This NYT article on the diagnosis of Bipolar Disorder in children really got to me. The kids described in the piece seemed so tortured and lost. I felt for their parents who must be totally overwhelmed and of course for the kids themselves who are trapped inside their own minds. Bipolar disorder, and all kinds of other mental illness and psycho-social disorders, have always intrigued me. I studied them a lot in my Neuroscience degree and have known enough people suffering from depression, bipolar etc. to know what these diseases can do to people's lives. At the same time, I worry about how often they are misdiagnosed and the ease with which so many doctors prescribe an antidepressant and send on you your way. There is no blood test or swab that will detect borderline personality disorder - it involves taking a history(the patients and their family's), a lot of self-reporting and some guess work. Sometimes it works, and I have seen people get well and thrive. Sometimes it doesn't.
When I was in my mid-twenties I was having a hard time. I felt overwhelmed by my emotions and I would often feel like there was a train running through my skull. This "train" of thoughts was so fast that I couldn't grab onto anything or verbalize what I was thinking. It was confusing and frustrating. Sometimes I felt so sad I would just sit in the bath tub for hours, crying. I felt alone and misunderstood and scared. I would go through bouts of joy where I felt like I was the coolest girl around. Other nights I would feel like a fraud. A failure at life. I would write long, agonizing poems about death and the futility of it all. Eventually, after many, many months of this I sought help. I went to a shrink. She asked me all kinds of questions about my family and my own life. It felt good to talk and have someone really listen to me. She diagnosed me with depression and gave me a prescription for Prozac. I made an appointment for the following week. The next week I sat down in her office again and low and behold if she didn't start asking me exactly the same questions she had asked the week before. At first I thought that maybe she thought I was some kind of compulsive liar and was fact-checking but soon realized that no, she had merely forgotten that she ever met me. It was the weirdest feeling. I never went back to her but I did keep taking the Prozac. I figured even if she was crazy, she was probably right about the depression and they might work. In the meantime, my family doctor had prescribed me Zyban (which is also known as Wellbutrin) and although I mentioned the Prozac she didn't make note of it. The combination of those two drugs put me in hospital with some kind of seizure. I stopped both drugs but suffered from anxiety after that episode that would take years to go away.
About 6 months later, when the anxiety still hadn't lessened and I was still struggling I decided to seek help again. I went to the Alberta Mental Health Services and they made me an appointment with a psychiatrist. We sat down and talked for a long time. He was such a nice man. He asked me if I ever went shopping. I loved to shop but as a student didn't have a lot of money. I told him about how I would go and buy all kinds of nice things and then just return them the following week. He asked about my childhood, asked if I ever felt moody and I said yes. I remember drawing him a picture of how I felt - exaggerated ups and downs. He wrote a long letter (which I still have) diagnosing me with Bipolar Disorder. He wanted to try me on lithium. I never went back to see him either.
I do not have Bipolar Disorder and I doubt that I even had depression. Everyone was so quick to label me, to diagnose me, that they never asked enough questions. As soon as I came off birth control pills (which my doctor put me on to regulate my cycle - another approach I take real issue with now) my pendulum-like emotions evened out. I got out of a bad relationship and stopped partying. I went to bed at regular hours and started exercising. I ate better. All of a sudden, after years of feeling horrible, I felt in control again. I felt strong and capable and drug-free. I have always been incredibly sensitive to hormones and so I've stayed away from the birth control pill ever since then. I wish I could go back to that nice doctor. As a man I'm sure it never even occurred to him that hormones (that in effect were fighting against the rhythm of my own natural hormones) could simulate the same highs and lows as Bipolar. Or that most 21-year-old girls love to shop. Or that as a particularly sensitive person, I had always worried about things that were out of my control or felt overwhelmed by how big the world was. I didn't tell wild stories because I was in a manic phase, I did it because I was a wild story-teller since birth. I wish I could go back and tell him to think twice the next time he prescribes someone lithium after one meeting - I mean, really! What would have happened if I had filled that prescription too? I don't really even want to know.
This story illustrates one of the problems with diagnosing mental illness but I do not for one minute think it turns out this way for everyone. Some people really do have Bipolar, or Depression or Schizophrenia etc. (There are some disorders that I do take issue with, namely PMDD (Premenstrual Dysphoric Disorder) since I witnessed its very creation shortly after the American Prozac patent expired and they needed to re-name it and re-brand it. Voila! A new drug for a new illness.) These people need kind, sensitive, professional care, not quick fixes. They need to be truly evaluated and any medications need to be part of an overall plan and should be monitored. It is alarming to think of what might have happened if I really did have depression or BPD and was left to monitor my own drugs, and just as alarming to consider what could have become of me had I stayed within the mental health system.
Just some of my own experiences and thoughts on what is always an emotional and complicated subject.