Transcript
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This is Polarized Lens with Jennifer Merchan.
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Polarized Lens is a podcast that examines life through the filter of bipolar disorder.
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Created and hosted by a person living with bipolar disorder,
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Polarized Lens aims to explore the challenges of that mode of life in this neurotypical world,
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raise awareness, and help those who want to understand more about bipolar disorder.
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Content Note There is brief mention of miscarriage and suicidal ideation.
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Episode 3 You Need to See a Psychiatrist
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Fighting the stigma of mental illness and getting properly diagnosed might seem disparate,
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but they're actually intimately intertwined.
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When you deny the seriousness of your condition, you sabotage yourself and risk inaccurate diagnosis.
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Shortly before my inpatient hospitalization 20 years ago,
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I was minimizing my illness to make the person I was married to at the time, let's call him Bob,
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less uncomfortable with the problems I was experiencing.
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I was seeing a general practitioner and, eventually, when I became desperate, a therapist.
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This therapist told Bob that I was a drug abuser with borderline personality disorder.
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Bob told me this over the phone after I had checked myself into the mental hospital.
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This was after I had shared my new bipolar 2 diagnosis with Bob,
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meaning he had latched onto this misdiagnosis and was basing decisions involving me
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on what the therapist had told him, not the accurate diagnosis provided by a qualified psychiatrist
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at a well-regarded mental hospital.
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My general practitioner had recommended this therapist.
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The first time I spoke with him, he mocked me when I said my job as a high school teacher was stressful.
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He later tried to steer me towards a 12-step program for taking prescription medication as prescribed.
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And when I tried to discuss my suicidal ideations with him,
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this therapist told me to grow up and act like an adult. Seriously.
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Because I refused to admit the gravity of the situation and schedule an appointment with a psychiatrist
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when my condition began to really interfere with my life,
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I opened myself up not only to inept treatment that made my condition worse,
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but also to misinformation being fed to people upon whom I depended
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by people less than qualified to diagnose a serious mental illness.
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And the person I was misguidedly trying to protect in the first place took that misinformation
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and ran with it--right out the door. But that's another story.
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After three weeks of talking to the psychiatrist at the hospital,
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the only thing I remember him telling me other than my new diagnosis is,
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you really need to be seeing a psychiatrist.
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So I did. When I was finally released, I started seeing him,
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the doctor who had diagnosed me and treated me in the hospital.
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I saw that doctor until I moved away from the big city to a small city in a neighboring state.
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For the record, I do not recommend waiting until you need to be hospitalized
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to get a proper diagnosis from a qualified psychiatrist.
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See a psychiatrist as soon as you can.
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Unfortunately, depending on where you live, that can involve waiting from weeks to months.
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So if you are in crisis, get help right away by calling or texting 988.
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If you are not in crisis, scour your area for available professional mental health resources,
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which are sometimes hiding in plain sight.
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If you do get a diagnosis from a general practitioner or therapist,
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make sure to later confirm that diagnosis with a psychiatrist.
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A therapist really should only be recommending that you get a diagnosis from a doctor,
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not offering one to you.
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Another reason to seek out a psychiatrist for a diagnosis is if you were first diagnosed
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as a teenager or young adult and you are older now.
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The Diagnostic and Statistical Manual of Mental Disorders is in its fifth edition with a text revision.
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It's the DSM-5-TR now and it has changed.
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My original misdiagnosis of major depressive disorder passed muster with more than one psychiatrist
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because bipolar 2 was so poorly understood in the 1990s,
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even though it debuted in the DSM-IV in 1994.
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Also, none of the people I saw bothered to take an extensive medical, family, mood, or behavioral history.
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As with any kind of doctor, some are better than others, and some are even bad.
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When I moved back to the small city and started grad school, I had no insurance and my options were limited.
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I took advantage of the university health clinic and saw a psychiatrist and a therapist there.
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My condition did not improve under their care, but I was able to get prescription medication that I was already taking.
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After I left school, I started seeing a general practitioner again and enrolled in a community program
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for people with low income that acted as an intermediary to provide free access to certain medications directly from the manufacturers.
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While this is a nice concept, I didn't always get what I needed when I needed it.
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And one time, I went weeks without the medications that had been prescribed for me.
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15 years ago, when I had insurance again, I chose a psychiatrist randomly off the list my insurance company provided.
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He had great availability.
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At my first appointment, I told him my previous diagnosis and he didn't even question it or me.
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He just acted as if he had diagnosed me himself.
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While seeing that same psychiatrist, I was having some issues with sleeping all the time and being unable to stay awake.
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His solution to this was to prescribe Adderall. To me, a person with bipolar disorder.
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I don't know how unusual it is, but for me, it felt like hypoglycemia with mental weirdness.
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I hated it.
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It felt awful.
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When I asked him to take me off, the psychiatrist just reduced the dose and told me that my body needed to get used to it.
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Within two weeks, I had complained enough that he said yes to discontinuation.
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I was on Seroquel at the time and thought he probably should get me off that, but as it happens,
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the sleepiness ended up being the result of, you've probably guessed it by now, early pregnancy.
