Diagnosis, muddled.

I am shaking as I get to my appointment. The drop off point for my taxi is called the ‘Tennis Court car park’ so as I leave the taxi I joke that I’m ‘off for a game of tennis with the psychiatrist’, the driver laughs heartily and wishes me well.
 
I am shaking when I get in the waiting room and get myself a drink of cool water, the plastic cup rattles in my hand. Seated next to me is a health worker who is reading to a young boy who is waiting for his mother to come out from her appointment. When she comes out, with her mother, she informs the health worker that her prescription of sertraline, an anti depressant, has been increased and she has a further appointment with a CPN. She says ‘I’m sorry’ and bursts into tears momentarily. ‘You can’t help how you feel!’ they reassure her.
 
My own eyes spring with tears and I look out the window with intensity and clutch my cup more tightly, but I want to hug her, and tell her everything will be okay. But I can’t.
 
She does the psychological ‘pulling up of socks’ act then, suppresses the tears and gets her bags ready and addresses her wee boy and they head out into the world, game face on. My heart breaks for her. For all of us.
***
 
Surprisingly my actual assigned psychiatrist was there today, and I was seen on time, but she does spring a medical student on me just as I enter the room, who will be sitting in and observing throughout my appointment. I actually don’t mind so much today, given that I was prepared and I actually don’t mind someone else witnessing what it’s actually like to be in there, proof that I’m not making it up as to how much it feels like slipping into an alternate reality.
 
She straight away informs me that she only has 20 minutes spare even though she gave me a later appointment in the hope that she’d be able to give me more time. She is clearly getting to know me, my complexities and the dance we do!
 
Last night I prepared all my mood charts which I have been keeping for months, colour coding them into low, high and mixed episodes- not to be confused with the ups and downs of an average day- for her perusal. I have also highlighted all of the symptoms/indicators from bipolar type 2 and borderline personality disorder and ADHD which correspond with my current symptoms/behaviours. These are not plucked from the land of random internet diagnoses, but from the DSM- diagnostics manual, and are the 3 main potential diagnosis she suspects I may have.
 
I am ready for battle with my folder full of what I jokingly refer to as ‘My Presentation’ but when it comes to it I start shaking and have a small cry. She asks whether anything in particular has brought it on. I tell her I am just anxious and feeling helpless at not having a diagnosis. That the longer it goes on the more I feel like I’m not being listened to or believed and that maybe I am just crap at life.
 
I tell her I am just exhausted, that it affects my everyday life, my relationships, that Ive not been able to work for 8 years, and even my volunteering isn’t regular because of my moods and energy.
 
I tell her my expectations are realistic, I know its not normal to have a flatlining mood all day, that there are always good days and bad, and that no one is happy and content all the time, but that it is also not normal to be bouncing up and down and not be able to make plans or maintain a regular pattern of habits because of my energy levels.
 
***
We discuss that I don’t have all of the factors for BPD, and I’m aware that I have done a lot of therapy and self help and life management to get to this point and that is why I don’t fit all of the descriptors for some of the impulsive behaviours- ie drink/drugging. I tell her I am even coping better with binge eating these days.
 
She asks to see my mood charts, (wow this never happens!) and agrees that my ‘ups’ are consistent with manic/hypomanic episodes. This is a first! She never normally looks and she has never acknowledged that that my manic episodes are actually mania. She says because I’ve been medication free since June it’s helpful to see how my moods are without medication.
 
She asks how bad my lows go, I tell her I have suicidal thoughts still, but they pass and I don’t make plans or cries for help, or self harm. She asks how I manage to cope with that, and I tell her, by talking to people, family, friends, and that I blog, that I write every day. And I tell her I’ve lived through a family members suicide, I’ve lost a lot of friends too young to drink and drugs, that I know what it’s like to be affected by grief, especially of people so young, so I always ask for help when it gets that bad. She commends me for that.
 
She explains that I am likely to have both BPD and BP, and she just wants to get it ‘right’ instead of giving me ‘any old diagnosis for the sake of having a diagnosis.’ And I just don’t fit into any of the ‘neat boxes’. She says at this point it seems I would be happier to have two diagnosis than none at all, and I agree with that. In fact I am relieved. So instead of it being a wishy washy on the fence situation it is looking likely I have both BPD and BP and she just wants to be sure, she confirms it is likely I have both, but it could be better to rule as many out as possible.
 
