(Originally published on Boundary Crosser)
I used to have a great deal of faith in psychiatry. Then, I experienced what psychiatric treatment for a serious mental illness can actually be like. I’m no longer convinced psychiatry is even a science. Neurology is definitely a science, but psychiatry without neurology is more of a subjective educated-guessing game. And too often, it’s the kind of game where conformist doctors pathologize and overmedicate nonconformists for little more than thinking for themselves.
My own bipolar diagnosis came from a well-respected psychiatrist who literally refused to use the scientific method, which is why I doubted him from the very beginning. As it turns out, his diagnosis was bogus. I’m going to explain how I figured this out.
A little background about me: Besides studying psychology, I am a longtime psychonaut. In case you’re new to this site, you might think of psychonautics as occupying a space midway between psychiatry and shamanism. The goals are similar, but the substances and methods are a bit different from either one. I know more than the average layperson about brain chemistry, and when I trip, I write down insights and recollections for later analysis.
I learned the practice of trip journaling from the writings of Aldous Huxley and John C. Lilly. So when I had my two manic episodes, I treated them as extended trips. Not only did I write down everything I remembered, but I was also able to get my psych papers from jail and the mental hospital. (The first manic episode included an arrest for disorderly conduct.) What I actually had were probably more like mystical experiences with psychotic features, but that’s only vaguely relevant to this post.
This is where it gets more interesting. I discovered that the psychiatrist at the jail lied and said I smelled of alcohol when I arrived. I am not a drinker, and I have clear memories of what I did and didn’t consume during that period. But I was in rural Pennsylvania, where they probably knew very little about what a tripping person looks like… so they lied and said I was a drunk. Not really a big deal, but weird and a little creepy.
I stuck with my current psychiatrist (we’ll call him Dr. A) after that first episode, but we decided I should stop taking Strattera for attention and anxiety. I had once been manic on it before when I was taking way too high of a dose, and I had been taking it along with Wellbutrin (whose effects it magnifies). I switched to taking Wellbutrin by itself, and things were good for a while. Then the second manic episode happened, and afterwards I decided to switch to a new psychiatrist (“Dr. B”) who my therapist often works with.
Dr. B and I agreed that I shouldn’t take any of the things I was taking when the manic episodes happened, so there went the Wellbutrin. This left me taking the lithium and haldol the hospital had prescribed, which Dr. B felt were still appropriate. I had terrible sleepiness and hand cramps from the haldol, so he switched me to risperdal. So far, so good. But this would be the only time he was willing to consider my input about medication.
Then came the confirmation bias and refusal to use the scientific method. I came in with a great deal of information, much of which he ignored, even though it was relevant:
1. I have only ever had manic episodes when I was either on Prozac, Effexor, Wellbutrin, or Strattera. These are all reuptake inhibitors for various neurotransmitters that affect mood and attention (serotonin, dopamine, and/or norepinephrine).
2. I have only ever had exogenous depression, the kind caused by bad things that happened to me. While I was very depressed in high school, it was because I was unpopular, in the closet, and a moody teenager with a mother who pretty much refused to let me be an introvert. When I got out of the hospital, I was depressed because my life had pretty much imploded, and I had lost my full-time tech support business and had to get a day job. I do not enjoy being an employee.
3. I require AD/HD medication in order to be able to focus on work. That’s what the Wellbutrin and Strattera were for. I don’t like the way Ritalin and Adderall give me the jitters, make my heart race, and make me sleepy when they wear off. They are not a good idea for people with anxiety.
4. I smoke the wacky tobacky not just because it’s fun, but because it helps with my anxiety also. Never been much of a drinker, and honestly marijuana is less harmful than alcohol anyway.
5. The DSM-V states that “More than 90% of individuals who have a single manic episode go on to have recurrent mood episodes.” This a direct admission that at least 9 percent of people with a bipolar diagnosis do not actually have bipolar disorder. The DSM-IV used to recognize drug-induced manic episodes, but the 5th edition no longer does.
The only pieces of information he was willing to act on were these:
1. I had two manic episodes in the same year.
2. He had never treated anyone with both bipolar disorder and AD/HD before.
3. He had only ever prescribed Ritalin or Adderall for AD/HD in the past.
4. Bipolar people often refuse to take their medication.
5. My uncle was bipolar and had recently committed suicide.
6. Bipolar people can sometimes remember things incorrectly, if the memories are from when they were manic or depressed.
Since I had had two manic episodes, and was refusing to take my medication, that meant I must be bipolar. He even used the words “if you respond to lithium, that means you have the disorder”. Early on, we had a conversation about how I was not convinced bipolar was the right diagnosis, because all my manic episodes had had psych meds and/or psychedelics involved. He agreed with me that after perhaps a year, I could go off the lithium and risperdal to test (scientifically!) whether or not I would ever have a manic episode in a vacuum.
