sex drive suppression more acceptable if we medicalized sex offenders as having a disease which needs treatment. Its shown that progesterone is a very good deterrent to all types of sexual abuse because it kills sexual interest (and most sexual crimes are motivated by sex drive to a significant degree). IT’s hard to get people on board with this treatment because the general consensus is that pedophiles and rapists choose to be evil and should just go to jail or get counseling so that they stop choosing to be evil. I do think sex crimes are heavily biological and forced compliance with a progesterone therapy would cut it down no time flat.

      I don’t see the point of labeling a wife beater as mentally ill, if he is actually just a selfish asshole who doesn’t care about anyone but himself and his selfish impulsive need to release his anger. How is labeling him bipolar going to get him to stop punching people? Will he even take the tranquilizers? Will they work?

      Furthermore, I also don’t see why we need to conflate criminals with people who have severe mental illnesses they can’t control. Why label a wife beater bipolar II, we can just label him with some kind of anger management personality disorder instead, and avoid ruining the reputation of people with manic depression for no reason. There are so many people stigmatizing bipolar disorder already (because they are jerks and not really bipolar) why should we even support any attempt to lump sociopaths and criminals as having a bipolar variant?

  4. One other thing:

    Among the numerous alarms the piece sounded, Frances warned that the new DSM, with its emphasis on early intervention, would cause a “wholesale imperial medicalization of normality” and “a bonanza for the pharmaceutical industry,” for which patients would pay the “high price [of] adverse effects, dollars, and stigma.”

    I really can’t believe this guy is this blind, but hatred of Pharma really makes people bananas. Is he saying that because it is a bonanza for Pharma, therefore it must be bad? Note he’s not saying that the bonaza will result in something bad down the road– it is specifically the fact that Pharma profits that he hates.

    He believes, erroneously, that normal people are going to be sucked into the psychiatric vortex and given meds they don’t need. That they don’t need the meds is true; but that lots of normal people are going to take them is false. The psychiatric umbrella isn’t extending to cover normal people, it is extending to cover marginalized people.

    You get a doctor’s note to get out of school. Are you sick? No, you lied, you just want the note. But the way medicine works, you still get counted in the rolls as “ill”: e.g. “in 2011, there were 50M absences from school due to illness. We need to increase our healthcare spending.”

    And this:

    I recently asked a former president of the APA how he used the DSM in his daily work. He told me his secretary had just asked him for a diagnosis on a patient he’d been seeing for a couple of months so that she could bill the insurance company. “I hadn’t really formulated it,” he told me. He consulted the DSM-IV and concluded that the patient had obsessive-compulsive disorder.

    “Did it change the way you treated her?” I asked, noting that he’d worked with her for quite a while without naming what she had.

    “No.”

    “So what would you say was the value of the diagnosis?”

    “I got paid.”

    This man’s an idiot. He had to consult the DSM to realize that the patient he’s been with for months had OCD?

    No, he’s not an idiot, he’s wiley and crafty and dangerous. The woman didn’t have OCD, he’s saying, “well, it has wings, and it flies south, so it’s a duck!” so he can get his private jet permission to land near a pond. That’s what we do in psych all day.

    • AnonymousAtLarge says:

      I would be willing to be the journalist wrote the part about him “consulting the DSM” in there. Most likely the doc already had her pegged as some kind of OCD issue but maybe he looked up the exact specific code for it or whatever.
      I find it hard to believe a psychiatrist could see someone for months and have no stereotyped preconceived notions about what was wrong with the patient. This is completely contradictory to my experiences with psychiatrists – they are all too happy to stereotype and box you into some category they have intuition you belong in, within minutes of meeting them.

  5. Zo says:

    And there are how many psychiatrists in America who agree with you?

    Plz. note addresses and phones. Kthx.

