Tuesday, November 17, 2009

My diagnostic disaster


I have read a few different stories about bad psychiatric diagnoses on the blogosphere and have been planning to tell my own weird tale. Grab a cuppa, sit back and listen to my odd encounter with the enigmatic Doctor Field (not his real name).

I first have to briefly explain the system in which psychiatrists work in Australia. The majority are in private practice, but they operate under Medicare, a taxpayer-funded national medical system.

This means the government provides set subsidies for all classes of consultation, but the psyches themselves have their own industry-recommended rates and it’s very unusual for them to charge only the amount of the government subsidy (that’s known as ‘bulk billing’). With some psyches willing to negotiate reduced fees, these days you might be paying anything from $30 to $100 or more per visit after the government rebate.

(You can now get a rebate for consultations with psychologists, but that’s a different story.)

Of course there are doctors working in the public psychiatric hospital system, which is very underfunded in Australia. Rural mental health is in the main poorly serviced, partly because many psychiatrists and psychologists simply don’t want to live in the country.

Anyone who lives in a large city like Melbourne and can afford to pay the amount over the Medicare rebate will have some degree of choice in accessing a psychiatrist. But they may have to wait a while if they want to see a particularly popular one, and really good female ones are especially thin on the ground.

I first went to see Dr Field way back in 1999, on the recommendation of Janine, a friend of mine. It was my own stupid fault I ever got ‘involved’ with him. I knew he was really into dispensing drugs – he’d put Janine on Epilem, a drug for epilepsy, because she had anger issues (she’s very mild, this friend – it wasn’t a behavioural issue, more about how she felt towards others).

I’d just finished up with my previous psychiatrist. She’d given me the structure and discipline to complete a post-grad degree but was next to useless when it came to what was at times an extreme form of social phobia. I started a full-time job after the degree but had to leave the job 3 1/2 months after I started because I wasn’t coping. At the time I was hopeless at managing my anxiety and panic disorder. It was a crucial period of my life and between us, my psyche and I stuffed it up.

By the time I left the job I’d gone downhill to the extent that I would get panic attacks almost every time I had to speak to an authority figure on the phone. I was looking around for a psyche and this time I wanted a man, to help me deal with my issues with men. Janine was seeing Dr Field in a therapy group she attended three times a week, and she thought he was brilliant.

So I went to his rather cramped, untidy ‘rooms’ near the CBD. He looked to be in his late fifties and had a heavy body bursting out of an expensive suit. His face was set in folds and, disconcertingly, the tip of his tongue protruded ever so slightly from his mouth. He was oddly cute: when making a point he tilted his head to the side and his eyes disappeared into the folds of his face as he gave his quizzical smile.

One of the first things he did was give me quite a long written test to fill out. This was to enable a preliminary form of diagnosis – ie what the practitioner would be likely to find in the patient, given the results shown. It’s odd but some of the extreme findings comforted me in an ‘I told you I was ill!’ kind of way.

Supposedly I had some indications of psychosis and paranoia, as well as the expected anxiety, and some unpleasant character traits that were a little bit too accurate for comfort. (For the record: I don’t and have never had psychosis.) Interestingly, following my job trauma, there were also signs of post-traumatic stress.

But the key thing he did, after either one or two consultations, was diagnose me with a mild form of bipolar. He believed my friend Janine had this mild form and, like her, he wanted me to go on Epilem.

Doctor Field is a maverick. He gets a bee in his bonnet about a particular pathology and sees everyone through the lens of it. I know that because it’s what he did to me. He believes – well, he did at the time – that this mild form of bipolar is incredibly common and under-diagnosed, and commonly expressed in unreasonable feelings of anger. But his diagnostic methods weren’t that sophisticated. I remember him asking me blatantly leading questions like ‘do your thoughts race sometimes?’

Anyways. I took the Epilem and got predicably freaked out about the fact that it made me vaguer than usual (this effect would probably have reduced if I’d continued to take it). I remember absent mindedly parking in a No Standing area and being furious when I got a parking fine (so much for the drug reducing my anger!). I immediately stopped taking the Epilem. I went back to Dr Field and told him I’d taken myself off it because it was making me vague. He called my reaction ‘hypomanic’ (it was certainly impulsive, but I was never going to warm to the Epilem and should have said so from the beginning).

We were fated to part company. He tried me on Prozac, and that was a disaster. Combined with the strong coffee I’d started drinking again – it was poison to me for a variety of reasons – I became a walking panic attack.

Soon I left Dr Field and found a kindly male psychiatrist, an elderly Freudian who probably did not pathologise me enough. Eventually he put me on another antidepressant and it did help. And eventually I left this psyche, not cured by any means, not happy or fulfilled, but convinced I had gone as far as I could with psychotherapy, and drugs for that matter.

So what the hell was I doing sitting in Dr Field’s office eight years later? And what would he diagnose me with this time? Tune in next week for the next instalment!

2 comments:

  1. Hello Catherine,

    I enjoyed your story and will be looking forward to the continuation.

    When I first went to a GP trying to get some answers for my irrational behaviour and unbearable confusion and emotional reactions, he basically told me to get my act together. It was at least 7 years later that I was finally diagnosed with depression, and started on the road to 'recovery'. I have also come to the end of the usefulness of psychotherapy.

    Thank you for sharing your story. The more people who are brave enough to share their stories of dealing with mental disorders, the more society is likely to become aware of these mysteries surrounding them as people pass them in the course of their daily lives. And the more likely it will be that someone will find your story and relate some part of it to themself and realise that they are not so alone in their afflictions.

    Well done.

    Kind regards,
    Gaye

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  2. Hi Gaye,

    Thanks for the kind words, and sharing your own experiences -- unfortunately, probably all too common before depression and similar disorders became better understood and even accepted by many. As you suggest, there's still a way to go before the stigma disappears.

    Writing about this 'adventure' was much more confronting than I'd thought it was going to be; it was ages before I posted this entry, and I deleted a fair bit of it first. It was even more confronting writing the second instalment (which I'm about to upload) but also surprisingly cathartic!

    Cheers
    Catherine

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