How ‘out’ are you about your illness to friends and colleagues and how has it affected your work?
Obviously I am very open about it. I mean, I have a public blog about it and I share all posts on my blog’s Facebook page. Also, all my friends know. I feel it is important in order for them to understand my behaviour and to support me. If they judge me, then they were never really worth being friends with. I’ve had much resistance though and it wasn’t all as easy. I remember with one of my best friends I started studying medicine with, we went through quite a bad patch when we were in 4th year and I had to discontinue my year due to Anorexia and Depression. She grew up with a family that has a view of “Pull yourself together, everyone goes through good and bad times.” So she never had to really deal with anything like this before and didn’t understand me at all. I was the sickest I had ever been back then; I starved myself, had the worst hell of depression I ever faced and was on no medication whatsoever because I struggled to be put on things that worked, I self-harmed, I overdosed on benzodiazepines which disinhibited me entirely and I’d end up full of cuts on my body and a bruise on my head but have no memory of it. I tried to overdose twice in an attempt to die but the thing with new psychiatric meds is they’re very unlikely to kill you on overdose. So I would just wake up feeling like utter shit after 3 or so days. I had this terrible sense of constant emotional pain that would smother me every second. I laid in bed all day and ignored my phone. I tried hard to do all I should like see my therapist, get admitted, try 20 medications, live healthily and meet up with friends but I had no energy or will to speak much when I met up with them. So as I said, I was sicker than ever. I remember one day my friend and I went to the park and had a picnic and I asked her whether she thinks I could ever get better and if I could ever be okay again. Her answer was, “I honestly don’t know. I hope they can help you.” What I needed to hear was that she still believed in me yet, she had given up on me too and she was all who I really had. For a while she disappeared out of the picture because we fought about my mental health issues. Surprisingly, after finding my new Doctor and the right meds, I got better. I went back to University, I was doing well and I was happy even though I missed her. She contacted me later through the year and said she had read my blog and that she was so sorry that she didn’t stay because she just didn’t understand. She cried. After that she never hesitated to help me and for that I am so very thankful because we grew a lot from it and only got closer. So telling people is one thing but having them be in your life and see how truly bad it really is, that is an entire new ballgame.
When it comes to colleagues, I am much more discrete about it. I do tell them if there is a need to and yes, there has been a few such times. Because I study Medicine, I have to go through quite a process with the Dean of our faculty. I had to meet up with him and tell him what was going on. Of course he was very supportive because I’m not the first med student who has had severe depressive issues and had to take time out. But they need to know you’re capable of fulfiilling your duties as you deal with patients. So my Psychiatrist had to write a letter stating my problems and need for admission, I then got a letter from the Dean with a bunch of conditions stipulated and that included continuous reports from my Psychiatrist and proof that I continued seeing her every 3 months minimum. Also a notice that my marks and progress will be monitored and if I have insufficient attendance then my studies may be decided to be terminated. It sounds more strict than it is though. I’ve had 3 admissions during my studies and because the Dean knows about my case so well he would never prevent me from continuing as long as I’m healthy according to my Psychiatrist. With regards to the people in my group whom I work with, about 4 of them know what I’m admitted for and 2 of them know more about the history behind it. The other people don’t know. One gets judged easily in Medicine and your competence gets doubted. Also, I have to work with these people and so, I don’t need them to disregard me. What I go through and all the details are really none of their business.
Do you think there are any commonalities, overdiagnosis, misdiagnosis or stereotypes with regards to your illness? What do you think about your diagnosis in general?
I think there are definitely many commonalities between the different disorders. Major Depressive Disorder and the depressive symptoms found in Bipolar 1 and 2 are very much similar whereas in Bipolar 2 the difference is that mania is more predominant than depressive symptoms. Both however experience severe depression. Also, Bipolar 2 is said to have hypomania which is a more mild form of type 1’s mania. Then there’s Generalised Anxiety Disorder and although the disorder itself means you experience it almost every day and it interferes with your day to day life, anxiety is also a frequent symptom of many other Psychiatric disorders. I think many people get diagnosed with GAD but they, in fact, don’t fully have the disorder itself and anxiety has more to do with their other diagnosis. Any disorder can have any feature really. Take psychosis where you have hallucinations and delusions – those can appear in any illness but that doesn’t mean you have a full blown psychotic disorder or Schizophrenia. They generally would say you have, for example, bipolar with psychotic features. So what essentially diagnosis you in a category is the predominant symptoms of a condition which you fulfill an adequate number of. But in general, many conditions have many symptoms in common. Because of that, I think there is way too often an overdiagnosis and misdiagnosis. Especially with Bipolar and Major Depressive Disorder it can be very easy to misdiagnose and miss Bipolar.