  6. EasternMind says:

    @AnonymousAtLarge: Sounds like you had some crappy experiences with psychiatrists. Not uncommon, I’m afraid. Great that you took control of your own health, identified your patterns and addressed them. Not all psychiatrists are indiscriminate diagnosticians or prescribers, though (enough, certainly, to warrant the contemptuous stereotype, but not all…). Keep this in mind, in the event that you ever go truly batshit, and need some assistance.
    @TLP: I think you misread the predominant emotion driving Frances–It’s not hatred of Big Pharma, it’s FEAR, and it’s damned-well founded. The pharmaceutical industry would think nothing of latching on to Attenuated Psychotic Disorder as a cash cow, conducting a few of 8 week clinical trials (with all the usual exclusion criteria guaranteed to pump up effect sizes), then market the hell out of their existing atypicals for use in this “early psychotic” disorder. There would be no studies comparing pharmaceutical management with psychosocial treatments; the narrative would be manipulated in such a way that drug treatment would be the only (medico-legally) legitimate option. This is not hatred. This is a keen-eyed assessment of reality; a very scary reality. Your vitriolic response to such a lucid point makes me wonder how many mojitos you’ve had on a drug company’s dime; but that is, admittedly, none of my fucking business.

  7. Rooster says:

    Why do psychiatrists think nothing of labeling a person seriously mentally ill?

    If you’re going to a psychiatrist, you’re seeking out help from the medical model of madness. It’s an excellent model in my book, but you can’t complain about “labeling a person seriously mentally ill” ore than you can complain about “labeling a person seriously diabetic”. It’s an illness as any other to the medical worldview.

    If you’re in a country with a separation of state and religion, you have choices. You can seek help from a psychoanalist, but he might just as well tell you that deep down you want to have sex with your mom. Now, that’s insulting, but if you want to work within psychoanalysis, you have to accept its expansive acceptance of societal taboos.

    The model with the better odds, statistically, is the medical one, and psychoanalysis is a tangled web of logically inconsistent concept that only a dedicated analyst would be able to wield with expertise.

    I’m not a shrink, but I’ve been a patient for five years. If this makes you comfortable, anyway.

  8. AnonymousAtLarge says:

    Here’s the difference, rooster.

    If a dude comes into a primary care doc’s office with foot infections, complaints of poorly healing wounds, pins & needles sensations in his feet, a + family history of diabetes, central abdominal obesity, elevated cholesterol, and a fasting blood sugar of 212, an A1c of 10, the primary care doctor is not wrong for noting that the patient has diabetes. The doctor is not wrong because the patient is so freaking diabetic and it is plainly evident on even priliminary basic labworks. When the patient takes a proper OGTT and various other more invasive/expensive tests, the exact nature and severity of his diabetes will be elucidated… but all the same, it totally is possible to quickly diagnose diabetes in many patients (such as the type of patient I described above). This is because diabetes is a real disease with objective, unmistakable signs and symptoms.

    Mental illnesses are not like diabetes.

    1) It is totally possible to be wrong.
    A patient can come into your office and you might be thinking x but it turns out their problem has nothing to do with x after a few weeks of seeing the patient. How many “depressed” patients turn out to have atypical thyroid gland disorders? Once I was reading this flow chart for the treatment of bipolar depression. Interestingly some so called “bipolar depressives” only seem to respond to T3. Interestingly that the psychiatrists who discovered this never seemed to figure out that hteir problem might not be “bipolar” but more thyroid hormone related? Fact: a TSH and T4 level will not and will never identify all types of hypothyroidism. A psychiatrist is considered excellent if they run at least a baseline TSH, as if that somehow rules out hypothyroidism definitively so feel free to pile on the wellbutrin at that point in time, because clearly it’s not thyroid if their TSH is relatively normal…duuuuh.

    2) Mental illnesses are diagnosed based on subjective, rather than objective criteria. What little objective criteria do exist (e.g. a hypomanic episode must be 4 days or else it is not hypomania) is considered highly malleable and psychiatrists feel free to interpret however they wish. If you find one psychiatrist, they will believe 6 hours of furious energy and elation and then back to “normal” counts as full on mania. If you speak to another psychiatrist, they barely even believe in hypomania and won’t diagnose it.

    Diabetes, on the other hand, is so unmistakably objective. No one is going to tell a dude with a fasting sugar of 95 that he’s diabetic. He might get warned he’s at risk for diabetes if his fasting sugar last year was 80, but no one is going to be like “you need to get on glyburide and metformin STAT before you lose your kidnaaaayz!”

    This is because the criteria for diabetes are clear, and a fasting sugar of 95 aint it. It’s black and white, either your blood sugar regulations system functions adequately or it isnt.

