Many of you know that I am not a fan of psychiatry and struggle very much to see the benefit the profession brings as it currently is. I was pleased to come across an article today in the Toronto Star that spoke to something I noticed as a teenager and recently, again, as an adult and demonstrates how far psychiatry still has to go in order to serve us better. The article, “Be wary of sloppy psychiatric diagnoses” by Jowita Bydlowska, speaks to the countless diagnostic errors given to people by psychiatrists. There are multiple reasons for this, but I feel it simply comes down to the fact that there is very little science in the diagnostic process.
But, let me organize myself a little bit to explain my thoughts on this article.
Since being diagnosed with Dysthymia (chronic depression) at age 16, I also had psychiatrists toss around Bipolar and Post Traumatic Stress Disorder. My Borderline Personality has been labeled as a disorder and then as traits. While only two of these diagnoses stuck with me I am bothered at how different psychiatrists can come up with different diagnoses (as seen in the research paper, Being Sane in Insane Places) based off of what I feel is nothing. While I greatly value anecdotal evidence and a person’s unique narrative, when it comes to providing myself with a label that can greatly alter the course of my life I would like more to be done than an hour long chat.
I often find myself becoming upset when I read research on Borderline Personality Disorder that says when the brain scans of someone with BPD and someone without BPD are compared it can be seen that the BPD brain is more emotionally on and has difficulty shutting off than the non-BPD brain (as seen, in research done by the Univrsity of Toronto). If we have seen this then why is brain imagery don’t a part of the diagnostic process?! I know this probably has something to do with “needing more research” but psychiatrists have already made so many diagnoses not based on these scans that I think adding it to the process wouldn’t hurt much. I’m sure cost comes into play as well, if not being one of the largest motivating factors for not providing it as an option. I WANT THE SCAN! I trust that.
The other part that I found interesting in the article is that the author talks about how certain diagnoses seem to be “in”. I noticed this when I was newly diagnosed. Many of my classmates seem to be getting diagnosed with some for of depression or bipolar disorder. I have a distinct memory of thinking, “How can everyone have depression?” Then, as the author mentioned, I noticed a few years ago that a lot of my friends were being diagnosed with PTSD or trauma language was being used a lot to describe their experiences. This past year, in the house that I live in, various occupants wondering, “Do I have ADHD?” and asking me for resources to receive a diagnosis (child and adult). As for 2015, I have noticed a great surge in BPD diagnoses. “BPD is so hot right now,” as I commonly say. It baffles me that these trends can exist. What is going on?
My final point is based off a comment in the article made by Dr. Andrew Lustig from the Centre of Addiction and Mental Health (CAMH, Toronto). He says, “the clinical picture of diagnosis can change over time as person develops in their illness, so sometimes a diagnosis that a person gets at one point (early) isn’t accurate at another point as the condition progresses.” This is cited as a reason for misdiagnosis and it is valid, but, I feel it is a tad weak. Aside from still coming from a patient-blaming perspective that ceases to acknowledge the systemic flaws of psychiatric, it ignores the fact that some diagnoses are not given out for certain reasons (age, gender, potential stigma etc.) or that a diagnosis is usually made after a 1 time visit that usually lasts an hour. Let me use myself as an example.
By the time I was 14 years old, I believed I had BPD. I displayed 8 or the 9 criteria (5 criteria are required at the minimum) but because I was still a teenager I could not receive the diagnosis and was given dysthymia instead. This meant that I was treated for depression which as I see now as an adult was very ineffective. If psychiatrists had looked at BPD as a potential option, seen that I had the traits, regardless of my age, then maybe I could have received treatment that actually helped me. My diagnosis of depression and BPD traits were made after a 1, 1-hour session with a psychiatrist. I was also prescribed medication during this session. I would think there is a lot of room for error if you are going off of your very first (and sometimes only) meeting with someone.
As always, my message is to be your own advocate. If you do not feel like you can step into that role yet or your doctor/psychiatrist will not listen to you, then find someone you trust to support you in having a conversation with your professional. You have to live your life and be comfortable in it.