Correct Diagnosis of Mental Illness is Difficult

Here’s the latest from Practicing Mental Illness:

It takes a while to diagnose someone with a mood disorder like bipolar disorder. In fact, the average delay between the first appearance of symptoms and a correct diagnosis is six years.

I remember when I first recognized that something unusual was occurring in my body and my behavior. I was having strange pains in my shoulders and gut, and I was losing interest in work and straying from a long-term relationship.

My doctor first prescribed an anti-inflammatory for fibromyalgia, then an anticholinergic for irritable bowel syndrome. When things didn’t improve he prescribed an antidepressant. He thought I was depressed, and he thought that would help.

Soon I was buying expensive art and an expensive car, abusing substances, having affairs and spending an unusual amount of time prowling through cemeteries. Then I went psychotic. I saw dead people and tried to sabotage the company I worked for. I registered to buy a gun, but fortunately I was admitted to a psychiatric hospital on my 31st birthday just before the waiting period for the firearms license passed.

For years before I had hypomanic and even manic symptoms, but they felt great, so I never thought anything was wrong. In the hospital they first thought I was schizophrenic. A second hospitalization followed, and I underwent a long course of electro-convulsive therapy before a doctor finally diagnosed me with rapid cycling mixed-episode bipolar disorder 1.

That this is not that unusual a story is heartbreaking.

The first doctor was a general practitioner who finally admitted he was out of his league. Like too many GPs, he was rushed and quick to diagnose and treat a behavioral problem. No real follow-up was scheduled. He randomly prescribed an antidepressant and sent me on my way.

People who visit GPs with unusual EKGs or difficult to control blood sugar are sent to specialists. Yet too many doctors feel they can diagnose and prescribe for behavioral conditions without referring their patients to a psychiatrist.

WebMD article describes how anxiety, depression and bipolar disorder share certain key symptoms. Unfortunately, if a patient is misdiagnosed and prescribed medication for the wrong condition, that medication can seriously aggravate the symptoms of the mood disorder the patient actually suffers from.

All too often someone with bipolar disorder is first diagnosed with depression or anxiety, or even ADHD, to frequently disastrous results.

Only when a clinician spent a significant amount of time with me, with frequent follow-up and a careful assessment of my condition, was I properly diagnosed. Only then was it OK to prescribe powerful psychopharmaceuticals. It’s unfortunate that that had to happen in a hospital.

If you or someone you care for is experiencing psychiatric symptoms, make sure the doctor is paying careful attention and taking a significant history. Make sure follow-up is scheduled soon after the initial visit. If this isn’t happening consider a referral to a psychiatrist before medication is prescribed. In cases of serious mental illness a specialist is called for immediately.

Bipolar disorder, as well as depression and anxiety, can be successfully treated with effectiveness rates higher than those for most physical health conditions. But a patient must be properly diagnosed first.

When I first started to question my behavior I was scared and had no idea where to turn for help. Today there are many sources of information, but they can contradict one another. The diagnosis must be made by a qualified doctor. Make sure your doctor is spending enough time with you to get full information about your condition, and make sure your doctor has the proper training in psychiatric medicine.

Since I received the proper diagnosis and the proper medication, and since I added helpful adjunct therapies like meditation, movement and meaningful work I have lived without a significant episode of mania or depression. For years. That success is available to almost everyone. You can achieve it too, if you and your doctor are willing to take the time to get it right.

This piece originally appeared in the blog for the International Bipolar Foundation.

Everyone suffers

Last summer I wrote a post on my blog “Getting Older With Bipolar” about the need to pause and listen to each other in the midst of uncertainty and upset. The blog is long gone, but I think the post is still very relevant. We can find answers in each other. But first we have to listen. Here’s the post:         

This week, with people crying out in the streets, I decided to just shut up and listen.

Underneath all of the slogans and signs, buried under opinions and blame, there is the voice of suffering. The unheard voice of suffering.

Every faith tradition I have ever studied or adhered to begins with the simple truth that there is one thing that we all share in common and that is that we all suffer.

