Monday, November 23, 2009

My diagnostic disaster: part two

In my last post I began relating the story of my odd encounter with a rogue psychiatrist, Dr Field (not his real name). Below is the second instalment.

When I left Doctor Field I never intended to go back. But eight years later, my brilliant career as an editor was floundering in a sea of uncertainty and self-doubt. I was at a crossroads: publishers were paying less, and wanting work done that was often beyond my expertise. I was weary of the chronic exhaustion and anxiety, not to mention loneliness and isolation, that large jobs forced on me. I wanted a style of work that was sustainable. Refusing the big jobs for the sake of my sanity, my savings were getting run down.

I needed some government help. I wasn’t going to stop working but find a niche that suited me, with a safety net underneath – a net flexible enough to allow me to work part time, as the particular payment I sought would do.

I was finally ready to admit that I had a serious, complex condition and that I couldn’t make it on my own. I was going to put my hand out.

But first I had to get the necessary documentation. This included a complicated form that had to be filled in by a doctor, stating the seriousness of the patient’s condition and that it was either stable or being treated.

This presented a dilemma; I had seen two psychiatrists consecutively for long periods of time, and I didn’t want to ask either of them to complete the report. Neither had ever presented me with a diagnosis, probably because they did not want to encourage what amounted to an obsession with self-analysis. But nor was either of them a specialist in anxiety disorders, and they had shown little or no interest in imparting skills to help me manage my anxiety. Despite this, all three of us had assumed that the goal for me was more or less normal functioning where work and love were concerned. I could not go back to either one of them and admit my ‘failure’.

Then I thought of Dr Field, and the results of his test. I rummaged around in my filing cabinet and found it: it was all there in black and white, the extent of my pathology. This could furnish some supporting evidence, but I would need to get it from the horse’s mouth. I would arrange to see Dr Field purely for the purposes of getting a doctor’s report on my condition. And, as our approaches to drugs and psychiatry were at such variance, I would make it clear that I did not want to see him on an ongoing basis.

The determination to foreclose ongoing treatment was my first mistake. There would be a few more before Dr Field and I were through for good.

I rang up his office and his receptionist answered. I bluntly asked her if I could make an appointment to see Dr Field on a short term basis. I made it clear, probably sounding over-determined, that I did not want to see him for long term treatment.

That’s the point at which the pathologising began. The receptionist passed on this message to Dr Field, and once we were in session he mentioned this reluctance as an instance of my pathology. Already there was more than a whiff of the 1950s approach to psychiatry in Dr Field’s attitude towards me. What next, a lobotomy?

The first minutes after I sat down in front of him, however, were quite okay. The room was small with an untidy shuffle of papers and a television in one corner, the walls painted a pale apricot beige, but the vinyl armchair that I sat in opposite him was low and comfortable. I had completely forgotten the look of him, and now recalled the unexpected cuteness, the expensive suit. Perhaps it would all be alright. I told him about my editing dilemma and he tipped his head to one side, quickly, in that rather appealing way – could it be he was really listening? ‘You’ve thrown in the towel’, he said. I nodded and had to stop the tears from welling up. Was he offering sympathy? understanding?

Half an hour later he had diagnosed me with attention deficit disorder (ADD) and told me the only hope for treatment was regular doses of dexamphetamine (otherwise known as speed). He had also apologised for diagnosing me with bipolar eight years earlier. Since our last encounter, he explained, he had discovered that many patients with what he’d thought were the symptoms of bipolar actually had ADD or ADHD.

So much was going on in my head as I smiled back at him. What was the point of trying to explain my chronic low blood sugar, the brain fog I already experienced from food intolerance, my battles with caffeine and the fact that my body reacted badly to any kind of drug? How could I possibly try and crack open that wall of medical certainty and blind faith he had in the efficacy of drugs to cure all mental ills? This combination of the old-fashioned and the maverick in him was bewildering. A psychiatrist like him, willing to be on the diagnostic cutting edge, should have been as focused on the body as he was on the mind – wasn’t that the point of psychiatrists being medical doctors as well as specialists in mental disorders?

At that moment I started to become what he had set out to portray me as – calculating and false.

But at the same time I was also knocked sideways by the actual diagnosis. Somehow it made sense. The literature he gave me to read later brought it home even more sharply.

According to the literature, there are a number of forms of ADD. The commonly known ADHD, characterised by hyperactivity and low academic achievement, is only one of them. There is also inattentive ADD, associated with girls and far harder to spot, as well as hyperfocused ADD, but also a couple of others even lesser known. If anything, I had inattentive ADD. I was considered a ‘brain’ at school, but was for the most part a lazy student until I pulled my finger out for the final year of secondary school and got pretty good marks, including a standardised perfect score in English. But I floundered at uni as an undergrad, failing some subjects and obtaining only mediocre or poor marks in most others.

At the age of nine, before I knew anything about mental illness, I’d suddenly come to the conclusion that there was something deeply wrong with me. Later I had assumed that this was just the first stirrings of my neurosis. But perhaps on some level I was aware of some more basic shortcoming in my neural architecture.

On the other hand, my ADD symptoms might have been environment related (as I’d always assumed), an attempt to respond to and escape from the conflicting emotional demands of parents who were respectively resentful, depressed and emotionally distant (my mother) and needy, obsessive and controlling (my father).

Regardless, Dr Field’s methods of diagnosis were lazy and reductive. One Australian ADD site has a list of other conditions that may present as ADD and should be eliminated before any diagnosis. Dr Field did not bother to eliminate any of these. What about my chronic low blood sugar, for example? Couldn’t that have been a culprit? (In my case, I believe it’s a separate condition, but who knows how it contributed to my adolescent difficulties?) When I asked Dr Field about whether I could get a brain scan to confirm the diagnosis he said a SPECT scan was available, but waved dismissively as he said it. (I decided not to – a confirmation of ADD would encourage my self-obsession).

A few more things about ADD before I leave the subject – I’ve done a bit of reading on brain plasticity, and I believe there are many types of brains, as well as many ways people can improve brain functioning. The fact that I’m an editor suggests that my brain has changed quite considerably already simply by the work I’ve done, and practices such as meditation and mindfulness, as well as life skills training, can help further.

Even if I had no physical health problems, I don’t believe the kinds of drugs that are prescribed for this condition – basically stimulants – should be the standard alternative in most cases, but rather a last resort.

Standard treatments for ADD that already exist and should be tried before drugs include behaviour modification, cognitive therapy, anger management, social training and family counselling.

To some extent these treatments seem to support the concept of brain plasticity (the brain's ability to alter itself to develop new capabilities), but more cutting edge treatments that further acknowledge plasticity, such as software that literally retrains the brain, are already available for disorders such as dyslexia -- why not for ADD?

It scares me to think of the number of children being diagnosed with this condition who may simply be suffering from food intolerance or low blood sugar. However, that doesn’t mean the condition doesn’t exist.

Anyway, just as the literature suggested was typical for an ADD person (the extent to which I fitted some of the ups and downs and brain states described was chilling) I caught the tram home thoroughly discombobulated. Dusk had fallen and as I stood in the swaying, brightly lit tram among the suited commuters clutching their mobiles, my mind was busily rewriting my entire life story – my difficulties, social and otherwise, made more sense than they ever had.

But in my bag was a prescription for dexamphetamine.

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