What happens when you are wrongly diagnosed as bipolar or whatever: and what it means, if anything…
Have you ever been the patient of a really bad psychotherapist? Lets be honest, there are more than a few of them out there. I actually seriously toyed with the idea of becoming one at one stage of my life. Except I was somewhat drawn by the writing life, and that was that.
Two things separate the good therapist from the bad one, assuming they have been properly trained and have had sufficient therapy themselves to be relatively free of transference and projection and all the other things we do that affects our relationships. Firstly the capacity to objectively listen with out prejudice and secondly the capacity to apply knowledge coupled with experience to an individual patient. Most if not all of the many bad therapists I have had over the years failed on either or both of those fronts. One stand-out moment which typifies my negative therapeutic experiences happened during a session some years ago and it led me to discontinue the therapy. The therapist turned to me in a moment of obvious frustration, and asked me was I by any chance writing a book about him?
I beg your pardon, I said?
And he repeated the question.
Why, I asked?
Well, the therapist said, rather solemnly, these sessions we were engaging in were more like two therapists discussing the practise of psychotherapy, than a patient going to and talking with a therapist.
I was pretty appalled and very angry.
I said no, I wasn’t writing a book about this. I am in trouble, big trouble. That’s why I am here. I don’t need to do that kind of research to write.
I then went on to say by the way that was a bizarre question. One of the most I have ever been asked in therapy.
I mentioned I had completed a draft novel I wasn’t really happy with. I went on to say that the novel had a therapist as the central character. I offered him a look at a draft of it to satisfy himself I wasn’t using his rather dull unimaginative personality as a blueprint (and no, I wasn’t being unkind, he was a dreadful bore)
The therapist said that wasn’t necessary.
But I pressed the issue. I said that as the issue had been raised, it was hard to see how this could not become a central issue during the therapeutic encounter.
I wasn’t there for copy. I was there because I was in trouble. My marriage was in difficulty at the time. I was very anxious and depressed about family of origin issues. I felt trapped. Hopeless. this was the third therapist I had been to with no help. As I didn’t get the help from either that quack therapist I needed, or from other equally awful therapists, I got more depressed. And things went downhill. Feeling helpless and unsupported has something of a domino effect. Things cratered to such an extent that I had a major depressive episode. After that I went to a psychiatrist and was misdiagnosed as bipolar. I completely accepted the diagnosis. I told friends and colleagues. I did radio interviews about it. This went on for a few years. Then, by sheer luck I met a good therapist who told me I was no more bipolar as I was a professional safe-cracker or an astronaut. Not that her word was enough, by the way. I met a few others who said the same thing. I took the hint and stopped seeing Psychiatrists. It was such a good move.
Along with the indignity of being misdiagnosed as bipolar, I have been put on some of the most awful mind numbing medications. The medication had withdrawal symptomatology far worse than the condition they were supposed to treat. After a couple of attempts I got off the meds. Things have massively improved. Years have passed. No ill effects.
How does this kind of thing happen? How does a depressed writer get diagnosed with a pretty serious condition which he does not have? Well, it’s easy in one way to see how it might happen. I mean when I am working on something I feel fantastic. The ideas come fast and I have a lot of energy. Afterwards I am tired and lethargic. As any writer or indeed anyone creative will tell you, one goes to rather extreme emotionally and spiritually exhausting places to write books. One isn’t in it for the money. Believe me there are easier way to make money. One writes because its what one was born to do. To not do it, to settle for less, is very dangerous thing to do. So this is the creative cycle, not the manic depressive cycle. There is a substantial difference, and a good therapist sees this.
‘The infinite monkey theorem states that a monkey hitting keys at random on a typewriter keyboard for an infinite amount of time will almost surely type a given text, such as the complete works of William Shakespeare.’ (wikipedia) – or if you are a writer, you just might get lucky some day…
The Discreet Charm of being Labelled
But it doesn’t work out like that. Labels stick. Like the bad writer stuck in a rut that pays, once you write your best seller or get your government grant or run enough magazines or give courses, you are labelled. And once that happens, everyone expects more of the same. You get comfortable. You feed the crowds. Similarly once you got the label, it stays. After initial diagnosis, there is little re-visitation of ones symptoms. One is labelled and medicated and that’s that. Aftercare was a twilight zone experience for me. Our health system makes you go see a trainee psychiatrist who is under the care of a Chief Psychiatrist. One sees a different one for every appointment, for the most part. They don’t know you, usually never met you before, and usually never will again. They are polite, friendly, witty, personable, professionally distant, and usually very busy. They have a few minutes to read your file, and on this basis, they interview you. This little psychodrama happens once every month or two. The pubescent psychiatrist is usually a doctor on psych rotation, someone who gives you twenty minutes and then ends the session with a prescription. Not ideal, to say the least. I had to aggressively lobby for therapy, and for the most part I got it only by the skin of my teeth. This rather hands-off approach of out patient psychiatry is something that needs urgent attention in my view.
