What Does it Take to Make a Diagnosis?

There are a couple of people who sometimes respond to my threads who don’t like it when I say we shouldn’t be calling people mentally ill just because we don’t like them or act in ways that we don’t like. I think it is time for me to outline what is required to make a diagnosis:

  • You have to be trained as a psychiatrist or a clinical psychologist. (Most “experts” or the “peanut crunching crowd” are not.)
  • You have to have actually examined the person. This goes beyond watching them on television or reading about them in magazines or newspapers.
  • You have to use proper diagnostic criteria.
  • You must be neutral. Most of the pseudo-diagnoses that I have seen fail magnificently on this score. In my experience, progressives are the worst, but this does not exonerate others including conservatives.
  • You must have the patient’s welfare in mind, not an opportunity to insult.
  • You must avoid stigmatizing people with mental illness who are not anything like the person you are diagnosing. E.g. By saying that terrorists are mentally ill, you are implying that people who are mentally ill are like terrorists. (Research shows that people with mental illness are less likely to be violent than the normal population.

Crossing Zones

Travel is one of the greatest dangers facing someone with bipolar disorder. The majority of medical evacuations from overseas happen when someone enters a manic or a psychotic state. I am no stranger to these issues: I have noticed that when I cross the country to attend DBSA conventions, the combination of the excitement of the convention and the messing up of my sleep cycles — especially when I am compelled to wake up earlier — often conspire to pushing me into a slightly manic and obnoxious state.

So when we made plans to visit my brother-in-law in Senegal, I took the time to confer with all my doctors but especially my GP and my psychiatrist. In addition to the necessary shots such as typhoid and yellow fever, we bought medical evacuation insurance for me. I also discussed my plans at length with my psychiatrist, particularly since I would find myself not merely in one different timezone, but four — Salt Lake City, Paris, London, and Dakar. Together, we hatched out a plan which involved my taking an extra tablet of carbamazepine while I was gone. Two days before my departure, I began taking the increased dose — two first thing in the morning, one with dinner, and one at bedtime.

Not even the hint of mania afflicted me. I kept my temper, didn’t laugh too much, kept my bearings, and didn’t engage in compulsive spending. We stuck to our plan in London and Paris, not doing too much in a day and always discussing our expenses as we went along.

When I came back, I felt so good on the new dose — who in their right mind misses the rages? — I asked my psychiatrist if I could stay at that dose. She let me under the condition that my drug and white blood cell levels were closely monitored at least in the beginning to be sure that they didn’t destabilize me. Four months after my trip, I continue to do well.

If you live with bipolar disorder, you can learn this from my trip. First, talk to your psychiatrist and consider raising your dosages of your mood stabilizer. Second, take pains to adjust your sleeping schedule. For two weeks before I left, I starting setting my going to bed time an hour ahead of when I usually woke until I was getting up at Paris time, about mid-afternoon. When I arrived at Orly, I felt fine. When we arrived in London that evening, I went right to sleep and woke up shortly after dawn. I wore a sleep mask and ear plugs to minimize disturbances. I used an alarm clock to wake myself and it worked. I jumped out of bed and I enjoyed each day. My regimen kept my mind stable. My sanity never wobbled.

The Night of The Cut *Graphic Self Harm Trigger Warning*

******TRIGGER WARNING: Anorexia somewhat and EXTREMELY GRAPHIC SELF HARM******

DO NOT READ THIS IF YOU ARE EASILY TRIGGERED BY SELF HARM ESPECIALLY IN GRAPHIC DETAIL.

You have been warned.

This is probably the single most important story in my life. It led to a cascade of events: hospitalization, my correct diagnosis of bipolar, getting kicked out of school, and finally getting the real help I needed.

It was 6am when I finally asked my ex-boyfriend for my knife back. We aren’t on speaking terms and we are clear that we can never be. We’re either together or not. And together is awful, dangerous, addicting, full of love, full of hate.

Today I see him to get it back, so I stress out about it of course. I overthink what I will wear. I felt the need to show him how much my appearance has changed, how much I have changed. Both of which are major improvements.