    I could see one psychiatrist, tell them my history, and they will be like “you are so totally bipolar, probably bipolar I”. Then I could see another doctor and they will be like “your problem is that you are a woman and because of this you are sensitive and can’t handle life or problems or emotions”. And a third might be like “you’re probably bipolar II, or cyclothymic, but i’m mostly concerned about your early signs of psychosis and schizophrenia”.
    I could tell all of them the exact same thing, but the BIASES and SUBJECTIVE INTERPRETATION of who I am, how I look, how I talk, how I act, filtered through their unique minds will lead to radically different diagnoses.

    So, you see, there is a huge problem when a young adult goes to see a crazy doctor, and the crazy doctor takes their wacky pen out and starts writing all over that patients records:
    SCHIZOAFFECTIVE BIPOLAR, BIPOLAR II, BIPOLAR MANIC SEVERE EPISODE NO PSYCHOTIC FEATURES, et al.
    … because, it has happened before, sometimes people DONT HAVE THAT SHIT and they are fine(ish), but now there is all this written evidence that the patient is a psycho and has certain baggage for employeers and risks to insurance companies. All this naive young adult wanted was to see a doctor and get a medical opinion. Greedy doctor, wanting to retain insurance payments, went nuts with writing all kinds of crap in his or her record, without any concern what so ever how it might affect that young adult in the future.

    THat’s fucked up. Because the fact is, YOU CANNOT DIAGNOSE BIPOLAR DISORDER OR SCHIZOPHRENIA OR ANY MAJOR MENTAL ILLNESS WITHIN MINUTES OF MEETING SOMEONE.

    You can strongly suspect, but you cannot possibly have enough information to maket he diagnosis. Even if a patient looks manic out of their skull, you can’t know FOR SURE.

    Look at charlie sheen. Back in early march every arrogant doctor and armchair psychiatrist was SURE he was having a manic episode, a severe one. They based this on a few minutes of him saying stuff like “I have tiger blood and adonis DNA… I’m bi-wining!” while looking a little high strung.

    Slowly but surely everyone backed away from the “he’s manic” angle when it became obvious C. Sheen was totally in control of himself and behaving in a logical and controlled and methodical manner, in spite of a superficial appearance otherwise. Did anyone admit they were wrong? Nope.

    That sort of crap happens every day and it’s not right that some people’s futres are being messed up just so a few greedy psychiatrists get a few weeks of insurance bennies.

    Because once you are diagnosed with that garbage you can’t get undiagnosed, and once youve been diagnosed, anyone can dig it up and use it against you.

    My coworkers all have heard the “Rumor” that I’m schizophrenic, bipolar. It got out, because I was careless. I don’t take meds, I’ve never been in a hospital, but all the same they wonder if I”m going to flip out one day.

  9. AnonymousAtLarge says:

    Have you ever heard of anyone going to a psychaitrist and being told “yep, your mind checks out okay, you’re fine! You don’t need psychiatry!”
    That happens when you go to normal doctors.
    Why don’t psychiatrists ever tell anyone they are healthy?
    Why do psychiatrist have the right to make up diseases and convince normal people that they need treatment?

    When I was ~25, I didn’t know that. I really thought the crazy doctor was just like the normal one, and you could go to the crazy doctor and they would use their medical training to tell you if you were crazy. I assumed they would be honest because of that whole oath thing, and that being a professional thing. It’s like, if I go to my primary doc, I don’t think he’s going to change the numbers on my labs to make up a case that I need treatment for some disease I don’t have. I expect my doctor to do a checkup and then be like “you’re fine, healthy and junk” (or god forbid, not if I”m not). That’s how the normal doctor(s) have always been with me, and it makes sense to me.

    I didn’t know that psychiatrists, as a whole, will make up diseases and prescribe meds you don’t need, just to keep the client. If I knew, I would have never bothered going in the first place, because how can you trust someone who is inherently a liar and primarily interested in your insurance payments?

    Now I’ve got this scarlet B for bipolar and it sucks because I’m not that crazy… and if I ever need to get insurance independently I am screwed (or, if I try to collect on my current insurance, I’m screwed, because I did not disclose my prior mental health diagnosis, and I did not disclose it because I have no reason to be3lieve it is correct).

