Saturday, September 8, 2012

The Probing Psychologist

Don't worry, he wasn't an alien.

At the time I was hospitalized, it was standard practice (I think) to have two things done: a CAT scan (I don't think they do these any more because of the increased risk of brain cancer); and a visit with a psychologist. The CAT scan was to make sure that I didn't have anything physically wrong with my brain. It showed that I indeed had a brain.

I think the difference between a psychiatrist and a hospital psychologist is this:

- A psychiatrist works with your brain chemistry, using chemicals and exposure to different stimuli (like light and electricity), to change the way your brain works.

- A hospital psychologist uses verbal and written diagnostic tests to determine to what extent your disease is caused by past experience.

My meeting with the psychologist started with me filling in forms with those little ovals you have to draw on with pencil. You can't use X's, or check marks, or O's; you have to fill in the little ovals exactly within the lines. This is hard to do when you have tremors from psych meds, so I was proud of my not-too-messy result. It was the same kind of pride I had in grade one when I got a perfect mark for colouring in my clown without going beyond the borders. (I hate clowns, but I wanted a good grade).

The Psychologist fed the sheets into a machine. Then he got a print-out. He looked at it, clearing his throat.

"It seems that you have behaviours that make it appear that you need to be rescued."

"Really? What kinds of behaviours?" I asked, genuinely worried. Was I talking about things that made me seem like I needed sympathy? Did I have a predisposition to be needy?

"You bang your head. And, you attempted to kill yourself. Do you enjoy being rescued?"

"I'm relieved to be rescued," I said. "I don't want to hurt myself."

"Interesting..." he said. He made some more notes.

And he made some more.

And some more.

"Excuse me," I interrupted. "Are you diagnosing me? If you are, I would be interested in knowing what you think."

"I think that you may not be entirely truthful about this voice you hear. It would be very rare. But if you are being truthful, then you would have a depression-induced psychosis."

That concluded the session. I felt low - "lower than a rattlesnake's belly in a wagon rut" the cowboys would say where I grew up. It hurt to be accused of lying.

You know what? Despite all of the note-taking, psychiatrist visits, and the visit with the psychologist, they all got it wrong. I find that interesting, and would love to meet them all again to let them know.

Sometimes, even with page after page of diagnostic tests and interview after interview with psychiatrists, nobody asks the right questions.

Not once, to my recollection, was I ever asked if I had experienced symptoms of hypomania.

Not once, to my recollection, was I ever asked what happened after I was prescribed an SSRI three months previously.

Those two questions may have been enough to diagnose me as bipolar, and for the doctors to consider that I might be in a dangerous mixed state (where one experiences symptoms of hypomania and depression at the same time). The risk of suicide is extremely hight in a mixed state, and would explain why sometimes I was happy in hospital, sometimes irritable, and sometimes incredibly depressed.

It would have affected my treatment, too. For two years I was on ineffective medications with horrible side effects.

Luckily, today I have a fantastic psychiatrist. Things are improving in the medical system. There is a more standardized way of collecting information, so that it is less likely to misdiagnose a patient.

Even so, where I live the average time from the first doctor visit to a proper diagnosis for a person with bipolar disorder is fifteen years.

I beat the average by three years, but I think that the medical system could do a lot better.

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