When I reread what I'd written about bipolar diagnosis yesterday, I realized that what I recommended only should be considered a small part of the larger diagnostic process. In fact, what I wrote was short-sighted, and I apologize.
What I should have said (and this is my personal opinion) is that while the process of mental illness diagnosis has degenerated into matching symptoms to the Diagnostic and Statical Manual of Mental Disorders (DMV IV) criteria, that's a huge disservice.
In traditional medicine, the best doctors have always known that diagnosis is an art. In The Lost Art of Healing: Practicing Compassion in Medicine, Bernard Lown, M.D., writes: "Practicing the art of medicine requires not only expert knowledge of disease, but an appreciation of the intimate details of a patient's emotional life usually presumed to be within the province of the psychiatrist."
And yet, how many psychiatrists really do effective diagnoses? No matter how many psychiatrists (and psychologists) I talked to, none of them really listened, and thought outside the box. If they had, things might have turned out differently, because I unknowingly had provided them with critical information, which they ignored.
At every first visit, I said: "My first depressive episode occurred when I was at Cal, and I think that while I was there something broke inside me that could never be fixed." Yet, none of the psychiatrists ever considered that to be an important piece of information, although I am one of the few people who believes that the initial trigger is extremely important.
I also said, "For 25 years I had these semiannual six-week periods of unhappiness (undiagnosed depressions) in April and October." Yet, no psychiatrist ever asked: "Is there anything significant about those months?"
If they had asked, I would have said, "April is my birthday and for years I used my birthday as a period of reflection. Every year I would ask myself over and over again, "What happened at Cal that caused such an enormous shift in my orientation to life, and these periods of such unhappiness?"
If my doctors had followed this line of inquiry, they would have understood that what I actually was doing was "rumination," which is thinking over and over about a negative experience. In my case, I didn't realize this was a bad thing to do. I thought I was using my critical thinking skills to try and heal myself.
The other significance of April is that it is the anniversary of the month I started college. A few years ago, I read that many people suffer depressions on the anniversary of a traumatic life experience. Thus, both the rumination and anniversary of starting college were viable reasons to experience the April depressions. And had a doctor uncovered them during the diagnosis, I might have been able to end the cycle.
The causal factors for the October depressions are less clear. There may have been a seasonal element to them. Yet, only one psychiatrist suggested the possibility that the fall depressions might be related to Seasonal Affective Disorder. Also, I returned to Cal in October of 1968--my second quarter--which was the very worst part of my experience there. Again, this is an anniversary of sorts.
My point is that these questions aren't rocket science. Each of us may have incidents in our lives that trigger depression episodes. The problem is that psychiatrists believe that while the first depressive episode may be triggered by a life event, subsequent ones are not. They are caused by brain kindling, which means that after a few depressive episodes, our brains become rewired and automatically switch into a depressive mode.
However, like much else related to bipolar disorder, this theory is conjecture. The fact is that our brains have elasticity. And if we know that a specific event is causing a depressive episode, it may well be that if we meditate, do guided visualization, or learn self-hypnosis, we can prevent this recurrence.
But the key to taking charge of our illness is to have a doctor ask questions during the diagnosis--or in subsequent meetings--which will uncover information to help heal us. Instead, once I was diagnosed as bipolar II, in every subsequent consultation with a new psychiatrist (and I've seen 5 different psychiatrists in the last 15 years), all they did was confirm the original diagnosis.
I believe this is medicine at its worst. As Dr. Lown says, "Doctors focus on the chief complaint (which in my case was always depression) mainly because medical schools do not train students in the art of listening. Obtaining a careful history, while emphasized, is not actually taught... Furthermore, the history provides soft data while a doctor craves solid facts... Limiting history-taking to the chief complaint often initiates fruitless pursuit of irrelevant matters that are quite tangential to the main problems.
(to be continued)