One of the most difficult things we realize as we grow up is that we must bear this suffering alone, for each of us suffers as individuals in our own individual way. Even those of us who know God still reach out for understanding to other people.

Sometimes it seems someone actually listens. For a moment a connection is made, until all too often the listener nods in allegiance and tells us what to do about it. However, to be truly present with suffering requires the listener to acknowledge that they have absolutely no idea how a person’s suffering feels. Or how they should best address it.

In the midst of the sirens and the helicopters and the screaming in the streets we must put aside all that we think we know better and just listen.

For the last few years I’ve been full of answers, and quick to engage people in debates aimed at bolstering my own understanding and agenda. I should have known better. I should have been listening.

Psalm 123 laments:

Our soul has had more than its fill

Of the scorn of those who are at ease,

Of the contempt of the proud.

I understand this psalm. I have been both at ease and held in scorn.

When I was 29, I was VP of Sales at a financial services company, collecting art, vacationing in Asia and Egypt, buying cars with cash. Then psychotic mania took hold and my bipolar disorder wrestled away all that I had. By age 40 I was on food stamps, one attic room in my parent’s house away from living on the street.

When I was at my lowest I needed someone to listen to me. When I was at ease I wanted to help others. Help them and feel good, yes, but was I listening?

There may be things that the people who protest and I have in common.

Still, I have no comprehension of the suffering of the people rioting in the streets or the people at home watching on TV complaining about them. They have no idea that they have something so basic in common. But they do, and from that we can hope for understanding. But we first must listen.

I remember, when I was at my lowest, that people would reach out and tell me “I know just how you feel.” That may have made them feel better, but it just locked me further away. They had no idea what I was feeling. They couldn’t. And they didn’t ask.

We all suffer as individuals. Even those of us who confront grave social injustice.

Proclamations of understanding often lead to recommendations and advice that only result in isolation, unburdening the ones who are at ease from culpability and enabling them to position themselves as part of the solution. But still, people are crying in the street. 

Suffering needs to be attended to, not told what to do or, worse yet, how to feel.  I fear that when we seek to change things, we don’t first consider listening to those who suffer the most. In time those of us who are at ease begin to rank the suffering of others. We assign labels of good and bad, just and not just, legitimate and illegitimate.

We in my neighborhood are among those who are proud. We’re fortunate and thought to have it easy. It’s understandable to point to those in the street and decide that their suffering is far worse than ours. But no one has any idea of the suffering that goes on in the houses around here.

In all houses people are ill at ease. It may beyond our comprehension that those who hold opposing views from us may be facing challenges, too.

Unless we first make the effort to sit with the suffering of others, even those we disagree with or have contempt of, we will always be wrong.

I don’t care what you think about what happened on the streets of the United States this past week, or what you think about being told to wear a mask in public, you need to find someone who disagrees with you and just listen. They’re suffering. Just like you.

The impulse is strong to legitimize some people’s suffering and delegitimize that of others, but that’s not our place and that’s not our call. Yet even as I write this I sit and judge. I sit and judge even as all of those same faith traditions I’m familiar with tell me that judgment, too, is wrong.

I should know better. Just when I draw on all my experience and education and just when I think I know it all, I realize haven’t been listening. Not a bit.

Everyone suffers. If we empathetically and compassionately listen to each other, if we let go of any preconceptions we bring to any aggrieved injustice, then we won’t suffer alone.

Neither will the people to whom we listen.

Meditation

I was in Jerusalem years ago, moved by the spiritual connection to my Catholic roots I found in this place that is so sacred in all the monotheistic religions. Out of tinny speakers blared the call to prayer for Muslims as the light began to change from white to yellow to orange on the old city walls at sunset. It was impossible to deny God.

My meditation practice draws on spiritual traditions, and in past issues of this newsletter I have presented sacred chants that range from the Buddhist Heart Sutra to Gregorian chant. Islam, too, has a rich tradition of prayer and contemplation from which we all can learn. For hundreds of millions of people, five times a day, it begins with the Azan. The pictures in this video are beautiful, but no match for the chant. Please close your eyes and have a listen.