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Which happened because on Seroquel, I was so drugged up, I couldn't remember to take my birth control pill.
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Once I tested positive for pregnancy hormones, but before the pregnancy could be confirmed via ultrasound,
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my psychiatrist had me stop all my psychiatric medications without tapering.
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There was no discussion about it.
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There was no warning about what would happen if I stopped all my meds suddenly.
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There was no waiting for the ultrasound.
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This was not a phone call.
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It was an in-office visit.
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My psychiatrist had every opportunity to offer me an informed choice or warn me of the consequences of discontinuation.
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He did not.
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I didn't question him.
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I had just found out that I could be pregnant, so I was not in a normal state of mind.
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Even so, I should not have blindly trusted him.
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But I did.
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And I trusted him again when he put me right back on everything at the same dose, including Lamictal,
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which must be started gradually.
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This put me in the emergency room.
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My psychiatrist did not respond to phone calls.
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From there, I entered an outpatient program at the mental health facility affiliated with a local hospital,
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where I encountered one of the psychiatrists who had diagnosed younger Jennifer with major depression.
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This time, I received a diagnosis of bipolar 2 disorder from him, 14 years too late.
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If I could do it all over again, what would I do differently?
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Well, 20 years ago, I was living in a major metropolitan area and had private insurance coverage.
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I had easy access to a full complement of mental health care.
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I should have worried less about stigma and the unease of others and more about the quality of my own care.
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When I first moved to that city, I was taking antidepressants and I knew that I had been diagnosed with major depressive disorder.
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I should have immediately searched for and found a new psychiatrist.
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15 years ago, I should have taken that insurance directory and composed a short list of doctors to research the specialties and ratings
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online instead of blindly choosing that one psychiatrist.
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The doctor who put me in the emergency room had negative ratings online as early as 2008.
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Had I seen those, I would have at the very least been wary of his advice.
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Maybe I would have even had the sense to avoid him altogether.
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My next psychiatrist was assigned to me by the outpatient program that helped me through the recovery from the previous psychiatrist's poor care and the miscarriage.
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He was the one I had also seen when I was 20.
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By this time, though, I had a better feel for what was best for me.
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And although his diagnosis was on target, I felt overmedicated and couldn't function under his care.
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He didn't listen when I told him this, so I sought help from a prescribing psychologist.
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I was frustrated by the care received from psychiatrists in the small city with its shortage of specialist doctors.
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I should have persisted with the search and sought recommendations for a better psychiatrist, but I had no more patience.
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Instead, I did my research and managed to get an appointment with one of the best psychologists in town.
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His intake interview included psychological testing, which was a first for me.
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This was 2008, and I stayed with him until 2022 when I developed heart palpitations while discontinuing Abilify.
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I chose to find a psychiatrist again because I should have been seeing a psychiatrist the entire time,
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and the medical effects of the discontinuation really drove that home.
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I chose my current psychiatrist after witnessing his intake interview technique with a family member.
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He started with physical symptoms to exclude possible physical causes.
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He proceeded to get personal, family, mood, and behavioral histories.
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He was intelligent, perceptive, communicative, and thorough.
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And he's a sleep specialist.
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For my intake, I also brought a family member so that he could help me fill in the blanks when my observations or memory failed me.
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Since my first visit, interactions with my current psychiatrist have been free of eyebrow-raising weirdness and health-risking edicts.
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He recently expertly guided me out of a hypomanic episode, meeting me ahead of our regular appointment schedule at my request.
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His office responds within a day of contact.
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At times, the doctor himself will call me directly to get more details about my issues.
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Choosing a psychiatrist is one of the most important and challenging tasks for a person living with mental illness, especially bipolar disorder.
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You can ask your GP, your therapist, or your insurance company for a recommendation for a psychiatrist if you don't know where to start.
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There are also directories put together by WebMD and the American Psychiatric Association that you can find online.
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It's also not a bad idea to get recommendations from friends living with mental illness who have experience with mental health professionals.
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One approach is to seek doctors or clinics that specialize in bipolar disorder.
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If your choices are limited and that isn't an option, get referrals, pick from a curated list, and ask how much experience the doctor has with bipolar disorder.
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Find the best, most qualified candidates you can, then schedule an appointment.
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On that first visit, if the doctor doesn't meet your expectations, if they don't really listen, if they don't ask questions,
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if their philosophy clashes with yours, if they seem off or make you feel uncomfortable, find another one and try again.
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It's an audition process and it may take time.
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In the meantime, keep seeing your current mental health care provider until you find a new one.
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Quality care is absolutely worth the time and effort put into finding a good trustworthy psychiatrist.
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Remember to visit the blog at polarized-lens.com for a list of far more in-depth resources to help you in your search for a psychiatrist.
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Good luck.
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Thank you for listening.
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This has been Polarized Lens with Jennifer Merchan.
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Visit polarized-lens.com for bonus content.
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I am not a doctor.
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This podcast is not medical advice.
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If you're experiencing a mental health crisis, don't hesitate.
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Call or text 988 and connect with someone who can help.
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Don't go down that road alone.
