I Love Psychiatry!
A bit of a turn up for the books, this is. After the misery of C yesterday, and my intense dislike for Dr C the last time I saw her, I am very happy with how this morning’s meeting with the latter went.
There is not a great deal of point in detailing the entire conversation I had with her, as a lot of it was her clarifying points I’d made previously and on matters she had discussed with C. I would be repeating a lot of this if I went into details. Suffice to say, I discussed the points she raised with me in detail, brought some of my own to her attention, and let her proceed.
I was interested by a number of things. Firstly, it was just Dr C I saw today, thankfully. Not that I have anything against Dr N, but having to speak to both of them felt like I was being interrogated by a panel of interviewers. Secondly, Dr C did not seem to be nastily questioning me in the way she had been before; I did not get the impression this morning that she felt I was a bullshitter, yet I previously had done so. I suppose she needs to take that stance to weed out those that are bullshitters. Thirdly, and perhaps most importantly, she spoke to me in absolutely non-patronising terms. She assumed I had previous knowledge of most matters, she spoke in academic and erudite terms and she didn’t come off with off with any airy-fairy arse biscuits whatsoever. It would be fair to say that I was impressed. I was surprised that I was impressed, as – as you know, dearest readers – I had not liked her at all when I first met her. But really, this was a positive change.
The crux of the meeting was that Dr C says my diagnosis is tricky. She says that I do not clearly fit the diagnostic criteria for any one mental problem, but I do have strong elements of some. Apparently it is not at all uncommon for crackpots like myself to not neatly fit into one diagnostic category.
The disorder that she feels is most strong in me is Borderline Personality Disorder. Perhaps unsurprisingly given this, I feel completely vindicated by this assessment. In fact, she actually asked me how I felt about this diagnosis; I told her it was one of the conclusions I had come to myself in my endless foray into self-analysis.
She was glad that I was not distressed by this but nevertheless went on to say that it is not just BPD. She said there are also clear signs of Bipolar II, a type of bipolar disorder in which the depressive elements are the prevailing symptom, but in which mania and hypomania are certainly present at times.
Of course, I still have clinical depression on top of all this. As a friend on Twitter said, I should win a prize for multiple diagnoses.
Dr C said that she believes the BPD to be stronger than the the bipolar disorder. She said the mainstay of treatment for BPD is psychotherapy combined with anti-depressants. Obviously it’s clear that Citalopram are not working in the least and as such she has now prescribed me Venlafaxine. According to her, NICE have recently issued guidelines advising strongly against the use of mood stabilisers and anti-psychotics in the treatment of BPD, apparently due to the fact that there is no evidence that such drugs help the illness.
Dr C had the decency to ask me what I thought of this. I said that I was no expert, evidently, but that based on the little I do know of mood stabilisers, I thought that they could potentially be helpful in my case. She considered this, and said that although she certainly thought they could have benefit in treating the bipolar elements of my mentalism, that she thought the BPD was the stronger illness and as such she was reluctant to try the mood stabilisers for now. To be fair, she says she is not at all ruling out prescribing them; if the Venlafaxine doesn’t work, or only works in some ways, she is willing to try other stuff.
She explained that as Venlafaxine is an SNRI rather than an SSRI, which is all I have taken hitherto, I may find it more useful than my previous medications. I’m still relatively cynical about its potential for success I suppose, but it’s reassuring to know that she is not ruling out other options in future if they are needed. As she said, we are both new to each other and it may or may not take some experimentation to get it all right.
All in all, I’m very pleased. Someone finally has the decency to tell me what is going on. I am grateful for all C does, of course, but it was important for me to get a name (or rather, names) for this fucking thing (or these fucking things), and now I have that (those).
I don’t think this is a solution – in fact, I know with absolute certainty that it isn’t. Nothing ever will be, and psychotherapy is going to continue to be incredibly difficult, I fear. Nonetheless, I am encouraged, and feel I it’s a step in the right direction.
Even though she almost certainly doesn’t know about, never mind read, this blog, I think I owe Dr C an apology for my previous rant against her. So sorry, Dr C – and thank you.
This entry was posted on Friday, 19 June, 2009 at 2:15 pm and is filed under Mental Health Diagnoses, Moods, Psychotherapy with tags anxiety, bipolar 2, bipolar II, borderline personality disorder, bpd, clinical depression, depression, insanity, insomnia, madness, major depressive disorder, mania, manic depression, mental health, mentalhealth, panic, panic attack, psychiatry, psychology, Psychotherapy, self harm, social anxiety, suicidal thoughts, suicide, suicide ideation, therapy. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.