Misunderstood and then misdiagnosed

I do most of my thinking for this blog while I'm walking to and from work. The motion and fresh air stimulate my thoughts. As I walk, I ruminate about something I heard or saw the day before.

 The bipolar disorder satire that has been seen on so many blogs, the one where the computer animated woman keeps telling the shrink how crummy she feels on the medication and he keeps repeating that she needs the medication because she has "the bipolar disorder," and it goes round and round from there. She tells him that she was feeling very upset because of a family tragedy when she was admitted to hospital and he says "that's the bipolar disorder."

What interested me recently about this clip was that the patient says she is on 10 mg of Abilify for "the bipolar disorder." A few months ago I half jokingly told Chris (on 5 mg Abilify) he was depressed, not schizophrenic, because I discovered that Abilify was now being prescribed as an add-on treatment for depression. But he can also be bipolar, if that's what he prefers, because Abilify is also for bipolar disorder. (A real wonder drug!) Who's to say Chris isn't bipolar? When he was first admitted to hospital, the doctors gave him only a 25% chance of being bipolar, but, as we know, doctors are often wrong, especially when it comes to psychiatric diagnoses.

Of course, I am being facetious, because the labelling is meaningless in the first place, but the blurring of diagnoses logically comes about because the same drug is used to treat supposedly different conditions. This is an open invitation to pick the diagnosis you would prefer to have. If a choice has to be made, wouldn't a patient want to join the higher status group of people like Britney, Catherine and Mel, who supposedly don't have schizophrenia, they have "the bipolar disorder." Is it logical to claim that if you are no longer on Abilify, you no longer have the bipolar disorder/schizophrenia/depression?

Along the same lines of my muddled thinking on Abilify, here is an excerpt from Pamela Spiro Wagner's blog, which relates how her friend  assumed that he was schizophrenic, based solely on the fact that he was prescribed Trilafon. The doctors never questioned this diagnosis once Joe told them what he was. They accepted what Joe told them as fact, without doing their own thinking. This is a very sad story, and unfortunately, it's an all too frequent one.

I believe that Joe was misdiagnosed for many many years with schizophrenia, when in fact he had had Asperger’s from childhood. Now, that’s a long story in itself and though I could make a case for it, I cannot prove it. But I am not the only one who knew him well to notice that he never once exhibited signs of psychosis or even real delusions or true paranoia. Furthermore, from what I gather, the only reason the diagnosis came about or “took” was because he was put on Trilafon by a well-known psychiatric incompetent who was later “defrocked” and when Joe looked the drug up in the PDR and read what it was used for, he concluded that that meant he must have schizophrenia. From then on, so his story was, he told subsequent doctors this diagnosis, and apparently they simply took it on faith. In fact, for all the years thereafter until his terminal illness of ALS, the one doctor he saw not only never questioned this, but also never even reconsidered his absurd concomitant Dx as bipolar, even though Joe clearly had one of the most placid temperament possible and certainly wasn’t the slightest bit moody. No one so far as I know ever even considered that there might be something else going on. Even when I once went with him to see his non-medical therapist, did she really seem even to want to think about the possibility, as if it might be too much trouble…Perhaps, though I cannot recall, it was too late, if in fact this was after Joe’s ALS diagnosis.

But as I said, that is a long story, and not being a doctor, I suppose I can’t make the diagnosis, except that as his closest friend, I do and I feel that a great injustice was done. Not only was he saddled with a serious psychiatric diagnosis, and a stigmatizing one at that, but that particular neuroleptic medication rendered him much too tired to work as an engineer. All his adult life that was what he really wanted to do. Work. But the drug sapped his stamina…Worst of all, although eventually on Zyprexa which helped what might have been poor social skills due to Asperger’s, after he had been on it for years it caused the diabetes that ultimately cost him his life.

So what is schizophrenia? I'll let Jung have the last word here. These are actually two quotes. I have added the second shorter quote to show how to cure a schizophrenic. (I like how he adds "provided one's own constitution holds out." How true!)

But even so one can bring about noticeable improvements in severe schizophrenics, and even cure them, by psychological treatment, provided that one’s own constitution holds out [in my own experience, I have had situations where I continued the long-term psychotherapy of several patients in inpatient state hospital settings, later transferred into my practice, in which I was physically attacked, reported to have sexually molested the patient , etc, to very positive outcomes, e.g., to the point where family thought their family member was originally misdiagnosed as schizophrenic, never having to return to the state hospital after many years of residing there, etc]. This question is very much to the point, because the treatment not only demands uncommon efforts but may also induce psychic infections in a therapist who himself has a rather unstable disposition. I have seen no less than three cases of induced psychoses in treatments of this kind.

A schizophrenic is no longer schizophrenic... when he feels understood by someone else.

- Carl Jung