The diagnosis

In 2000 I was diagnosed with “Bipolar II” disorder, which is like regular Bipolar disorder but not as bad. The “manic” episodes are milder and called “hypomanic.”

At the time, I had heard a little about bipolar disorder, but I didn’t know much.  I asked the doctor–I’ll call him Dr. W–if he could recommend a book for me to learn more. He recommended Bipolar Disorder by Francis Mark Mondimore (not the exact edition I linked to, but whichever one was current in 2000).

Reconsiderations

I read the book. What it described didn’t seem like what I was going through. While there were some superficial similarities between my situation and the malady the book described, the diagnosis mostly seemed wrong.

I tried to imagine episodes in my life that could plausibly be called “hypomanic,” but they didn’t  seem to match what the book described as hypomania. I may have had some episodes that could be described as “depressive,” but those, too, didn’t quite fit what the book said.

I came to believe Dr. W had made a hasty diagnosis. At least one of the questions he had asked seemed in retrospect leading. He asked, “do you ever have racing thoughts?” (“Racing thoughts” is a symptom of mania or hypomania.) I took the question to mean something like, “do you ever have a lot of ideas that come up at the same time so that you have a hard time staying focused on one of them?” I am an intellectually curious person who really likes to read. When left to myself and with nothing else to do, I think about a lot of things–things I’ve read, things in the news, ideas I’ve learned about. I let my imagination run and yes, sometimes I don’t focus on just one thing and my thoughts therefore plausibly seem to “race” from one to another.So, I answered “yes” to the “racing thoughts” question.

I also had also answered one of his questions wrong. There had been a period in my life (in 1993, about 7 years before I saw Dr. W) in which I got very little sleep because I was taking 19 credit hours in college and working about 30 hours per week. Dr. W asked if I had been tired. I foolishly answered “no” when I should have said, “yes.” Looking back, I was always tired. I’m not sure exactly why I said what I said. But I said it, and Dr. W interpreted that as a hypomanic episode.

And finally, I don’t recall us discussing any other alleged hypomanic episodes since 1993. I’m no expert on bipolar disorder, but 7 years without a documented hypomanic episode seems like it should be a long enough time to make someone wonder if Bipolar II disorder is the presenting problem.

The 15-minute revisit

Up to that point, my sole interaction with Dr. W had been a single one-hour appointment. So I decided to go back and discuss some of my reservations about his diagnosis. We met again for 15 minutes. (Fifteen minutes cost less than the full one-hour appointment, and I was uninsured.) During that 15 minutes, I tried to explain that what the book he recommended described didn’t seem to match match my situation.

Dr. W treated me as if I was desperately in denial, as if by simply raising the possibility he might be mistaken reflected my refusal to face reality. He lectured me about my 1993 “hypomanic” episode, saying that’s not what happens with healthy people.

In fairness to him, I did not relate my reservations as clearly as I have in this post. I didn’t mention I found the “racing thoughts” question too leading, and I didn’t try hard enough to change my answer about being tired seven years before (neither did I remind him that I had been 19 years old in 1993 and possibly just had more energy at that age). In light of my failure to bring up these two points, you could be forgiven for thinking that he simply didn’t have the information to reconsider his diagnosis. All I can say–and I have not proof other than my own testimony–is that he struck me as very dismissive of my concerns.

Second opinion

The irony is that I had actually wanted the diagnosis to be true. It gave a name and some legitimacy to whatever it was that I was going through. And, to use a cliche that understandably irks people who actually suffer from bipolar disorder, the illness itself seemed “interesting.” Looking back, I now believe that one of my primary problems at that time was a lack of emotional maturity and my refusal to take responsibility for my life choices.

At any rate, when my 15 minutes with Dr. W were up, he suggested I get a second opinion. Here my memory is suspect, but I believe he said something like “don’t tell the other doctor you came to see me.” (However, he might have just said, “don’t tell the doctor about the diagnosis I gave you.”) I interpreted that statement to mean “lie to the next doctor you go to about having seen a psychiatrist and see if he comes to the same conclusion.”

