The Mental Health Checklist

Hey everyone!

I don't mean for this to be an anti-psych post, and hopefully it doesn't end up there. I just wanted to share an experience I had with one psychiatrist a couple years ago. I forget where exactly I heard about this "mental health checklist" before, but it made SO much sense, and I've experienced it firsthand. I'll try to keep it short...

At first, with this psychiatrist, my diagnosis was schizophrenia. One day my dad came with me to my appointment - after chatting between the two of us the night before, we realized I may have had episodes that may be considered hypomania - and we mentioned to my psychiatrist these strange mood episodes I had experienced, and all of a sudden my diagnosis was bipolar with psychotic features. The one thing I'll thank this psychiatrist for is putting me on a mood stabilizer and taking me off the antidepressants.

The next appointment I had with him, he pulled out his DSM and proceeded to ask me a series of questions related to BPD. I answered yes to many of them, and without hesitation he "changed" my diagnosis to BPD and told me to go off all my medications. He told me the voices were just my conscience and in my head, it wasn't really psychosis. "Your medications aren't going to help you. They will stop working at some point and this will keep happening to you." His words, roughly.

What an idiot. I'm sure there are TONS of people who don't have any mental illness that can answer yes to many of the questions he asked me related to BPD. The part he ignored about this diagnosis, is there must be a PATTERN of these symptoms over a period of time. The ones I answered yes to had happened maybe once or twice...there was no pattern.

Anyway, what I'm getting at is some psychiatrists have zero experience with some types of mental illness, and rely solely on their "mental health checklist" to diagnose. It was just very frustrating, but actually quite amusing at the same time that someone is allowed to practice this way.

Sorry for the rant, but has anyone else ever experienced this before? I just think it's totally ridiculous!

Nupy

This sort of carries over into that other thread (not the anti-psych one) where we were talking about the DSM being taken as gospel, when in reality it changes over time and is far from perfect. It seems like your doctor was taking this DSM-as-gospel thing to the nth degree, though, by shifting you to each new condition he thought you might fit on paper, which is not only ridiculous and myopic, but dangerous. As I'm cure you've figured by now, it would definitely be in your best interest to find someone better informed and willing to look at the bigger picture (rather than putting together a bunch of smaller pictures and jumping from one to the other). It frankly sounds like he forgot that you were a person, and that his "decisions" had real-life consequences for you. I'm sorry you had to deal with someone like that.

The weird thing about him changing the dx to BPD from BP is that there's symptom overlap between them, and the medication is often the same anyway (at least at first). Even if you were BPD instead, telling you to just drop all the meds was highly irresponsible and could have landed you in the hospital. If I were you, I'd run far, far away from him and try to find someone who actually listens to you.

(And to answer your question, I haven't run into anyone who takes the DSM as some kind of perfect checklist, but I have seen some really poorly informed doctors who were clearly trying to #######4 their way through the sessions, because they knew nothing about mood disorders; they didn't try to treat me, though, just recommended I find someone more familiar with moods/trauma.)

Thanks for the reply, Lexicon.

I guess I should have specified that I no longer see this psychiatrist, as I asked for a second opinion after he did that, and he proceeded to tell me he didn't want to see me as a patient anymore if that was the route I wanted to take. Good riddance.

Nupy

Sounds like that was for the best. It's weird, some psychs seem to take seeking a second opinion like you're breaking up with them or something; to me, that's a huge red flag. No one wants a clingy psychiatrist!

I guess it shatters their self esteem. Maybe he had to go see his psychiatrist after that appointment.

Nupy,

I know just what you are talking about. I've had this happen, just in a more circuitous manner. For years I was initially medicated for depression by my family doctor(s) and would see a pdoc on doen the line. By the time I got to the pdoc, I would be improved and he would continue the same meds. This happened over and over for 22 years as I went on and off meds (my choice). I guess my point is that my family docs were using a checklist and the the pdoc would just follow along and really only ask questions that lead to the same diagnosis.

Luckily, two years ago I found a therapist I really connected with and went to the pdoc she trusted with meds and diagnosis. Two weeks ago after I had some truly manic hypomanic days, followed by an oh so brilliantly scary psychotic episode, my therapist was finally certain I was bipolar (as she had suspected for 2 years with no good evidence to substantiate it) and she helped me narrow down what part of my experiences it was most vital for my pdoc to hear. Due to the short pdoc appointment length she knew just one example would suffice, not the 50+ I would give if left to my own devices. He confirmed BP II with hypomania and psychotic episodes. Pdoc would have figured it out on his on I'm sure, but my therapist was really key. Pdoc was thrilled at this long overdue breakthrough, as was/am I. Looking back at 22 years of this roller coaster without being properly treated is overwhelming.

Sorry for rambling. I just started on a mood stabilizer 2 weeks ago and have quite a ways to go to get the dose right.

Take good care,
Alice

Thanks for the reply, Alice!

Having to endure symptoms for 22 years must have been a nightmare. I'm sorry you had to go through that. It's upsetting that doctors need their checklist, but at the same time psychiatry isn't at its finest, and may not be for a long time. Thankfully I have a great psychiatrist and team who have been following me for the past two years (pretty much since my appointments ended with the psychiatrist I mentioned in this thread), and I trust them to do what's right. My psychiatrist tends to go more on her experience rather than by the book. That approach also has its issues, as mental illness is a large spectrum, but like I said, I trust my team.

Nupy