    • Comus says:

      AnonymoysAtLarge, I’m truly sorry for your bad experiences, but the way your throwing this around the board cries for a comment. Especially as I have quite a hard time connecting the proper dots here.So this is not an evaluation, not a criticism, not even a proper confrontation.

      So you first say that you went insane when you were 25, with (extreme) elation, disordered thinking, paranoia, confusion and the like. Before this you have had severe depression periods (untreated, I’d assume, based on your frequency of visits). Onset of these mania symptoms was around 23. This, you say the psychologists coded as obvious bipolar. I wouldn’t agree. See there are also different levels of bipolar, or even psychosis, it’s not all cutting out your gums as they are planted with surveillance, psychosis is only the shattering of your perception of reality, the centre of you losing it’s gravitational pull. It may even be regarded as a defence mechanism of sorts. Now, this far into the story for what you’ve told, and given your family history, I’d be quite comfortable as diagnosing you as a BP and continue with symptom-based treatment. This dg took two hours, which implies a good diagnostic interview.

      They prescribed you with medicine (though not recommending therapy or follow-ups, which is, at least in my culture, close to a malpractice- in theory, practice is far from), which you cleverly decided no to need, and bounced back to a next looming bout of mania (feeling the energy feelings again), and decided to see another doctor, and not begin with your already prescribed treatment. This of course implies you were not happy with your diagnosis, and the doctor complied and changed it to BPII, which would appear appropriate, given you’re dismissal of manic episodes and the freq of depression. Then the doctor starts swaying from dx to another (on the prescription mind you), so this could also be a form of symptom based treatment. You have a manic episode, you are treated for that. Yet all this time you feel that the doctor was not in it for you, but for personal gain. I suspect this makes you suspicious of the treatment and the drugs as well. So after 5 weeks you drop the antipsychotics (not lithium? Carbamazepine) and before all you slide to next severe depression.

      Now, despite being diagnosed and recommended treatment for Bipolar (I or II), you get a third option. So far in your story I see no sign of nothing but worry for your well-being from the doctors, een the drug heavy treatment is more or less the sorry norm. By this time you had reached suicidal depression, albeit not being even close to the worst you’ve experienced.

      Now here you notice the pattern, something which you should definitely take credit for, it is often seeral months of therapy before people see the patterns, the continuities, and you did this all yourself, and in midst of a rough patch. Your mania and depression clearly follow the seasons, as they often do.

      Now comes the interesting bit. The obviously not_so_competent doctor. Now I suspect you got the dx “borderline” here.

      Now, knowing nothing of you but what you’ve told, and I’ve referenced here, I have a few thoughts.

      Firstly, you’ve appeared to have gone through a load of excrement, and managed to pull through. And in doing this also found a suitable coping method, figured out the pattern of your episodes and seeked treatment. This speaks for an intelligent and resilient person.

      Secondly, the diagnoses are not aimed at diminishing you, they are ways of assessing the situation and to keep a sort of common understanding and treatment lines going between practitioners. Sure, there are misdiagnoses, and even more there are in so called regular medicine, which by far is not infallible, and I’ve observed several misdiagnoses, bad and not needed for operations, in internal medicine alone. See, all information is relative, all the practitioners are human (or close to). The system works so that the patient sees a doctor because he or she is worried, the doctor then assesses and for the best of his or her knowledge diagnoses and treats. There is no oppressive control of the Other, it is not the man beating you down with the crazy stick, it is best possible care with limited resources. Far from optimum, yes, but still better for nothing. The problem with mental health issues is that people do dismiss treatment as it’s on a schema level much more threatening to treat your thoughts than your leg. So people get off the medicine, drop off of therapy, and claim they know themselves better than the fraud in the coat. Especially in BP this happens when mania is beginning to rise. Dismissing treatment is not a power struggle in which you plant a dagger into the oprressive heart of the psychiatrist, it is planting the carriage in front of the horse and preparing to race.

      Thirdly, from my experience there is a difference how most of the psychologists and psychiatrist read the Bible. Psychiatrists, being doctors, and having gone through the schooling that emphasizes infallibility and certainty in all things, often see it as more of a description of objective reality. You get the points needed, you are X. Psychologists, et least here, are often more careful. They see the diagnosis as a rough estimate, an uncertain try at assessing what’s wrong. It’s not perfect, and surely there’s lots of lobbying and foul play in research. This all is obviously an oversimplification. The point is the diagnosis is not supposed to define you, it is supposed to describe you.