I did get a second opinion. About halfway through the first session I felt so guilty about not telling the guy that I had already seen another doctor, that I spilled the beans about everything. I apologized for deceiving him and explained I was just looking for a second opinion. This new guy accepted my apology graciously. He also, after several sessions and several uninsured payments later, eventually concluded that I don’t have bipolar disorder.

This post is not about bipolar disorder

Bipolar disorder is a real thing. Those who suffer from it face real challenges. I’ve known a few people in person and online with the disorder, and from everything they’ve said, it’s no picnic and it’s definitely not an “interesting” personality quirk. I’m not against treating bipolar disorder as something serious. When I said above that I now believe my main problem was “lack of maturity,” I in no way mean to say that people who suffer from the disorder or other disorders lack maturity. I’m just talking about my own situation as I see it now, seventeen years later.

When I reflect on the experience, I still get angry with Dr. W. It’s not because he was (as far as I can tell) wrong. Anyone can make a mistake. Instead, it’s that he didn’t seem even to acknowledge that he might be wrong or that I had anything legitimate to add to the discussion.

My readers are at a disadvantage here. I’m asking you to believe my account when Dr. W isn’t on this blog to defend himself or explain his thinking. After all, I did say I had racing thoughts. And just because there was only one documented “hypomanic” episode from seven years prior doesn’t mean that there hadn’t been others since then. I also haven’t told you other “symptoms” that may have led Dr. W to his diagnosis.

There are a few different lessons I could take this situation. One is, “always get a second opinion (if you can afford one).” Another is “be wary of getting a first opinion if you can’t afford it.” Yet another is, there’s a little bit of Dr. W in all of us and maybe we should be wary lest we come off as dismissive of others’ legitimate concerns.

At any rate, I just wanted to tell my story.


Category: Hospital

About the Author

Gabriel Conroy (conroy, fka Pierre Corneille and corneille1640) is an ex-graduate student. Now he writes blogs! He has a solo blog--Ye Olde Republicke. The views expressed by Gabriel (or Pierre, or corneille1640) are his alone and do not necessarily reflect those of his spouse, employer, or his co-bloggers at Hitcoffee.

8 Responses to When I was bipolar

  1. fillyjonk says:

    I also think, “Sometimes when a person sees a lot of something, they begin to look for it everywhere” (in re: Dr. W.’s diagnosis).

    By his definition, I have “racing thoughts” – I get curious about stuff, to the point where I have to write things down while reading (or tell myself, “You can look that up later”). And I KNOW I have low-level anxiety.

    I cope with it….mostly OK. I find vigorous exercise first thing in the morning bleeds off enough of the anxiety that it transforms into “focus” and I can get stuff done better.

    When I first went to the DO I am currently seeing as a “general all-around doctor” it was because I’d had several high-ish blood pressure readings at other visits elsewhere (and was denied the ability to donate blood once as they said my BP was too high). Her first thought was “anxiety” (because I mentioned I was “nervous” about the outcome of my bloodwork – I hadn’t had any done in five years and it seemed reasonable to me someone would be apprehensive something “bad” might turn up). Not knowing me, she first asked me if I wanted to try an anxiolytic for the blood pressure. I resisted, knowing friends who had gone the psych meds route and how it took seeming ages to dial in the right dosage, and in a couple cases the person wasn’t safe to drive at first. (And secretly? I was afraid that blissing myself out – which what what I envisioned those meds as doing – might make me work less hard and everyone would then see it wasn’t so much I was “smart” but that I busted my hump every day of my life….)

    So I got put on a beta blocker, which – no surprise to me – lowered my blood pressure to back into the “acceptable” range. (Everyone on my dad’s side of the family has been on bp meds at least at some point in their life).

    Now that my doctor knows me better, she knows I’m “just a worrier.”