Should I go laid back in my cute dorm-room college girl get up all from Victoria’s Secret? Or should I go with my traditional assemble which people describe as “edgy” because its boots and leather jackets and what not?
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The Beast

I think it is important to make a separation between ourselves and the disease. This, I think, is a state of mind more than anything else. I give mine a name — The Beast. Sometimes The Beast is ravenous and chews on my rib cage; other times it is rabid and tears out the sinews of my self control. I do my best to tame The Beast and part of that taming is taking my meds. But The Beast is only part of what makes me, me. I feel that The Beast, properly leashed, is part of the “essential and precious character” of my person, but not the only one to be acknowledged, reviled, or celebrated.

What Makes for a Good Caregiver?

When one takes aim at a system of privilege, some jump to the conclusion that you hate the people who stand to gain from that system and have no compassion for their struggles. Caregivers can make it hard on themselves and on the patient. They give twenty four hours a day seven days a week looking after people in severe episode. They neglect their own health. They grow weary and cross from all their over-involvement.

Our DBSA chapter feels that caregivers need their own place where they can talk about their issues and we have provided one. We do not tell them what they can and can’t talk about. We do not ask them to support certain laws or advocate for changes that they do not want. We don’t have a patient monitor the group to be sure that they act according to some unbearable standard of political correctness — people need to vent. We shelter them from people who may have an ax to grind (I have heard about other groups where caregivers were roasted over hot coals by angry patients) and who don’t appreciate how hard it is. We encourage them to talk to peers who know what it is like. We always ask them how they are feeling when they come to our patient-family support groups, reminding them that they, too, are important. We feel that their mental and physical health is as important as the patient’s and we tell them so.

I’ve been hit with some innuendo from some online caregivers who imply that I don’t care about the mentally ill. What I believe they are really saying is that I don’t care about caregivers. I do. It aches when I see a caregiver overburdened and I do my best to relieve that. Many have been the times when I have had a couple in a group and told the patient that she or he needs to realize that her or his manic state of mind is creating an extremely stressful environment for her or his spouse. How does this make me a foe of caregivers? I think much of the misapprehension stems from my opposition to Murphy’s Law, which I have explained at length elsewhere. It scares caregivers to hear me talk about sane privilege– just like it scares white people when we are talking about black people — where we who live with mental illness are left out of decisions about our treatment.

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A Response to Marya Hornbacher’s Research Project

Kitt O’Malley put me onto a research project by Marya Hornbacher who is writing a book that “will profile the lives of people who have a mental illness or who work in the field, and she’s trying to develop a deeper understanding of how the public views mental illness.” I couldn’t resist throwing in my own two cents. Because I have a long track record of never being included in such studies, I thought I would share my answers to her questionnaire here for your consideration and discussion:

Has mental illness affected you personally? If so, how?

Yes, I live with bipolar disorder, PTSD, and ADD. I lived in quiet torment for many years, occasionally bubbling over in rages that left my wife emotionally overwhelmed. This left me with feelings of deep guilt, but I didn’t do anything at first because I had been told that suffering was part of life and I should just buck up and endure it. When I finally did seek help, I was diagnosed with major depression and put on Prozac. Because I was “cured” the next day, I sought no further insights into my diagnosis until I came to the brink of committing suicide at age 47.
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The Disease Didn’t Do It — You Did

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Many people in bipolar support groups counsel the newly diagnosed not to feel shame for things they did while they were in episode: it was the disease that did it, not them is the reasoning. This cleaving of the self, I think, does not help us get a handle on the illness and its effects on others in our life. In fact, it strikes me as downright irresponsible: you never have to make amends for anything you did.

Denial of the damage we cause is linked to this exculpation due to mania. Some say that making amends has nothing to do with apologizing. Warped logic causes it to mean nothing more than admitting to yourself what you did without making restitution or apology to those we harmed while addicted or in the throes of mental illness. I find this cheap recovery and I am suspicious of anyone who flaunts it.
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11 Commandments for People Living with Bipolar Disorder

Recovery from bipolar disorder is almost like a religion or an ethical system. Certain devotions must be part of our lives if we are to recover our balance.

  1. I shall hold myself accountable for all works of my body and my mind including those which I wreak when I am in episode.
    It is important, I feel, not to separate the illness from ourselves. We did the things that happened while we were in episode. There was no second soul seizing control of our bodies. Our mind is a stream that flows continuously, sometimes over rough ground, sometimes in placid stretches, and sometimes over cliffs. We own all these states of our being.

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