Later, he claimed this conversation had not occurred, and that either I was twisting his words or that I led him to say something he didn’t mean. I needed to stop smoking, because it would “obviously” unbalance me and cause mania. The two studies I found, saying that bipolar people who use lithium and marijuana have better cognitive function than those who take lithium by itself, “didn’t count” because I found them on the internet. Nevermind that they were peer-reviewed. And my lack of desire to take a medication that could eventually put me into kidney failure was just another symptom of my bipolar disorder.
My logic teacher used to call this last bit a self-sealing argument. Any criticism of the argument is interpreted as proof the argument is true. It’s maddening. See also “if you believe in rational thought and don’t believe in God, you must be an Antichrist” and “if you think psychoanalysis doesn’t work, that’s obviously a neurosis we need to treat with psychoanalysis”.
Dr. B refused to prescribe me anything for my attention, despite the fact that I repeatedly told him I needed it for work. I don’t think he actually believed in adult AD/HD at all. When he finally came around on this issue, he told me he was only willing to prescribe Ritalin or Adderall because he had prescribed them before. Even though they were much more likely to cause mania than the modafinil I asked for.
Instead, I would need to come in every week, to be checked for mania from a medication I already knew I didn’t like. And in order to get even that, I had to stop taking “the soup” (his words) of nootropics I was taking on my own to try to mitigate the AD/HD somewhat. This was the last straw that caused me to go back to Dr. A. He isn’t perfect either, and sometimes a little too laissez-faire, but at least he listens to me and considers the research I do. He says he never thought I was bipolar in the first place, but rather that my natural state is a little hypomanic, and I just need to be careful not to pile too many mania triggers on top of it. Totally reasonable and good advice.
Most importantly, Dr. A doesn’t pull any of the authoritarian, paternalistic, manipulative gaslighting bullshit I had to deal with from Dr. B. And he has a friendly, conversational bedside manor. Dr. B’s bedside manor was nonexistent: once, when he had to up my medication to reverse what felt like a new manic episode, I literally had to ask him to tell me everything would be okay before he did. “Cold and clinical” barely even covers it.
Fast-forward to now. I have gone back to my old psychonaut ways, and have not taken lithium or risperdal for over two years. Modafinil has been every bit as great as I hoped it would be. There has not been a single hiccup. Every time I check myself or ask someone to check my behavior for signs of mania, it turns out that I’m just happy or excited in a normal way. Smoke without fire, in other words.
I don’t have manic episodes without the influence of SSRIs, SNRIs, sleep deprivation, immersive trance work or role-playing, and/or strong psychedelics, and I have always known this to be the case. I told Dr. B this was probably true when I first met him. But when you are a hammer, everyone else looks like a nail. And Dr. B has been a hammer for a long, long time. I could forgive his inflexibility and the wrong assumptions that might have left me taking lithium until my kidneys were destroyed. But he also caused me to doubt my own perception and sanity at a time when the absolute last thing I needed was to be doing any more of that. And that, I don’t think I will ever be able to forgive.
Let me be clear: I am not a typical patient. I do lots of research and am very assertive with doctors. I’m the son of a school counselor, who once tried to get one of my doctors fired for suggesting my mild asthma meant I shouldn’t go to summer camp. I’ve always read psychological research on my own because it interests me. Most importantly, I’ve explored both sober and drug-induced altered states of consciousness enough to know how my own mind works.
I might have stayed manic for months, rather than a week and a half each time, if not for previous experience diving deep into an altered state and finding my way back up again. Even the hospital doctors were surprised how quickly I became lucid after the mania. Since that time, I’ve tested all the factors that may have contributed to it individually (psych meds, psychedelics, sleep deprivation, trance work, immersive LARPing) to ensure they weren’t dangerous for me by themselves.
One of the best things I ever learned from my mother is that the doctor-patient relationship is about trust and referred power. If you don’t trust someone, then you shouldn’t give them power over you. And if they don’t listen to reasonable questions and suggestions, there is no reason you should trust them. Doctors are fallible human beings just like everyone else. And there is never any shame in getting a second or third opinion.
Don’t let anyone tell you “not taking your medication means you must have the disorder”. It could mean your reason and/or your intuition is telling you the diagnosis just doesn’t fit your experience. Don’t listen to those who tell you that you’re “just shopping for a doctor who will give you a diagnosis you like better”. A second opinion is a form of peer review. And without peer review, the diagnosis cannot be scientific.
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