    But yeah – I think when someone sees a lot of something, they begin to suspect it pretty readily.

    • Yeah, I can certainly see that point about seeing what one is looking for. And I’ve heard rumors that the late 1990s and early 2000s was a time when Bipolar disorder was being overdiagnosed. (The 10 seconds or so I spent on Google didn’t seem to justify that rumor, however. Maybe if I had spent an extra 20 seconds, I’d have found the confirmation I was looking for :)) My complaint isn’t so much that another human being has the cognitive weaknesses of a human being, but that my doctor didn’t seem willing to accept questioning.

      I do know one person who is on psych meds (treat a depression that let to an psychotic episode), and he or she is fortunate to have found a working dosage relatively quickly. (I don’t know if that’s the type of medicine you’re referring to, or if they’re taking a different type.)

      I find vigorous exercise first thing in the morning bleeds off enough of the anxiety that it transforms into “focus” and I can get stuff done better

      I’m not sure if this counts as “rigorous,” but I try to walk to work every morning. It’s almost 3 miles. However, I don’t walk very fast. It does, I think, help me focus a bit.

  2. KenB says:

    I’m no psych(iatr/olog)ist but it seems to me that diagnosing someone with a mild form of a mental illness would be a pretty tricky thing — so many of the symptoms for the common ones are things that anyone can experience from time to time, and the difference between health and illness seems to be largely in intensity and frequency. Once in a while I’ll see one of those 5- or 10-question evaluations for one or another condition in a magazine or something, and it’s rare that I don’t come away a tiny bit worried, just because I could sort of say yes to most of them, occasionally or a little.

    • I also think someone can (or will) choose as an answer what they “want” to be true. “Want” here can be a term of art, so that someone might “want” to be the type of person who has such and such a condition, even if that same person wouldn’t really “want” to experience it if they knew what it was really like.

      (I also think that’s true on personality tests, like the myers-briggs. I had an acquaintance who took that type of test quite often, and was afraid she was “becoming” an extrovert because she really wanted to be an introvert.)

      • KenB says:

        I’ve noticed something similar in myself on occasion — e.g. looking at a list of symptoms on WebMD, I find myself subconsciously trying to make my experience fit the list instead of the other way around. It’s a strange thing — maybe an innate desire for our lives to be “interesting”?

        Somewhat related — when we had our son evaluated for Asperger’s (which involves a parent survey as well as observation of the child), the therapist was practically steering us towards a Yes answer. Our son is definitely on the spectrum but not specifically Aspie (e.g. his language development is lagging, not advanced), but I got the sense that her assumption was that we wanted the diagnosis in order to get services.

        • I do wonder how much framing an answer is designed “to get services,” or perhaps to get coverage by insurance, is part of the problem. (I was uninsured at the time, but I wouldn’t be surprised if the default for this doctor was to offer a diagnosis recognized by an insurance company.)

  3. Dr X says:

    My opinion: bipolar is overdiagnosed. I won’t diagnose it unless I see/hear mania in person, or the person presents a very compelling picture of mania in their history. Being really busy and active doesn’t count. Even with hypomanic states, I want to see it in my office.

    In the 90s, it seemed that psychiatrists especially began to overdiagnose bipolar. I’m not sure why. Yes, you need a definitive DSM/ICD diagnosis for insurance purposes, but there’s no insurance reason to favor bipolar over other diagnoses.

    I get why he told you not to mention his diagnosis when getting a second opinion (to protect from bias by the next clinician), but I don’t like the idea of asking a patient to withhold information. I’ve disagreed with other clinicians even when I knew the other clinician’s diagnosis. Most often disagree with diagnoses of bipolar and borderline personality organization, which is, in my opinion, also overdiagnosed.

  4. Thanks for the comment. I should say that I don’t honestly remember the Dr. asking me to withhold information, although that is definitely how I interpreted what he told me to do. So, it’s always possible that he didn’t ask me to withhold information.

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