Reasons why Bipolar is difficult to diagnose:
It has different components, which manifest at different times, so often the doctor has only what s/he sees at a given time to go on, eg:
– has similarities to other illnesses such as major depressive
– when presents as psychotic, any disorder which includes psychosis
– may present as a normal, well person, etc.
This can also apply to someone who is seeing a psychologist for crisis evaluation or a psychiatrist for emergency med management, you can seem normal then too. How? Read on if you wish. (Be warned, it’s another of my personal horror stories, very recent)…
All few of you who read this blog know I’ve been struggling for some time now with a great depressive epoch, and have recently found that some of the symptoms of my “depression” are actually more symptoms of mania. . .. therefore I’m rapid cycling like the wheels of a bicycle racer near the finish line. (please forgive the obvious metaphor, I’m not too creative at the moment, heh).
My life is unpredictable, my family never knows what will happen next. I don’t either. I know something is wrong with my meds, yet I’m reluctant to have them adjusted, especially by a doctor who no longer is familiar with my case, because of the release I’ve experienced on my current meds from cognitive dysfunction, and having regained a lot of my lost memory on the current regimen.
Yet, I sensed a crisis impending so my husband, who also sensed it, did what we both had sworn we’d never do. . . call that place for crisis help again. In this oddly rare instance, a “crisis counselor” was not available, though we’d expressed our reluctant understanding of the need to jump through that deplorable hoop before seeing a psychiatrist. It turned out that we were referred to the main crisis guy, over the phone, who mysteriously was able to produce an opening in the psychiatrist’s schedule on the spot!
Wonderful, we thought. So we saw her, and she, after only a few minutes, pronounced me normal and doing well and no adjustment of my meds was needed and she would see me again in 6 months. No opportunity to dispute that was apparent. Period. Then (unbeknownst to us) she canceled my previously scheduled appointment with my regular psychiatrist, which had been coming up fairly soon. A week later, I had the crisis my husband and I had feared.
Something triggered my destructive half, and I knew I was losing it fast. I felt rage and frustration and knew I was going out of control. So I went to an area where someone had stacked T-posts without consulting me and where I did not want them, and began heaving them out of there. What I was doing appeared like random destruction, to observers, but I had every intention of re-stacking them in a more appropriate place when I was done heaving them out of the stupid place. The kind of thing I had been counseled to do, take out my feelings in a safe way without hurting myself or exposing my family to my “episode”.
The observers (hubby and daughter) did not know what I was doing or why, and so hubby attempted to interfere with my work. Well, he successfully interfered with it, and there I went, set off. An argument ensued, which quickly escalated into something beyond my control and I began to self-harm in my usual way when out of control, which is to start bashing my head into things.
I was being yelled at to “just stop it! Please stop!”
What my interferer didn’t know was just how hard I WAS trying to stop it. I was bashing my head into the horizontal 2x4s of the horse stall wall instead of the 8×8 cemented support post that I FELT COMPELLED to bash my head into. For example. Also, how when I was smashing the bowl in the kitchen, my body/brain was screaming at me to smash WINDOWS. And other things, which I was given to understand made me a bad person who was acting out on purpose. It ended up hours later with me lying on the thin, softening ice of our stock pond trying to “cool off” but preferably go to sleep there and actually perish of hypothermia.
Unfortunately, my crying kids found me there and begged me to get off the ice. I was heartbroken, for them, but could not move. Then my husband showed up and was a little more belittling than I felt he need be. I felt, soon after I had been gotten into the house, that I was being treated the way Therapist K had treated me all those months ago, calling the police to the mental-health facility, like I was a sub-human animal who was acting out on purpose.
The horror of the whole thing for me was that I had all these self-harm/suicide prevention strategies hard-wired (I thought) into my brain. And yet they were not sufficient.
All this about a week after the psychiatrist had pronounced me normal and in no need of a medication adjustment. Boy were we glad I had another appointment already scheduled with my usual psychiatrist (who was to be leaving the institution soon).
The next day, of sound mind, it occurred to me that I’d better check that. Make a call to confirm that appointment, since I already knew the system was broken, the front desk people were overworked, and the policies were often stupid and usually detrimental to the mental health patient.
So I called to confirm the appointment and surprise, surprise, there was no appointment. My recently-visited psychiatrist had cancelled all other appointments in favor of the one six months away. I was a bit disappointed about that, considering what had happened last night, and insisted the appointment be rescheduled since I had been suicidal. Oh, no, that appointment was already filled, did I want to be put on a cancellation list?
I explained how important it was that I see a psychiatrist immediately, so I got an appointment for three weeks hence. And I was told I am on the cancellation list, although I’m pretty sure that if I were, I’d have gotten in by now.
My husband has tried very hard to get through to them. Not even my new therapist, who had replaced Therapist K on my case because she was of a more appropriate age and qualification, had anything at all helpful to offer him. So he went to the head crisis guy, who found him to be in crisis himself! My poor husband, doing all he can with what he has, and has been doing so for 19 years! What greater love can there be from a mortal than that I am blessed with from him???? ❤ ❤ ❤
So, there’s an example of how bipolar can present in ways that result in incorrect diagnoses with potentially disastrous results. In my case, I had the diagnosis, but my status was incorrectly evaluated, or rather, not evaluated at all, because of how I seemed when I walked into the consultation room. So a patient, with or without a diagnosis, should be very sure to make certain the doctor hears the whole enchilada and doesn’t have to go only by what he/she sees in the consulting room.
Siege of the Spirit 