Then there is a deeper issue at work here. It leads me to the notion of how in our cognitive processes, belief tends more often than not to precede evidence. Evidence should always precede belief. Otherwise one is guilty of cognitive bias. I displayed symptoms of bipolarity. But I was not bipolar. I had creative cycles. I was depressed due to life circumstances. I needed help. I needed the good therapy I had been looking for, not a cheap and easy diagnosis. I needed a good therapist. Not years of medication.
Then there are examples and studies. I found a really interesting one in my reading. In the early 1970’s, much to the huge outrage of the psychiatric community a psychiatrist called David Rosenhan conducted a case study which led to some rather fascinating results. He persuaded seven friends, none of whom had any case history of any kind of mental illness, to enter various mental hospitals to see if they could persuade members of the mental health care community that they were mentally ill. This was between 1969 and 1972. What did these sane folks do to convince the doctors they were sick? Well they all claimed to hear the words “thud, and “empty” and “hollow” and they all got admitted. Every one of them. And they were all diagnosed as having some form of mental illness, mostly schizophrenia. They were given a total of 2100 pills (they had been taught to ‘cheek’ their meds before going in), only two of which were ever actually swallowed. Other than lying about their names and lying about hearing the words, they were told to be completely honest. After Rosenthan had gotten his diagnosis, staff began to read into his actions. For instance, his study required him to make notes. This was described as ‘writing behaviour’. One of the other impostor patients was and artist and drew these fantastic line drawings of the hospital they were in, they too were described as indulging in ‘drawing/painting behaviour’. Finally Rosenthan couldn’t get out of the hospital. The only way he could actually get out of the hospital was to tell the doctors that they were completely correct in their views, that he Rosenthan was insane, and that he was getting better bit by bit.
This is not dissimilar to the experience of Robert Pirsig, author of Zen and the Art of Motorcycle Maintenance, who suffered a very real and very debilitating breakdown and was admitted to a mental hospital, a hospital which he simply could not get out of. His method was to tell the doctors that he was feeling better incrementally. He would every day tell staff that things were getting better for him; that he was feeling just a little bit better than yesterday, till they let him go. Check out his second book Lila for a description of this process.
The point of all this is the question of belief. These professionals couldn’t distinguish between sick and well folks. My therapists couldn’t do that either. If you are seen as a patient and not as a person, your views of reality-no matter how valid – are somehow seen as secondary. This is because the belief that the doctor imposes on the patient presupposes disbelief of the patient’s valid world-view. I can even report that this is how exactly I experienced my treatment. I accepted the doctors word for what was ‘wrong’ with me. I accepted it and trusted them, despite the fact that the more I read about my condition, and the more I discussed my condition, the more doubts I had about whether or not I actually had Bipolar Disorder.
No, Really – I Engage in Writing Activity
But back to Rosenbaum. Rosenbaum told the doctors repeatedly that he was actually a professor of psychology. They asked him did he often feel he was a professor of psychology. I told my doctors I was a writer, that I had written novels and plays, poetry and articles. They didn’t believe me. They had to ask asked my wife (now deceased sadly) and my doctor, who assured them that yes I was indeed a writer. It’s what Rosenbaun refers to as the ‘stickiness of psycho diagnostic labels’ – prejudicial thinking, the imposition of an unscientific mindset on presenting symptomatology.
It would be somewhat facile to suggest that there is an easy way through what I see as a complex and rather perennial difficulty. What is sanity? In a world deeply troubled, what is a sane mind? Obviously we are all grasping at an answer to this question. Suffice to say that though there is no absolute answer to this question, we live in a world of consensus based on an ever expanding pool of knowledge and research and clinical experience to draw from. The people who diagnosed me were most definitely trying to help a person who was in a lot of pain. Sadly, though they did help, they left me in something of a mess for quite a while until I figured out what they had gotten wrong, and thanks to the brilliant help of a few really gifted therapists, I did. I wonder if there are more creative people out there who have similar experiences. Those who are of a more creative bent, who pursue the extremities of human experience, are naturally inclined to suffer trauma, and at times to become unwell. Its unfortunate that the labelling of a creative person can also lead to the labelling of their work, indeed the tenor of their entire lives. This reflects badly on our culture and on our society. Though it is true that some creative folk most definitely do suffer throughout their lives from various flavours of psychiatric disorders, many others I am sure, like myself, were subject to misdiagnosis based on a consensus misunderstanding of creativity. I live in the hope that my and many others experience will form a teachable moment and shift our cultural understanding of the needs of the creative person.