Take for instance, my case. I was diagnosed with MDD and so since my initial Doctors put me in that box they had to follow that protocol of treatment which mainly just involves your antidepressants. One Doctor even showed me the hierarchy in her textbook of the order of antidepressants to try and we tried them all… But because I was only put on antidepressants and they never thought of giving me a mood stabiliser, which they give in Bipolar, I didn’t get better. I was severely depressed, yes, but I did have very erratic moods as well and it wasn’t until the mood stabilisers were started that I got so much better and my depression went into remmission. So because of that and my erratic moods, the Doctor I am with now had to classify me as Bipolar type 2, otherwise the medical aid won’t pay for mood stabilisers. Whether I actually have Bipolar 2 is uncertain. In type 2, depressive symptoms are more intense and predominate over manic symptoms and the mania you find in type 1 is only hypomania in type 2. Whether I am hypomanic is also not fully certain because mania isn’t just excessive exuberance, hyperactivity, spending sprees, flight of ideas , thoughts and speech and feeling like you can conquer the world. Mania can also be irritability and impulsivity which are often overlooked. I have very severe impulsivity at times and also irritability and there have been periods where I am very talkative and outgoing but besides from the impulsivity, it’s hard to say whether the other behaviours I displayed were relevant. It can be a very gray area and all we know is I respond very well to mood stabilisers and when we try to wean me off them, I severely relapse.
There are also your personality disorders – narcissistic personality disorder, borderline personality disorder, dissociative identity disorder, antisocial, histrionic, avoidant, dependent, paranoid and schizoid personality disorders… These especially I think are even more uncertain than any other psychiatric conditions. Sure, some people very clearly fall into one of those disorders and are textbook cases, but many people only have several traits of that disorder, yet not enough to meet the adequate criteria to make a diagnosis. Every single person on this planet, mentally healthy or ill, have personality traits that fall in some of these categories, but they don’t all have personality disorders. We all have features of some or other aberrant personality because we are flawed humans. It has been said to me, in my last admission that I have Borderline Personality Disorder. You need to meet 5 out of 9 criteria to be diagnosed. I meet 4 – 5 and I was, again, put into a box, but the criteria also seem very much to overlap with other illnesses.
The criteria for BPD is:
1) Frantic efforts to avoid real or imagined abandonment.
2) A pattern of unstable intense interpersonal relationships alternating between extremes of idealisation and devaluation.
3) Identity disturbance: Markedly and persistently unstable self-image or sense of self. (Many mentally healthy people have this problem)
4) Impulsivity in spending, sex, substance abuse, reckless driving or binge eating. (Also fits in with Bipolar symptoms and just many people’s abnormal coping mechanisms)
5) Recurrent suicidal behaviour. (Obviously fits in with depression, bipolar and many others.)
6) Affective instability due to marked reactivity of mood (e.g. intense episodic dysphoria, irritabilty or anxiety lasting a few hours and only rarely more than a few days.) (Irritability and anxiety is very non-specific and again, can fit in with your mood disorders.)
7) Chronic feelings of emptiness. ( Fits in with depression and the general ailments of the human condition…)
8) Inappropriate, intense anger or difficulty controlling anger.
9) Transient, stress-related paranoid ideation or severe dissociative symptoms.
According to a 344 question personality assessment questionnaire I was made to fill in during my last admission, my definite criteria I fit in with is 3, 5, 6, 7 and possibly 1. What made me uncomfortable is that I was so boxed into a disorder because of those suggestive behaviours I had, where many may really just fit in with depression or are just too non-specific.
Stereotypes as well, which builds on what I’ve said above; when you say bipolar, people immediately see mania. When you say depression, people see sad. When you say Schizophrenia, people see psychotic. It’s very easy for people to glue one single word to a disorder and define us entirely by it, meanwhile, there’s so much variation going on behind it all.
What I think is important is that we stop boxing ourselves into labels and assume we have all the problems within a diagnosis and we all require the exact same treatment. In general, treatment in any medical condition is based on symptoms and the symptoms are targeted. One needs to think very logically about your approach to treatment. If you have issues that are suggestive of a personality disorder I don’t think it really matters to add another set in stone diagnosis to your list when it might be incorrect and it just makes you feel all the more f***ed up. The point remains that you have to address each one of those behaviours individually in therapy if they are interfering with your functioning.