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Wednesday, March 29, 2017

Label Ready

Posted by fxckfeelings on October 16, 2014

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You know that the how/when/why of diagnosis is a loaded topic, not just because you’re either longing to find or determined to reject one, but because those of you who read this site with some regularity know how many letters we get on the subject. A diagnosis is a powerful thing, but, like your authors’ posts, it’s rarely the last word. As always, ask yourself what a diagnosis really means before giving it too much meaning, or too little. We won’t be shocked or disappointed, however, if you want to ask us about what it means, also.
Dr. Lastname

I have severe mood swings which don’t help at all, because some days/weeks I will be normal anxious me, but then I can have periods where nothing scares me anymore, pretty much like I’m ‘on top’, and I’ll have so much confidence. But then I have periods which are the exact opposite, meaning that I’ll be constantly upset and feeling self hatred for the way I am. As a result of this, I researched Bipolar Disorder and I have nearly all of the symptoms, I also took some of the online tests, which I know are not completely accurate but I thought they would give me a brief outline. Each one said that I possibly have moderate to severe Bipolar Disorder. After thinking for a while, I spoke to my mum, but she shunned the idea. I later convinced her to do some research on it and let me know her opinions, which I think she had no intention to let me know her thoughts as I only got a reply one month later as a result of my frequent questioning. She said I am definitely not bipolar. I have now been put on the contraceptive pill to control my irregular periods and mood swings, however they have not altered my moods, nor has the Teen Multivitamins that my mum has been buying me to prove that it’s entirely just my hormones. My goal is to control my moods and lessen my anxiety.

Just as there are eight major levels for classifying biological organisms—from general “life” down to the precise “species”—there are several unofficial levels of diagnoses. The most general level might be by location (e.g., the brain) and the more specific would be by identifying the cause of the disease. Unlike with plants and animals or even more common diseases, however, scientists can’t classify your individual diagnosis beyond basic symptoms. In sum, not surprisingly, it’s hard to classify crazy.

If the characteristics of the bipolar “species” vary greatly, depending on the person experiencing bipolar illness, then the usefulness of the diagnosis is limited, and your own observations and evaluation become much more important. What matters most then is not whether you do or don’t have a certified bipolar diagnosis, but whether your mood swings interfere with your life.

Technically, you can call yourself bipolar if you’ve had a manic episode, meaning a period of excited agitation when you couldn’t stop talking or doing, took unnecessary risks, overspent, oversexed, and didn’t need any sleep. Mania feels great while you’re experiencing it, but the credit card debt, broken relationships, and/or life-threatening scenarios it causes feel far less great, and the depression that inevitably follows isn’t fun, either.

If you’ve experienced such a wild episode, whether or not you managed to avoid serious trouble, then it’s useful to think of yourself as bipolar while you do whatever you can to prevent it from happening again. (“Bipolar II” is a different diagnosis, and only applies to depressed people who respond to mood stabilizing medication rather than to antidepressants; as always, the sequel is no better than the original.)

Since you (fortunately) don’t yet qualify for either diagnosis, ask yourself what you need to do about your moods. If depressive symptoms hurt but don’t interfere with work or relationships, then maybe exercise and a good sleep schedule are enough to keep you on track. Similarly, if your confident periods aren’t too wild and do you no harm, enjoy them. Just don’t blame yourself when they end.

Since the biggest risk of mood swings is that they’ll distort your thoughts, causing self-hatred, which you mentioned, or, conversely, overconfidence, start reading books about cognitive therapy and consider getting a therapist or coach who can help you identify those thoughts and prevent them from affecting your judgment or decisions.

As ever, medication is worth exploring if you think other methods (like the ones suggested above) aren’t helping enough. Medications for depression have very little risk of causing you serious harm, other than the slight chance of triggering a manic episode. Many mood stabilizers—medications for mania—carry a higher risk than antidepressants, particularly the ones that are most effective, so it often makes sense to try the lower risk drugs first unless you’re very sick and need help right away.

Remember, the meaning of a psychiatric diagnosis is very limited, much more limited than people think. Do get help if you think you need it, but don’t expect a definite classification as “bipolar” to be necessary or helpful, especially not at the beginning. Decide whether your moods and thoughts need managing, and define your needs for yourself.

STATEMENT:
“My moods worry the hell out of me, but they don’t keep me from speaking up in class or getting homework done, and sometimes they even help. I’ll learn more about the thought distortion they cause and methods for managing them. I’ll try medication only if I think it’s necessary.”

My uncle has all the symptoms of depression, but he refuses to get help. I’m not a doctor, but when he was hospitalized a couple years ago when he got suicidal, a psychiatrist said he had major depression and needed medication and psychotherapy. My uncle refused treatment and said he’d taken a wrong turn, and then, when he got better, he said he’d straightened himself out without relying on treatment, just as he knew he would. Now that he’s feeling bad again, he says he’ll use the same method, which includes drinking himself to sleep every night. He’s holding down a job and my aunt isn’t about to leave him, but he’s been like a father to me, and I don’t like to see him suffer and don’t want to lose him. My goal is to get him to get help for his illness.

The biggest danger of having depression and denying it’s an illness is that you’re much more susceptible to accepting the negative thoughts that go with it, as well as blaming yourself if you’re not able to get those thoughts to go away. Your uncle may be right about the treatment of depression—treatment doesn’t always help—but he’s showing signs of taking too much responsibility for his condition.

Taking credit for his recovery from the last bout, unfortunately, means that he’s now made himself responsible for curing himself again. If he can’t, he’s more vulnerable to self-blame and suicide, and since his current, boozy approach to treatment is almost certainly making things worse, you’re right to be worried about his health.

Of course, he may wink and tell you that his “medicine” is working well and is all he needs. Unfortunately, however, alcohol is a depressant in the long run, and it carries the risk of many other dangerous, well-known side effects. So, while it may be the only thing that makes him feel better, it’s not the kind of compromise he’d wish on a friend.

Instead of making ignored entreaties for him to get help, help him yourself. Tell him he’s just having another episode of illness and that there’s lots of evidence that it comes and goes, like arthritis, regardless of what he does. This episode may well end on its own, just like the last one, but you’re worried about the way it made him suicidal last time.

Tell him there are good coaches who can help him fight negative thoughts and use diet and exercise as treatment. If he is determined to use medication, as evidently he is (given his nightly drinking), he should use something with a better benefit-to-risk ratio than booze. If he refuses to find a real coach or medication, ask him to at least tell you if he gets suicidal again.

Don’t argue that treatment will help, but point out that his current treatment techniques won’t necessarily help, either. Tell him that you don’t like the idea that he should be able to straighten himself out—you like him the way he is—and you don’t like his idea of self-medication.

You think he’d get better sooner, and with less risk, if he realized he was sick, meaning he’s not responsible for having a relapse, and took proper care of himself. It’s not his fault for being depressed, and if you do your best to help him, it’s not your fault if his health takes a bad turn.

STATEMENT:
“I can’t stand watching my uncle suffer while he mistreats his illness, but I won’t suggest that anyone has a cure. I will urge him not to take responsibility for the fact that he’s having an episode of depression, while saying he should take responsibility for not making it worse by mis-medicating himself.”

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