      Different diagnoses are not separate entities, comorbidity is more common than not, and also implies something about the system we are yet to fathom. Disorders are not rigid, but more of a sliding scale that are pushed about by numbers of different variables. Especially with disorders so close to each other (schizoaffective vs. BP) it is a must to assess for both.

      Now what plagues me with this story of yours is that not a single person asked you about your personal history. Not of the events that might lead to this. The last doctor at least should have assessed whether something, a loss, a trauma, had happened during autumn, that would emphasize the seasonal changes.

      Also, wtf with the health care system? You said you were suicidally depressed and had to wait for treatment long enough to get better, buy a bright lamp, get better buy it and only then got an appointment. No treatment meetings or consulting between the people you’ve been treated by. No follow-ups.

      There appears to be nothing worse than privatized insurance-run medicine.

      • AnonymousAtLarge says:

        I was a little shocked when you said if there was a personal stressor which exacerbated the seasonal depression… because that year, that is exactly what happened. Prior to that rather significant depression, I was going through a ton of family stress. My sister is also crazy (I was still living at home at the time) and she was acting extremely abusively and out of control toward me, frequently attacking me and the police to get her under control. She also has a bipolar diagnosis, and she was flipping her shit. I am not trying to sound like a victim, but I know that’s unavoidable… seriously, she would just go insane like all the time, trash my room, physically attack me, destroy things, at all hours of the day.

        Eventually she went to the psycho doctor and got put on pills and started to calm down… since she is a crazy fuck and totally needs/needed them.

        However the damage was already done, and my body and mind were wrecked and when the season turned into autumn I fell into a major hole. It wasn’t just the season, it was also that severe stress. Stress always makes me insane. It augments my seasonal shifts. I remember feeling how unfair it was that she was all mellow and normal and happy… just when I fell so far under as a direct result of the stress she subjected everyone too. Even my mother developed a heart condition after what she did (an arrhythmia, no doubt exacerbated by stress).

        Similarly the year I went super duper nuts (25) I had just been under extreme stress due to school, I was hardly sleeping.. .then pop went nuts-ish like never before. Suddenly I was electrified and pacing around at night feeling elated and fantasticer than anything ever. I felt like I was possessed by spirits. It was awesome and horrifying at the same time.

        If my life is nice and relaxed my moods are not as bad. Stress is a big trigger for me to have moods. If a major stress happens I sort of expect it… and the type of mood I get is dependent on season.

        Anyway, rambling.
        I am taken aback in general by your comments because I didn’t expect anyone to respond thoughtfully.

        I don’t think the doctors were out to be maleficent… I think the psychologists really did care, they seemed like they really wanted to help people. I don’t think the doctors cared that much, for them it was just a job and their goal was money. I don’t think they would turn away a healthy person. I think their goal was to retain clients. They didn’t mean to be crappy, they just didn’t care about not being crappy.

        The only doctor who I took medicine from was doctor #2 (the one who had me bipolar II and wondering if I was psychotic). She refused mood stabilizers and wanted me only on antipsychotics, she seemed to believe antipsychotics were adequate mood stabilizers (she told me this) and she was concerned about my “psychosis”. I knew that was wrong. Felt wrong from the outset. It didn’t make any sense to me as antipsychotics are emergency meds usually, which shut off fucked up brains. They don’t stabilize brain energy use or otherwise address the fundamental defects in mood disorders. Everything I had researched (and I had done some at this point) lead me to believe that mood disorders are fundamentally a disorder in brain cell energy use… which is why there are SO MANY OVERLAPS between seizures and bipolar (organic mood disorder). Everything that causes mania will cause seizures, typically. Almost all antiepileptics double as antimanics.

        Regarding the delay in seeing a doctor while depressed… I don’t exactly remember how it worked with my HMO. I think they asked if I was suicidal, I don’t know if I lied or not. I am sure I would downplay any suicidality though because I am an extremely private person and I felt extremely embarrassed even calling for psychiatric services. I know I never would have truly admitted how much I was thinking about it. I have a lot of willpower, I am good at suffering, I am not impulsive. I would never call a psych service hotline and tell them the truth depths of what was in my head. Calling at all , AT ALL, was hard enough. I couldnt imagine being like “yea, all week, I’ve been crying in my car and thinking about jumping off this bridge near my house”. At best I could only say I need to see someone for depression. They probably would have directed me to an ER if I said I was suicidal, and I wasnt going to an ER because I wasn’t suicidal to the point of acting.

