Lame Name Game

Posted by fxckfeelings on September 15, 2013

If Shakespeare was right and a rose by any other name would smell as sweet, then a mental illness, no matter how it’s diagnosed, will always mean you feel sort of nuts. If you want to know what’s wrong with you, receiving a diagnosis feels very important, even if it sometimes leaves you yearning for something better, or resenting being labeled in the first place. The truth is that many diagnoses do little more than satisfy the irrational human need to exert magical control by naming whatever is painful and scary. So, when faced with symptoms that frighten you, don’t pay too much attention to the diagnosis; instead, find out what it says about your chance of getting better and the possible benefit and risks of treatment. Remember, it’s easier to deal with the unknown—and keep smelling the roses—when you don’t pretend to know more than you do.
–Dr. Lastname

I have a quick question but a lasting problem. I went to the doctor recently to talk about my roller-coaster emotions. She told me that I was manic-depressive with bipolar tendencies. I just want to ask you, since you went to Harvard, what the fuck does this mean?

Sadly, even with my Harvard-ified shrink expertise, I can’t tell you what the meaning of having a “manic depressive” or “bipolar” diagnosis is, because that’s for you to determine, not your shrink, this shrink, or anyone else. That’s because the diagnosis doesn’t add much meaning to what you already know about yourself and your roller-coaster moods.

So if your lows are crushing or your highs make you act like a nut, then you have good reason to get help in managing your mood, but the decision is up to you. If your highs push you to constant activity, long periods without fatigue or sleep, rapid-fire non-stop yakking, and super-big ideas about your achievements, then yes, you fall into the category of having an attack of “mania” and therefore “being a manic depressive.”

No, there’s no blood test to confirm the diagnosis, but that’d just confirm that you have a bunch of symptoms, which you already know. What matters is that your mood swings interfere with your life, which is a determination only you can make. You already knew that something was wrong before the doctor told you what it was, you just didn’t know it had a name. You, meet bipolar, bipolar, you.

The only significance of the manic depressive diagnosis is to steer you towards a group of medications called mood stabilizers that might level your mood, while warning you away from antidepressants, which might kick you from a low into a high. That’s useful information if and when you decide that medication is worth trying. If you start a medication trial, don’t do it because a psychiatrist gives you a diagnosis, but because you believe that mood swings are fucking up your life and experiments with medication are worth the effort. Otherwise, there’s no crime in living with your symptoms.

The one exception to the above definition of what it means to be bipolar is the “bipolar II” category, which applies to a group of depressed people who never have manic periods but nevertheless feel less depressed when they take mood stabilizer medications after getting nowhere with regular antidepressant medications. In reality, it’s a diagnosis you give yourself, based on experience with medication trials, as a way of reminding yourself that bipolar-management medications are the ones to use.

Once again, though, you’re the one who decides to try medication, not because of a diagnosis, but because your depressions are too much to bear and all the non-medical tricks you’ve developed for managing them, like exercise and positive thinking, just aren’t enough. That’s when you try, first antidepressants and then, if they aren’t working, mood stabilizers, and then you give yourself the diagnosis that seems to fit.

So now that you know your rollercoaster has a name, it’s time to decide whether you need help in slowing it down. And no, they don’t teach you anything about this at Harvard.

STATEMENT:
“I hate the idea of having a diagnosis of mental illness, but I will not forget that the meaning of such a diagnosis is very limited and will never affect my right to make my own decisions about whether medication is worth trying and/or taking for the long run.”

I got Lyme disease this summer from a tick bite—I’m not sure when I was bitten, but after I started feeling a bunch of the regular symptoms, I rushed to the doctor and she quickly diagnosed and treated me. Still, I’ve read a lot about Lyme and how it lingers for some people, and I’m worried that the medication I took hasn’t fully worked to rid my body of the disease. I still suffer from fatigue, and now I’m getting a strange rash on my elbows. I’ve also noticed that my temperature is slightly higher than normal, and I sometimes feel short of breath. I keep going back to my doctor, so now she thinks I’ve got an anxiety disorder and should see a shrink, but people on the internet think I probably have a chronic infection that needs proper treatment. My goal is to figure out who to believe and what I should to do improve my health.

When treatment isn’t working and you’re not feeling better, it’s hard to accept that it’s not that you’ve got the wrong diagnosis, but that you may have an illness that doctors just don’t understand. You’re fucked, and you may never find a definitive answer to what’s wrong or how to get better.

It’s even worse if you look for a definitive answer when one doesn’t exist, because you may ruin your life by dwelling on what’s wrong and feeling increasingly helpless, frustrated, and victimized. It’s dangerous to focus on pain when you can’t fix it, let alone identify it. Remember, instead, that there’s a priority even more important than finding out what’s wrong with you, and that’s to go about your business and manage your symptoms whenever you determine there’s nothing you can do about them.

So get a consultation, by all means, from an infectious disease specialist who can answer all your questions about Lyme, describe any and all treatments that have helped people in your position, and help you plan out a series of treatments. If your symptoms aren’t better after you’ve finished these treatments, however, accept that your fatigue and other symptoms are here to stay for as long as they want, regardless of diagnosis, and it’s time to see a psychiatrist.

Seeing a psychiatrist doesn’t mean your symptoms are all in your head, just that they’re partly in your brain, no one knows what’s going on, and psychiatric treatments may help you deal with them. You’re not there to get shrunk unless you feel there’s an issue you need to talk about.

Instead, you’re there to be coached on how to live with chronic symptoms and treated for those that psychiatrists know how to manage. The fact that a psychiatrist or other mental health professional is your coach doesn’t mean your problem is mental; it just means we’re the ones who see people other doctors can’t diagnose and that the treatments we’ve developed for mental illness are often helpful for other problems as well. Ask your psychiatrist whether there are any medications that might help your symptoms, particularly anxiety-related physical symptoms and fatigue.

Hopefully, you’ll find a cure. If not, however, your symptoms need never turn you into a victim as long as you know you’ve done your best to solve your illness, whatever it’s called, and are ready to accept and manage your symptoms, if that’s what you have to do, for as long as you have to do it.

STATEMENT:
“I feel like fatigue and pain are destroying my life, but I will provide myself with good medical care and live my life in spite of these symptoms if I can’t cure them.”