I explain that sometimes it is just more useful to have a label, sometimes you don’t want to explain your life story, especially to potential employers or the job centre, and you can just say ‘bipolar’ or ‘borderline’ and people get it, regardless of any stigma attached to it, I would rather know than not know. I would like to be able to go to a support group and not feel like a fraud, because I don’t have the specific diagnosis.
 
It is not that I want to be ill, but I am ill, I just need to know why and how I can help myself. She assures me I am doing all the right things.
 
Without it I feel weaker, like I am just pathetic and find every day life hard for no good reason and just need to ‘get a grip.’ Having an illness with a name is more empowering. I don’t get to choose what bits are illness and what bits are my identity or personality just now, and I think it is important to me to be able to make that distinction.
 
I also spoke to her about the possibility of ADHD, which I was assessed for before. I scored highly with all the descriptors for the adult diagnosis but not for the childhood symptoms, I had since read that there is a questionnaire for parents/family to fill in which can help, and I suggest my mum might be able to offer more insight, and that I had more problems with anger in childhood and teenage years that I had almost omitted from memory at the time of the test. She says at the moment we can save time by trying me on a medication, which people with ADHD notice a real difference almost immediately. She schedules me an appointment for an ECG to check my heart function and a phone appointment for the following week to see how I am getting on with the medication.
 
I agree because at this point I am curious as to how the ADHD symptoms are linked with and overlap with bipolar symptoms. I am sick of anti-depressants and mood stabilisers that don’t work and now my system is clear of them I am willing to try these.
 
As they are a controlled substance she goes through some questioning to assess my likelihood for abusing them, or anyone I am in contact with abusing them. I don’t really have people around me like that anymore, certainly not in my cosy home- just the cat! I explain that I’ve been sober for 6 years next month and she asks about my former use of drugs and how I found amphetamines. I said it was hard to say because I usually mixed them with other drugs with drink, but I do remember finding cocaine doing not much for me at all. Apparently these drugs will give a regular person a buzz, and ADHD a clarity and calming affect.
 
She also checks that I don’t have a history with anorexia etc, I tell her about the binge eating but tell her I’ve improved my diet and exercise over the last few months and am much more consistent with my eating etc. She feels confident I am not at risk of abusing them so goes ahead with the prescription.
 
I thank her again for listening to me, and wish the medical student good luck on the way out.
 
And so here I am, I feel listened to, at last, and I am thankful for that. I feel like I understand better, that I am, as a former doctor called me, ‘a complex case’ and that the likelihood is that one day I will be diagnosed as having several conditions, something which I think me and my family have known for a very long time.
 
I feel I was very honest and was able to express myself today, and that she really did hear me and was also very frank with me. I think she understands better that I don’t fear having a diagnosis, or several, I fear not knowing. And she also commends me for the efforts I put in to keep myself well, to keep track of my moods and the healthy coping strategies I have put into place.
 
And at least within the next couple of weeks I will know whether I have ADHD or not, and that is one thing that can be checked off the list.
 
***
I am aware that one day I may not want all these letters, BP, BPD, ADHD, that in another culture or different schools of thought I would be diagnosed/assessed in a very different way, and some of them might sit better than others. But for now I need to know I am doing enough. I want to live a full life, I know I am far from my full potential, and I can only imagine how I could excel if I didn’t have this holding me back so much. I am tired of being a victim to this, feeling out of control, and I can have all the insight in the world, but if I don’t know what I am supposed to be tackling, then it will feel like everything I manage to achieve, I have had to fight for the long way round.
On the bus home a lady sits next to me. She asks me ‘did everything go okay?’ Puzzled, I answer that yes, yes it did. I desperately rack my brain to remember if she was working on the reception or a fellow patient in the waiting room, but I don’t recognise her at all, so I conclude she has me confused with someone else, or maybe she’s some kind of guardian angel or hallucination or maybe I’m a figment of her imagination after all. What a wonderful imagination to have, I think. I smile and vow to never let that be written off as a symptom.
The quest continues….

 

One thought on “Diagnosis, muddled.”

  1. Fabulous xxx everything is written with control…Detail…And in it is You. Your observations of people are so well described and become palpable. I wonder how the student spoke about his day? I think maybe he went home to review his life path. Being heard ,being asked for your charts…And discussing together the next step everything that was missing. Well done hon …Bring it blooming well on (gently) xx

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