        Each doctor I saw was worse than the previous, which makes you give up (or rather realize that psychiatry is bullshit).

        I know there are a lot of people which are thankful for psychiatric services… I’m not in that group.

        You make a good point, there are different levels of psychosis, different levels of insanity. I think that the more “normal” you are, the less you can benefit from psychiatry. I don’t know if I am at a level of insanity where I will benefit from it. I have never gone nuts like that since then; I’ve had my short spells, my mild highs, but my thoughts have not broken down like that since. There have been a few times since then where I’ve wondered if I was losing it, during my highs. Once was after the light therapy made me manic (a month later, I found myself elated ). One particular night I was completely out of control and unable to even speak coherently due to how high I was. Scary but it went away and I didn’t go cray cray. I thought I was ER bound, lol. The faces of all the onlookers was a combo of shock and fear. I felt I was poisoned, I wonder if someone had poisoned me. No, I was just high. High in janurary, in some perversion of nature… mood episodes are perverse in of themselves, so I suppose you could say it is a perversion of a perversion. One should not be pacing around laughing and elated when there is snow on the ground in the depths of winter. It was WEEEERIDDD.

        And then of course the usual spring/summer highs… right now I”m a little high. I’ve been flirting with it since early march, to be honest. Up and then lower and then up again. When the sun comes out and the temp goes up I really feel it, it’s like my brain has a thermal sensitive sensor and it adjusts my brain chemicals and brain activity to the ambient temperature and light availability.

        I was really high in early march for 2 weeks, elated and high, sleeping less, mind running at night and turning on before i even open my eyes when I wake up… silly and creative and just feeling fabulous and immune to anything and everything.

        Right now I feel high… a little. I can tell because my appetite has plumetted, and I have slept 5 hrs last night, and 6 the night before, and I don’t feel tired at all, in fact I have a lot of energy and want to go for a walk and listen to music even though it is almost 2 am. I don’t want to eat, but I have huge energy. Did some impulsive spending (when the spending had started to get better, when I was calmer). Feel more creative and really good in general.

        I don’t know. But I’m fine, I”m totally functional.

        So the point I was making is… there is normalcy, there is disease. There is in between. I think people with “bipolar”, at least some of them who aren’t full on seriously sick, a lot of the times their moods are subclinical and maybe even adaptive. Highs, when mild, are adaptive, they are great… you feel great, you function way better. Fears and anxieties melt away, the ordinary becomes exciting. Everything is rewarding. Everything feels possible and there is no doubts.

        The doctors made a case where they tried to have me think of myself as incurably and seriously mentally ill – outright lying in some cases (I’m not psychotic and it was totally false to call me schizoaffective I am extremely high functioning and independent). It seemed like their priority was selling me pills and having me come back for 15 minute med checks with little regard to whether I needed the pillos, whether the pills were helping, whether they were right.

        I tend to think that genetics for bipolar disorder are adaptive, it’s only when they manifest in a pathological way that they are not. Things like omega 3 fatty acid deficiency and severe stressors early in life and various other insults can turn an otherwise beneficial trait which aids in novel thinking and creativity and ingenuity and getting a head start on the new season can accumulate into a psychiatric disaster. I mean , I’m not speaking for everyone. But “bipolar II” and cyclothymia and stuff, maybe.

  10. Withnail says:

    AnonymousAtLarge

    Tonight I have followed your journey on this thread with great interest and sympathy. It’s too late for me to post a full response now but as someone with bipolar II I can identify with many of your experiences (eg seasonal mood shifts, the blurred line between hypomania as enabling/creative and disintegrative). Given the amount of research you’ve done, although you are rightly wary of the medical model you seem open to the possibility that you may be on the bipolar spectrum – it will be interesting to see if the new version
    of the Bible (DSM-5) develops s a more dimensional approach to the traditional categorical one, especially if that could help undermine received ideas about normality. Anyways.

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